bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergence of High-Level Mupirocin Resistance in Methicillin-Resistant Staphylococcus aureus Isolated From Brazilian University Hospitals
Authors: Santos Kátia Regina Netto dos , Souza Fonseca Leila de , Gontijo Filho Paulo Pinto 
Published: September 2009

AbstractSurveillance for methicillin-resistant Staphylococcus 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.
Analysis of Infection Control Surveillance Data in a Long-Term–Care Facility: Use of Threshold Testing
Authors: Mylotte Joseph M. 
Published: September 2009

AbstractObjective:To describe long-term trends in nosocomial infection rates and the threshold testing method for evaluating nosocomial sur veillance data in a long-term–care facility (LTCF).Design:Descriptive epidemiology of prospectively collected infection control sur veillance data and application of threshold testing for detecting possible outbreaks. Threshold testing uses the binomial distribution to calculate probabilities of infection frequency at selected endemic levels (mean number of infections per month) and compares these probabilities to obser ved infection frequency.Setting:One hundred twenty-bed LTCF located within a public, university-affiliated hospital.Patients And Methods:The study period was 1987 through 1994. Yearly endemic levels of specific types of infection were calculated and threshold levels were determined using a previously published method. In this study, a probability of P=.01 was chosen to determine the threshold at a specific endemic level; if the observed number of infections in a month reached or exceeded the threshold level, the likelihood that this occurred by chance alone was 1% or less.Interventions:None.Results:The overall mean nosocomial infection rate ranged from three to five episodes per 1,000 resident care days per year; mean yearly rates from 1990 onward were higher and more stable than those from 1987 to 1989. The most common infections identified were lower respiratory tract, skin and soft tissue, urinary tract, and conjunctivitis. For each of these infections, threshold levels were calculated periodically, using only the monthly frequency of infection. Despite variations in the yearly mean endemic level of various infections, threshold levels were stable except for skin and soft-tissue infection.Conclusions:Threshold testing for analysis of infection control sur veillance data in the LTCF setting is straightfor ward and does not require knowledge of statistics, special computer software, or calculation of rates; given the stable population in the typical LTCF, threshold testing can be based on variations in the monthly count of infections and provides an objective evaluation of surveillance data and a method to identify when outbreaks may be occurring.
Antimicrobial Resistance in Long-Term–Care Facilities
Authors: Strausbaugh Larry J. , Crossley Kent B. , Nurse Brenda A. , Thrupp Lauri D. ,   SHEA Long-Term–Care Committee
Published: September 2009

AbstractDuring the last quarter century, numerous reports have indicated that antimicrobial resistance commonly is encountered in long-term–care facilities (LTCFs). Gramnegative uropathogens resistant to penicillin, cephalosporin, aminoglycoside, or fluoroquinolone antibiotics and methicillin-resistant Staphylococcus aureus have received the greatest attention, but other reports have described the occurrence of multiply-resistant strains of Haemophilus influenzae and vancomycin-resistant enterococci (VRE) in this setting. Antimicrobial-resistant bacteria may enter LTCFs with colonized patients transferred from the hospital, or they may arise in the facility as a result of mutation or gene transfer. Once present, resistant strains tend to persist and become endemic. Rapid dissemination also has been documented in some facilities. Person-to-person transmission via the hands of healthcare workers appears to be the most important means of spread. The LTCF patients most commonly affected are those with serious underlying disease, poor functional status, wounds such as pressure sores, invasive devices such as urinary catheters, and prior antimicrobial therapy. The presence of antimicrobial-resistant pathogens in LTCFs has serious consequences not only for residents but also for LTCFs and hospitals. Experience with control strategies for antimicrobial-resistant pathogens in LTCFs is limited; however, strategies used in hospitals often are inapplicable. Six recommendations for controlling antimicrobial resistance in LTCFs are offered, and four priorities for future research are identified.
Knowledge of the Transmission of Tuberculosis and Infection Control Measures for Tuberculosis Among Healthcare Workers
Authors: Lai Kwan Kew , Fontecchio Sally A. , Kelley Anita L. , Melvin Zita S. 
Published: September 2009

AbstractTwo hundred seventy-five of 325 (85%) healthcare workers (HCWs) completed a questionnaire testing their knowledge of transmission of tuberculosis (TB) and infection control measures for TB. Of the 75 HCWs with no patient contact, 49 (65%) felt that masks should be worn, and 40 (53%) would use gowns. In contrast, 175 (88%) of 200 HCWs having contact with patients thought masks should be worn, and 70 (35%) would use gowns (P=.0001 and .0085, respectively). Only 87% of HCWs with patient contact felt that respiratory precautions should be instituted for TB patients. The results of our sur vey showed that HCWs should be reeducated about TB.
Assessing Blunt Cannulae as Replacements for Hypodermic Needles During Intravenous Therapy Safety and Utility
Authors: Kempen Paul Martin 
Published: September 2009

AbstractObjective:Recently, blunt 18-gauge (ga) metal cannulae have become nationally commercially available as safety products. The ability of these blunt cannulae to prevent needlestick injury and to enable direct access of all standard latex ports and vial membranes, thus eliminating hypodermic needles entirely from the intravenous (IV) drug administration process, is assessed.Design and Setting:In the laboratory setting, the needlestick injury potential of small-bore blunt cannulae versus hypodermic needles was studied using blinded and randomized methods. Insertion force requirements were studied for cannulae and needles. Metal 18-ga blunt cannulae were inserted into four brands of standard Y-ports and vial stoppers to assess postpuncture integrity and force requirements.Results:Needlestick injury did not occur using small-bore blunt cannulae (P<.001; n=51). Metal 18-ga cannulae passed into prepierced standard Y-ports as easily as hypodermic needles and without loss of Y-port integrity. Insertion of metal 18-ga cannulae without prior port puncture was possible, but was associated with substantial coring and loss of integrity of the port seal, except for IVAC brand ports (P<.03).Conclusions:Metal 18-ga cannulae can be inserted through virtually all intact standard rubber vial membranes or standard Y-ports to allow safe IV access. A single prepuncture of any standard latex membrane allows economical blunt metal cannula access equally efficiently as with expensive pre-slit membranes and without loss of membrane integrity.
The Effectiveness of a Needleless Intravenous Connection System An Assessment by Injury Rate and User Satisfaction
Authors: Lawrence Louann W. , Delclos George L. , Felknor Sarah A. , Johnson Philip C. , Frankowski Ralph F. , Cooper Sharon P. , Davidson Anthony 
Published: September 2009

AbstractObjective:To assess the impact of a needleless intravenous (IV) connection system on the rate of reported intravenous-connection–related (IVCR) percutaneous injuries, and to assess user satisfaction, frequency of use, and barriers to use.Design:A pre-post inter vention design, with injury incidence rates being compared 3 years before and 1 year after hospitalwide device implementation; and a cross-sectional descriptive user satisfaction survey.Setting:Two tertiar y-care teaching hospitals, one general and one pediatric, located in a large metropolitan medical center.Outcome Variable:All IVCR percutaneous injuries reported to the employee health ser vices at both hospitals during the years from 1989 to 1991 and 1993.Study Population:Survey participants were selected randomly from licensed nursing employees at both hospitals.Intervention:IV connection system consisting of blunt plastic cannulas and compressed latex injection sites.Results:After device implementation, the IVCR injury rate was reduced 62.4% (rate ratio [RR], 0.38; 95% confidence inter val [CI95], 0.27-0.53) at the general hospital and 70.2% (RR, 0.30; CI95, 0.17-0.53) at the pediatric hospital. After adjusting for the reduction in injury rate due to factors other than device implementation, the IVCR injury rate was reduced 54.5% (adjusted RR, 0.46; CI95, 0.32-0.65) at the general hospital and 57.2% (adjusted RR, 0.43; CI95, 0.24-0.78) at the pediatric hospital. Approximately 94% of survey respondents (n=478, response rate=51%) were satisfied with the device and recommended continued use. However, needles still were being used for activities that could have been performed with the needleless system because of compatibility, accessibility, and other technical problems related to the device.Conclusions:The device was effective in reducing the rate of reported IVCR percutaneous injuries and users were satisfied with the device, but barriers to universal use were identified.
Gender Differences in Early Suspicion of Tuberculosis in Hospitalized High-Risk Patients During 4 Epidemic Years, 1987 to 1990
Authors: Cegielski J. Peter , Goetz Matthew B. , Jacobson Jeffrey M. , Cohn Susan E. , Weinstein Robert A. , DeHovitz Jack A. , Bennett Charles L. 
Published: September 2009

AbstractObjectives:To assess the degree to which, from 1987 to 1990, physicians suspected tuberculosis (TB) in the first 2 hospital days in human immunodeficiency virus (HIV)-infected patients with pulmonary disease.Design:Retrospective cohort study.Setting:96 hospitals in five US cities.Patients:2,174 adult patients with acquired immunodeficiency syndrome discharged with a diagnosis of Pneumocystis carinii pneumonia from 1987 to 1990. The diagnosis generally was not known on admission.Results:Physicians suspected TB in the first 2 hospital days in 66% of these patients in 1987, a rate that increased steadily to 74% in 1990. However, the extent to which physicians considered TB among female patients decreased from 76% to 71% over the 4 years. Controlling for confounding variables by multiple logistic regression, the odds that TB would be suspected early increased 1.8-fold among men (odds ratio [OR], 1.8; 95% confidence interval [CI95], 1.4-2.4), but not in women (OR, 0.6; CI95, 0.2-1.9). Among the five cities, the odds of early suspicion of TB increased most in New York City (OR, 3.9; CI95, 2.0-7.9).Conclusions:Physicians considered TB in a timely manner in an increasing majority of male, but not female, high-risk patients during the first years of TB resurgence in the United States. Physicians must be aware of the changing epidemiology of HIV and TB, as well as their practice patterns, to prevent nosocomial transmission of this disease
Secular Trends in the Epidemiology of Nosocomial Fungal Infections at a Teaching Hospital in Taiwan, 1981 to 1993
Authors: Nettleman Mary D. , Chen Yee-Chun , Chang Shan-Chwen , Sun Chun-Chuan , Yang Li-Se , Hsieh Wei-Chuan , Luh Kwen-Tay 
Published: September 2009

AbstractObjective:To describe the incidence and patterns of nosocomial fungal infection in a large teaching hospital in Taiwan.Design:Prospective, hospitalwide nosocomial surveillance data from 1981 through 1993 were analyzed to show the secular trend in nosocomial fungal infection rates and to identify the most common pathogens and sites of infection (other than skin) in this hospital.Setting and Patients:The National Taiwan University Hospital is a medical school-affiliated hospital in the city of Taipei, Taiwan, with a 1,200-bed capacity before 1991 and 1,500 beds since 1992. It provides both primary and tertiary medical care.Results:The overall nosocomial fungal infection rate rose from 0.9 infections per 1,000 discharges in 1981 to 6.6 per 1,000 discharges in 1993, with the highest rate at the medical intensive-care unit (26.5/1,000 discharges in 1993). This increase in infection rate was found at four major anatomic sites of infection, particularly including the bloodstream (0.08-2.19/1,000 discharges) and the urinary tract (0.36-2.95/1,000 discharges). Of 256 pathogens causing nosocomial fungemia from 1981 through 1993, Candida albicans was the most commonly isolated (50.8%), followed by Candida tropicalis (17.6%), Candida parapsilosis (11.7%), and Candida glabrata (8.2%). As compared to isolates from 1981 through 1988, the proportion of C parapsilosis and C glabrata isolated between 1989 and 1993 increased more than sixfold and fourfold, respectively. The increasing importance of fungal infections was confirmed further by the increased use of amphotericin B and azoles in this hospital.Conclusions:Candida species and other yeasts have become a prominent cause of nosocomial infections in this hospital. These fungal pathogens accounted for a higher proportion of nosocomial bloodstream and urinary infections than any single bacterial species. Therefore, it is important to conduct a prospective epidemiological study and to establish in vitro antifungal susceptibility testing to enhance efforts to control nosocomial fungal infections and to minimize the risk of emergence of antifungal resistance.
Microbiological Hazards Related to Xenotransplantation of Porcine Organs Into Man
Authors: Borie Dominic C. , Cramer Donald V. , Phan-Thanh Luu , Vaillant Jean Christophe , Bequet Jean Louis , Makowka Leonard , Hannoun Laurent 
Published: September 2009

ABSTRACTPigs are emerging as the most likely providers of genetically engineered organs and cells for the purpose of clinical xenotransplantation. Introduction of clinical trials has been delayed primarily by uncertainties regarding the risk of swine pathogen transmission that could harm the recipient. The concern that xenotransplantation carries the potential for a new epidemic has been highlighted by recent experiences with both bovine spongiform encephalopathy and human immunodeficiency diseases.As clinical trials have been postponed and xenotransplantation teams are working actively to gather data for an estimation of the risk, this review provides the reader with a state-of-the-art estimation of the microbiological hazards related to xenotransplantation of porcine organs to man. Particular emphasis is put on viral and retroviral hazards. Both current diagnostic tools and those under development are described, along with breeding strategies to provide donor animals that would not put the recipient or the general population at risk
Fate and removal of pharmaceuticals and illicit drugs in conventional and membrane bioreactor wastewater treatment plants and by riverbank filtration
Authors: Petrovic Mira , de Alda Maria Jose Lopez , Diaz-Cruz Silvia , Postigo Cristina , Radjenovic Jelena , Gros Meritxell , Barcelo Damià 
Published: September 2009

Pharmaceutically active compounds (PhACs) and drugs of abuse (DAs) are two important groups of emerging environmental contaminants that have raised an increasing interest in the scientific community. A number of studies revealed their presence in the environment. This is mainly due to the fact that some compounds are not efficiently removed during wastewater treatment processes, being able to reach surface and groundwater and subsequently, drinking waters.
This paper reviews the data regarding the levels of pharmaceuticals and illicit drugs detected in wastewaters and gives an overview of their removal by conventional treatment technologies (applying activated sludge) as well as advanced treatments such as membrane bioreactor. The paper also gives an overview of bank filtration practices at managed aquifer recharge sites and discusses the potential of this approach to mitigate the contamination by PhACs and DAs.
The epidemiology and possible mechanisms of disinfection by-products in drinking water
Authors: Nieuwenhuijsen Mark J. , Grellier James , Smith Rachel , Iszatt Nina , Bennett James , Best Nicky , Toledano Mireille 
Published: September 2009

This paper summarizes the epidemiological evidence for adverse health effects associated with disinfection by-products (DBPs) in drinking water and describes the potential mechanism of action.There appears to be good epidemiological evidence for a relationship between exposure to DBPs, as measured by trihalomethanes (THMs), in drinking water and bladder cancer, but the evidence for other cancers including colorectal cancer is inconclusive and inconsistent. There appears to be some evidence for an association between exposure to DBPs, specifically THMs, and little for gestational age/intrauterine growth retardation and, to a lesser extent, pre-term delivery, but evidence for relationships with other outcomes such as low birth weight, stillbirth, congenital anomalies and semen quality is inconclusive and inconsistent. Major limitations in exposure assessment, small sample sizes and potential biases may account for the inconclusive and inconsistent results in epidemiological studies. Moreover, most studies have focused on total THMs as the exposure metric, whereas other DBPs appear to be more toxic than the THMs, albeit generally occurring at lower levels in the water.The mechanisms through which DBPs may cause adverse health effects including cancer and adverse reproductive effects have not been well investigated. Several mechanisms have been suggested, including genotoxicity, oxidative stress, disruption of folate metabolism, disruption of the synthesis and/or secretion of placental syncytiotrophoblast-derived chorionic gonadotropin and lowering of testosterone levels, but further work is required in this area.
Phosphate (Pi) Starvation Effect on the Cytosolic Pi Concentration and Pi Exchanges across the Tonoplast in Plant Cells: An in Vivo 31P-Nuclear Magnetic Resonance Study Using Methylphosphonate as a Pi Analog
Authors: Pratt James , Boisson Anne-Marie , Gout Elisabeth , Bligny Richard , Douce Roland , Aubert Serge 
Published: September 2009

Abstract
In vivo 31P-NMR analyses showed that the phosphate (Pi) concentration in the cytosol of sycamore (Acer pseudoplatanus) and Arabidopsis (Arabidopsis thaliana) cells was much lower than the cytoplasmic Pi concentrations usually considered (60–80 μm instead of &gt;1 mm) and that it dropped very rapidly following the onset of Pi starvation. The Pi efflux from the vacuole was insufficient to compensate for the absence of external Pi supply, suggesting that the drop of cytosolic Pi might be the first endogenous signal triggering the Pi starvation rescue metabolism. Successive short sequences of Pi supply and deprivation showed that added Pi transiently accumulated in the cytosol, then in the stroma and matrix of organelles bounded by two membranes (plastids and mitochondria, respectively), and subsequently in the vacuole. The Pi analog methylphosphonate (MeP) was used to analyze Pi exchanges across the tonoplast. MeP incorporated into cells via the Pi carrier of the plasma membrane; it accumulated massively in the cytosol and prevented Pi efflux from the vacuole. This blocking of vacuolar Pi efflux was confirmed by in vitro assays with purified vacuoles. Subsequent incorporation of Pi into the cells triggered a massive transfer of MeP from the cytosol to the vacuole. Mechanisms for Pi exchanges across the tonoplast are discussed in the light of the low cytosolic Pi level, the cell response to Pi starvation, and the Pi/MeP interactive effects.
Maintaining Environmental Resources in the International System: A Comparison of Contractual Arrangements*
Authors: Coram Alex T. 
Published: September 2009

Objectives. State A may control an environmental resource that has value for other actors in the international system. The objective of this article is to compare different contractual arrangements between State A and other agents for preservation of this resource. I concentrate on direct purchase schemes and dynamic (stream‐of‐payment) schemes.Methods.The problem is analyzed by constructing a model of the returns to State A from exploiting the resource; its public goods value; and transfer payments from other agents.Results.Among the main results are that continual transfers may be better than a one‐off buyout and, if the resource does not have a public goods value for the owner, compensation may not be effective.Conclusions.Generally, the analysis points out the gains to be made from paying attention to the type of contractual arrangement. Most of these results would not have been intuitively clear. I also show that rental schemes may be the least risky option.
The impact of elephants, Loxodonta africana, on woody vegetation through selective debarking in Samburu and Buffalo Springs National Reserves, Kenya
Authors: Ihwagi Festus W. , Vollrath Fritz , Chira Robert M. , Douglas‐Hamilton Iain , Kironchi Geoffrey 
Published: September 2009

AbstractThe impact of elephants on the woody plant community through debarking was investigated in Samburu and Buffalo Springs National Reserves, Kenya. Acacia elatior Brenan, the most abundant tree species in the riverine zone, accounted for 68% (n = 1375) of woody plants. A. tortilis (Forsskal) Hayne dominated plots away from the river. Debarking incidences were significantly higher for A. elatior than for other species indicating selective utilization. The riverine zone by virtue of having more trees of the preferred species, A. elatior, had the highest debarking incidences. Presence of very few saplings along the river is attributed to both elephant trampling and herbivory by other species. An estimated 38.5% and 22.5% of the riverine A. elatior and A. tortilis trees respectively, were bound to die within the next 4–5 years because of severe debarking, ≥75% of bark circumference. Debarking was positively correlated with stem circumference; the medium‐sized trees being the worst affected by the elephants’ selective debarking behaviour. Intense debarking incidences were recorded during the dry season. Through the elephants’ selective debarking, the riverine habitat is bound to open up gradually, leading to considerable habitat change in the near future. Elephant impact on vegetation is less away from the river and increases with their densities.