bluuebunny/crossref_metadata_2025 huggingface dataset:
The Dramatization of Inner Experience: The Opening Scene of Seneca's Agamemnon
Authors: Shelton Jo-Ann
Published: August 2016

Attempts to determine an absolute chronology for the composition of Seneca's tragedies have been frustrated by our lack of both external and internal evidence for dating. Even a relative chronology moreover will be open to dispute as long as we must depend almost solely on metrical, stylistic and linguistic considerations. Recently, for example, Calder has questioned the opinion of Leo, and other scholars, thatAgamemnonwas written beforeThyestes. Calder has examined stylistic features of both plays, and he suggests, quite correctly, that the opening scene ofAgamemnonis similar to that ofThyestesin structure and imagery but is less skilfully connected to the subsequent action. He concludes, however, thatThyestesis the earlier play, and he offers the following conjectures as proof: Seneca borrowed the opening scene of Thyestes from a play of Sophocles; then, when composingAgamemnon, instead of using the watchman's prologue of Aeschylus, he attempted to create a new opening scene after the pattern of his Thyestes. Not explicitly stated, though perhaps implied, is the unfortunate conclusion that theThyestesopening scene is successful because Seneca followed Sophocles, thatAgamemnonis flawed because Seneca later tried to innovate, to deviate from his Greek ‘models’.

Such a conclusion fails, I think, to take into proper consideration Seneca's creativity in his use of sources, and the reasons why he used an opening scene by a superhuman figure, rather than a watchman. Three of Seneca's plays begin with a scene in which appears a superhuman figure:Hercules Furens, AgamemnonandThyestes. If we compare the first two plays with theHeraklesof Euripides and theAgamemnonof Aeschylus, which both open with human figures, we find that in both Seneca has preferred not to imitate the prologues of the Greek dramatists. (We have, unfortunately, no complete GreekThyesteswith which we can compare Seneca's.) In addition, his opening scenes differ in style from those Greek plays in which a superhuman figure does appear in the prologue. Obviously, the choice of a human or non-human prologist, as Heldmann says, depends on something other than a Greek source.
Slavish Pleasures and Profitless Curiosity: Fall and Redemption in Apuleius' Metamorphoses
Authors: Penwill J. L.
Published: August 2016

The Metamorphoses of Apuleius is now generally agreed to be much more than the collection of amusing stories in the Milesian vein that the author proclaims it. Current scholarship sees it as ‘a fable about the journey of the soul through life’, ‘the story of a soul which fell, and which suffered by reason of that fall, and which the merciful hand of Isis raised up and saved’. The eleventh book effects the metamorphosis which transforms the tales of Books 1-10 into such a fable; the kev to the interpretation of the novel in Isiac terms is seen to be the Priest's speech at 11.15, where the events leading up to Lucius' transformation (the ‘fall’ of Festugière's summary) are described as follows:

Nec tibi natales ac ne dignitas quidem, vel ipsa, qua flores, usquam doctrina profuit, sed lubrico virentis aetatulae ad serviles delapsus voluptates curiositatis inprosperae sinistrum praemium reportasti.

(Neither your birth, nor your position, nor even that learning you were so good at was of any help to you; instead you slipped on the green path of youth and fell into slavish pleasures, and carried off a sinister reward for your profitless curiosity.)
His Dupes and Accomplices: A Study of Ovid the Illusionist in the Amores
Authors: Connor Peter J.
Published: August 2016

Ovid tells us everything in the first poem. Love poetry requires a lover. Experience and involvement are essential ingredients of this poetry. The subjective nature of elegy is critical.

Cupid poises his bow: the picture is breath-catchingly drawn. After the crisp unfolding of the earlier part of the poem, these lines hang in suspense. We feel the suspended moments as the bow bends and the string tightens, as the arm steadies, takes aim and lets fly:questus eram, pharetra cum protinus ille solutalegit in exitium spicula facta meumlunavitque genu sinuosum fortiter arcum‘quodque canas, vates, accipe’ dixit ‘opus.’

(I finished my complaint. Immediately, he opened his quiver, chose a dart made for my destruction and flexed the sinuous bow with strength; ‘a task to sing, poet,’ he said, ‘take this.’)

There is also the careful selection of the correct arrow and Cupid's statement, its effortful staccato imitating his physical tensing and swift release.
Curse and Oath in Euripides' Hippolytus
Authors: Segal Charles
Published: August 2016

Curses and oaths play an interesting and important role in the tragic action of theHippolytuswhich is generally overlooked. They dominate two of the play's most powerful scenes, Theseus' imprecation of doom upon his son (885-98) and Hippolytus' defense (1025-31).

I shall begin with the latter passage. Here the hero's solemn oath of self-destruction (ἐξώλεια ) forms a dramatic climax to his denial of the charges against him (1025-31):

Now I swear by Zeus, God of Oaths, and by the soil of the earth that I never touched your marriage-bed nor would have conceived the wish or the thought. May I perish without honour, without city, without home, an exile wandering over the earth, and may neither sea nor earth receive my flesh when I am dead if I have been a base man.
Theocritean Criticism and the Interpretation of the Fourth Idyll
Authors: Segal Charles
Published: August 2016

If the critical re-evaluation of classical authors in recent years has brought nothing else, it has given us a humbling awareness of how difficult it is to arrive at a fully satisfactory reading of ancient pastoral poetry. The poet of the Eclogues, seen less and less as merely a painter of dreamy landscapes or a contriver of political allegories, has emerged increasingly as a self-conscious artist whose conventional, but highly symbolic and allusive language embraces questions of man's relation to art and imagination, to passion and work, to the potential for order and violence in his own being. Is it valid to look at Theocritus in similar terms? Is there more in the Idylls than keenly etched portraits of shepherds among verdant hills singing of love in dulcet hexameters and in an atmosphere of easeful sensuousness? Or should we merely enjoy the surface felicities and depart sated and content, like Horace's well-fed guest? The rhythms and resonances of Theocritus will continue to give pleasure as long as Greek is read. Yet recent work in both ancient and later pastoral suggests that the Idylls will sustain and reward a critical reading which looks beneath this charming surface.
A Pseudoepidemic of Pulmonary Fungal Infections Related to Fiberoptic Bronchoscopy
Authors: Schleupner Charles J. , Hamilton John R.
Published: August 2016

During a three-week period a pseudoepidemic of fungal infections occurred involving patients from two different services.Trichosporon cutaneumand aPenicilliumspecies were isolated from bronchial washings and sputa obtained after fiberoptic bronchoscopy on eight clinically uninfected patients. Investigation revealed contamination of cocaine solutions used for topical anesthesia during bronchoscopy. Contamination is thought to have occurred during preparation of the solutions by pharmacy personnel. Revision of techniques used in formulating and dispensing the solutions resulted in cessation of the pseudoepidemic.
Sinus Contamination withPseudomonas paucimobilis: A Pseudoepidemic Due to Contaminated Irrigation Fluid
Authors: Faden Howard , Britt Michael , Epstein Beverly
Published: August 2016

During a five-week period,Pseudomonas paucimobiliswas isolated from maxillary sinus irrigation washes of four patients who attended an ear, nose and throat clinic. The saline irrigation solution was found to be contaminated with the same organism. Further investigation demonstrated the organism in a majority of hospital sinks surveyed. AlthoughP. paucimobiliswas isolated from clinical specimens, the presence of the organism did not appear to have clinical significance [Infect Control 1981; 2(3): 233-235.]
Ordering Patterns, Collection, Transport, and Screening of Sputum Cultures in a Community Hospital: Evaluation of Methods to Improve Results
Authors: Jacobson Julie T. , Burke John P. , Jacobson Jay A.
Published: August 2016

The clinical usefulness of sputum cultures depends on the quality of specimens submitted to the laboratory. In a community hospital, during two separate surveillance periods, we evaluated ordering practices and circumstances under which sputum specimens were obtained and techniques to improve the quality of the specimens. Physicians themselves rarely participated in obtaining specimens of sputum, and members of the nursing staff directly instructed patients or supervised specimen collection in only one third of cases. The mean elapsed time from collection at the bedside to processing in the laboratory was two hours, with a range from several minutes to 13 hours. One fifth of all the specimens in this study were obtained from patients with no discernible evidence of lower respiratory tract infection. Microscopic screening revealed that one half of the specimens were of poor or uncertain quality. After the first survey, inservice education of nursing personnel in the proper techniques of sputum collection, along with regular use of the screening procedure in the clinical laboratory, failed to effect any long-term change in ordering patterns or collection practices. However, the screening procedure did improve the quality of the sputum cultured, through rejection of unsatisfactory specimens [Infect Control 1981; 2(4):307-11.]
Clinical and Laboratory Studies of NosocomialStaphylococcus aureusResistant to Methicillin and Aminoglycosides
Authors: Bock Bonnie V. , Pasiecznik Karen , Meyer Richard D.
Published: August 2016

A methicillin/aminoglycoside-resistant strain ofStaphylococcus aureus(MARS) was likely introduced by transfer of a patient from another hospital. Over the next year, 20 other patients were colonized or infected with MARS of the same phage type, although antibiograms varied. Affected patients usually had serious underlying disease and were in intensive care units. Vancomycin therapy was frequently delayed and MARS may have contributed to the death of some patients. The mode of spread was not definitively delineated, but two nurses were found to be colonized. Institution of isolation procedures was difficult, but the problem gradually waned.

Susceptibility testing showed vancomycin to be the most active agent. Synergy studies showed no consistent effect of combining methicillin with an aminoglycoside. This experience illustrates the problem of MARS spread between hospitals and wards, the need for institution of effective control measures, and consideration of early empiric use of vancomycin.
Reliability of Disc Diffusion Susceptibility Testing
Authors: Murray Patrick R. , Zeitinger Jacquelyn R. , Krogstad Donald J.
Published: August 2016

We retested 2,181 bacteria-antibiotic combinations with the Kirby-Bauer disc-diffusion technique and found interpretive changes with 120 (5.5%). Most changes (101 of 120) were single steps (i.e. from R to I, I to R or S, or S to I). Of the 19 remaining, 10 of them were from R to Sand nine from S to R. These changes were significantly more frequent for combinations with zone diameters clustered near interpretive breakpoints (within 2mm) than for other combinations, and there was a linear relationship between decreased reproducibility and increased clustering near interpretive breakpoints.

Based on an analysis of all susceptibility testing results performed in 1978, combinations most commonly clustered near interpretive breakpoints included: Ampicillin with Klebsiella pneumoniae; erythromycin with enterococci; chloramphenicol with Serratia marcescens; gentamicin with Pseudomonas aeruginosa and enterocci; and tetracycline with Enterobacter spp., Escherichia coli, and K. pneumoniae.
An Efficacy Evaluation of a Synergized Glutaraldehyde-Phenate Solution in Disinfecting Respiratory Therapy Equipment Contaminated During Patient Use
Authors: Townsend Timothy R. , Wee Siok-Bi , Koblin Beryl
Published: August 2016

Reusable, corrugated, expiratory limb ventilator tubing that had been in use for 24 hours, were randomly allocated to one of three groups: no treatment (N=36); detergent wash (N = 83); or a detergent wash followed by a 10 minute immersion in a 1:16 dilution of synergized glutaraldehyde-phenate solution which was reused for 30 days. (Between 10 and 22 tubes were tested in each five day interval during this 30-day period.) Tubes were quantitatively and qualitatively cultured. There were significant differences in both the percent of contaminated tubes (no treatment = 92%, detergent wash = 72%, glutaraldehyde-phenate = 0 to 20%) and numbers of microorganisms per tube (no treatment = 3.2 × 106, detergent wash = 1.3 x 104, glutaraldehyde-phenate = 0 to 182) between groups. There was no apparent decrease in glutaraldehyde-phenate's efficacy throughout the 30-day reuse period, and in the final five days of the reuse period it was completely effective.
Transient and Resident Microflora of Burn Unit Personnel and Its Influence on Burn Wound Sepsis
Authors: Heggers John P. , Robson Martin C. , Ko Francis , Cook JoDell , Landa Stuart J.F.
Published: August 2016

The exogenous contamination of a thermally injured patient by contact with the health care team has been a major concern of all burn units. Since the University of Chicago Burn Center routinely monitors each burn injury for sepsis by quantitative bacteriology and recently examined the microbial population present on the hands of the health care team, it was felt that these combined data would shed some pertinent information on exogenous burn wound sepsis.

Twenty-nine patients with clinical burn wound sepsis and a bacterial level of >105 bacteria/gram of tissue were studied. These patients yielded a variety of microorganisms with P. aeruginosa and Staphylococcus aureus being predominant, followed in incidence by Candida albicans. The resident and transient microflora isolated from each member of the health care team treating the specific individual concerned did not correlate with the causative agent of burn wound sepsis. The most frequent isolate from the staff personnel was Staphylococcus epidermidis followed by Micrococcus species.

Though colonization of the thermally injured individual has been reported, these data strongly suggest that colonization is primarily one of an endogenous source rather than that of an exogenous one.
Recommended Precautions for Patients with Legionnaires' Disease
Authors: Jarvis William R.
Published: August 2016

As diagnostic techniques for the identification of Legionella species have become readily available, recognition of the pneumonic form of Legionellosis has increased. In particular, cases of hospital-acquiredLegionella pneumophilaare being identified and this has led to concern over possible person-to-person transmission. In most epidemiologic investigations where a source has been identified, water has been implicated. Person-to-person transmission has not been convincingly documented. Therefore, we discourage expensive or inconvenient special precautions for patients hospitalized with Legionnaires' Disease. Rather, we recommend that such patients be placed in secretion precautions until effective antimicrobial therapy has eradicated the organism.
Nosocomial Spread of Clostridium Difficile
Authors: Savage Alice M. , Alford Robert H.
Published: August 2016

Environmental transmission of Clostridium difficile, the causative agent of antibiotic-associated pseudomembranous colitis (PMC), has been supported by animal studies and implicated in spread of C. difficile among leukemic children receiving non-absorbable antibiotics. We report antibiotic-associated C. difficile-related colitis in two adults who shared a commode chair during hospitalization.
Topics in Clinical Microbiology
Authors: Stratton Charles W. , Verrall Rosemary
Published: August 2016

Serratia marcescenshas an interesting and many-faceted history. The presence of the red pigmented organism on starchy food products long had been noted and was thought to be blood; its presence on consecrated wafers was thought to be the blood of Christ. It was not until 1819 that Bizio, a pharmacist, demonstrated that a microorganism was responsible for the red pigment. He named this microorganismSerratia marcescens;Serratiain honor of Serafino Serrati, an Italian physicist who invented the steamboat andmarcescensfrom the Latin, “to decay.”

Because of the pigment production and becauseSerratia marcescenswas believed to be a benign, saprophytic organism, it was used widely as a biological marker from 1906 to 1968. This use has been controversial in regard to experiments conducted by the US Army involving biological warfare techniques. In addition, the recognition in the 1950s of the ability of this organism to cause nosocomial infections has curtailed its use as a biological marker.Serratia marcescensis now recognized as a cause of serious infections in man. It has been implicated in practically every kind of infection and is a particularly serious problem with nosocomial infections.
Storage of Human Breast Milk
Authors: Larson Elaine , Zuill Ramona , Zier Vicki , Berg Barbara
Published: August 2016

The bacteriologic content of expressed breast milk was studied in 30 mothers at the time of expression and after 24 and 48 hours of refrigeration. There were no significant differences in colony counts between the three time intervals. All samples contained Staphylococcus epidermidis. In addition, eight other species were found, including four which were gram-negative. All samples contained <106 colonies/ml, and there were no significant differences in mean colony counts between samples expressed at home and at the hospital. We conclude that it is bacteriologically safe to refrigerate expressed breast milk for up to 48 hours.
Morganella morganii:Epidemiology of Bacteremic Disease
Authors: McDermott Carolyn , Mylotte Joseph M.
Published: August 2016

A retrospective review of microbiology records revealed 19 documented episodes ofM. morganiibacteremia in 18 patients at a Veterans Administration hospital during a 5.5 year period. Thirteen of 19 bacteremias were related to nosocomial infections; 11 of the 13 nosocomial bacteremias occurred in surgical patients. Nine of the 13 patients with nosocomial bacteremia had received recent therapy with a beta-lactam antibiotic. The most common source of bacteremia was a postoperative wound infection (seven episodes). Only one episode was related to a urinary tract infection.

Retrospective analysis showed that clusters of cases ofM. morganiibacteremia had occurred almost yearly. This finding prompted a six-month period of prospective monitoring of all cultures forM. morganiito identify human reservoirs in our institution. Sixty percent of all cultures growingM. morganiicame from urine cultures, 18% came from wound cultures, and the remaining 22% came from a variety of body fluids or tube drainage. Thirty-one percent of patients harboringM. morganiiwere on the Surgical Service.

M. morganiibacteremia most commonly occurs in postoperative patients who receive beta-lactam antibiotics. From the data in this study,M. morganiiis an infrequent cause of bacteremia, and its presence in blood cultures may be an indicator of an environment conducive for an outbreak of nosocomial infection.
Contamination of Irrigation Solutions in an Operating Theatre
Authors: Andersson Britt Marie , Lidgren Lars , Schalén Claës , Steen Anita
Published: August 2016

Sterile irrigation solutions, used in open systems in a conventional orthopedic operating theatre, were examined for bacterial contamination. At the end of 13 of 21 operations (duration ≥ one hour) the solution tested displayed the growth of Staphylococcus epidermidis and/or diphtheroid rods and/or other species. It is concluded that irrigation by solutions, kept in open bowls during an operation, is a potential source of contamination.
Detection of Bacteremia and Fungemia: Microscopic Examination of Peripheral Blood Smears
Authors: Graham Barney S.
Published: August 2016

The treatment of suspected septicemia includes empirical antimicrobial regimens and supportive care. The antimicrobial treatment remains empirical until blood cultures reveal the pathogen and antibiotic sensitivities can be determined. Microscopic examination of peripheral blood is a simple method that can be used to hasten the confirmation of septicemia and may allow more specific therapy.
Enterobacter Sepsis in Infants and Children Due to Contaminated Intravenous Fluids
Authors: Matsaniotis Nikos S. , Syriopoulou Vassiliki Ph. , Theodoridou Maria Ch. , Tzanetou Konstantina G. , Mostrou Glyceria I.
Published: August 2016

Sixty-three cases of nosocomial sepsis occurring from April through October 1981, in a 500-bed pediatric hospital, were traced to bacterial contamination of intravenous fluid produced by a single manufacturer. Two species of uncommon blood stream pathogens,Enterobacter cloacaeandEnterobacter agglomeranscontaminated the fluid. Infections with these organisms might have contributed to the death of four patients; two who were immunosuppressed, one who was asplenic and one premature infant. Epidemiologic and laboratory investigations identified the site of contamination to be within the screw-caps of the bottles containing the intravenous fluid. Contamination occurred during insertion of the intravenous fluid administration set into the bottle. The “epidemic” terminated when the hospital discontinued the use of infusion fluids from that manufacturer. We conclude that intravenous fluids should be examined during outbreaks of nosocomial bacteremia due to unusual pathogens.
Haemophilus ducreyi
Authors: Daly Judy A.
Published: August 2016

Chancroid, or soft chancre (ulcus molle), was first differentiated from syphilis by Bassereau in 1852. The causative organism,Haemophilus ducreyi, was first described by Ducrey in 1889, although he was unable to grow the organism in vitro. The first successful culture has been attributed to Petersen (1895).Haemophilus ducreyihas been clinically associated only with genital ulcer disease and direct inoculation infections. There is no difficulty acceptingHaemophilus ducreyias a legitimate clinical and taxonomic species because it is the sole humanHaemophilusspecies with a requirement only for X factor as determined by the porphyrin test. The emergence ofHaemophilus ducreyistrains resistant to multiple antibiotics has restricted efforts to curb the spread of this increasingly prevalent sexually transmitted disease.
Cost of Hepatitis B Prevention in Hospital Employees: Post-Exposure Prophylaxis
Authors: Kirkman-Liff Bradford , Dandoy Suzanne
Published: August 2016

To determine the cost of post-exposure prevention of hepatitis B among hospital employees, a 12-month prospective study was conducted in six Phoenix-area hospitals. Data on reported employee accidents which involved exposure to blood and any subsequent medical attention were obtained weekly. Costs were assigned to all tests, treatments, and working time lost. For 518 potential hepatitis B exposures, the mean cost per incident was $92. Costs associated specifically with preventing hepatitis accounted for 80% of the costs. When data on these incidents were applied to a model procedure for handling potential exposures to hepatitis B, the costs increased to $109 per incident. One work-related case of clinical hepatitis B cost the hospital $13,376. A determination of total hospital costs for hepatitis B should include the direct and indirect cost of each employee case of the disease, the costs of routine serologic screening of employees, and the cost of post-exposure strategies.
Prospective Payment and Infection Control
Authors: Beyt B. Eugene , Troxler Susan , Cavaness Joel
Published: August 2016

Under prospective payment utilizing the diagnostic related groups (DRG) classification, hospital administrators have begun to rethink accepted hospital procedures. It is now necessary to consider every factor that contributes to the cost of care, because those costs will be borne more and more by the hospital rather than the patient. Administrators must determine if an expenditure really improves the quality of care and shortens the length of stay. Unfortunately, in many cases there are no mechanisms or criteria for such an evaluation. The health care industry is in danger of cutting away tissue when the fat is being trimmed away. An effort tojustify and quantify the benefit of an infection control program in a 270-bed acute care general hospital led to eye-opening results, and a decision to expand the program rather than reduce it. The expanded program is expected to recover cost two-fold.
Recommended Precautions for Patients Undergoing Hemodialysis Who Have AIDS or Non-A, Non-B Hepatitis
Authors: Favero Martin S.
Published: August 2016

Precautions used for dialysis patients who have acquired immunodeficiency syndrome or non-A, non-B hepatitis are based on infection control strategies developed for the control of hepatitis B in dialysis centers. Specificially, these recommendations include identifying infected patients; isolating (except for non-A, non-B hepatitis patients) patients, and separating staff, and equipment; applying blood precautions and aseptic techniques; and using good environmental control procedures. AIDS patients can be safely dialyzed by either hemodialysis or peritoneal dialysis in hospital-based or free-standing centers, or at home without risk of AIDS transmission to other patients or to staff members, if precautions that have been developed for the control of hepatitis B infection in dialysis units are employed. Further, the type of dialysis treatment, or modality, should be based on the needs of the patient and not on a fear of risk of disease transmission.
Whirlpool Operation and the Prevention of Infection
Authors: Davis Barry J.
Published: August 2016

Disease outbreaks involving public whirlpools have been reported frequently since their use has become popular in recent years. Because public whirlpools are often used by persons who have only transient contact, infections resulting from their use are difficult to identify, and published reports probably represent only a small portion of a larger public health problem. Most published outbreaks have reportedPseudomonas aeruginosacontamination of the whirlpool as a result of failure to operate the pool according to recommended practices. Maintaining the microbiologic quality of whirlpool water and preventing infection absolutely require regular operation and maintenance, including monitoring and record keeping by qualified personnel.
Readers' Forum: Public Health Implications Regarding the Epidemiology and Microbiology of Public Whirlpools
Authors: Castle Stuart P.
Published: August 2016

High temperature bathing in hot tubs, spas and whirlpools poses four potential public health concerns: injury/death, disease transmission, possible teratogenic effects, and congestive heart failure or dysrhythmias for individuals with cardiac problems. Health departments need criteria before initiating environmental and epidemiologic investigations. These criteria must include severity of the disease and number of individuals possibly exposed. In addition, public health officials are obligated to define the magnitude of the problem, inform affected individuals and institute appropriate control measures. Optional information should be collected during an environmental and epidemiologic investigation to clarify the mechanisms of disease transmission and design control measures. The public health response to improving hot water bathing safety and sanitation should be directed at primary prevention. Educational efforts would be directed toward whirlpool operators, users and the medical community. Included should be a review of regulations addressing the construction and operation of public spas and whirlpools.
Cost Containment in Infection Control: Is Cost Effective Ordering of Microbiology Tests for Infection Control Possible?
Authors: Isenberg Henry D.
Published: August 2016

Prospective payment fever is an all pervasive affliction that will spare no segment of the health care field. The implied rigidity of these regulations will probably not accommodate arguments that infection control efforts are cost-effective in the long run. It shall force all who labor in this field to exercise judicious restraint in the use of institutional resources. Microbiological analyses provide the most factual information lor infection control efforts. However, recent graduates of medical and nursing schools are the victims of the de-emphasis of bread-and-butter microbiology in their curricula. They lack the ability to request only clinically relevant examinations and do not appreciate the implications of microbiological results with respect to the patient and the health of the hospital or the community at large.

Cost-effective ordering of microbiological and related patient examinations must, therefore, be based on an educational effort that indoctrinates responsible personnel in the appropriateness of requests based on clinical judgment and laboratory instructions. The DRG-induced change in the basic philosophy of patient care demands that microbiologists must become involved in the clinical use of the information they generate, ie, in the relevance of laboratory data to the care of patients. This interaction must benefit the laboratory scientist, for he or she can now insist that important patient information accompany each specimen.
A Prospective Study of Postoperative Fever in a General Surgery Department
Authors: Galicier C. , Richet Herve
Published: August 2016

During a 4-month period, 693 patients undergoing surgical procedures were prospectively studied to investigate the etiology of postoperative fever (≥38°C during 48 hours or more). The overall rate of fever was similar for the three categories of surgical procedures studied (14%, 13.4% and 13.1% respectively after clean, clean contaminated and contaminated surgical procedures). No cause of fever was found in 5%, 2.7% and 1.7% of patients who underwent clean, clean contaminated and contaminated surgical procedures. Several episodes of fever were observed for 12 patients after clean surgery; for 11 of them this was due to infection. The mean interval between febrile episodes was 4.7 days. After clean wound surgery, fever documented as infectious began significantly later (2.7 vs 1.6 days) and lasted significantly longer (5.4 vs 3.5 days) than fever for which no source was determined. Only half of the infections were associated with fever.
Cost Effective Blood Cultures—Is It Possible or Impossible to Modify Behavior?
Authors: Neu Harold C.
Published: August 2016

Why are blood cultures drawn? Is there a purpose to the blood culture or is it a reflex reaction to a fever? Nurse says, “patient has fever,” Doctor replies “draw blood culture.” I fear that the latter is all too often the scenario that exists in the hospital today. As we enter an era where the extra laboratory tests do not “make money, keep the techs employed and justify the lab,” we must re-examine the rationale for blood cultures.
Hospital Experience with Varicella-Zoster Virus
Authors: Krasinski Keith , Holzman Robert S. , LaCouture Rita , Florman Alfred
Published: August 2016

Varicella-zoster virus (VZV), one of the most common highly communicable agents of disease, stimulates aggressive infection control measures. In a 1-year period, at one hospital, at least 93 inpatients (82 adult patients, 11 pediatric patients) and 2 hospital staff with active varicella-zoster infections served as potential sources of nosocomial infection. Six incidents of exposure to the virus that occurred without the protection of standard infection control precautions were investigated by the infection control surveillance team. One hundred fifty-six patients and 353 hospital staff were exposed. Fifty-one patients had no history of varicella-zoster infection, but only five were susceptible by serologic testing. One hundred one staff members had no history of varicella-zoster, but only 11 were susceptible by serologic testing. These exposures resulted in three secondary varicella-zoster infections, six courses of varicella-zoster immune globulin prophylaxis and furlough of 13 staff members. Epidemiologic investigation consumed approximately 356 hours of staff time, and management of exposed persons cost approximately $41,500. Prospective knowledge of the immune status of health care workers would vastly decrease the time and effort required to control hospital VZV exposures.
An Approach for Selection of Health Care Personnel Handwashing Agents
Authors: Larson Elaine , Talbot George H.
Published: August 2016

Given the wide range of available health care personnel handwashing agents, selection of an appropriate product may be difficult. This decision may be made on the basis of user preference, cost, or other factors unrelated to product effectiveness. Four criteria—efficacy, safety, cost, and acceptability—are appropriate for systematic evaluation of handwashing products. These criteria are applied to para-chloro-meta-xylenol (PCMX), a compound used with increasing frequency in health care personnel handwashing agents. Published data regarding the biochemical properties, efficacy, and safety of PCMX are summarized. We conclude that the substance appears to be safe and efficacious. However, the activity of PCMX is highly formula-dependent and many of the studies available in scientific literature have been conducted in Europe using a variety of testing conditions and formulations different from those currently available in the US. Clinical studies of marketed formulations are beginning to appear in the literature. Such studies will provide the data needed for adequate product evaluation.
Protective Ribs for Connectors
Authors: Walterspiel Juan N.
Published: August 2016

Currently available connectors for IV lines are not well protected against contamination. This also pertains to urinary and peritoneal catheters, as well as any other infusion or drainage system. The male portions of the connectors are particularly vulnerable to accidental contact with the environment, eg, the fingers of caretakers or the patient himself under the conditions of home therapy. Contamination of catheter hubs is well-documented and has recently been implicated as a cause of nosocomial infections withMalassezia furfurin neonates.
Methicillin-ResistantS. aureusandS. epidermidisStrains: Modern Hospital Pathogens
Authors: Wenzel Richard P.
Published: August 2016

The international recognition of the emergence of methicillin-resistantStaphylococcus aureusas major nosocomial pathogens dates to the late 1970s. The weight of evidence from many institutions suggests that transmission involves spread from patient to patient of the same or very similar strain and that effective control, if not elimination, involves isolation of infected and colonized patients.

More recently, a number of reports have suggested the emergence of methicillin-resistantS. epidermidisand other coagulase-negative staphylococci as significant nosocomial pathogens. Although the organisms undoubtedly share many similarities with methicillin-resistant strains ofS. aureus, it is certain that biologic differences exist which are important for infection control.
Strategies for Preventing Neonatal Group B Streptococcal Disease
Authors: Goldmann Donald A.
Published: August 2016

Despite increased awareness and the availability of potent chemotherapeutic agents, the Group B streptococcus remains the leading cause of life-threatening bacterial infections in the neonatal period. The majority of infections occur in the first few days of life. These so-called “early-onset” infections are often fulminant and are associated with a very high case fatality rate, ranging from more than 20% in recent reports to as high as 80% in older series. “Late-onset” disease occurs, by definition, after the first week of life. It usually presents with meningitis, although a wide spectrum of infections has been reported, including cellulitis, adenitis, septic arthritis, and osteomyelitis. Late-onset disease is usually less serious than early-onset disease, although deaths do occur and major sequelae are not rare. Accordingly, attempts to prevent group B streptococcal infections have concentrated on the more common and frequently lethal early-onset disease. Strategies that have been considered to date include antibiotic- and immuno-prophylaxis. In the preceding article, Easmon advocates an additional approach; topical use of the antiseptic Chlorhexidine gluconate in the vagina during labor.
Isolation Usage in a Pediatric Hospital
Authors: Kim Mee-Hai Marie , Mindorff Cathy , Patrick Mary Lou , Gold Ronald , Ford-Jones E. Lee
Published: August 2016

In a prospective 12-month study at a university-affiliated pediatric hospital, isolation usage was quantitated by ward/service, season, isolation category and type of infection (community-acquired vs nosocomial). Such information may be helpful in designing hospitals, recognizing time utilization of the pediatric infection control nurse, and defining educational and isolation needs. Hospitals with multiple bed rooms and inadequate numbers of single rooms may be unable to meet current federal isolation guidelines.

The mean number of isolation days was 153 per 1000 patient days or 15.3% of bed days used. This ranged from 18.5% on the infant/toddler/preschool medical ward to 2.8% on child/teenage orthopedic surgery. Isolation requirements vary seasonally and rose to 32% in winter on one ward. Proportional frequencies of isolation category included enteric—29%, protective—28%, strict—16%, barrier (contact)—10%, multiply resistant organism (MRO)—8%, wound—5%, pregnant women (careful handwashing)—3%, blood and body fluid precautions—1%. Isolation of patients with and contacts of nosocomial infections account for 32% of isolation usage. During one third of the 365-day year, the hospital is unable to provide adequate numbers of single rooms for one to 20 patients.
Determinants ofLegionella pneumophilaContamination of Water Distribution Systems: 15-Hospital Prospective Study
Authors: Vickers Richard M. , Yu Victor L. , Hanna S. Sue , Muraca Paul , Diven Warren , Carmen Neil , Taylor Floyd B.
Published: August 2016

We conducted a prospective environmental study forLegionella pneumophilain 15 hospitals in Pennsylvania. Hot water tanks, cold water sites, faucets, and show-erheads were surveyed four times over a one-year period. Sixty percent (9/15) of hospitals surveyed were contaminated withL pneumophila.Although contamination could not be linked to a specific municipal water supplier, most of the contaminated supplies came from rivers. Parameters found to be significantly associated with contamination included elevated hot water temperature, vertical configuration of the hot water tank, older tanks, and elevated calcium and magnesium concentrations of the water (P< 0.05). This study suggests thatL pneumophilacontamination could be predicted based on design of the distribution system, as well as physicochemical characteristics of the water.
The Epidemiology and Risk Factors for Nosocomial Catheter-Associated Bacteriuria Caused by Coagulase-Negative Staphylococci
Authors: Larsen Robert A. , Burke John P.
Published: August 2016

Studies of the risk factors for bacteriuria associated with the use of temporary indwelling urinary catheters have focused on gram-negative bacilli and enterococci, the predominant causes of nosocomial urinary tract infection. During a prospective study of 747 catheterized patients, bacteriuria with ≥1,000 bacteria/mL were found in 96 patients. Coagulase-negative staphylococci (CNS) accounted for 19% of the episodes of bacteriuria, andS. epidermidiswas the most frequent species of CNS. Significant risk factors for bacteriuria were a positive meatal culture for CNS, non-surgical illness, and no antibiotic therapy during catheterization. In contrast to the results of this and earlier studies that females were at greater risk factor for catheter-associated bacteriuria with gram-negative bacilli and enterococci, this was not a risk factor for acquisition of CNS. Possibly this is due to the more similar prevalence of meatal colonization with CNS of males and females compared to the striking difference in prevalence of meatal colonization with gram-negative bacilli and/or enterococci of males and females.
Infection Prevention and Control in the Long-Term-Care Facility
Authors: Smith Philip W. , Rusnak Patricia G.
Published: August 2016

More than 1.5 million residents reside in US nursing homes. In recent years, the acuity of illness of nursing home residents has increased. Long-term-care facility residents have a risk of developing nosocomial infection that is similar to acute-care hospital patients. A great deal of information has been published concerning infections in the long-term-care facility, and infection control programs are nearly universal.

This position paper reviews the literature on infections and infection control programs in the long-term-care facility, covering such topics as tuberculosis, bloodborne pathogens, epidemics, isolation systems, immunization, and antibiotic-resistant bacteria. Recommendations are developed for long-term-care infection control programs based on interpretation of currently available evidence. The recommendations cover the structure and function of the infection control program, including surveillance, isolation, outbreak control, resident care, and employee health. Infection control resources also are presented.
Improving the Governance of the SEQ Metropolitan Region
Authors: Hoban Des
Published: August 2016

The terms of reference for the SEQ 2001 Project were to come up with policies and processes for managing the region. The author's assignment as Director of the SEQ 2001 Project was completed in July 1993 with the release for comment of a set of policy reports including a report on institutional arrangements.
The Bunya in Queensland's Forests
Authors: Smith Ian R. , Butler Don
Published: August 2016

Much publicity has been given over the past decade to the discovery of the Wollemi pine (Wollemia nobilis) north of Sydney and its status as a ‘living fossil’. It is not generally realised that the bunya (Araucaria bidwillii), a unique part of Queensland's forests, has a similar status. The tree is the last surviving species of the section Bunya of the genus Araucaria. This section was more diverse and widespread during the Mesozoic, (Table 1), with some species having cone morphology similar to A. bidwillii appearing during the Jurassic with fossils extending into the northern hemisphere.
The impact of regulatory accumulation on U.S. Federal District Courts
Authors: RANDOLPH GREGORY M. , FETZNER JAMES
Published: August 2016

While regulation is increasingly relied upon to address economic and social issues in developed economies, research has yet to examine the impact of the growing use of regulation on the courts. This paper explores the relationship between regulation and criminal judicial enforcement. Data regarding regulatory cases and defendants filed in U.S. district courts and regulation at the U.S. federal level are analyzed. The results suggest that increased reliance on regulation leads to growth in regulatory court cases and defendants filed. These findings imply that the courts continue to play an important role when regulation is employed to address problems and that the courts might experience increasing responsibilities as the use of regulation grows. Additionally, the results suggest that the relationship between regulation and the courts should be considered in the design and implementation of regulation in practice.
Functional screening implicates miR-371-3p and peroxiredoxin 6 in reversible tolerance to cancer drugs
Authors: Sahu Nisebita , Stephan Jean-Philippe , Cruz Darlene Dela , Merchant Mark , Haley Benjamin , Bourgon Richard , Classon Marie , Settleman Jeff
Published: August 2016

Acquired resistance to cancer drug therapies almost always occurs in advanced-stage patients even following a significant response to treatment. In addition to mutational mechanisms, various non-mutational resistance mechanisms have now been recognized. We previously described a chromatin-mediated subpopulation of reversibly drug-tolerant persisters that is dynamically maintained within a wide variety of tumour cell populations. Here we explore a potential role for microRNAs in such transient drug tolerance. Functional screening of 879 human microRNAs reveals miR-371-3p as a potent suppressor of drug tolerance. We identify PRDX6 (peroxiredoxin 6) as a key target of miR-371-3p in establishing drug tolerance by regulating PLA2/PKCα activity and reactive oxygen species. PRDX6 expression is associated with poor prognosis in cancers of multiple tissue origins. These findings implicate miR-371-3p as a suppressor of PRDX6 and suggest that co-targeting of peroxiredoxin 6 or modulating miR-371-3p expression together with targeted cancer therapies may delay or prevent acquired drug resistance.
Effects of carbon sources on the enrichment of halophilic polyhydroxyalkanoate-storing mixed microbial culture in an aerobic dynamic feeding process
Authors: Cui You-Wei , Zhang Hong-Yu , Lu Peng-Fei , Peng Yong-Zhen
Published: August 2016

Microbial polyhydroxyalkanoate (PHA) production serves as a substitute for petroleum-based plastics. Enriching mixed microbial cultures (MMCs) with the capacity to store PHA is a key precursor for low-cost PHA production. This study investigated the impact of carbon types on enrichment outcomes. Three MMCs were separately fed by acetate sodium, glucose, and starch as an enriching carbon source, and were exposed to long-term aerobic dynamic feeding (ADF) periods. The PHA production capacity, kinetics and stoichiometry of the enrichments, the PHA composition, and the microbial diversity and community composition were explored to determine carbon and enrichment correlations. After 350-cycle enriching periods under feast-famine (F-F) regimes, the MMCs enriched by acetate sodium and glucose contained a maximum PHA content of 64.7% and 60.5% cell dry weight (CDW). The starch-enriched MMC only had 27.3% CDW of PHA. High-throughput sequencing revealed that non-PHA bacteria survived alongside PHA storing bacteria, even under severe F-F selective pressure. Genus of Pseudomonas and Stappia were the possible PHA accumulating bacteria in acetate-enriched MMC. Genus of Oceanicella, Piscicoccus and Vibrio were found as PHA accumulating bacteria in glucose-enriched MMC. Vibrio genus was the only PHA accumulating bacteria in starch-enriched MMC. The community diversity and composition were regulated by the substrate types.