bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of an Outbreak of Gram-Negative Bacteremia Among Hematology-Oncology Outpatients
Authors: Penzak Scott R. , Gubbins Paul O. , Stratton Shawna L. , Anaissie Elias J. 
Published: February 2006

AbstractObjective:To identify risk factors associated with an outbreak of gram-negative bacteremia (GNB).Setting:A university hospital.Patients:Hematology-oncology outpatients.Design:Retrospective case-control study.Results:Thirty-eight patients developed GNB; 13 patients experienced more than one episode, and eight blood cultures grew more than one gram-negative organism. The most frequently isolated organisms were Stenotrophomonas maltophilia, Klebsiella pneumoniae, Acinetobacter baumannii, and Acinetobacter johnsonii. When the GNB patients (cases) were compared with randomly selected hematology-oncology patients (controls), central venous catheter (CVC) self-care (71% vs 39%; P=.02), and duration of recent hospital stay (median, 15 vs 4 days; P=.01) were identified as risk factors. In a logistic regression model, duration of recent hospital stay was the only risk factor significantly associated with GNB (odds ratio, 1.05; 95% confidence interval, 1.01-1.08; P<.02).Conclusions:Hematology-oncology patients providing their own CVC care who have recently been hospitalized for more than 2 weeks may be at increased risk of GNB. CVCs should be protected from possible environmental contamination in hematology-oncology patients. Patients providing their own CVC care should undergo continued rigorous education regarding proper CVC care.
Nosocomial Ringworm in a Neonatal Intensive Care Unit: A Nurse and Her Cat
Authors: Drusin Lewis M. , Ross Barbara G. , Rhodes Karen Helton , Krauss Alfred N. , Scott Rachelle A. 
Published: February 2006

AbstractAn outbreak of nosocomial ringworm involved five infants in a neonatal intensive care unit. The index case was a nurse infected with Microsporum canis by her cat. After standard infection control measures were initiated, the outbreak was resolved successfully by an interdisciplinary professional collaboration of physician and veterinary dermatologists and infection control personnel.
A Pilot Study of Antibiotic Cycling in a Hematology-Oncology Unit
Authors: Dominguez Edward A. , Smith Theresa L. , Reed Elizabeth , Sanders Christine C. , Sanders W. Eugene 
Published: February 2006

AbstractObjective:To determine the safety and treatment efficacy of cycling antibiotic regimens for prophylaxis or treatment of patients with profound neutropenia.Design:A prospective, nonrandomized, observational trial.Setting:A 20-bed adult hematology-oncology inpatient unit at a university referral hospital.Patients:Hospitalized adult patients with chemotherapy-or radiation-induced neutropenia (absolute neutrophil count less than 500 cells/mm3).Intervention:Between July 1994 and January 1996, 295 hospitalized patients were evaluated on an intent-to-treat basis for the cycling protocol. Of these, 271 were eligible and assigned to one of four antibiotic regimens being used at the time of enrollment: (1) ceftazidime+vancomycin; (2) imipenem; (3) aztreonam+cefazolin; (4) ciprofloxacin+clindamycin. Data on infection rates and types, and antibiotic resistance patterns, toxicity, and effectiveness were collected.Results:Twenty-four patients were excluded. Of the 271 evaluable patients, 123 (42%) were able to complete treatment on the assigned regimen. Of the 148 patients (50%) unable to do so, the reasons for failure included persistent fever (79%), breakthrough bacteremia (14%), and drug toxicity (7%). The antibiotic susceptibility profiles over the study period showed no increase in resistance. However, there was a marked increase in enterococcal infections.Conclusions:Our data show no significant increase in side effects or decrease in efficacy while cycling antibiotics among neutropenic patients and thus support further study of its role.
Pharmacodynamic Modeling of Risk Factors for Ciprofloxacin Resistance in Pseudomonas aeruginosa
Authors: Hyatt Judith M. , Schentag Jerome J. 
Published: February 2006

AbstractObjective:To determine risk factors for ciprofloxacin resistance in Pseudomonas aeruginosa.Methods:Patients with cultures (any site) positive for P aeruginosa, susceptible to ciprofloxacin, between January 1993 and December 1996 were identified using a computerized database. Factors predictive of emergence of ciprofloxacin resistance in P aeruginosa strains isolated from the same cultured site, within 21 days of the initial culture, were determined. Factors considered included length of stay prior to initial P aeruginosa culture, isolation site, initial minimum inhibitory concentration (MIC), antibiotic area under the 24-hour concentration curve (AUC24), total area under the 24-hour inhibitory concentration curve ([AUIC24] AUC24/MIC summed for all active drugs), antibiotic(s) used as dichotomous variables (yes/no), and use of monotherapy or combination therapy.Results:Of 635 patients, 43 (7%) subsequently had ciprofloxacin-resistant P aeruginosa isolated. Four significantly differing patient groups were identified: group 1, P aeruginosa isolates from all sites other than the respiratory tract, treated with any drugs; group 2, respiratory tract isolates treated with drugs other than ciprofloxacin; group 3, respiratory tract isolates treated with ciprofloxacin at AUIC24 > 110 (μg·h/mL)/μg/mL; and group 4, respiratory tract isolates treated with ciprofloxacin at AUIC24 ≤110 (μg·h/mL)/μg/mL. The observed percentage resistant was a continuous function of prior length of stay in all four groups. Respiratory tract isolates had higher rates of ciprofloxacin resistance (12%) than isolates from other infection sites (4%). Respiratory tract isolates exposed to ciprofloxacin at AUIC24 ≤110 (μg·h/mL)/μg/mL had the highest resistance (17%). At AUIC24 >110 (μg·h/mL)/μg/mL, resistance was decreased to 11%, a rate similar to that seen in respiratory isolates not exposed to ciprofloxacin (7%).Conclusions:Application of pharmacokinetic and pharmacodynamic principles to dosing of ciprofloxacin may reduce the risk of ciprofloxacin resistance to the level seen in isolates exposed to other agents.
Antimicrobial Cycling: Lessons Learned From the Aminoglycoside Experience
Authors: Gerding Dale N. 
Published: February 2006

AbstractSeveral discrete strategies have been suggested to prevent or reduce microbial resistance to antimicrobials, including optimal use of the agents (also known as good stewardship); control, removal, or restriction of antimicrobials; use of antimicrobials in combination; and rotational or cyclic use of antimicrobials. The latter strategy is attractive because it periodically removes from the institutional environment certain classes or specific agents that could induce or select resistance. Hospitalwide studies of aminoglycoside substitution employed from the late 1970s through the early 1990s, although not originally intended to test cycling or rotation of aminoglycosides, serendipitously provided data that may be useful in designing future studies. In particular, one 10-year study at the Minneapolis Veterans' Affairs Medical Center (MVAMC) rotated amikacin and gentamicin use over cycles of 12 to 51 months' duration. Significantly reduced resistance to gentamicin was found when amikacin was used, but resistance to gentamicin returned with the first gentamicin recycle. This was followed by reintroduction of amikacin a second time with decreased resistance to gentamicin and, finally, a second reintroduction of gentamicin without resistance to it recurring. Thus, some evidence of proof of principal can be garnered, albeit subject to considerable criticism. Critical examination of the design of the aminoglycoside rotation study and the unforeseen pitfalls is provided as a 13-element guidance list for design of future rotational studies. Rotational usage practices are likely to be most appropriate for drugs active against gram-negative bacilli because of the wide choices available for rotation. Future availability of new agents active against resistant gram-positive organisms will present the opportunity to cycle these agents as vancomycin substitutes. Careful monitoring of clinical outcomes and resistance will be required. Multicenter controlled trials that follow carefully designed protocols are most likely to produce statistically significant and clinically meaningful results.
Potential Role of Pharmacokinetics, Pharmacodynamics, and Computerized Databases in Controlling Bacterial Resistance
Authors: Hyatt Judith M. , Schentag Jerome J. 
Published: February 2006

AbstractBacterial resistance to antibiotics continues to be a problem, in spite of increased knowledge of resistance mechanisms. Due to the multifactorial nature of bacterial resistance, studies that evaluate the association between antimicrobial exposure and emergence of resistance may fail to find a relationship unless other factors, in particular the association between patient-pathogen pharmacokinetics (PK) and pharmacodynamics (PD) and the emergence of bacterial resistance, are evaluated as well. It has been hypothesized that, in conjunction with good infection control practices, cycling of antimicrobial agents may prove to be effective in reducing resistance emergence.There is some indication that there may be a relationship between the level of antibiotic exposure and the probability of emergence of bacterial resistance. As shown in our companion article in this supplement, factors associated with ciprofloxacin resistance in Pseudomonas aeruginosa included increased length of stay prior to isolation, exposure to ciprofloxacin, and respiratory tract site of bacterial isolation. However, in patients who received ciprofloxacin therapy, when exposure was at an area under the 24-hour inhibitory concentration curve (AUIC24)>110 (μg·h/mL)/μg/mL, resistance was decreased to 11%, a rate similar to that seen in respiratory isolates not exposed to ciprofloxacin (7%).While the length of time the patient spends in the hospital and the site of infection cannot be controlled, by using PK and PD principles for dosing of ciprofloxacin, the emergence of ciprofloxacin resistance in P aeruginosa may be reduced. Prospective antibiotic-cycling studies may help to determine not only the impact of antibiotic cycling on the institution's antibiogram but also, through the use of PK and PD principles, may help to determine appropriate dosing schedules for antibiotics in order to reduce the probability of emergence of bacterial resistance.
Osteoprotegrin Knockout Mice Demonstrate Abnormal Remodeling of the Otic Capsule and Progressive Hearing Loss
Authors: Zehnder Andreas F. , Kristiansen Arthur G. , Adams Joe C. , Kujawa Sharon G. , Merchant Saumil N. , McKenna Michael J. 
Published: February 2006

AbstractObjectives: The otic capsule, when compared with other bones in the body, is unique in that it undergoes no significant remodeling of bone after development. We previously demonstrated that osteoprotegerin (OPG), which inhibits formation and function of osteoclasts, is produced at high levels in the inner ear of normal mice and secreted into the perilymph from where it diffuses into the surrounding otic capsule bone through a lacunocanalicular system. To test our hypothesis that the high level of OPG may be important in the inhibition of otic capsule remodeling, we studied the light microscopic histology of the otic capsule in OPG knockout mice for evidence of abnormal remodeling of bone. We also tested the hearing in OPG knockout mice to determine whether OPG and its influence on surrounding bone is important for auditory function.Methods: Temporal bone histopathology and pathophysiology were compared in homozygous OPG knockout mice and C57BL/6 (B6) mice, the background strain for the knockouts. Auditory function in age‐matched animals from each group was evaluated at approximately 4‐week intervals from 8 to 21 weeks using frequency‐specific auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE). After each of the last three evaluations, the cochleae from one mouse of each group were harvested, processed, and examined by light microscopy.Results: Osteoprotegerin knockout mice demonstrated abnormal remodeling of bone within the otic capsule with multiple foci showing osteoclastic bone resorption and formation of new bone. Such changes were not seen in the age‐matched B6 controls. The active bone remodeling process in the knockout animals showed many similarities to otosclerosis seen in human temporal bones. Over the time period that we monitored, auditory function was significantly and progressively compromised in the knockout animals relative to B6 controls. At the earliest age of test (8 wk), the loss was apparent as a mild, high‐frequency reduction in sensitivity by ABR. In contrast, DPOAE losses in the knockouts were substantial even at 8 weeks, and by 21 weeks, these losses exceeded our equipment limits. Results of ABR testing showed hearing sensitivity changes in the animals of the background strain were confined largely to the high frequencies, whereas OPG knockouts demonstrated substantial low‐frequency shifts in addition to those at high frequencies.Conclusions: The histopathological and pathophysiological findings in OPG knockout mice support the hypothesis that OPG is important in the inhibition of bone remodeling within the otic capsule and the maintenance of normal auditory function. This mouse may provide a valuable animal model of human otosclerosis.
Long‐Term Result of the New Endoscopic Vocal Fold Medialization Surgical Technique for Laryngeal Palsy
Authors: Nishiyama Koichiro , Hirose Hajime , Masaki Takashi , Nagai Hiromi , Hashimoto Daimon , Usui Daisuke , Yao Kazuo , Tsunoda Koichi , Okamoto Makito 
Published: February 2006

AbstractObjective: The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap.Study Design and Methods: In the present study, we modified the method of medialization using the ATFV technique to obtain effective closure of a large glottal gap. To overcome this difficulty, an attempt was made to extend the site of transplantation more posteriorly so as to adduct the vocal process of the arytenoid cartilage in the body of the vocal fold.Results: This new technique was applied to eight cases of patients with unilateral laryngeal paralysis with severe dysphonia. None of the patients showed any evidence of falling off of the graft. Elongation of the maximum phonation time and a decrease in airflow rate during phonation were obtained with improvement in voice quality in all patients 1 year after the surgery.Conclusions: This method, with its less invasive approach, proved to be useful for the treatment of large glottal gap due to unilateral laryngeal nerve paralysis.
The Histone Deacetylase Inhibitor Sodium Butyrate Protects Against Cisplatin‐Induced Hearing Loss in Guinea Pigs
Authors: Drottar Marie , Liberman M Charles , Ratan Rajiv R. , Roberson David W. 
Published: February 2006

AbstractObjective: There is a need for otoprotective agents that can be administered systemically without compromising cancer treatment. Histone deacetylase inhibitors are anticancer agents that act by upregulating the expression of cell‐cycle control genes. They are also neuroprotective, leading us to hypothesize that they might be otoprotective. The goal of this study was to determine if the antitumor agent sodium butyrate (a histone deacetylase inhibitor) protects against cisplatin ototoxicity when administered systemically.Study Design: This was an animal study.Methods: Cisplatin was administered to guinea pigs who received either 12 days of sodium butyrate (7 d before and 5 d after cisplatin) or equivolume saline injections. Hearing was tested with distortion product otoacoustic emission (DPOAE) analysis before the start of the study and 2 weeks after cisplatin treatment.Results: Guinea pigs given a single intraperitoneal injection of 14 mg/kg cisplatin experience a mean hearing loss of 8 dB across the frequencies of 3.5, 5, 7, 10, 14, and 20 kHz. Intraperitoneal injection of 1.2 mg/kg sodium butyrate per day for 7 days before and 5 days after cisplatin almost completely eliminates this threshold shift (P = .0011).Conclusions: The histone deacetylase inhibitor sodium butyrate gives almost complete protection in a single‐dose model of cisplatin ototoxicity in guinea pigs. Because histone deacetylase inhibitors are anticancer agents with very few side effects, they may be candidates for clinical use during cisplatin chemotherapy.
Fluorodeoxyglucose‐Positron Emission Tomography/Computed Tomography Imaging in Patients with Carcinoma of the Larynx: Diagnostic Accuracy and Impact on Clinical Management
Authors: Gordin Arie , Daitzchman Marcello , Doweck Ilana , Yefremov Nikolay , Golz Avishay , Keidar Zohar , Bar‐Shalom Rachel , Kuten Abraham , Israel Ora 
Published: February 2006

AbstractObjectives: The objectives of this study were to assess the value of 18F‐fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with carcinoma of the larynx as compared with PET and CT alone and to assess the impact of PET/CT on further clinical management.Study Design: This was a prospective, nonrandomized study.Materials and Methods: Forty‐two patients with laryngeal cancer had 51 PET/CT examinations. There were 34 men and eight women, aged 39 to 80 years. All studies were interpreted prospectively with knowledge of the clinical history and results of previous imaging tests. The performance of different imaging modalities was compared on both a study‐ and lesion‐based analysis for sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and accuracy. Changes in patient care resulting from the PET/CT studies were recorded.Results: The study analysis showed that PET/CT had a sensitivity of 92%, specificity 96%, PPV 96%, NPV 92%, and accuracy of 94% as compared with 92%, 73%, 76%, 91%, and 82% for PET, and 88%, 8%, 48%, 40%, and 51% for CT, respectively. There were 112 suspicious sites evaluated in the 51 studies. PET/CT altered management in 25 patients (59%) by sparing previously planned diagnostic procedures (n = 13), by changing the planned therapeutic approach (n = 9), and by guiding a biopsy to a metabolically active laryngeal area (n = 3).Conclusions: The performance of PET/CT is better than standalone PET or CT in patients with cancer of the larynx. PET/CT had a major impact on management of 59% of patients.
The Effect of Erythropoietin on Gentamicin‐Induced Auditory Hair Cell Loss
Authors: Monge Arianne , Nagy Ivana , Bonabi Sharouz , Schmid Stephan , Gassmann Max , Bodmer Daniel 
Published: February 2006

AbstractObjective/Hypothesis: Mammalian auditory hair cells that are unable to regenerate and various agents, including gentamicin, can irreversibly damage the hair cells. Erythropoietin, known as the primary regulator of erythropoiesis, exerts also neuroprotective effects by binding to its receptor. We tested whether erythropoietin can protect the hair cells from gentamicin‐induced damage.Study Design: This study localized the erythropoietin receptor in the cochlea and analyzed the effect of erythropoietin on gentamicin‐damaged hair cells in vitro.Methods: Expression of erythropoietin receptor in the rat cochlea was analyzed by reverse transcriptase–polymerase chain reaction (RT‐PCR) and immunohistochemistry. Protection of auditory hair cells from gentamicin was tested in vitro by exposing cultured rat organs of Corti with increasing concentrations of erythropoietin (0.1 U/mL, 1 U/mL, and 10 U/mL).Results: We detected erythropoietin and erythropoietin receptor mRNA expression in the organ of Corti, spiral ganglion, and stria vascularis by RT‐PCR. Immunohistochemistry revealed that the erythropoietin receptor localizes to the outer and inner hair cells and supporting cells of the organ of Corti, as well as to the spiral ganglion cells and the stria vascularis. Significantly less hair cell loss occurred in the organs of Corti that were pretreated with 0.1 U/mL erythropoietin as compared with samples treated with gentamicin only.Conclusion: Decreased hair cell loss in erythropoietin‐treated organs of Corti that had been exposed to gentamicin provides evidence for a protective effect of erythropoietin in aminoglycoside‐induced hair cell death.
Exiting TANF: Individual and Local Factors and Their Differential Influence Across Racial Groups*
Authors: Parisi Domenico , McLaughlin Diane K. , Grice Steven Michael , Taquino Michael 
Published: February 2006

Objective. We ask whether individual and local factors known to influence reliance on welfare continue to be important under the TANF program, and if such factors differentially affect exit from TANF for African Americans and whites.Methods. We use monthly administrative data on TANF recipients from October 1996 to July 2004 from the Mississippi Department of Human Services. These data are linked to local economic, social, and spatial characteristics to estimate discrete time hazard models of TANF exit.Results. Personal barriers to work (e.g., low education and children) and limited economic and social opportunities in communities reduce the likelihood of leaving TANF. The results show that African‐American exits from TANF are more influenced by human capital and local economic, social, and spatial conditions than are whites' TANF exits.Conclusion. The work‐first initiative under TANF is most viable where individual barriers to work are limited and economic opportunities and community support to become self‐sufficient exist for all people.
State Growth Management and Housing Prices*
Authors: Anthony Jerry 
Published: February 2006

Objective. In the United States, growth regulations aimed at environmental protection and better‐quality urban areas have become very popular since the 1960s. Although many studies have examined the housing‐price effects of local and regional growth management regulations, none has examined the effects of a state law. Past research has also tended to be cross‐sectional, rather than longitudinal, and has frequently ignored alternate hypotheses that could explain housing‐price trends. The research presented in this article examines the housing‐price effects of Florida's Growth Management Act of 1985.Methods. Using secondary source data from all 67 counties of the state for the period 1980–1995 and employing pooled time‐series analysis techniques I test the hypothesis that the Act had an inflationary effect on single‐family house prices.Results. After controlling for alternate hypotheses such as population, income, and size of house, I find a statistically significant increase in the price of single‐family houses attributable to statewide growth management. Also, the demand‐side and supply‐side price inflationary effects of growth management are similar in magnitude.Conclusions. Since higher housing prices could become the Achilles heel of growth management programs and thwart their implementation, I suggest a few ways some of the price inflationary effects may be reduced.