bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nosocomial Infection Caused by Antibiotic-Resistant Organisms in the Intensive-Care Unit
Authors: Flaherty John P. , Weinstein Robert A. 
Published: May 2019

AbstractResistance to antimicrobial agents is an evolving process, driven by the selective pressure of heavy antibiotic use in individuals living in close proximity to others. The intensive care unit (ICU), crowded with debilitated patients who are receiving broad-spectrum antibiotics and being cared for by busy physicians, nurses, and technicians, serves as an ideal environment for the emergence of antibiotic resistance. Problem pathogens presently include multiply resistant gram-negative bacilli, methicillin-resistantStaphylococcus aureus, and the recently emerged vancomycin-resistant enterococci. The prevention of antimicrobial resistance in ICUs should focus on recognition via routine unit-based sur veillance, improved compliance with handwashing and barrier precautions, and antibiotic-use policies tailored to individual units within hospitals.
Quantitative Epidemiology
Authors: Freeman Jonathan 
Published: May 2019

AbstractWe provide guidance for new practitioners in the vocabulary of modern epidemiology and the application of quantitative methods. Most hospital epidemiology involves surveillance (observational) data that were not part of a planned experiment, so the rubric and logic of controlled experimental studies cannot be applied. Forms of incidence and prevalence often are confused. The names “cohort study” and “case-control study” are unfortunate, as cohort studies rarely involve cohorts and case-control studies allow no active control by the investigator. Either type of study can be prospective or retrospective. Results of studies with discrete outcomes (infected or not, lived or died) often are represented best by a form of the risk ratio with 95% confidence intervals. The potential distorting effects of selection bias, misclassification, and confounding need to be considered.
Capture-Recapture Methods in Epidemiological Studies
Authors: Stephen Craig 
Published: May 2019

AbstractMedical researchers often are faced with the challenge of estimating the total number of cases in a population based on incomplete samples. Because of a lack of explicit methods for determining if all cases have been counted, indirect methods for estimating the abundance of disease have been developed. Capture-recapture models are an indirect method of estimating population sizes that have been employed in recent epidemiological studies. These methods, derived from techniques developed for studies of animal abundance, estimate the true population size by evaluating the degree of overlap among incomplete lists of cases from existing data sources. Although intuitively appealing, the successful application of these methods is dependent upon a clear understanding of the biology of the disorder involved, the dynamics of the reference population, and the assumptions and robustness of the specific models used. Failure to address these issues can lead to inaccurate and sometimes misleading results. This article describes some of the strengths and limitations of recapture techniques and provides the reader with a foundation from which to explore the methods in further detail.
Emerging Infectious Diseases in the Institutional Setting: Another Hot Zone
Authors: Ostroff Stephen M. 
Published: May 2019

AbstractDuring the closing years of the 20th century, there has been an unprecedented number of newly recognized infectious agents and a resurgence of infectious diseases only recently thought to be conquered. These problems have been compounded by the increasing number of pathogens that have evolved resistance to antimicrobial agents. Hospitals and other institutional settings occupy a pivotal niche in the emergence of infectious agents due to factors such as the large concentrations of ill and immunocompromised persons, evolving technologies in healthcare settings, routine breeches of host defense mechanisms, and frequent use of antimicrobial agents. Any comprehensive strategy to address emerging infectious diseases must incorporate provisions for healthcare settings, including efforts to enhance surveillance, response capacity, training, education, applied research, and routine implementation of prevention measures.
Methicillin-Resistant Staphylococcus aureus Control in Hospitals: The French Experience
Authors: Richet Hervé , Wiesel Michel , Le Gallou Florence , André-Richet Béatrice , Espaze Eric ,   Association des Pays de la Loire pour l'Eviction des Infections Nosocomiales
Published: May 2019

AbstractThe first cases of isolation of Staphylococcus aureus resistant to methicillin in France were published in 1962. However, until recently, very few epidemiological studies or attempts to control the epidemic have been done in France. In this article, we present the results of a prospective study performed during a 3-month period in 27 hospitals of the Région des Pays de la Loire. Among the 94,605 hospitalized patients included in the study, 0.45% (427) developed methicillin-resistant Staphylococcus aureus (MRSA) infections, the incidence rate ranging from 0% to 1.2%. Thirty-four percent of MRSA-infected patients were 80 years old or older, 30% had been transferred from another service and 19% from another hospital, 56% were hospitalized at least once during the previous year, MRSA had been isolated at least once previously in 18% of MRSA-infected patients, 19% died, 16% were transferred to another service and 11% to another hospital, and only 32% were discharged to their homes. A poor compliance to contact isolation precautions was observed in all hospitals: 46% of MRSA-infected patients were hospitalized in a private room; gloves, masks, and gowns were worn for the care of 63.4%, 14%, and 42.5% of MRSA-infected patients, respectively; and handwashing was feasible in the rooms of 52% of the patients.
Methicillin-ResistantStaphylococcus aureusControl in Hospitals: The Dutch Experience
Authors: Vandenbroucke-Grauls C.M.J.E. 
Published: May 2019

AbstractThe Netherlands is one of the few countries where methi-cillin-resistantStaphylococcus aureus(MRSA) still is uncommon. In 1988, the Werkgroep Infectie Preventie (Working Party on Infection Prevention) issued guidelines on the control of MRSA that could be applied nationwide. The mainstay of the guideline is that all patients who carry MRSA are strictly isolated in single rooms. In 1989, a surveillance study was started by the National Institute of Public Health and the Environment. This study showed that approximately 200 new cases of MRSA colonization or infection occur each year. Small outbreaks of MRSA occur occasionally in The Netherlands, but the surveillance data confirm the success of the Dutch policy.
Host-Bacteria Interactions in Foreign Body Infections
Authors: François Patrice , Vaudaux Pierre , Foster Timothy J. , Lew Daniel P. 
Published: May 2019

AbstractPersistent staphylococcal infections are a major medical problem, especially when they occur on implanted materials or intravascular catheters. This review describes some of the recently discovered molecular mechanisms ofStaphylococcus aureusattachment to host proteins coating biomedical implants. These interactions involve specific surface proteins, called bacterial adhesins, that recognize specific domains of host proteins deposited on indwelling devices, such as fibronectin, fibrinogen, or fibrin. Elucidation of molecular mechanisms ofS aureusadhesion to the different host proteins may lead to the development of specific inhibitors blocking attachment ofS aureus, which may decrease the risk of bacterial colonization of indwelling devices.
How to Limit the Spread of Creutzfeldt-Jakob Disease
Authors: Dormont Dominique 
Published: May 2019

AbstractTransmissible spongiform encephalopathies are rare lethal diseases induced in humans and animals by unconventional agents called transmissible spongiform encephalopathy agents (TSEAs), virions, or prions. Several cases of iatrogenic Creutzfeldt-Jakob disease (CJD) have been reported in the literature after neuro-surgery, treatment with pituitary-derived hormones, corneal grafting, and use of dura mater lyophilisates. In a given infected individual, TSEA-associated infectiousness depends on the nature of the organ: the central nervous system has the highest infectiousness, spleen and lymph nodes a medium infectiousness, and organs such as bone, skin, or skeletal muscles do not harbor any detectable infectiousness in experimental models. Transmissible spongiform encephalopathy/prions have unconventional properties; in particular, they resist almost all the chemical and physical processes that inactivate conventional viruses. Therefore, prevention of CJD agent transmission must be taken into account in daily hospital practice. Efficient sterilization procedures should be determined. In tissue and blood donation, donors with a neurologic history must be excluded, and patients treated with pituitary-derived hormones should be considered potentially infected with TSEA and excluded.
Operative Precautions in HIV and Other Bloodborne Virus Diseases
Authors: Raahave Dennis 
Published: May 2019

AbstractMathematical means have suggested that the surgical team is at particular risk of acquiring HIV (or other bloodborne viruses) from a source patient. To reduce this risk, it is mandatory to avoid accidental injuries during operative procedures. The surgeon must handle tissues with instruments and must minimize finger use. Sharp instruments should be passed through a neutral zone to ensure that the surgeon and nurse do not touch the same instrument at the same time. Instruments should not be handled blindly, but instead should be accompanied by eye and verbal contact. We find these changes in surgical technique are necessary for present and future generations of surgeons.
AIDS, Emergency Operations, and Infection Control
Authors: Wittmann Mark Matthias , Wittmann Annemarei , Wittmann Dietmar H. 
Published: May 2019

AbstractAcquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) may turn out to be the largest lethal epidemic of infection ever. The estimated global number of HIV-infected adults in 1993 was 13 million, with projections of up to 40 million by the year 2000. Human immunodeficiency virus infections and AIDS are relevant to surgeons with respect to the surgical management of AIDS patients in general, the treatment of the increasingly long list of surgical complications specific to AIDS patients in particular, and the risks of patient-to-surgeon and surgeon-to-patient HIV transmission. Because of migration of individuals and populations throughout the world, even surgeons practicing in relatively unaffected regions should be familiar with the potential surgical implications of AIDS. Ethical considerations arise, as well. Are surgeons obliged to operate on HIV-positive or AIDS patients? Some surgeons adhere strictly to the Hippocratic Oath, whereas others reserve the right to be selective on whom they operate, except in emergencies. Other common ethical considerations in the AIDS patient are similar to those arising in the terminal cancer case: whether to operate or not; whether to provide advanced support such as total parenteral nutrition or hemodialysis. Answers are not simple and require close collaboration between the surgeon, the AIDS specialist, and involved members of other specialties. Emergency operations become necessary to treat AIDS independent disease such as acute cholecystitis and appendicitis or AIDS-related life-threatening conditions such as gastrointestinal bleeding, obstruction, perforation, or ischemia complicating Kaposi's sarcoma, lymphoma, and cytomegalovirus or disseminated nontuberculous mycobacterial infections. Delays and errors in diagnosis are frequent. Poor nutritional state with weight loss, low serum albumin, and leukocyte count prevails in most patients requiring emergency operations and account for a high mortality. By applying solid judgment and selecting management appropriately, the surgeon has the ability to prolong life and to improve the quality of life for these unfortunate patients, and to do so with extremely minimal risk to himself and his team.
Prevention of Fungal Infections in Hematology Patients
Authors: Philpott-Howard John 
Published: May 2019

AbstractEndogenous infections such as candidiasis can be minimized by oral fluconazole prophylaxis, although oral or intravenous amphotericin, or itraconazole, are suitable for certain patients. Exogenous fungal infections most commonly are transmitted by the airborne route, but the benefits of high-efficiency particulate air-filtered room air probably are diminishing as broad-spectrum prophylaxis againstAspergillusspecies and other fungi improves. However, high-risk environmental sources such as construction work always must be avoided near neutropenic patients. Reactivation of quiescent pulmonaryAspergillusinfection can be prevented by surgical resection during remission, or by systemic amphotericin prophylaxis during subsequent neutropenic episodes.
Epidemiology, Diagnosis, and Therapy of Fungal Infections in Surgery
Authors: Giamarellou Helen , Antoniadou Anastasia 
Published: May 2019

AbstractOver the past decade, the incidence of hospital-acquired bloodstream infections caused byCandidastrains has risen, while the implicated species have changed.Candida tropicalis, Candida parapsilosis, andCandida glabrataall have increased in incidence. Data from the Centers for Disease Control and Prevention reveal that, between 1980 and 1990,Candidaemerged as the sixth most common nosocomial pathogen (7.2.%) and was the fourth most common pathogen in nosocomial bloodstream infections, surpassed only by coagulase-negative staphylococci,Staphylococcus aureus, and enterococci. The incidence of candidemia is dramatically higher in high-risk critical-care units: 25% of cases occur in surgical intensive-care units (ICUs) versus 25% in bone marrow transplantation units, 20% in medical ICUs, 20% in general medical wards, and 10% in oncology-hematology units. Burns and gastrointestinal surgery predispose to nosocomial candidemia. Independent risk factors include prior therapy with multiple antibiotics, isolation ofCandidafrom sites other than blood, and prior hemodialysis. Crude mortality exceeds 55% and is associated with older age and concomitant renal failure, hepatic failure, acute respiratory diseases, or postoperative shock. In addition to extreme vigilance for early recognition ofCandidasepsis in critically ill surgical patients, the high risk for candidemia probably necessitates fungal surveillance cultures and initiation of preemptive antifungal therapy in high-risk surgical patients.
Implementation and Evaluation of an Algorithm for Isolation of Patients With Suspected Pulmonary Tuberculosis
Authors: Pegues Clare F. , Johnson Douglas C. , Pegues David A. , Spencer Maureen , Hopkins Cyrus C. 
Published: May 2019

AbstractObjective: To implement and evaluate an algorithm designed to assist in the consistent placement of patients with suspected pulmonary tuberculosis into negative-pressure isolation rooms (NPIRs).Design: A standard algorithm was designed for the appropriate room placement of patients with suspected pulmonary tuberculosis using clinical, radiographic, and laboratory criteria and reported risk factors. A case-patient was defined as an inpatient who had at least one Mycobacterium tuberculosis culture-positive respiratory specimen from January 1, 1993, through December 31, 1994. Demographic, clinical, laboratory, case contact, and isolation and room placement data were collected prospectively on all case-patients.Setting: A 900-bed university teaching and referral center.Results: During 1993 and 1994, 69 patients were evaluated for possible pulmonary tuberculosis, and 31 case-patients were identified. Of the 31 case-patients, 26 (84%) were placed on respiratory isolation in NPIRs, including 19 (61%) who were isolated within 24 hours of admission (1993, 14 of 20 [70%]; 1994, 5 of 11 [45%]). Seven case-patients (23%) were isolated in NPIRs following delays that ranged from 2 to 31 days (median, 9 days), and five case-patients (16%) never were isolated during admissions of from 3 to 28 days (median, 4 days). These 12 case-patients contributed a total of 136 patient-exposure days during their hospitalizations. Misclassification of patient risk status by user error delayed isolation of five (42%) of the 12 improperly isolated case-patients.Conclusions: The use of an algorithm incorporating radiographic, laboratory, and clinical criteria and reported risk factors may assist in the rapid isolation of patients with suspected pulmonary tuberculosis.
The Effect of a Portable Hepa-Filtered Body Exhaust System on Airborne Microbial Contamination in a Conventional Operating Room
Authors: Bohn William W. , McKinsey David S. , Dykstra Mark , Koppe Susan 
Published: May 2019

AbstractObjective:To study the effect of a portable HEPA-filtered air exhaust system (Stackhouse Freedom Surgical Helmet System) on airborne microbial contamination in a modern conventional operating room.Design and Setting:Microbial air sampling was done with a two-stage Anderson sampler at the wound site during 46 total joint replacements. All operations were performed by the same surgeon in the same operating room at a large community hospital.Results:In 18 cases done without air exhaust hoods, the number of bacterial and fungal colony-forming units (CFU) ranged from 0.6 to 11.7 (mean, 3.6). Air sampling during 28 operations with the operating team in air exhaust hoods revealed a mean of 3.6 CFU (range, 0 to 11.4). Bacterial CFU averaged 3.4 without hoods and 3.2 with exhaust hoods. Coagulase-negative staphylococci were the most common isolates (48% of isolates with hood, 55% without hood). No infections occurred.Conclusion:We conclude that these air exhaust hoods did not lower airborne microbial contamination detectable with this air sampling method, as compared to standard head cover and mask, in a modern conventional operating room.
An Outbreak of Fatal Nosocomial Infections Due to Group A Streptococcus on a Medical Ward
Authors: Ramage L. , Green K. , Pyskir D. , Simor A.E. 
Published: May 2019

AbstractGroup A streptococcus is an uncommon but important cause of nosocomial infections. Outbreaks of infection most often have occurred in surgical or obstetrical patients. We describe an outbreak of severe group A streptococcal infections that occurred on a medical unit of a community hospital. Within an 8-day period, three patients developed fatal nosocomial skin and soft-tissue infection due to group A streptococcus. Three nurses who had provided care to one or more of these patients subsequently developed strepto-coccal pharyngitis, and three other nurses were treated with antibiotics for pharyngitis (cultures not obtained). Patient isolates were serotype M-nontypeable, T-11, opacity factor-positive, and shared identical DNA profiles when typed by pulsed-field gel electrophoresis; staff isolates were not available for typing. To prevent further spread of infection, the ward was closed to new admissions, and symptomatic staff were treated with antibiotics and relieved of patient-care duties. This outbreak demonstrates the ability of group A streptococcus to spread rapidly in a hospital setting and to cause severe life-threatening disease in hospitalized patients.
Influenza Vaccination of Medical Residents at the University of Virginia: 1986 to 1994
Authors: Fedson David S. 
Published: May 2019

AbstractDuring the 9-year period from 1986 to 1994, medical residents at the University of Virginia Health Sciences Center were offered free influenza vaccine in the General Medicine Clinic (GMC). Vaccination rates rose from 24% in 1986 to 99% in 1991. With changes in the GMC staff, the rates during the next 2 years dropped to 82% and 63%, respectively. Renewed attention to the vaccination program in 1994 led to a vaccination rate among eligible residents of 97%. Although the Employee Health Service also conducted its own vaccination programs for hospital personnel, the GMC accounted for most of the influenza vaccinations given to the medical residents throughout the 9-year period. The success of the GMC program demonstrates the importance of offering influenza vaccine to healthcare workers at their worksites and of focused responsibility to ensure that this is done.
The Communicative Development Inventory-WORDS Short Form as an index of language production
Authors: Corkum Valerie , Dunham Philip 
Published: May 2019

ABSTRACTThis longitudinal study was designed to examine the CDI-WORDS Short Form vocabulary checklist (Reznick & Goldsmith, 1989) as an index of language production. In particular, we were curious about: (1) the concurrent associations between the CDI-WORDS Short Form checklist measure and directly observed measures of lexical production; (2) the associations between Short Form checklists administered at different ages; and (3) the predictive associations between Short Form scores and subsequent measures of more general intellectual abilities (i.e. the Wechlser Preschool and Primary Scale of Intelligence; WPPSIR; Wechsler, 1989). In a sample of 32 children, significant correlations were found between CDI-WORDS Short Form scores and directly observed measures of lexical production at both 1;6 and 2;0. Further, both the Short Form checklist and the observed measure of lexical production were found to predict WPPSI-R Verbal IQ scores but not the Performance IQ scores at 4;0. Additional analyses demonstrated the predictive and convergent validity of the CDI-WORDS Short Form, and underscored the additional value of direct observational measures of lexical production during early lexical development.
The development of segmental phonological production in a bilingual child: a contrasting second case
Authors: Schnitzer Marc L. , Krasinski Emily 
Published: May 2019

ABSTRACTA longitudinal diary-and-videotape study of the production of phonological segments by a Spanish—English bilingual child, age 1;6–4;6, revealed a consistent separation of the phonological systems of the two languages from the earliest period, with minimal interference at later times. These results are in contrast to results obtained from another child in a similar study (Schnitzer & Krasinski, 1994). The relevance of these data to the issue of whether bilingual children first use a single system before acquiring two discrete languages is discussed, as is the general question of how to interpret the early phonological production of bilinguals.
Resolving apparent contradictions: adults' and preschoolers' ability to cope with non-classical negation
Authors: Sharpe Dean , Eakin Laurel , Saragovi Carina , Macnamara John 
Published: May 2019

ABSTRACTIf the logic of natural language negation were classical – a simple matter of true and false – then it would be a disaster to answer a question likeIs this essay good?withYes and no. The overwhelming majority of adults (N= 40) asked to resolve this apparent contradiction were found to do so by appealing to the structure of the essay (e.g.Its thesis was good but its argument was not). Three-year-olds (N= 24), when suitably prepared, also appealed to object structure to resolve a similar apparent contradiction. These results are discussed in relation to a non-classical logical model that can handle object structure.