bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attributable Costs and Length of Stay of an Extended-Spectrum Beta-Lactamase-ProducingKlebsiella pneumoniaeOutbreak in a Neonatal Intensive Care Unit
Authors: Stone Patricia W. , Gupta Archana , Loughrey Maureen , Della-Latta Phyllis , Cimiotti Jeannie , Larson Elaine , Rubenstein David , Saiman Lisa 
Published: March 2006

AbstractObjectives:To determine the costs of the interventions aimed at controlling the 4-month outbreak and to determine the attributable length of stay (LOS) associated with infection and colonization with extended-spectrum beta-lactamase-producingKlebsiella pneumoniae.Design:A retrospective cost analysis was conducted from the hospital perspective. A micro-costing approach was employed. The LOS of four groups of hospitalized patients were compared with each other. National Perinatal Information Center criteria were used to stratify infants for severity of risk. The LOS of each group was compared with that of a national sample of similarly stratified infants.Setting:A level III-IV, 45-bed neonatal intensive care unit.Patients:Infant groups were infected (n = 8), colonized (n = 14), concurrent cohort (n = 54), and prior cohort (n = 486).Results:The cost of the outbreak totaled $341,751. The largest proportion of costs was related to healthcare worker time providing direct patient care (2,489 hours at a cost of $146,331). Infected and colonized neonates had longer LOS than either the concurrent cohort or the prior cohort (P< .001). Compared with the national sample, infected infants had a 48.5-day longer mean LOS (95% confidence interval [CI95], 1.7 to 95.2), whereas the prior cohort's mean LOS was 6 days shorter (CI95, -9.4 to -2.9).Conclusions:This study increases the understanding of the burden of these multidrug-resistant organisms. Further research is needed to estimate the societal costs of these infections and the cost-effectiveness of preventive interventions.
Ultraviolet Light Disinfection of Hospital Water for Preventing NosocomialLegionellaInfection: A 13-Year Follow-Up
Authors: Hall Keri K. , Giannetta Eve T. , Getchell-White Sandra I. , Durbin Lisa J. , Farr Barry M. 
Published: March 2006

AbstractBackground and Objective:CDC has estimated that 23% ofLegionellainfections are nosocomial. When a new hospital was being constructed and a substantial increase in transplantation was anticipated, an ultraviolet light apparatus was installed in the water main of the new building because 27% of water samples from taps in the old hospital containedLegionella.This study reports the rate of nosocomialLegionellainfection and water contamination since opening the new hospital.Methods:Charts of all patients with positiveLegionellacultures, direct immunofluorescent antibody (DFA), or urine antigen between April 1989 and November 2001 were reviewed. Frequencies of DFAs and urine antigens were obtained from the laboratory.Results:None of the 930 cultures of hospital water have been positive since moving into the new building. Fifty-three (0.02%) of 219,521 patients had a positiveLegionellatest; 41 had pneumonia (40 community acquired). One definiteL. pneumophilapneumonia confirmed by culture and DFA in August 1994 was nosocomial (0.0005%) by dates. This patient was transferred after prolonged hospitalization in another country, was transplanted 11 days after admission, and developed symptoms 5 days after liver transplant. However, tap water from the patient's room did not growLegionella.Seventeen (2.5%) of 670 urine antigens were positive forLegionella(none nosocomial). Thirty-three (1.2%) of 2,671 DFAs were positive, including 7 patients (21%) without evidence of pneumonia and 6 (18%) who had an alternative diagnosis.Conclusion:Ultraviolet light usage was associated with negative water cultures and lack of clearly documented nosocomialLegionellainfection for 13 years at this hospital.
AChryseobacterium meningosepticumOutbreak in a Neonatal Ward
Authors: Güngör Serdal , Özen Metehan , Akinci Aysehan , Durmaz Riza 
Published: March 2006

AbstractObjective:To report epidemiologic, bacteriologic, and clinical features of aChryseobacterium meningosepticumoutbreak.Design:Outbreak investigation.Setting:A neonatal intensive care unit (NICU) of a referral teaching hospital.Methods:During 2 weeks in September 2001, four neonates in the NICU developed sepsis and underwent laboratory investigation. Multiple samples were obtained for cultures from endotracheal tubes, mechanical ventilators and humidifier boxes, infant incubators, parenteral and antiseptic solutions, feeding bottles, sinks, faucets, doors, and healthcare workers.Results:C. meningosepticumwas isolated from the blood cultures of four patients. The first isolate was identified 5 days after the death of the index case. Although all isolates were ciprofloxacin susceptible in vitro, the remaining three patients did not respond to ciprofloxacin therapy given for 6 or 7 days. Therapy was switched to vancomycin and rifampin and all three patients survived, with one having a complication (hydrocephalus). Environmental surveillance revealedC. meningosepticumin the stock lipid solution as the source of the epidemic. The outbreak was controlled after discontinuation of intravenous lipid solution, restriction of further neonatal admissions, and thorough disinfection of the unit and its equipment.Conclusion:Early identification of an epidemic and its source is important in avoiding morbidity and mortality. A contaminated lipid stock bottle was the source of this outbreak associated with multiple cases and one death.
Vaccination Without Documentation: Influenza Immunization Among Medical Residents at a Tertiary-Care Medical Center
Authors: Bearman Gonzalo , Fuentes Linda , Vorenkamp Jaclyn Van Lieu , Drusin Lewis M. 
Published: March 2006

AbstractSixty-four percent of medical residents unimmunized by the Occupational Health Service were immunized elsewhere. Those unvaccinated lacked time to comply. An immune staff is critical to prevent transmission to high-risk patients and limit absenteeism. The hospital is implementing a program to deliver medical care to the house staff.
Effect of Vancomycin Therapy for Osteomyelitis on Colonization by Methicillin-ResistantStaphylococcus aureus: Lack of Emergence of Glycopeptide Resistance
Authors: Bernard Louis , Vaudaux Pierre , Vuagnat Albert , Stern Richard , Rohner Peter , Pittet Didier , Schrenzel Jacques , Hoffmeyer Pierre ,   Osteomyelitis Study Group
Published: March 2006

AbstractBackground:In treating orthopedic infections, the long-term impact of vancomycin therapy on colonization by methicillin-resistantStaphylococcus aureus(MRSA) and the emergence of vancomycin-intermediate S.aureusis unknown.Design:Prospective surveillance of the effect of long-term vancomycin therapy on colonization by MRSA and the emergence of vancomycin-intermediateS. aureus.Methods:Thirty-four patients with MRSA osteomyelitis that was microbiologically documented were longitudinally observed for the emergence of vancomycin-intermediate S.aureusat 3 body sites (wound, anterior nares, and groin) during the initial period of vancomycin therapy and at the 2-month follow-up. Twenty patients received the standard dose (20 mg/kg/d) for 34 ± 6 days and 14 patients received a high dose (40 mg/kg/d) of vancomycin for 37 ± 9 days.Results:During vancomycin treatment, global MRSA carriage (all body sites) fell from 100% to 25% in the group of patients receiving the standard dose of vancomycin, and from 100% to 40% in the group receiving the high dose. During the 2-month follow-up period after vancomycin therapy, global MRSA carriage increased from 25% to 55% in the group receiving the standard dose and decreased from 43% to 36% in the group receiving the high dose.Conclusion:Therapy with a high dose of vancomycin contributes to the sustained eradication of MRSA carriage without promoting the emergence of glycopeptide resistance.
Additional Costs for Preventing the Spread of Methicillin-Resistant Staphylococcus aureus and a Strategy for Reducing These Costs on a Surgical Ward
Authors: Herr Caroline Eva Wella , Heckrodt Thomas Hilarius , Hofmann Frank Andreas , Schnettler Reinhard , Eikmann Thomas Friedrich 
Published: March 2006

AbstractObjective:To determine the added costs of hygienic measures (barrier precautions, isolation, and decontamination) required for MRSA carriers in German hospitals and possible strategies for cost reduction.Design:On a septic surgical ward caring for 35% of all MRSA cases in a university hospital (1,182 beds), additional costs for personnel time and materials were calculated and medical charts of all MRSA cases admitted to the ward during 1 year were analyzed retrospectively. Twelve of the ward's 13 beds were located in rooms with at least 2 beds.Patients:Four hundred ninety-eight MRSA carrier hospital-days (of 20 MRSA cases) could be assessed. All patients (80% men, 50% older than 74.5 years) had broken skin.Results:In 95% of the cases, microbiological findings suggested transmission of MRSA during the current or a previous stay on this ward. The study found total avoidable costs of approximately 142,794.01 euros in 1 year, averaging 371.95 euros for one MRSA patient hospital-day and 9,261.56 euros per MRSA case. The most expensive single measure was blocked beds in multibed rooms (305.75 euros/day), which accounted for 82% of the extra costs. Costs most likely were underestimated.Conclusions:Daily additional case costs amounted to 96% of social security payments. Blocked beds in multibed rooms accounted for more than 80% of these excess costs. Isolation has been scientifically validated and is required by law in Germany. Building an adequate number of single-bed rooms should help prevent spread and would greatly lower the added costs of infection.
Role of Healthcare Workers in Outbreaks of Methicillin-ResistantStaphylococcus aureus: A 10-Year Evaluation From a Dutch University Hospital
Authors: Blok Hetty E. M. , Troelstra Annet , Kamp-Hopmans Titia E. M. , Gigengack-Baars Ada C. M. , Vandenbroucke-Grauls Christina M. J. E. , Weersink Annemarie J. L. , Verhoef Jan , Mascini Ellen M. 
Published: March 2006

AbstractBackground and Objective:The benefit of screening healthcare workers (HCWs) at risk for methicillin-resistantStaphylococcus aureus(MRSA) carriage and furloughing MRSA-positive HCWs to prevent spread to patients is controversial. We evaluated our MRSA program for HCWs between 1992 and 2002.Setting:A university medical center in the Netherlands, where methicillin resistance has been kept below 0.5% of all nosocomial S.aureusinfections using active surveillance cultures and isolation of colonized patients.Design:HCWs caring for MRSA-positive patients or patients in foreign hospitals were screened for MRSA. MRSA-positive HCWs had additional cultures, temporary exclusion from patient-related work, assessment of risk factors for persisting carriage, decolonization therapy with mupirocin intranasally and chlorhexidine baths for skin and hair, and follow-up cultures.Results:Fifty-nine HCWs were colonized with MRSA. Seven of 840 screened employees contracted MRSA in foreign hospitals; 36 acquired MRSA after contact with MRSA-positive patients despite isolation precautions (attack rate per outbreak varied from less than 1% to 15%). Our hospital experienced 17 MRSA outbreaks, including 13 episodes in which HCWs were involved. HCWs were index cases of at least 4 outbreaks. In 8 outbreaks, HCWs acquired MRSA after caring for MRSA-positive patients despite isolation precautions.Conclusion:Postexposure screening of HCWs allowed early detection of MRSA carriage and prevention of subsequent transmission to patients. Where the MRSA prevalence is higher, the role of HCWs may be greater. In such settings, an adapted version of our program could help prevent dissemination.
BioHMM: a heterogeneous hidden Markov model for segmenting array CGH data
Authors: Marioni J. C. , Thorne N. P. , Tavaré S. 
Published: March 2006

Abstract
Summary: We have developed a new method (BioHMM) for segmenting array comparative genomic hybridization data into states with the same underlying copy number. By utilizing a heterogeneous hidden Markov model, BioHMM incorporates relevant biological factors (e.g. the distance between adjacent clones) in the segmentation process.
Availability: BioHMM is available as part of the R library snapCGH which can be downloaded from
Contact: J.Marioni@damtp.cam.ac.uk
Supplementary information: Supplementary information is available at
Subsidence in the super‐deep Pattani and Malay basins of Southeast Asia: a coupled model incorporating lower‐crustal flow in response to post‐rift sediment loading
Authors: Morley Christopher K. , Westaway Rob 
Published: March 2006

ABSTRACTTwo Early Cenozoic rifts in Southeast Asia (beneath the Pattani and Malay basins) experienced only limited upper‐crustal extension (β≤1.5); yet very thick post‐rift sequences are present, with 6–12 km of Late Cenozoic terrestrial and shallow‐marine sediment derived from adjacent sources. Conventional post‐rift backstripping requires depth‐dependent lithospheric thinning by β=2–4 to explain these tremendous thicknesses. We assess an alternative explanation for this post‐rift subsidence, involving lower‐crustal flow from beneath these basins in response to lateral pressure‐gradients induced by the sediment loads and the negative loads arising from the erosion of their sediment sources. We calculate that increased rates of erosion in western Thailand in the Early Miocene placed the crust in a non‐steady thermal state, such that the depth (and thus, the pressure) at the base of the brittle upper crust subsequently varied over time. Following such a perturbation, thermal and mass‐flux steady‐state conditions took millions of years to re‐establish. In the meantime, the lateral pressure‐gradient caused net outflow of lower crust, thinning the crust beneath the depocentre by several kilometres (mimicking the isostatic effect of greater crustal extension having occurred beforehand) and thickening it beneath the sediment source region. The local combination of hot crust and high rates of surface processes, causing lower‐crustal flow to be particularly vigorous and thus making its effects more readily identifiable, means that the Pattani and Malay basins represent a set of conditions different from basins in many other regions. However, lower‐crustal flow induced by surface processes will also occur to some extent, but less recognisably, in many other continental crustal provinces, but its effects may be mistaken for those of other processes, such as larger‐magnitude stretching and/or depth‐dependent stretching.
A critical appraisal of the use of recombinant factor VIIa in acquired bleeding conditions
Authors: Mittal Sajjan , Watson Henry G. 
Published: March 2006

SummaryRecombinant activated factor VII (rVIIa) was initially used for the treatment of inhibitors in patients with haemophilia. However, its localised mode of action at sites of damage to the vessel combined with dramatic clinical observations in exsanguinating patients have resulted in huge interest in its use as a global haemostatic agent. Although it appears safe, with no obvious excess of thrombotic events, its use in assorted acquired bleeding disorders, especially those associated with the development of complex coagulopathies, such as in the post‐trauma state, has proved to be less dramatic than hoped.
Infantile pyknocytosis: a cause of haemolytic anaemia of the newborn
Authors: Eyssette‐Guerreau Stéphanie , Bader‐Meunier Brigitte , Garcon Loïc , Guitton C. , Cynober Thérèse 
Published: March 2006

SummaryThis study defined the incidence, clinical and haematological characteristics of infantile pyknocytosis in a monocentric retrospective study of 149 blood samples referred for unexplained neonatal haemolytic anaemia. Pyknocytosis was diagnosed in 14 patients (9·4%). All patients had neonatal jaundice and severe anaemia (mean nadir haemoglobin: 6·8 g/dl) at a mean age of 21 d. The percentage of pyknocytes was 4–23%. Packed red blood cell transfusions were needed in 11 of 14 patients. Haemoglobin levels reached normal values within a mean time of 4 months. Infantile pyknocytosis is an unusual cause of neonatal haemolytic anaemia, which requires careful examination of blood smears.
Max Schultze (1865), G. Bizzozero (1882) and the discovery of the platelet
Authors: Brewer Douglas B. 
Published: March 2006

SummaryMax Schultze published the first accurate and convincing description of platelets as part of a study devoted mainly to the white blood cells in 1865. He recognised them as a normal constituent of the blood and ‘enthusiastically recommended’ them as an object for further study by ‘those concerned with the in‐depth study of the blood of humans’. In 1882, Bizzozero demonstrated the value of this recommendation in his much more comprehensive study. He observed them microscopically in the circulating blood of living animals and in the blood removed from the blood vessels. In well‐planned experiments, he showed that they were the first component of the blood to adhere to damaged blood vessel walls in vivo and, in vitro, that they were the first components of the blood to adhere to threads that subsequently became covered with fibrin.
Impact of age on survival after intensive therapy for multiple myeloma: a population‐based study by the Nordic Myeloma Study Group
Authors: Lenhoff Stig , Hjorth Martin , Westin Jan , Brinch Lorentz , Bäckström Bengt , Carlson Kristina , Christiansen Ilse , Dahl Inger Marie , Gimsing Peter , Hammerström Jens , Johnsen Hans E , Juliusson Gunnar , Linder Olle , Mellqvist Ulf‐Henrik , Nesthus Ingerid , Nielsen Johan Lanng , Tangen Jon Magnus , Turesson Ingemar ,   Nordic Myeloma Study Group
Published: March 2006

SummaryThe value of intensive therapy, including autologous stem cell transplantation, in newly diagnosed myeloma patients >60 years is not clear. We evaluated the impact of age (<60 years vs. 60–64 years) on survival in a prospective, population‐based setting and compared survival with conventionally treated historic controls. The prospective population comprised 452 patients registered between 1998 and 2000. Of these, 414 received intensive therapy. The historic population, derived from our most recent population‐based study on conventional therapy, comprised 281 patients. Of these, 243 fulfilled our eligibility criteria for intensive therapy. For patients undergoing intensive therapy it was found that two factors, beta‐2‐microglobulin and age <60 years vs. 60–64 years, had independent prognostic impact on survival. However, compared with the historic controls a survival advantage was found both for patients <60 (median 66 months vs. 43 months, P < 0·001) and 60–64 years (median 50 months vs. 27 months; P = 0·001). We conclude that in a population‐based setting higher age adversely influences outcome after intensive therapy. Our results indicate that intensive therapy prolongs survival also at age 60–64 years but with less superiority than in younger patients.
Sulphydryl modifications alter scramblase activity in murine sickle cell disease
Authors: de Jong Kitty , Kuypers Frans A. 
Published: March 2006

SummaryIncreased oxidant stress has been suggested to play a role in the process of phosphatidylserine (PS) externalisation in the red blood cells of sickle cell patients. Inhibition of the ATP‐driven translocation from outer to inner monolayer (flippase) by sulphydryl modification has been established. The present study showed that phospholipid scrambling was also sensitive to protein sulphydryl modification. Treatment with N‐ethylmaleimide lead to enhanced PS exposure and a lower Ca++ requirement for scrambling. In contrast, pyridyldithioethylamine treatment inhibited PS exposure. Red blood cells from a murine model for sickle cell disease exhibited a reduced response to both reagents, suggestive of previous sulphydryl modifications to the protein(s) involved in phospholipid scrambling. We conclude that sulphydryl modifications to both scramblase and flippase underlie the enhanced formation of PS‐exposing cells in sickle cell disease.
Fixed‐dose single agent pegfilgrastim for peripheral blood progenitor cell mobilisation in patients with multiple myeloma
Authors: Hosing Chitra , Qazilbash Muzaffar H. , Kebriaei Partow , Giralt Sergio , Davis Marilyn S. , Popat Uday , Anderlini Paolo , Shpall Elizabeth J. , McMannis John , Körbling Martin , Champlin Richard E. 
Published: March 2006

SummaryHigh‐dose chemotherapy and autologous peripheral blood progenitor cell transplantation is an effective treatment for multiple myeloma. Progenitor cells are generally mobilised into the peripheral blood by administration of filgrastim. Pegfilgrastim is a covalent conjugate of filgrastim with a longer half‐life. The results of a phase II study of pegfilgrastim, administered as a single injection to mobilise autologous peripheral blood progenitor cells in patients with multiple myeloma, is reported. All patients (n = 19) received 12 mg of pegfilgrastim. Leukaphaeresis was started when the peripheral blood CD34+ count was >0·015 × 109/l. Daily, leukaphaeresis was performed until the target progenitor cell dose was obtained. The median number of leukaphaeresis procedures required to collect the target CD34+ cell dose was 2 (range 1–5). A median of 8·4 × 106 CD34+ cells/kg (range 4·1–15·8) was collected. The most common toxicity was bone pain/myalgia. Sustained haematological recovery occurred in all the patients who underwent high‐dose chemotherapy followed by autologous peripheral blood progenitor cell transplantation with pegfilgrastim‐mobilised cells. A single fixed dose of pegfilgrastim was effective in mobilising adequate peripheral blood progenitor cells in patients with multiple myeloma. The efficacy and toxicity profile was similar to that described with filgrastim treatment.
Mechanisms of immune suppression by interleukin‐10 and transforming growth factor‐β: the role of T regulatory cells
Authors: Taylor Alison , Verhagen Johan , Blaser Kurt , Akdis Mübeccel , Akdis Cezmi A. 
Published: March 2006

SummarySpecific immune suppression and induction of tolerance are essential processes in the regulation and circumvention of immune defence. The balance between allergen‐specific type 1 regulatory (Tr1) cells and T helper (Th) 2 cells appears to be decisive in the development of allergy. Tr1 cells consistently represent the dominant subset specific for common environmental allergens in healthy individuals. In contrast, there is a high frequency of allergen‐specific interleukin‐4 (IL‐4)‐secreting T cells in allergic individuals. Allergen‐specific immunotherapy can induce specific Tr1 cells that abolish allergen‐induced proliferation of Th1 and Th2 cells, as well as their cytokine production. Tr1 cells utilize multiple suppressor mechanisms, such as IL‐10 and transforming growth factor‐β (TGF‐β) as secreted cytokines and various surface molecules, such as cytotoxic T‐lymphocyte antigen 4 and programmed death‐1. IL‐10 only inhibits T cells stimulated by low numbers of triggered T‐cell receptors, which depend on CD28 costimulation. IL‐10 inhibits CD28 tyrosine phosphorylation, preventing the binding of phosphatidylinositol 3‐kinase p85 and consequently inhibiting the CD28 signalling pathway. In addition, IL‐10 and TGF‐β secreted by Tr1 cells skew the antibody production from immunoglobulin E (IgE) towards the non‐inflammatory isotypes IgG4 and IgA, respectively. Induction of antigen‐specific Tr1 cells can thus re‐direct an inappropriate immune response against allergens or auto‐antigens using a broad range of suppressor mechanisms.