bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tephrostratigraphy of the Bedded Tuff Member (Kapthurin Formation, Kenya) and the nature of archaeological change in the later middle Pleistocene
Authors: Tryon Christian A. , McBrearty Sally 
Published: March 2006

AbstractCorrelation of volcaniclastic deposits of the Bedded Tuff Member (K4) of the Kapthurin Formation (Kenya) provides the means to assess the nature of archaeological change during the later middle Pleistocene, a time period critical to human evolution but poorly represented at other African localities. Field stratigraphic evidence, and petrographic and electron microprobe geochemical analyses of volcanic glass and phenocrysts, define eight subdivisions of K4 tephra. These include a succession of deposits from a local volcanic source that erupted intermittently, as well as other tuffs likely from different sources outside the Baringo basin. Upper portions of the Bedded Tuff Member date to ∼235,000 yr. The Bedded Tuff Member is underlain by sediments that include the Grey Tuff, dated to 509,000 ± 9000 yr. The tephrostratigraphic framework defined here is used to place Acheulian and Middle Stone Age (MSA) archaeological sites in chronological order. Results show the persistence of Acheulian large cutting tool manufacture after the advent of points, considered an MSA artifact type. Two assemblages from the site of Koimilot record the appearance at ∼200,000–250,000 yr of a variety of Levallois flake production methods, an integral if incompletely understood feature of the MSA, here likely derived from local technological antecedents. Combined evidence from the tools and flake production methods suggest an incremental and mosaic pattern of change in hominin adaptive strategies during the Acheulian–MSA transition.
Some Results Using Triamcinolone on Immobilized Joints
Authors: Weckesser Elden C. 
Published: March 2006

The frequency and causes of joint stiffness are reviewed. The most sophisticated repair may be for naught if the joints stiffen. Treatment of the established condition leaves much to be desired. Since mobility cannot be maintained during many postoperative periods and during the treatment of many conditions, any aid to prophylaxis is desirable especially if the side effects are negligible. Steroids have been chosen because of their influence on collagen metabolism and because much is known of their toxicity and side effects. The drug was first given into the knee joints of rats where it was found effective in preventing joint stiffness in joints immobilized three weeks. In view of the animal success, fourteen patients with thenar pedicles have had a single dose of triamcinolone injected into the peri-articular tissues of their proximal interphalangeal joints at the time of construction of the pedicle. Follow up observation shows all patients to have complete proximal interphalangeal joint extension and flexion to 95°. Side effects were minimal.
Subcutaneous Ring Anaesthesia in the Prevention Of Tourniquet Pain in Hand Surgery
Authors: Rousso M. , Wexler M. R. , Weinberg H. , Vatashky E. , Aronson B. 
Published: March 2006

A simple method for achieving satisfactory regional anaesthesia for a wide range of hand surgery is presented. It entails separate attention to the two aims of regional anaesthesia, namely analgesia of the tourniquet and of the operative site. This study of 149 patients indicated that (a) subcutaneous ring anaesthesia produced excellent tourniquet analgesia, both in the forearm as well as the upper arm; (b) a tourniquet applied to the forearm provided excellent regional ischaemia in 98% of our cases, contrary to what has been previously accepted. The advantages of this method are its safety and simplicity even for the relatively untrained surgeon. It also obviates the need for brachial plexus blocks, intravenous regional or general anaesthesia with all their drawbacks.
Analysis of failure of voice production by a sound-producing voice prosthesis
Authors: van der Torn M , van Gogh C D L , Verdonck-de Leeuw I M , Festen J M , Mahieu H F 
Published: March 2006

Objective: To analyse the cause of failing voice production by a sound-producing voice prosthesis (SPVP).Methods: The functioning of a prototype SPVP is described in a female laryngectomee before and after its sound-producing mechanism was impeded by tracheal phlegm. This assessment included: perceptual voice evaluation of read-aloud prose by an expert listener; inspection of the malfunctioning SPVP; and aero-acoustical in vivo registrations using a computer-based data acquisition system.Results: Sound-producing voice prosthesis speech is higher pitched, stronger, contains less aperiodic noise and requires a lower airflow rate than the patient's regular tracheoesophageal (TE) shunt speech. Tracheal phlegm caused malfunction of the vibrating silicone lip of the SPVP by causing it to stick to its stainless steel container in an opened position, thereby reducing the SPVP to no more than a regular TE shunt valve from a functional point of view. Tracheal phonatory pressure and dynamic vocal intensity range were not affected by the functional status of the SPVP.Conclusions: To exploit the advantages an SPVP could offer female laryngectomees with an atonic or severely hypotonic pharyngoesophageal segment, the sound-producing mechanism of the SPVP needs to be less vulnerable to tracheal phlegm.
Fine needle aspiration cytology in diagnosis and management of thyroid disease
Authors: Bajaj Y , De M , Thompson A 
Published: March 2006

The objective of this study was to determine the efficacy of fine needle aspiration cytology in diagnosis and management of thyroid nodules. The study also evaluated the predictive value of pre-operative fine needle aspiration cytology (FNAC) in surgical decision making, by comparing the final pathological diagnosis with the initial FNAC result.All patients who underwent thyroidectomy between 1999 and 2003 were analysed. One hundred and sixty patients who underwent pre-operative FNAC were included in this study.Fine needle aspiration was accurate in 119 (74.3 per cent) patients. Fine needle aspiration cytology and histology did not correlate in 32 (20 per cent) patients and FNAC was inadequate in nine (5.6 per cent) cases. Failures were mainly noted in cases of follicular neoplasm.Our results indicate that FNAC is helpful in the diagnosis of thyroid pathology. However, complete histopathological analysis is essential to distinguish follicular adenoma from follicular carcinoma.From this study, it can be concluded that FNAC is a cost-effective method of evaluating thyroid pathology pre-operatively and plays a useful role in planning the surgical management of thyroid nodules. However, results must be interpreted with the clinical picture in mind.
Adenoid mast cells and their role in the pathogenesis of otitis media with effusion
Authors: Abdullah B , Hassan S , Sidek D , Jaafar H 
Published: March 2006

Introduction: Otitis media with effusion (OME) is an inflammation of the middle ear in which a collection of liquid is present in the middle-ear space while the tympanic membrane is intact. The association between adenoid inflammation and OME has long been noted but the exact mechanism is still much debated. We studied the role of adenoid mast cells in the causation of OME.Objective: To study the distribution and role of adenoid mast cells in the causation of OMEMethodology: A cross-sectional, prospective study was carried out in the otorhinolaryngologic clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, from June 1999 to September 2001. A total number of 50 cases were studied. Twenty-five of these patients underwent adenoidectomy, while another 25 patients underwent adenoidectomy and myringotomy with ventilation tube insertion. The adenoid specimens from all patients were examined for the number of adenoid mast cells present, using light microscopy and toluidine blue as the staining agent. The results were analysed using SPSS version 10.0 computer software.Result: The population of adenoid mast cells in children with OME was significantly greater than that in children without OME (p = 0.000).Conclusion: The increased number of adenoid mast cells in patients with OME suggests that inflammation may play a role in this condition.
Waiting times for primary care psychological therapy and counselling services
Authors: Trusler Karen , Doherty Clare , Mullin Tracy , Grant Stewart , McBride Jenny 
Published: March 2006

AbstractWaiting times for primary care psychological therapy and counselling are an increasingly important area by which the effectiveness of service delivery is measured. Authorities and advisory bodies advocate a reduction in waiting times and improvements in waiting list management (Department of Health, 1999, 2001, 2004; Healthcare Commission, 2005a; Health and Social Care Advisory Service, 2002). Research and practice both report large variations and inconsistencies in service waiting times. This paper uses the CORE National Research Database for Primary Care Psychological Therapies and Counselling (valid = 31882 clients) to develop benchmarks that services can use to measure their performance at a national level. Three time frames are analysed: Referral to first assessment, last assessment to first therapy, and referral to first therapy. The average waiting times were 8 weeks, 2 weeks, and 10 weeks respectively. The practical use of, and implications for these benchmarks within and between services and practitioners are explored by managers of primary care psychological therapy and counselling services. The discussion explores the significance of the benchmarks in relation to both political agendas and overall service performance. Initiatives to reduce waiting times and factors that may effect them are also discussed.
Routine outcome measurement completion rates of the CORE‐OM in primary care psychological therapies and counselling
Authors: Bewick Bridgette M. , Trusler Karen , Mullin Tracy , Grant Stewart , Mothersole Geoff 
Published: March 2006

AbstractFormally evaluating and reporting on the progress of clients is now seen as a central component of clinical practice. Generally, research suggests that the percentage of practitioners who use outcome measures as part of their clinical practice is relatively low. However, no national benchmarks have yet been presented which allow both practitioners and services to assess their relative performance in terms of data collection. The present study uses the CORE National Research database (n=31882) and reports pre‐ and post‐therapy assessment completion rates, thereby enabling services to track their performance relative to other services. On average, pre‐therapy CORE‐OMs were reliably completed by 83% of clients while post‐therapy forms were completed by 39%. However, there were large variations between services. The practical use and implications of the results presented are discussed by managers of NHS primary care counselling services.
Risk Factors ForStenotrophomonas MaltophiliaBacteremia In Oncology Patients: A Case–Control Study
Authors: Apisarnthanarak Anucha , Mayfield Jennie L. , Garison Teresa , McLendon Patricia M. , DiPersio John F. , Fraser Victoria J. , Polish Louis B. 
Published: March 2006

AbstractObjective:To characterize risk factors forStenotrophomonas maltophiliabloodstream infection in oncology patients.Design:A 3:1 case–control study.Setting:Stem Cell Transplant and Leukemic Center at Barnes–Jewish Hospital (St. Louis), a 1,442-bed, tertiary-care teaching hospital with a 26-bed transplantation ward.Method:From June 1999 to April 2001,13 patients withS. maltophiliabacteremia were compared with 39 control-patients who were on the transplantation unit on the same day as the case-patients' positive blood cultures. Information collected included patient demographics, medical history, history of transplantation, transplantation type, graft versus host disease, neutropenia, antibiotic use, chemotherapy, mucositis, diarrhea, the presence of central venous catheter(s), cultures, and concomitant infections.Results:Significant risk factors forS. maltophiliabacteremia included severe mucositis (7 [53.8%] of 13 vs 8 [20.5%] of 39;P= .034), diarrhea (7 [53.8%] of 13 vs 8 [20%] of 39;P= .034), and the use of metronidazole (9 [69.2%] of 13 vs 8 [20.5%] of 39;P= .002). In addition, the number of antibiotics used (median, 9 vs 5;P< .001), duration of mucositis (median, 29 vs 15 days;P= .032), and length of hospital stay (median, 34 vs 22 days;P= .017) were significantly different between case- and control-patients. NineS. maltophiliaisolates tested by pulsed-field gel electrophoresis were found to be distinctly different.Conclusion:Interventions to ameliorate the severity of mucositis, reduce antibiotic pressure, prevent diarrhea, and promote meticulous central venous catheter care may help preventS. maltophiliabloodstream infection in oncology patients. The role of gastrointestinal tract colonization as a potential source ofS. maltophiliabacteremia in oncology patients deserves further investigation.
Natural History of Colonization With Vancomycin-Resistant Enterococci, Methicillin-Resistant Staphylococcus Aureus, And Resistant Gram-Negative Bacilli Among Long-Term–Care Facility Residents
Authors: Pacio Glenn A. , Visintainer Paul , Maguire George , Wormser Gary P. , Raffalli John , Montecalvo Marisa A. 
Published: March 2006

AbstractObjective:To determine the natural history of colonization with vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and resistant gram-negative bacilli among long-term–care facility (LTCF) residents.Design:Observational cohort study.Setting:A 355-bed LTCF with a ventilator unit and a subacute unit.Participants:Residents with colonization or infection with VRE, MRSA or resistant gram-negative bacilli housed at the LTCF between December 1,1999, and February 29, 2000.Methods:Cultures of clinical and surveillance sites were performed at regular intervals. Charts were reviewed for clinical characteristics associated with clearance of colonization. Kaplan–Meier curves were constructed to analyze the number of days to clearance of colonization.Results:Forty-nine residents had 65 episodes of colonization (27 VRE, 30 MRSA and 8 resistant gram-negative bacilli). Eighteen (28%) of the episodes cleared. The clearance rate was 2.7 episodes per 1,000 person-days. Clearance occurred significantly more often with resistant gram-negative bacilli colonization compared with VRE or MRSA colonization (6 [75%] vs 12 [21%]; P = .007; relative risk, 4.17; 95% confidence interval, 1.26 to 11.8). There was a trend toward longer use of antimicrobial agents among residents with persistent colonization. Infections occurred most frequently with MRSA The urinary tract was the most common site of infection.Conclusion:Among LTCF residents, colonization with resistant gram-negative bacilli is four times more likely to clear than colonization with VRE or MRSA. Performance of surveillance cultures at regular intervals may reduce the need for contact precautions for LTCF residents with resistant gram-negative bacilli colonization.
AcinetobacterOutbreaks, 1977–2000
Authors: Villegas Maria Virginia , Hartstein Alan I. 
Published: March 2006

AbstractThis review ofAcinetobacteroutbreaks summarizes factors related to the presence and recognition of organism transmission and describes the implementation of control and prevention measures directed at limiting spread. Exogenous transmission ofAcinetobactershould be considered when infections are endemic and when case rates increase. Increasing or new antimicrobial resistances in a collection of isolates also suggest transmission, and transmission can be definitively confirmed when isolates are found to be indistinguishable from or related to one another by a discriminatory genotyping test. An investigation for a common source should be conducted. When a common source cannot be found and eliminated, or once an endemically transmitted organism is established, containment or prevention efforts may require aggressive interventions, complex interventions, or both. Colonization at multiple sites, the relative ease of induction of antibiotic resistance in the organism following patient exposure to multiple drugs, and long-term environmental survival provide enhanced opportunities for the transmission ofAcinetobacterbetween and among patients. New approaches and interventional trials are needed to define effective measures for the prevention and control ofAcinetobacterinfections.
Colonization and Infection With Multiple Nosocomial Pathogens Among Patients Colonized With Vancomycin-ResistantEnterococcus
Authors: Donskey Curtis J. , Ray Amy J. , Hoyen Claudia K. , Fuldauer Peter D. , Aron David C. , Salvator Ann , Bonomo Robert A. 
Published: March 2006

AbstractObjective:To test the hypothesis that patients colonized with vancomycin-resistantEnterococcus(VRE) have a higher frequency of colonization or infection with other nosocomial pathogens than do patients who are not colonized with VRE.Design:A rectal swab culture survey was conducted to determine the point-prevalence of stool colonization with ceftazidime-resistant gram-negative bacilli in hospitalized patients with or without VRE stool colonization. For a 6-month period, the frequency ofClostridium difficilediarrhea and isolation of antibiotic-resistant (ie, ceftazidime-, piperacillin/tazobactam-, levofloxacin-, or trimethoprim/sulfamethoxazole-resistant) gram-negative bacilli, methicillin-resistantStaphylococcus aureus(MRSA), and non-albicansCandidaspecies from clinical specimens other than stool was examined.Setting:A Department of Veterans Affairs medical center.Patients:All patients hospitalized in the acute care facility and one nursing home unit during a 1-week period in February 2001.Results:VRE-colonized patients had a higher point-prevalence of rectal colonization with ceftazidime-resistant gram-negative bacilli than did patients not colonized with VRE (17% vs 4%;P= .026). During a 6-month period, the VRE-colonized patients were more likely to haveClostridium difficile–associated diarrhea (26% vs 2%;P= .001), MRSA infection (17% vs 4%;P= .017), or colonization or infection with gram-negative bacilli resistant to 4 different antibiotics.Conclusion:VRE-colonized patients in our institution have a higher frequency of colonization or infection with other nosocomial pathogens than do patients who are not colonized with VRE. This suggests that isolation measures implemented to control VRE could help limit the dissemination of other, coexisting pathogens.
Implication of a Healthcare Worker With Chronic Skin Disease in the Transmission of an Epidemic Strain of Methicillin-Resistant Staphylococcus aureus in a Pediatric Intensive Care Unit
Authors: Berthelot Philippe , Grattard Florence , Fascia Pascal , Fichtner Christine , Moulin Martine , Lavocat Marie Pierre , Teyssier Georges , Lucht Frédéric , Pozzetto Bruno 
Published: March 2006

AbstractThis outbreak of colonization of neonates in a 10-bed pediatric intensive care unit illustrates the probable role of a healthcare worker (HCW) in the transmission of methicillin-resistant Staphylococcus aureus, despite good hygienic practices. It raises the issue of preventive exclusion of HCWs affected by chronic skin disease from high-risk units.
Impact of Antibiotic-Resistant Pathogens Colonizing the Respiratory Secretions of Patients in an Extended-Care Area of the Emergency Department
Authors: Dantas Sônia R. P. E. , Moretti-Branchini M. Luiza 
Published: March 2006

AbstractObjective:To determine the incidence of acquired infection, and the incidence, risk factors, and molecular typing of multidrug-resistant bacterial organisms (MROs) colonizing respiratory secretions or the oropharynx of patients in an extended-care area of the emergency department (ED) in a tertiary-care university hospital.Methods:A case-control study was conducted regarding risk factors for colonization with MROs in ED patients from July 1996 to August 1998. The most prevalent MRO strains were determined using plasmid and genomic analysis with PFGE.Results:MROs colonized 59 (25.4%) of 232 ED patients and 173 controls. The mean ED length of stay for the 59 cases was 13.9 days versus 9.8 days for the 173 controls. The mean length of stay prior to the first isolation of MROs was 9.9 days. MRO species includedAcinetobacter baumannii, Staphylococcus aureus,andPseudomonas aeruginosa.The rate of hospital-acquired infection was 32.7 per 1,000 ED patient-days. The case fatality rate was significantly higher for cases. Univariate analysis identified mechanical ventilation, nebulization, nasogastric intubation, urinary catheterization, antibiotic therapy, and number of antibiotics as risk factors for MRO colonization. Multivariate regression analysis found that mechanical ventilation and nasogastric intubation independently predicted MRO colonization. Endemic clones were identified by PFGE in ED patients and were also found in patients in other parts of the hospital.Conclusions:Prolonged stay in the ED posed a risk for colonization with MROs and for contracting nosocomial infections, both of which were associated with increased mortality. Patients colonized with antibiotic-resistantA. baumanniimay serve as a reservoir for spread in this hospital.
A Prospective Observational Study of the Effect of Penicillin Skin Testing on Antibiotic Use in the Intensive Care Unit
Authors: Arroliga Mercedes E. , Radojicic Christine , Gordon Steven M. , Popovich Marc J. , Bashour C. Allen , Melton Alton L. , Arroliga Alejandro C. 
Published: March 2006

AbstractBackground:Patients with penicillin allergy admitted to the intensive care unit (ICU) frequently receive non-beta-lactam antimicrobials for the treatment of infection. The use of these antimicrobials, more commonly vancomycin and fluoroquinolones, is associated with the emergence of multidrug-resistant infections. The penicillin skin test (PST) can help detect patients at risk of developing an immediate allergic reaction to penicillin and those patients with a negative PST may be able to use a penicillin antibiotic safely.Methods:We determined the incidence of true penicillin allergy, the percentage of patients changed to a beta-lactam antimicrobial when the test was negative, the safety of the test, and the safety of administration of beta-lactam antimicrobials in patients with a negative test. Skin testing was performed using standard methodology.Results:One hundred patients admitted to 4 ICUs were prospectively studied; 58 of them were male. The mean age was 63 years. Ninety-six patients had the PST: one was positive (1.04%), 10 (10.4%) were nondiagnostic, and 85 (88.5%) were negative. Of the 38 patients who received antimicrobials for therapeutic reasons, 31(81.5%) had the antibiotic changed to a beta-lactam antimicrobial after a negative reading versus 7 patients of the 57 (12%) who had received a prophylactic antimicrobial (P < .001). No adverse effects were reported after the PST or after antimicrobial administration.Conclusions:The PST is a safe, reliable, and effective strategy to reduce the use of non-beta-lactam antimicrobials in patients who are labeled as penicillin allergic and admitted to the ICU.