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COVID-19 passenger screening to reduce travel risk and translocation of disease
- Lindsay L. Waite, Ahmad Nahhas, Jan Irvahn, Grace Garden, Caroline M. Kerfonta, Elizabeth Killelea, William Ferng, Joshua J. Cummins, Rebecca Mereness, Thomas Austin, Stephen Jones, Nels Olson, Mark Wilson, Benson Isaac, Craig A. Pepper, Iain S. Koolhof, Jason Armstrong
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- Journal:
- Epidemiology & Infection / Volume 152 / 2024
- Published online by Cambridge University Press:
- 08 February 2024, e36
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Aviation passenger screening has been used worldwide to mitigate the translocation risk of SARS-CoV-2. We present a model that evaluates factors in screening strategies used in air travel and assess their relative sensitivity and importance in identifying infectious passengers. We use adapted Monte Carlo simulations to produce hypothetical disease timelines for the Omicron variant of SARS-CoV-2 for travelling passengers. Screening strategy factors assessed include having one or two RT-PCR and/or antigen tests prior to departure and/or post-arrival, and quarantine length and compliance upon arrival. One or more post-arrival tests and high quarantine compliance were the most important factors in reducing pathogen translocation. Screening that combines quarantine and post-arrival testing can shorten the length of quarantine for travelers, and variability and mean testing sensitivity in post-arrival RT-PCR and antigen tests decrease and increase with the greater time between the first and second post-arrival test, respectively. This study provides insight into the role various screening strategy factors have in preventing the translocation of infectious diseases and a flexible framework adaptable to other existing or emerging diseases. Such findings may help in public health policy and decision-making in present and future evidence-based practices for passenger screening and pandemic preparedness.
DIFFaX Simulations of Polytypism and Disorder in Hydrotalcite
- Grace S. Thomas, Michael Rajamathi, P. Vishnu Kamath
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- Journal:
- Clays and Clay Minerals / Volume 52 / Issue 6 / December 2004
- Published online by Cambridge University Press:
- 01 January 2024, pp. 693-699
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DIFFaX simulations show that the 3R1 and 3R2 polytypes of hydrotalcites (HT) have distinctly different X-ray powder diffraction (XRPD) patterns. The HT samples obtained by coprecipitation as well as those subjected to a subsequent hydrothermal treatment exhibit non-uniform broadening of lines in their XRPD patterns as well as anomalous variation in the intensities of the basal reflections. The reflections appearing in the mid-2θ region (30–50°; 3–1.8 Å) are excessively broadened and do not correspond to either of the 3R polytypes. This broadening is shown to be due to a stacking of layers randomly rotated about the c crystallographic axis by n × 120° (n = 1,2). The intensities of the basal reflections vary due to the departure of the layer composition from the nominal value, essentially due to an increase in the intercalated water content.
Bowel habits, faecal microbiota and faecal bile acid composition of healthy adults consuming fruit pomace fibres: two-arm, randomised, double-blinded, placebo-controlled trials
- Celeste Alexander, Mary Brauchla, Kristen D. Sanoshy, Traci M. Blonquist, Grace N. Maloney, Eunice Mah, Kathleen Kelley-Garvin, Oliver Chen, DeAnn J. Liska, Jin-E Shin, Thomas W. Boileau, Kelly S. Swanson
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- Journal:
- British Journal of Nutrition / Volume 130 / Issue 1 / 14 July 2023
- Published online by Cambridge University Press:
- 14 September 2022, pp. 42-55
- Print publication:
- 14 July 2023
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Dietary fibre modulates gastrointestinal (GI) health and function, providing laxation, shifting microbiota, and altering bile acid (BA) metabolism. Fruit juice production removes the polyphenol- and fibre-rich pomace fraction. The effects of orange and apple pomaces on GI outcomes were investigated in healthy, free-living adults. Healthy adults were enrolled in two double-blinded, crossover trials, being randomised by baseline bowel movement (BM) frequency. In the first trial, subjects (n 91) received orange juice (OJ, 0 g fibre/d) or OJ + orange pomace (OJ + P, 10 g fibre/d) for 4 weeks, separated by a 3-week washout. Similarly, in the second trial, subjects (n 90) received apple juice (AJ, 0 g fibre/d) or AJ + apple pomace (AJ + P, 10 g fibre/d). Bowel habit diaries, GI tolerance surveys and 3-d diet records were collected throughout. Fresh faecal samples were collected from a participant subset for microbiota and BA analyses in each study. Neither pomace interventions influenced BM frequency. At Week 4, OJ + P tended to increase (P = 0·066) GI symptom occurrence compared with OJ, while AJ + P tended (P = 0·089) to increase flatulence compared with AJ. Faecalibacterium (P = 0·038) and Negativibacillus (P = 0·043) were differentially abundant between pre- and post-interventions in the apple trial but were no longer significant after false discovery rate (FDR) correction. Baseline fibre intake was independently associated with several microbial genera in both trials. Orange or apple pomace supplementation was insufficient to elicit changes in bowel habits, microbiota diversity or BA of free-living adults with healthy baseline BM. Future studies should consider baseline BM frequency and habitual fibre intake.
Interrelationship between micronutrients and cardiovascular structure and function in type 2 diabetes
- Grace W. M. Walters, Emma Redman, Gaurav S. Gulsin, Joseph Henson, Stavroula Argyridou, Thomas Yates, Melanie J. Davies, Kelly Parke, Gerry P. McCann, Emer M. Brady
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- Journal:
- Journal of Nutritional Science / Volume 10 / 2021
- Published online by Cambridge University Press:
- 04 October 2021, e88
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Micronutrients are important for normal cardiovascular function. They may play a role in the increased risk of cardiovascular disease observed in people with type 2 diabetes (T2D) and T2D-related heart failure. The aims of this study were to (1) examine micronutrient status in people with T2D v. healthy controls; (2) assess any changes following a nutritionally complete meal replacement plan (MRP) compared with routine care; (3) determine if any changes were associated with changes in cardiovascular structure/function. This was a secondary analysis of data from a prospective, randomised, open-label, blinded end-point trial of people with T2D, with a nested case–control [NCT02590822]. Anthropometrics, cardiac resonance imaging and fasting blood samples (to quantify vitamins B1, B6, B12, D and C; and iron and ferritin) were collected at baseline and 12 weeks following the MRP or routine care. Comparative data in healthy controls were collected at baseline. A total of eighty-three people with T2D and thirty-six healthy controls were compared at baseline; all had micronutrient status within reference ranges. Vitamin B1 was higher (148⋅9 v. 131⋅7; P 0⋅01) and B6 lower (37⋅3 v. 52⋅9; P 0⋅01) in T2D v. controls. All thirty participants randomised to routine care and twenty-four to the MRP completed the study. There was an increase in vitamins B1, B6, D and C following the MRP, which were not associated with changes in cardiovascular structure/function. In conclusion, changes in micronutrient status following the MRP were not independently associated with improvements in cardiovascular structure/function in people with T2D.
Pediatric research priorities in healthcare-associated infections and antimicrobial stewardship
- Susan E. Coffin, Francisca Abanyie, Kristina Bryant, Joseph Cantey, Anthony Fiore, Stephanie Fritz, Judith Guzman-Cottrill, Adam L. Hersh, W. Charles Huskins, Larry K. Kociolek, Matthew Kronman, Ebbing Lautenbach, Grace Lee, Matthew Linam, Latania K. Logan, Aaron Milstone, Jason Newland, A. Christine Nyquist, Debra L. Palazzi, Sameer Patel, Karen Puopolo, Sujan C. Reddy, Lisa Saiman, Thomas Sandora, Andi L. Shane, Michael Smith, Pranita D. Tamma, Theoklis Zaoutis, Danielle Zerr, Jeffrey S. Gerber, for the CDC Prevention Epicenters Program
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 42 / Issue 5 / May 2021
- Published online by Cambridge University Press:
- 26 November 2020, pp. 519-522
- Print publication:
- May 2021
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Objective:
To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.
Participants:The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification).
Methods:Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and antimicrobial stewardship. The multistep, 7-month process included a literature review, interactive teleconferences, web-based surveys, and 2 in-person meetings.
Results:A final list of 12 high-priority research topics were generated in the 2 domains. High-priority healthcare-associated infection topics included judicious testing for Clostridioides difficile infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections. Antimicrobial stewardship topics included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level “harm index” for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions.
Conclusions:We identified 6 healthcare-associated infection topics and 6 antimicrobial stewardship topics as potentially high-impact targets for pediatric research.
Cost Savings Associated With Decolonization of Postdischarge MRSA Carriers: Results From the CLEAR Randomized Trial
- Natasha K. Stout, Grace M. Lee, Anastasiia S. Weiland, Caleb S. Chen, Syma Rashid, Raveena D. Singh, Thomas Tjoa, Jiayi He, James A. McKinnell, Loren G. Miller, Susan S. Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s28-s29
- Print publication:
- October 2020
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Background: Greater than 10% of hospitalized MRSA carriers experience serious MRSA infection in the year following discharge. Prevention opportunities have primarily focused on hospital stays; however postdischarge interventions have the potential to reduce morbidity, mortality and healthcare costs. The CLEAR trial found a 30% hazard reduction in postdischarge MRSA infections among patients who had inpatient MRSA cultures and were given postdischarge decolonization (5 days twice-a-month for 6 months) relative to hygiene education alone. We conducted a cost analysis of the CLEAR intervention to quantify the economic implications and understand the value of adopting this MRSA decolonization strategy. Methods: We constructed a decision model to estimate the one-year healthcare utilization and costs associated with postdischarge decolonization relative to hygiene education. Trial results for MRSA infection risk and downstream outcomes (including outpatient and emergency room visits, hospitalizations, related nursing home stays, and postdischarge antibiotics) were used to parameterize the model. Other medical care and prescription drug costs were based on Medicare Fee Schedules, Red Book and the literature. Patient out-of-pocket costs and time costs associated with subsequent infections were from a survey of trial participants experiencing infection (n=405). All costs were reported in 2019 US dollars. The analysis was conducted using healthcare system and societal perspectives. Sensitivity analyses were conducted on key parameters. Results: Among a hypothetical cohort of 1,000 hospitalized MRSA carriers, we estimated that a postdischarge decolonization intervention versus hygiene education would result in at least 36 fewer subsequent MRSA infections (130 vs 93 of 1,000, respectively) and >40 fewer MRSA-attributable healthcare events including 32 hospitalizations and 6 postdischarge nursing home visits over the course of a year. Assuming an intervention cost of $185 per individual, the program would result in an overall cost savings of $469,000 per 1,000 MRSA carriers undergoing decolonization. This translates to an overall savings of $13,200 per infection averted and $9,000 per infection averted from the healthcare system perspective. Even assuming a lower infection rate or a less effective intervention (15% reduction in infections vs 30% in the CLEAR trial), or a more expensive (up to $653 per patient) intervention, a decolonization program would still result in cost-savings for society, the healthcare system and patients. Conclusions: In addition to health benefits of preventing infections, postdischarge decolonization of MRSA carriers yields substantial savings to society and the healthcare system. Future recommendations for reducing postdischarge MRSA-related disease among MRSA carriers should consider routine decolonization at hospital discharge.
Funding: This study was supported by a grant from the AHRQ Healthcare-Associated Infections Program (R01HS019388) and by the University of California Irvine Institute for Clinical and Translational Science, which was funded by a grant from the NIH Clinical and Translational Sciences Award program (UL1 TR000153).
Disclosures: Dr. Huang reports conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker (Sage Products), Mölnlycke, 3M, Clorox, Xttrium Laboratories, and Medline. Ms. Singh reports conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker (Sage Products), 3M, Clorox, Xttrium Laboratories, and Medline. Dr. Rashid, conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker(Sage Products), Clorox, and Medline. Dr. McKinnell reports receiving grant support to his institution from Melinta Therapeutics, and fees for serving as a research investigator from Lightship, conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker (Sage Products), 3M, Clorox, Xttrium Laboratories and Medline, and serving as cofounder of Expert Stewardship. Dr. Miller reports receiving grant support from Gilead Sciences, Merck, Abbott, Cepheid, Genentech, Atox Bio, and Paratek Pharmaceuticals, grant support and fees for serving on an advisory board from Achaogen and grant support, consulting fees, and fees for serving on an advisory board from Tetraphase and conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker (Sage Products), 3M, Clorox, Xttrium Laboratories, and Medline.
Multi-method process maps: An interdisciplinary approach to investigate ad hoc modifications in protocol-driven interventions
- Thomas I. Mackie, Leah Ramella, Ana J. Schaefer, Monica Sridhar, Alice S. Carter, Abbey Eisenhower, Grace T. Ibitamuno, Marisa Petruccelli, Shawna V. Hudson, R. Christopher Sheldrick
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- Journal:
- Journal of Clinical and Translational Science / Volume 4 / Issue 3 / June 2020
- Published online by Cambridge University Press:
- 26 February 2020, pp. 260-269
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Introduction:
Implementation scientists increasingly recognize that the process of implementation is dynamic, leading to ad hoc modifications that may challenge fidelity in protocol-driven interventions. However, limited attention to ad hoc modifications impairs investigators’ ability to develop evidence-based hypotheses about how such modifications may impact intervention effectiveness and cost. We propose a multi-method process map methodology to facilitate the systematic data collection necessary to characterize ad hoc modifications that may impact primary intervention outcomes.
Methods:We employ process maps (drawn from systems science), as well as focus groups and semi-structured interviews (drawn from social sciences) to investigate ad hoc modifications. Focus groups are conducted with the protocol’s developers and/or planners (the implementation team) to characterize the protocol “as envisioned,” while interviews conducted with frontline administrators characterize the process “as realized in practice.” Process maps with both samples are used to identify when modifications occurred across a protocol-driven intervention. A case study investigating a multistage screening protocol for autism spectrum disorders (ASD) is presented to illustrate application and utility of the multi-method process maps.
Results:In this case study, frontline administrators reported ad hoc modifications that potentially influenced the primary study outcome (e.g., time to ASD diagnosis). Ad hoc modifications occurred to accommodate (1) whether providers and/or parents were concerned about ASD, (2) perceptions of parental readiness to discuss ASD, and (3) perceptions of family service delivery needs and priorities.
Conclusion:Investigation of ad hoc modifications on primary outcomes offers new opportunities to develop empirically based adaptive interventions. Routine reporting standards are critical to provide full transparency when studying ad hoc modifications.
Variability in antimicrobial use in pediatric ventilator-associated events
- Manjiree V. Karandikar, Susan E. Coffin, Gregory P. Priebe, Thomas J. Sandora, Latania K. Logan, Gitte Y. Larsen, Philip Toltzis, James E. Gray, Michael Klompas, Julia S. Sammons, Marvin B. Harper, Kelly Horan, Matthew Lakoma, Noelle M. Cocoros, Grace M. Lee
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 40 / Issue 1 / January 2019
- Published online by Cambridge University Press:
- 09 November 2018, pp. 32-39
- Print publication:
- January 2019
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Objective
To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
DesignDescriptive retrospective cohort with nested case-control study.
SettingPediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.
PatientsChildren≤18 years ventilated for≥1 calendar day.
MethodsWe identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.
ResultsAmong 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20–67%; PICU, 0–70%; and NICU, 0–43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.
ConclusionsAntimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.
A Pediatric Approach to Ventilator-Associated Events Surveillance
- Noelle M. Cocoros, Gregory P. Priebe, Latania K. Logan, Susan Coffin, Gitte Larsen, Philip Toltzis, Thomas J. Sandora, Marvin Harper, Julia S. Sammons, James E. Gray, Donald Goldmann, Kelly Horan, Michael Burton, Paul A. Checchia, Matthew Lakoma, Shannon Sims, Michael Klompas, Grace M. Lee
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 38 / Issue 3 / March 2017
- Published online by Cambridge University Press:
- 05 December 2016, pp. 327-333
- Print publication:
- March 2017
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OBJECTIVE
Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.
DESIGNRetrospective cohort
SETTINGPediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals
PATIENTSPatients ≤18 years old ventilated for ≥1 day
METHODSWe identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.
RESULTSIn total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.
CONCLUSIONSWe propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes.
Infect Control Hosp Epidemiol 2017;38:327–333
Contributors
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- By Magdalena Anitescu, Charles E. Argoff, Arash Asher, Nyla Azam, Nomen Azeem, Sachin K. Bansal, Jose E. Barreto, Rodrigo A Benavides, Niteesh Bharara, Justin B. Boge, Robert B. Bolash, Thomas K. Bond, Christopher Centeno, Zachariah W. Chambers, Jonathan Chang, Grace Chen, Hamilton Chen, Jeffry Chen, Jianguo Cheng, Natalia Covarrubias, Claire J. Creutzfeldt, Gulshan Doulatram, Amirpasha Ehsan, Ike Eriator, Jeff Ericksen, Mark Etscheidt, Frank J. E. Falco, Jack Fu, Timothy Furnish, Annemarie E. Gallagher, Kingsuk Ganguly, Eugene Garvin, Cliff Gevirtz, Scott E. Glaser, Brandon J. Goff, Harry J. Gould, Christine Greco, Jay S. Grider, Maged Guirguis, Qiao Guo, Justin Hata, John Hau, Garett J. Helber, Eric R. Helm, Lori Hill Marshall, Dean Hommer, Jeffrey Hopcian, Eric S. Hsu, Jakun Ing, Tracy P. Jackson, Gaurav Jain, Chrystina Jeter, Alan David Kaye, James Kelly, Soorena Khojasteh, Ankur Khosla, Daniel Krashin, Monika A. Krzyzek, Prasad Lakshminarasimhiah, Steven Michael Lampert, Garrett LaSalle, Quan D. Le, Ankit Maheshwari, Edward R. Mariano, Joaquin Maury, John P. McCallin, John Michels, Natalia Murinova, Narendren Narayanasamy, Rebekah L. Nilson, Elliot Palmer, Vikram B. Patel, Devin Peck, Donald B. Penzien, Danielle Perret Karimi, Tilak Raj, Michael R. Rasmussen, Mohit Rastogi, Rahul Rastogi, Nashaat N. Rizk, Rinoo V. Shah, Paul A. Sloan, Julian Sosner, A. Raj Swain, Minyi Tan, Natacha Telusca, Santhosh A. Thomas, Andrea Trescot, Michael Truong, Jason Tucker, Richard D. Urman, Brandon A. Van Noord, Nihir Waghela, Irene Wu, Jiang Wu, Jijun Xu, Jinghui Xie, William Yancey
- Edited by Alan David Kaye, Louisiana State University, Rinoo V. Shah
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- Case Studies in Pain Management
- Published online:
- 05 October 2014
- Print publication:
- 16 October 2014, pp xi-xv
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Cost Savings of Universal Decolonization to Prevent Intensive Care Unit Infection: Implications of the REDUCE MRSA Trial
- Susan S. Huang, Edward Septimus, Taliser R. Avery, Grace M. Lee, Jason Hickok, Robert A. Weinstein, Julia Moody, Mary K. Hayden, Jonathan B. Perlin, Richard Platt, G. Thomas Ray
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 35 / Issue S3 / October 2014
- Published online by Cambridge University Press:
- 10 May 2016, pp. S23-S31
- Print publication:
- October 2014
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Objective.
To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients).
Design.Cost analysis using decision modeling.
Methods.We developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature.
Results.In the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions.
Conclusions.A strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization.
Contributors
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- By Lenard A. Adler, Pinky Agarwal, Rehan Ahmed, Jagga Rao Alluri, Fawaz Al-Mufti, Samuel Alperin, Michael Amoashiy, Michael Andary, David J. Anschel, Padmaja Aradhya, Vandana Aspen, Esther Baldinger, Jee Bang, George D. Baquis, John J. Barry, Jason J. S. Barton, Julius Bazan, Amanda R. Bedford, Marlene Behrmann, Lourdes Bello-Espinosa, Ajay Berdia, Alan R. Berger, Mark Beyer, Don C. Bienfang, Kevin M. Biglan, Thomas M. Boes, Paul W. Brazis, Jonathan L. Brisman, Jeffrey A. Brown, Scott E. Brown, Ryan R. Byrne, Rina Caprarella, Casey A. Chamberlain, Wan-Tsu W. Chang, Grace M. Charles, Jasvinder Chawla, David Clark, Todd J. Cohen, Joe Colombo, Howard Crystal, Vladimir Dadashev, Sarita B. Dave, Jean Robert Desrouleaux, Richard L. Doty, Robert Duarte, Jeffrey S. Durmer, Christyn M. Edmundson, Eric R. Eggenberger, Steven Ender, Noam Epstein, Alberto J. Espay, Alan B. Ettinger, Niloofar (Nelly) Faghani, Amtul Farheen, Edward Firouztale, Rod Foroozan, Anne L. Foundas, David Elliot Friedman, Deborah I. Friedman, Steven J. Frucht, Oded Gerber, Tal Gilboa, Martin Gizzi, Teneille G. Gofton, Louis J. Goodrich, Malcolm H. Gottesman, Varda Gross-Tsur, Deepak Grover, David A. Gudis, John J. Halperin, Maxim D. Hammer, Andrew R. Harrison, L. Anne Hayman, Galen V. Henderson, Steven Herskovitz, Caitlin Hoffman, Laryssa A. Huryn, Andres M. Kanner, Gary P. Kaplan, Bashar Katirji, Kenneth R. Kaufman, Annie Killoran, Nina Kirz, Gad E. Klein, Danielle G. Koby, Christopher P. Kogut, W. Curt LaFrance, Patrick J.M. Lavin, Susan W. Law, James L. Levenson, Richard B. Lipton, Glenn Lopate, Daniel J. Luciano, Reema Maindiratta, Robert M. Mallery, Georgios Manousakis, Alan Mazurek, Luis J. Mejico, Dragana Micic, Ali Mokhtarzadeh, Walter J. Molofsky, Heather E. Moss, Mark L. Moster, Manpreet Multani, Siddhartha Nadkarni, George C. Newman, Rolla Nuoman, Paul A. Nyquist, Gaia Donata Oggioni, Odi Oguh, Denis Ostrovskiy, Kristina Y. Pao, Juwen Park, Anastas F. Pass, Victoria S. Pelak, Jeffrey Peterson, John Pile-Spellman, Misha L. Pless, Gregory M. Pontone, Aparna M. Prabhu, Michael T. Pulley, Philip Ragone, Prajwal Rajappa, Venkat Ramani, Sindhu Ramchandren, Ritesh A. Ramdhani, Ramses Ribot, Heidi D. Riney, Diana Rojas-Soto, Michael Ronthal, Daniel M. Rosenbaum, David B. Rosenfield, Durga Roy, Michael J. Ruckenstein, Max C. Rudansky, Eva Sahay, Friedhelm Sandbrink, Jade S. Schiffman, Angela Scicutella, Maroun T. Semaan, Robert C. Sergott, Aashit K. Shah, David M. Shaw, Amit M. Shelat, Claire A. Sheldon, Anant M. Shenoy, Yelizaveta Sher, Jessica A. Shields, Tanya Simuni, Rajpaul Singh, Eric E. Smouha, David Solomon, Mehri Songhorian, Steven A. Sparr, Egilius L. H. Spierings, Eve G. Spratt, Beth Stein, S.H. Subramony, Rosa Ana Tang, Cara Tannenbaum, Hakan Tekeli, Amanda J. Thompson, Michael J. Thorpy, Matthew J. Thurtell, Pedro J. Torrico, Ira M. Turner, Scott Uretsky, Ruth H. Walker, Deborah M. Weisbrot, Michael A. Williams, Jacques Winter, Randall J. Wright, Jay Elliot Yasen, Shicong Ye, G. Bryan Young, Huiying Yu, Ryan J. Zehnder
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Book:
- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp xi-xx
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Contact Precautions More Is Not Necessarily Better
- Sorabh Dhar, Dror Marchaim, Ryan Tansek, Teena Chopra, Adnan Yousuf, Ashish Bhargava, Emily T. Martin, Thomas R. Talbot, Laura E. Johnson, Ameet Hingwe, Jerry M. Zuckerman, Bartholomew R. Bono, Emily K. Shuman, Jose Poblete, MaryAnn Tran, Grace Kulhanek, Rama Thyagarajan, Vijayalakshmi Nagappan, Carrie Herzke, Trish M. Perl, Keith S. Kaye
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 35 / Issue 3 / March 2014
- Published online by Cambridge University Press:
- 10 May 2016, pp. 213-219
- Print publication:
- March 2014
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Objective.
To determine whether increases in contact isolation precautions are associated with decreased adherence to isolation practices among healthcare workers (HCWs).
Design.Prospective cohort study from February 2009 to October 2009.
Setting.Eleven teaching hospitals.
Participants.HCWs.
Methods.One thousand thirteen observations conducted on HCWs. Additional data included the number of persons in isolation, types of HCWs, and hospital-specific contact precaution practices. Main outcome measures included compliance with individual components of contact isolation precautions (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting) and overall compliance (all 5 measures together) during varying burdens of isolation.
Results.Compliance with hand hygiene was as follows: prior to donning gowns/gloves, 37.2%; gowning, 74.3%; gloving, 80.1%; doffing of gowns/gloves, 80.1%; after gown/glove removal, 61%. Compliance with all components was 28.9%. As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%—4.9%) and with all 5 components (31.5%—6.5%) was observed. In multivariable analysis, there was an increase in noncompliance with all 5 components of the contact isolation precautions bundle (odds ratio [OR], 6.6 [95% confidence interval (CI), 1.15-37.44]; P = .03) and in noncompliance with hand hygiene prior to donning gowns and gloves (OR, 10.1 [95% CI, 1.84—55.54]; P = .008) associated with increasing burden of isolation.
Conclusions.As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases. Placing 40% of patients under contact precautions represents a tipping point for noncompliance with contact isolation precautions measures.
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- By Zachary W. Adams, Margarita Alegría, Atalay Alem, Jordi Alonso, Victor Aparicio, Rifat Atun, Florence Baingana, Emily Baron, Marco Bertelli, Dinesh Bhugra, Sanchita Biswas, José Miguel Caldas de Almeida, Edwin Cameron, Somnath Chatterji, Erminia Colucci, Janice L. Cooper, Carla Kmett Danielson, Diego De Leo, Mary-Jo DelVecchio Good, Marten W. de Vries, Maureen S. Durkin, Xiangming Fang, Julia W. Felton, Sally Field, Andrea Fiorillo, Lance Gable, Teddy Gafna, Sandro Galea, Patrick Gatonga, Sofia Halperin-Goldstein, Yanling He, Grace A. Herbert, Sabrina Hermosilla, Simone Honikman, Takashi Izutsu, Ruwan M. Jayatunge, Janis H. Jenkins, Rachel Jenkins, Lynne Jones, Jayanthi Karunaratne, Ronald C. Kessler, Rob Keukens, Lincoln I. Khasakhala, Hanna Kienzler, Sarah Kippen Wood, M. Thomas Kishore, Robert Kohn, Natasja Koitzsch Jensen, Sheri Lapatin, Anna Lessios, Isabel Louro Bernal, Feijun Luo, Laura MacPherson, Matthew J. Maenner, Anne W. Mbwayo, David McDaid, Ingrid Meintjes, Victoria N. Mutiso, David M. Ndetei, Samuel O. Okpaku, Lijing Ouyang, Ramachandran Padmavati, Clare Pain, Duncan Pedersen, Jordan Pfau, Felipe Picon, Rodney D. Presley, Reima Pryor, Shoba Raja, Thara Rangaswamy, Jorge Rodriguez, Diana Rose, Moosa Salie, Norman Sartorius, Ester Shapiro, Manuela Silva, Daya Somasundaram, Katherine Sorsdahl, Dan J. Stein, Deborah M. Stone, Heather Stuart, Athula Sumathipala, Hema Tharoor, Rita Thom, Lay San Too, Atsuro Tsutsumi, Chris Underhill, Anne Valentine, Claire van der Westhuizen, Thandi van Heyningen, Robert van Voren, Inka Weissbecker, Gail Wyatt
- Edited by Samuel O. Okpaku
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- Essentials of Global Mental Health
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- 05 March 2014
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- 27 February 2014, pp x-xiv
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Essential Clinical Anesthesia
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- 05 January 2012
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- 11 July 2011, pp xv-xxviii
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- By Ashok Agarwal, Joseph P Alukal, Deborah J Anderson, Linda D Applegarth, Saleh Binsaleh, Elizabeth M Bloom, Karen E Boyle, Nancy L Brackett, Robert E Brannigan, James V Bruckner, Victor M Brugh, Ettore Caroppo, Grace M Centola, Aleksander Chudnovsky, Susan L Crockin, Fnu Deepinder, David M. Fenig, Aaron B Grotas, Matthew P. Hardy, Wayne J. G. Hellstrom, Stanton C Honig, Stuart S Howards, Keith Jarvi, Rajasingam S Jeyendran, William E Kaplan, Edward Karpman, Sanjay S Kasturi, Mohit Khera, Nancy A Klein, Dolores J Lamb, Jane M Lewis, Larry I Lipshultz, Kirk C Lo, Charles M Lynne, R. Dale McClure, Antoine A Makhlouf, Myles Margolis, Clara I. Marín-Briggiler, Randall B Meacham, Jesse N Mills, John P Mulhall, Alexander Müller, Christine Mullin, Harris M Nagler, Craig S Niederberger, Robert D Oates, Dana A Ohl, E. Charles Osterberg, Rodrigo L Pagani, Vassilios Papadopoulos, Joseph A Politch, Gail S Prins, Angela A Reese, Susan A Rothmann, Edmund S Sabanegh, Denny Sakkas, Jay I Sandlow, Richard A Schoor, Paulo C Serafini, Mark Sigman, Suresh C Sikka, Rebecca Z Sokol, Jens Sønksen, Miguel Srougi, James Stelling, Justin Tannir, Anthony J Thomas, Paul J Turek, Terry T Turner, Mónica H. Vazquez-Levin, Moshe Wald, Thomas J Walsh, Thomas M Wheeler, Daniel H Williams, Armand Zini, Barry R Zirkin
- Edited by Larry I. Lipshultz, Stuart S. Howards, University of Virginia, Craig S. Niederberger, University of Illinois, Chicago
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- Infertility in the Male
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- 19 May 2010
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- 24 September 2009, pp vii-x
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Incident at Airport X: Quarantine Law and Limits
- Susan M. Allan, Barret W. S. Lane, James J. Misrahi, Richard S. Murray, Grace R. Schuyler, Jason Thomas, Myles V. Lynk
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- Journal:
- Journal of Law, Medicine & Ethics / Volume 35 / Issue S4 / Winter 2007
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- 01 January 2021, p. 117
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- Winter 2007
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