bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of MHC- and non-MHC-associated genes in determining the human immune response to malaria antigens
Authors: Riley E. M. 
Published: May 2019

SUMMARYIndividual susceptibility to malaria infection, disease and death is influenced by host genotype, parasite virulence and a number of environmental factors including malaria-specific immunity. Immune responses are themselves determined by a combination of host genes and environmental effects. The extent to which host genotype limits the spectrum of possible immune responses may influence the outcome of infection and has consequences for vaccine design. Associations have been observed between human major histocompatibility complex (MHC) genotype and susceptibility to severe malaria, but no similar associations have been observed for mild malarial disease or for specific antibody responses to defined malaria antigens. Epidemiological studies have shown that, in practice, neither T helper cell nor antibody responses to malaria parasites are limited by host MHC genotype, but have revealed that genes lying outside the MHC may influence T cell proliferative responses. These genes have yet to be identified, but possible candidates include T cell receptor (TcR) genes, and genes involved in TcR gene rearrangements. More importantly, perhaps, longitudinal epidemiological studies have shown that the anti-malarial antibody repertoire is selective and becomes fixed in malaria-immune individuals, but is independent of host genotype. These findings suggest that the antibody repertoire may be determined, at least in part, by stochastic events. The first of these is the generation of the T and B cell repertoire, which results from random gene recombinations and somatic mutation and is thus partially independent of germline genes. Secondly, of the profusion of immunogenic peptides which are processed and presented by antigen presenting cells, a few will, by chance, interact with T and B cell surface antigen receptors of particularly high affinity. These T and B cell clones will be selected, will expand and may come to dominate the immune response, preventing the recognition of variant epitopes presented by subsequent infections - a process known as original antigenic sin or clonal imprinting. The immune response of an individual thus reflects the balance between genetic and stochastic effects. This may have important consequences for subunit vaccine development.
Childhood and adolescent psychotic experiences and risk of mental disorder: a systematic review and meta-analysis
Authors: Healy Colm , Brannigan Ross , Dooley Niamh , Coughlan Helen , Clarke Mary , Kelleher Ian , Cannon Mary 
Published: May 2019

AbstractBackgroundPsychotic experiences (PEs) are common in childhood and adolescence and their association with mental disorders is well-established. We aim to conduct a quantitative synthesis the literature on the relationship between childhood and adolescent PEs and (i) any mental disorder; and (ii) specific categories of mental disorder, while stratifying by study design.MethodThree electronic databases (PUBMED, PsycINFO and EMBASE) were searched from inception to August 2017 for all the published literature on childhood and adolescent PEs and mental disorder (outcome) in non-help-seeking community samples. Study quality was assessed using a recognised quality assessment tool for observational studies. Two authors conducted independent data extraction. Pooled odds ratios were calculated for mental disorders using random-effects models. Additional analyses were conducted investigating different categories of mental disorder while stratifying by study design.ResultsFourteen studies from 13 community samples (n = 29 517) were identified with 9.8% of participants reporting PEs. PEs were associated with a three-fold increased risk of any mental disorder [odds ratio (OR) 3.08, confidence interval (CI) 2.26–4.21, k = 12]. PEs were associated with four-fold increase risk of psychotic disorder (OR 3.96, CI 2.03–7.73, population-attributable-fraction: 23.2%, k = 5). In addition, PEs were associated with an increased risk of affective disorders, anxiety disorders, behavioural disorders and substance-use disorders. Few longitudinal studies have investigated childhood and adolescent PEs and subsequent non-psychotic disorders which limited a meaningful synthesis and interpretation of these results.ConclusionThis meta-analysis confirms that PEs are prevalent in childhood and adolescent community samples and are associated with a variety of mental disorders beyond psychotic disorders. Further longitudinal research is necessary to fully determine the longitudinal relationship between PEs and non-psychotic disorders.
SVILUPPO ORGANIZZATIVO DEI NUOVI MOVIMENTI SOCIALI E CONTESTO POLITICO
Authors: Kriesi Hanspeter 
Published: May 2019

IntroduzioneNello studio dei movimenti sociali prevalgono ormai due orientamenti: uno incentrato sulla mobilitazione delle risorse e uno incentrato sui processi politici. Il primo approccio si occupa dell'infrastruttura organizzativa dei movimenti sociali, la quale viene considerata il fattore più influente nella loro mobilitazione. Il secondo approccio ha una prospettiva più ampia e situa la mobilitazione dei movimenti sociali all'interno di un contesto politico: la mobilitazione dipende in grande misura dalla struttura delle opportunità politiche che in un dato contesto sono offerte ai movimenti. Sebbene l'approccio basato sui processi politici si sia sviluppato a partire da quello relativo alla mobilitazione delle risorse, rimane carente lo studio dello sviluppo dell'infrastruttura organizzativa dei movimenti sociali in rapporto al contesto politico. La maggior parte degli studi riguardanti i movimenti sociali si è occupata soprattutto delle loro origini, poco del loro sviluppo successivo (McAdamet al.1988). Inoltre, nella misura in cui si è studiato lo sviluppo organizzativo dei movimenti sociali, esso è stato raramente messo in relazione alle strutture di opportunità politica.
IL DEBITO ESTERO IN AMERICA LATINA. ATTORI, CONFLITTI E COALIZIONI
Authors: Fossati Fabio 
Published: May 2019

IntroduzioneL'obiettivo di questo articolo è l'approfondimento del conflitto distributivo che si è sviluppato sull'applicazione di programmi di aggiustamento economico da parte dei governi dell'America Latina. Tale conflitto ha coinvolto sia gli attori interni che quelli internazionali, e all'interno di questi ultimi, soprattutto i creditori. La crisi del servizio del debito estero dei paesi dell'America Latina negli anni ottanta, ha rappresentato la variabile condizionale determinante dell'aggiustamento, almeno in questa congiuntura storica. L'analisi comparata di tre paesi chiarirà quanto l'influenza di altri fattori, come il ruolo dei governi o degli attori in gioco, abbiano introdotto elementi di diversità rispetto all'evoluzione storica condizionata dalla variabile internazionale, cioè dal debito estero.
Electrophysiologic Monitoring in the Intensive Care Unit
Authors: Hill Rosamund A. , Chiappa Keith H. 
Published: May 2019

AbstractElectroencephalography (EEG) and evoked potential studies are established monitoring tools in the neurological intensive care unit (ICU). These neurophysiologic techniques provide information on physiological state and response to therapy, and may aid diagnosis and prognosis. Serial studies or continuous monitoring may enable changes to be detected prior to irreversible deterioration in the patient's condition. Current computer technology allows simultaneous display and correlation of electrophysiologic parameters, cardiovascular state and intracranial pressure (ICP). Continuous EEG monitoring in the ICU has been shown to have a decisive or contributing impact on medical decision making in more than three-quarters of patients. In addition, continuous EEG monitoring has revealed previously unsuspected non-convulsive seizures in one-third of patients. SEPs and BAEPs can provide useful prognostic information in coma - however, these tests are etiologically nonspecific and must be carefully integrated into the clinical situation. Motor evoked potentials offer a potentially useful tool for evaluating motor system abnormalities in the ICU.
Ethical Issues in Ageing and Biography
Authors: Kenyon Gary M. 
Published: May 2019

AbstractThe increasing use of biographical materials in research and intervention in the field of ageing gives rise to significant ethical issues. In this inquiry, four of these issues are explicated. First, the notion of informed consent is explored in relation to selected contexts of research and intervention in ageing and biography. Second, the issues of autonomy and competence are considered from the point of view of identifying contexts where biography is a prerequisite for ethically responsive action. The third ethical issue concerns respecting the groundrules of various biographical approaches. Finally, the notions of authenticity and truth in lifestories are explored in an attempt to clarify the limitations and expectations of ageing and biography. The discussion of these ethical issues proceeds on the basis of an argument that indicates the fundamental importance of biographical ageing or the stories we are.
Use of Biography in the Development of Applicable Knowledge
Authors: Polkinghorne Donald E. 
Published: May 2019

AbstractA narrative understanding of clients is needed to supplement traditionally developed research for making clinical judgments about which approaches should be used in working with older adults. Narrative biographical knowledge of clients integrates the historical events and happenings of their lives with the social and cultural contexts through which they attribute meaning to their distresses and symptoms. Applications based on narrative knowledge differ from those based on the conventional model. The conventional model draws on general knowledge of what interventions are likely to be effective in treating particular diagnoses. Narrative understanding is concerned in knowing the configuration of past events and present tasks that compose individual lives. Expert practitioners make use of a narrative understanding of their clients in judging their intervention activities. Development of a narrative understanding of present clients can be assisted by consulting narratives of clients with whom a practitioner has previously worked. Narratives are remembered as stories, retaining the patterns and details of the individual clients’ lives. Through experience, practitioners develop a collection of remembered narratives of the clients they have assisted. A practitioner's experiential collection of narratively known clients can be supplemented with narrative biographies and case studies of clients treated by other practitioners. When working with a new client, practitioners can draw on these narratively retained past understandings by comparing the similarities and differences of their present client to a remembered past client. The process of comparison with past narratively understood clients helps the practitioner compose a new narrative that expressly captures the individual life of the present client. This narrative understanding of the client provides an integrated view of the influence of general social and biological contexts with the unique values, aims, and history of the client.
Communication Between Provider and Patient: Values, Biography, and Empowerment in Clinical Practice
Authors: Clark Phillip G. 
Published: May 2019

AbstractCommunication between elderly people and their health care providers is becoming more important due to the chronic nature of geriatric health problems and their impact on quality of life. At the core of the challenge of improving this dialogue are factors related to essential human values and the clash between two different cultures – one scientific and the other personal. Only by gaining an understanding of this clinical decisionmaking interaction can new approaches to bridge the communication gap be developed. The purpose of this paper is fourfold: (1) to summarise the fundamentally different bases for communication between health care provider and patient, (2) to discuss the shortcomings of various methods (such as advance directives) to embody patients’ wishes about their care, (3) to review new models of geriatric care that have implications for this communication process, and (4) to develop a framework – based on biographical methods and the concept of empowerment – that suggests some potential solutions to these communication problems. Such methods reflect new approaches to developing life stories and themes suggestive of ways to retain the personal life voice of the individual in the development of a clinical partnership with the health care provider.
Basics of Stratifying for Severity of Illness
Authors: Gross Peter A. 
Published: May 2019

AbstractConventional wisdom suggests that those who assess healthcare processes and outcomes always should stratify cases by severity of illness; however, infection control personnel should analyze each quality assessment tool with and without severity adjustment and determine whether such adjustment is necessary. This article briefly reviews severity adjustments for diseases or procedures involving specific organ systems, as well as those applicable to all diseases, including the commercially available systems. Also discussed is whether and how these various systems for severity adjustment can be compared. Finally, the article will provide selected references for individuals who will use these scoring systems and need more information.
Elimination of Nasal Carriage ofStaphylococcus aureusin Hemodialysis Patients
Authors: Kluytmans Jan A.J.W. , Manders Marie-Jose , van Bommel Erik , Verbrugh Henri 
Published: May 2019

AbstractObjective:To study the efficacy of mupirocin for the elimination of nasal carriage ofStaphylococcus aureusin hemodialysis patients.Design:The efficacy of mupirocin was studied in a prospectively followed cohort. The effect of this intervention on the rate ofS aureusbacteremia was evaluated using a historic control group.Setting:Patients on the hemodialysis unit of the University Hospital Rotterdam, a tertiary referral center.Patients:The study group consisted of consecutive patients on hemodialysis from February 1, 1992, until November 1, 1993. They were screened by taking nasal cultures monthly during their time on hemodialysis. IfS aureuswas isolated, treatment with mupirocin nasal ointment was initiated. The control group consisted of patients treated on the same hemodialysis unit from January 1, 1990, until January 1, 1992.Results:The study group consisted of 226 patients, of whom 172 were evaluated to determine the efficacy of mupirocin. Sixty-seven (39%) were identified as nasal carriers. Following the initial treatment, 66 nasal cultures (98.5%) became negative. After 3 months and 6 months, respectively, 63 (94%) and 61 (91%) of the treated carriers had negative cultures. The rate of bacteremia (defined as the number of episodes of5 aureusbacteremia per patient-year on hemodialysis) was significantly lower among the 226 patients in the study group (0.04 per patient-year) than among the 273 patients in the control group (0.25 per patient year;P<.001). Development of resistance and adverse effects were not observed.Conclusions:Mupirocin nasal ointment effectively eliminates nasal carriage of5 aureusin patients on hemodialysis. This was associated with a significant reduction of the incidence of5 aureusbacteremia, as compared to historic controls.
A Prolonged Outbreak of Methicillin-Resistant Staphylococcus aureus in the Burn Unit of a Tertiary Medical Center
Authors: Meier Patricia A. , Carter Cheryl D. , Wallace Sarah E. , Hollis Richard J. , Pfaller Michael A. , Herwaldt Loreen A. 
Published: May 2019

AbstractObjective:To report an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in our burn unit and the steps we used to eradicate the organism.Design And Setting:Outbreak investigation in the burn unit of a 900-bed tertiary-care medical center.Outbreak:Between March and June 1993, MRSA was isolated from 10 patients in our burn unit. All isolates had identical antibiograms and chromosomal DNA patterns.Control Measures:Infection control personnel encouraged healthcare workers to wash their hands after each patient contact. The unit cohorted all infected or colonized patients, placed each affected patient in isolation, and, if possible, transferred the patient to another unit. Despite these measures, new cases occurred. Infection control personnel obtained nares cultures from 56 healthcare workers, 3 of whom carried the epidemic MRSA strain. One healthcare worker cared for six affected patients, and one cared for five patients. We treated the three healthcare workers with mupirocin. Subsequently, no additional patients became colonized or infected with the epidemic MRSA strain.Conclusions:The outbreak ended after we treated healthcare workers who carried the epidemic strain with mupirocin. This approach is not appropriate in all settings. However, we felt it was justified in this case because of a persistent problem after less intrusive measures.
Randomized Prospective Study of the Impact of Three Needleless Intravenous Systems on Needlestick Injury Rates
Authors: L'Ecuyer Paul B. , Schwab Elizabeth Owens , Iademarco Elizabeth , Barr Norma , Aton Elizabeth A. , Fraser Victoria J. 
Published: May 2019

AbstractObjective:To determine the impact of three needleless intravenous systems on needlestick injury rates.Design:Randomized controlled trial.Setting:1,000-bed tertiary-care Midwestern hospital.Participants:Nursing personnel from general medical, general surgical, and intensive-care units.Interventions:From June 1992 through March 1994, a metal blunt cannula (MBC), two-way valve (2-way), and plastic blunt cannula (PBC) were introduced into three study areas, and needlestick injury rates were compared to three control areas using traditional needled devices.Results:24 and 29 needlestick injuries were reported in study and control areas. Intravenous-therapy-related injuries comprised 45.8% and 57.1% of injuries in each area. Thirty-seven percent and 20.7% of study and control area needlestick injuries were considered to pose a high risk of bloodborne infection. The 2-way group had similar rates of total and intravenous-related needlestick injuries compared to control groups. The PBC group had lower rates of total and intravenous-related needlestick injuries per 1,000 patient-days (rate ratios [RR], 0.32 and 0.24; 95°% confidence intervals [CI95], 0.12-0.81 and 0.09-0.61;P=.02 andP=.003, respectively) and per 1,000 productive hours worked (RR, 0.11 and 0.08; CI95, 0.01-0.92 and 0.010.69;P=.03 andP=.005, respectively) compared to controls.Conclusions:Needlestick injuries continued in study areas despite the introduction of needleless devices, and risks of bloodborne pathogen transmission were similar to control areas. The PBC device group noted lower rates of needlestick injuries compared to controls, but there were problems with product acceptance, correct product use, and continued traditional device use in study areas. Low needlestick injury rates make interpretations difficult. Further studies of safety devices are needed and should attempt greater control of worker behavior to aid interpretation.
Nasal and Cutaneous Carriage of Staphylococcus aureus in Hemodialysis Patients: The Effect of Nasal Mupirocin
Authors: Boelaert Johan R. , Van Landuyt Herman W. , Gordts Bart Z. , De Baere Yvan A. , Messer Shawn A. , Herwaldt Loreen A. 
Published: May 2019

AbstractFifteen of 20 hemodialysis patients who carried Staphylococcus aureus in their nares also carried the organism on their hands; 2 of 20 patients who did not carry S aureus in their nares carried S aureus on their hands (P<.001). Eightyseven percent of patients who carried S aureus in their nares and on their hands carried the same strain at both sites. Intranasal mupirocin eliminated S aureus from both sites.
Emergence of High-Level Mupirocin Resistance in Methicillin-ResistantStaphylococcus aureusIsolated From Brazilian University Hospitals
Authors: Santos Kátia Regina Netto dos , Souza Fonseca Leila de , Gontijo Filho Paulo Pinto 
Published: May 2019

AbstractSurveillance for methicillin-resistantStaphylococcus aureus(MRSA) was implemented in Rio de Janeiro and Uberlândia University Hospitals, which had different policies on use of mupirocin. One hundred fourteen multiresistant MRSA strains were isolated from 62 patients. Mupirocin resistance was observed in 63% of strains in Rio de Janeiro, where there was extensive use of topical mupirocin, and 6.1% in Uberlândia, where its use was rare.
Preventing the Emergence of Multidrug-Resistant Microorganisms Through Antimicrobial Use Controls: The Complexity of the Problem
Authors: Jarvis William R. 
Published: May 2019

AbstractWidespread use of antimicrobials in the inpatient and outpatient setting has been associated with the emergence of multidrug-resistant microorganisms. A variety of methods exist to improve the appropriateness of antimicrobial use in the inpatient setting, including guidelines, antimicrobial use evaluations, microbiology laboratory guidance, formulary development and antimicrobial restriction, use of antimicrobial order or automatic stop order forms, and antimicrobial audits. To decrease the selective pressure that leads to development of pathogen resistance and to reduce antimicrobial expenditures, infectious disease, infection control, pharmacy, and administrative staff need to improve clinician use of antimicrobials through development and implementation of antimicrobial use committees. Through the implementation of a comprehensive, multidisciplinary approach to antimicrobial use and development of clinician education programs, inappropriate antimicrobial use can be reduced, patient care can be improved, and substantial cost savings can be realized.
Methicillin-ResistantStaphylococcus aureusEpidemiology and Control in Belgian Hospitals, 1991 to 1995
Authors: Struelens Marc J. , Ronveaux Olivier , Jans Béatrice , Mertens Raf ,   Groupement pour le Dépistage, l'Etude et la Prévention des Infections Hospitalières
Published: May 2019

AbstractObjectives:To describe the Belgian methicillin-resis-tantStaphylococcus aureus(MRSA) surveillance network, the evolution of methods used in Belgian hospitals for MRSA detection and control, and MRSA incidence from 1994 to1995.Design, Setting, and Participants:Questionnaire surveys; infection control physicians from acute-care hospitals in Belgium.Intervention:Publication of national guidelines for MRSA control in 1993.Results:The participation rate in surveys ranged from 42% to 57% of hospitals. In 1995, 88% of participants detected MRSA strains by disk diffusion tests, with little improvement in standardization since 1991. More centers employed the oxacillin agar screen method (27%), automated systems (29%), or a combination of methods (29%) than in 1991 (P<.005). Between 1991 and 1995, the proportion of hospitals reporting MRSA control measures increased from 68% to 95% (P<.01). Practices that were used increasingly included patient placement in private room (from 50% to 93%,P<.01) and hand decontamination with antiseptic (from 43% to 87%,P<.01). The proportion of centers that reported screening MRSA carriers and treating them topically increased two- and threefold, respectively (P<.05). Surveillance data from 1994 to 1995 showed that MRSA represented a mean of 21.3% ofS aureusclinical isolates (range, 1.6% to 62.4%). The median incidence of nosocomial MRSA acquisition was 2.8 per 1,000 admissions, with a wide range (0 to 13.7 per 1,000 admissions) across hospitals of all sizes. The median incidence decreased over the first three semesters of surveillance in hospitals with continuous participation.Conclusion:MRSA detection and control measures have improved in Belgian hospitals after publication of national guidelines. However, MRSA incidence rates show the persistence of nosocomial transmission, with large variations between centers. The national MRSA surveillance network should indicate whether control efforts eventually will curb the problem.