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Autonomic dysfunction in older people
- J Richard G Marigold, Monica Arias, Michael Vassallo, Stephen C. Allen, Joseph SK Kwan
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- Journal:
- Reviews in Clinical Gerontology / Volume 21 / Issue 1 / February 2011
- Published online by Cambridge University Press:
- 15 October 2010, pp. 28-44
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- February 2011
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The autonomic nervous system comprises the sympathetic, parasympathetic and enteric nervous systems and plays an integral role in homeostasis. This includes cardiovascular and temperature control, glucose metabolism, gastrointestinal and reproductive function and increasing evidence to support its involvement in the inflammatory response to infection and cancer. Ageing is associated with autonomic dysfunction, and many clinical syndromes associated with older adults are due to inadequate autonomic responses to physiological stressors. The aim of this review is to explore the relationship between autonomic dysfunction and ageing illustrated with examples of maladaptive autonomic responses in a variety of different clinical syndromes including an exploration of autonomic cellular changes. Appropriate investigation and management strategies are outlined, recognizing the fine balance needed to improve symptoms without creating further medical complications.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. 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Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Antiepileptic drugs for older people
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- Peter Burbridge, Stephen Allen, Michael Vassallo, Joseph Kwan
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- Journal:
- Reviews in Clinical Gerontology / Volume 18 / Issue 1 / February 2008
- Published online by Cambridge University Press:
- 01 February 2008, pp. 1-12
- Print publication:
- February 2008
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Epilepsy in older people is a common problem. It is estimated that in Europe there are 85 000 new cases of epilepsy annually in those over 65 years old, equivalent to an incidence of 100 per 100 000. Incidence increases with age and the rate in older people is higher than in all but the first year of life. The older population has a median prevalence of 4.7 per 1000 (range 3.0 to 7.3) from nine studies and may be underestimated by case-ascertainment bias common to many studies of older people.
Impact of Alcohol-Based, Waterless Hand Antiseptic on the Incidence of Infection and Colonization With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci
- Kwan Kew Lai, Sally Fontecchio, Zita Melvin, Stephen P. Baker
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 27 / Issue 10 / October 2006
- Published online by Cambridge University Press:
- 21 June 2016, pp. 1018-1024
- Print publication:
- October 2006
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Objective:
Colonized and infected inpatients are major reservoirs for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and transient carriage of these pathogens on the hands of healthcare workers remains the most common mechanism of patient-to-patient transmission. We hypothesized that use of alcohol-based, waterless hand antiseptic would lower the incidence of colonization and/or infection with MRSA and VRE.
Methods.On June 19, 2001, alcohol hand antiseptic was introduced at the University campus and not the nearby Memorial campus of the University of Massachusetts Medical School (Worcester, MA), allowing us to evaluate the impact of this antiseptic on the incidence of MRSA and VRE colonization and infection. From January 1 through December 31, 2001, the incidence of MRSA colonization or infection was compared between the 2 campuses before and after the hand antiseptic was introduced. Its effect on VRE colonization and infection was only studied in the medical intensive care unit at the University campus.
Results.At the University campus, the incidence of MRSA colonization or infection decreased from 1.26 cases/1,000 patient-days before the intervention to 0.75 cases/1,000 patient-days after the intervention, for a 1.46-fold decrease (95% confidence interval, 1.04-2.58; P = .037). At the Memorial campus, the incidence of MRSA colonization or infection remained virtually unchanged, from 0.34 cases/1,000 patient-days to 0.49 cases/1,000 patient-days during the same period. However, a separate analysis of the University campus data that controlled for proximity to prevalent cases did not show a significant improvement in the rates of infection or colonization. The incidence of nosocomial VRE colonization or infection before and after the hand antiseptic decreased from 12.0 cases/1,000 patient-days to 3.0 cases/1,000 patient-days, a 2.25-fold decrease (P = .018). Compliance with rectal surveillance for detection of VRE was 86% before and 84% after implementation of the hand antiseptic intervention. The prevalences of VRE cases during these 2 periods were 25% and 29%, respectively (P = .017).
Conclusions.Alcohol hand antiseptic appears to be effective in controlling the transmission of VRE. However, after controlling for proximity to prevalent cases (ie, for clustering), it does not appear to be more effective than standard methods for controlling MRSA. Further controlled studies are needed to evaluate its effectiveness.
The case for strategic international alliances to harness nutritional genomics for public and personal health†
- Jim Kaput, Jose M. Ordovas, Lynnette Ferguson, Ben van Ommen, Raymond L. Rodriguez, Lindsay Allen, Bruce N. Ames, Kevin Dawson, Bruce German, Ronald Krauss, Wasyl Malyj, Michael C. Archer, Stephen Barnes, Amelia Bartholomew, Ruth Birk, Peter van Bladeren, Kent J. Bradford, Kenneth H. Brown, Rosane Caetano, David Castle, Ruth Chadwick, Stephen Clarke, Karine Clément, Craig A. Cooney, Dolores Corella, Ivana Beatrice Manica da Cruz, Hannelore Daniel, Troy Duster, Sven O. E. Ebbesson, Ruan Elliott, Susan Fairweather-Tait, Jim Felton, Michael Fenech, John W. Finley, Nancy Fogg-Johnson, Rosalynn Gill-Garrison, Michael J. Gibney, Peter J. Gillies, Jan-Ake Gustafsson, John L. Hartman IV, Lin He, Jae-Kwan Hwang, Jean-Philippe Jais, Yangsoo Jang, Hans Joost, Claudine Junien, Mitchell Kanter, Warren A. Kibbe, Berthold Koletzko, Bruce R. Korf, Kenneth Kornman, David W. Krempin, Dominique Langin, Denis R. Lauren, Jong Ho Lee, Gilbert A. Leveille, Su-Ju Lin, John Mathers, Michael Mayne, Warren McNabb, John A. Milner, Peter Morgan, Michael Muller, Yuri Nikolsky, Frans van der Ouderaa, Taesun Park, Norma Pensel, Francisco Perez-Jimenez, Kaisa Poutanen, Matthew Roberts, Wim H.M. Saris, Gertrud Schuster, Andrew N. Shelling, Artemis P. Simopoulos, Sue Southon, E. Shyong Tai, Bradford Towne, Paul Trayhurn, Ricardo Uauy, Willard J. Visek, Craig Warden, Rick Weiss, John Wiencke, Jack Winkler, George L. Wolff, Xi Zhao-Wilson, Jean-Daniel Zucker
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- Journal:
- British Journal of Nutrition / Volume 94 / Issue 5 / November 2005
- Published online by Cambridge University Press:
- 08 March 2007, pp. 623-632
- Print publication:
- November 2005
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Nutrigenomics is the study of how constituents of the diet interact with genes, and their products, to alter phenotype and, conversely, how genes and their products metabolise these constituents into nutrients, antinutrients, and bioactive compounds. Results from molecular and genetic epidemiological studies indicate that dietary unbalance can alter gene–nutrient interactions in ways that increase the risk of developing chronic disease. The interplay of human genetic variation and environmental factors will make identifying causative genes and nutrients a formidable, but not intractable, challenge. We provide specific recommendations for how to best meet this challenge and discuss the need for new methodologies and the use of comprehensive analyses of nutrient–genotype interactions involving large and diverse populations. The objective of the present paper is to stimulate discourse and collaboration among nutrigenomic researchers and stakeholders, a process that will lead to an increase in global health and wellness by reducing health disparities in developed and developing countries.
Rapid Eradication of a Cluster of Serratia marcescens in a Neonatal Intensive Care Unit: Use of Epidemiologic Chromosome Profiling by Pulsed-Field Gel Electrophoresis
- Kwan Kew Lai, Stephen P. Baker, Sally A. Fontecchio
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 25 / Issue 9 / September 2004
- Published online by Cambridge University Press:
- 02 January 2015, pp. 730-734
- Print publication:
- September 2004
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Objective:
To investigate a cluster of patients infected and colonized with Serratia marcescens in a neonatal intensive care unit (NICU).
Methods:In June 2001, two neonates in the NICU had clinical infections with S. marcescens and one died. Infection control surveillance data for the NICU revealed that S. marcescens was rarely isolated from clinical specimens. Surveillance and environmental cultures were performed and isolates were typed using pulsed-field gel electrophoresis. Staff and neonates were cohorted and a waterless, alcohol-based handwashing agent was introduced. A case-control study was performed.
Results:From June 2 through August 20, 2001, 11 neonates with S. marcescens infection and colonization were identified. The incidence of S. marcescens infections increased from 0.19 per 1,000 patient-days in 2000 to 0.52 per 1,000 patient-days in 2001 (P < .0001). In the first 3 weeks of the investigation, there were 2 sets of patients and sinks with indistinguishable strains; however, in subsequent weeks, all isolates were of unique strains, signifying no further transmission of the two initial predominant strains. Neonates with S. marcescens were more likely to have a lower gestational age and birth weight. There was no association between cases and healthcare workers (HCWs).
Conclusions:A cluster of S. marcescens was quickly terminated after the introduction of preventive measures including cohorting of infected and colonized neonates and HCWs, contact precautions, surveillance cultures, and a waterless, alcohol-based hand antiseptic. Chromosomal typing determined that strains with an indistinguishable pattern were no longer present in the unit after control measures were implemented.
Impact of a Program of Intensive Surveillance and Interventions Targeting Ventilated Patients in the Reduction of Ventilator-Associated Pneumonia and Its Cost-Effectiveness
- Kwan Kew Lai, Stephen P. Baker, Sally A. Fontecchio
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 24 / Issue 11 / November 2003
- Published online by Cambridge University Press:
- 02 January 2015, pp. 859-863
- Print publication:
- November 2003
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Objective:
We hypothesized that a program of prospective intensive surveillance for ventilator-associated pneumonia (VAP) and concomitant implementations of multimodal, multidisciplinary preventive and intervention strategies would result in a reduction in the incidence of VAP and would be cost-effective.
Setting:Medical and surgical intensive care units (ICUs) in a university teaching hospital.
Interventions:All ventilated patients in the medical and surgical ICUs were monitored for VAP from January 1997 through December 1998. Interventions including elevation of the head of the bed, use of sterile water and replacement of stopcocks with enteral valves for nasogastric feeding tubes, and prolongation of changing of in-line suction catheters from 24 hours to as needed were implemented.
Results:The rates of VAP decreased by 10.8/1,000 ventilator-days in the medical ICU (CI95, 4.65-16.91) and by 17.2/1,000 ventilator-days in the surgical ICU (CI95> 2.85-31.56) when they were compared for 1997 and 1998. With the use of the estimated cost of a VAP of $4,947 from the literature, the reduction resulted in cost savings of $178,092 and $148,410 in the medical and surgical ICUs, respectively, for a total of $326,482. In addition, $25,497 was saved due to the lengthening of the time for the change of in-line suction catheters, resulting in a cost savings of $351,979. This total cost savings of $351,979 minus the cost of enteral valves of $2,100 resulted in total net savings of $349,899.
Conclusion:Intensive surveillance and interventions targeted at ventilated patients resulted in reduction of VAP and appeared to be cost-effective.
The Changing Epidemiology of Vancomycin-Resistant Enterococci
- Kwan Kew Lai, Sally A. Fontecchio, Anita L. Kelley, Stephen Baker, Zita S. Melvin
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 24 / Issue 4 / April 2003
- Published online by Cambridge University Press:
- 02 January 2015, pp. 264-268
- Print publication:
- April 2003
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Objective:
To determine the distribution of vancomycin-resistant enterococci (VRE) cases in our hospital and those from outside of our hospital from 1993 through 1998.
Methods:Weekly rectal surveillance was instituted whenever there were two or more cases present in the units. Cases were divided into acquired in our hospital, acquired outside of our hospital (VRE positive after and within 72 hours of admission, respectively), and indeterminate. Hospital cases were attributed to the originating ward or intensive care unit (ICU) if patients were noted to be positive within 72 hours of transfer.
Results:From 1993 to 1998, the rate of VRE per 1,000 admissions increased threefold, from 3.2 to 9.8, for the hospital. VRE cases acquired outside of the hospital increased by approximately 5% per year (r = 0.87; P = .03). The rate of VRE per 1,000 admissions increased 1.7-fold in the ICUs and 3.6-fold in the wards. The ICUs had an average of 75.3 cases per year, with the number of new cases per year increasing by approximately 9 (r = 0.80; P = .028). In the wards, there were an average of 22.0 new cases per year, with a slight upward trend of 3 additional new cases per year (r = 0.69; P = .64). There was a highly significant increasing linear trend (P = .0007) for VRE colonization and infection.
Conclusion:Although VRE still predominate in the ICUs, cases originating from outside of our hospital and the wards are becoming more common. VRE colonization remained more frequent than infection.
The Epidemiology of Fecal Carriage of Vancomycin-Resistant Enterococci
- Kwan Kew Lai, Sally A Fontecchio, Anita L Kelley, Zita S. Melvin, Stephen Baker
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 18 / Issue 11 / November 1997
- Published online by Cambridge University Press:
- 02 January 2015, pp. 762-765
- Print publication:
- November 1997
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An outbreak of vancomycin-resistant enterococci (VRE) began at the University of Massachusetts Medical Center in May 1993. As of September 1995, we had a total of 253 patients infected or colonized with VRE, with consequent increasing demand for private rooms. We analyzed results of surveillance cultures for VRE of 49 patients known to be colonized or infected with VRE. Of these, 34 (70%) were classified as persistent carriers, defined as patients with at least three consecutively positive cultures from any site taken over at least a 2-week period. The length of carriage varied from 19 to 303 days (median, 41 days); 11 patients were converters, defined as patients with three consecutive negative cultures from all previously colonized sites taken over a 3-week period. These patients were free of VRE for 39 to 421 days (median, 142 days). Four were recolonizers after they were documented to be clear of VRE for 33 to 106 days. VRE carriage tends to be prolonged, and hospitalization of patients with VRE will require continued isolation and contact precautions for control of transmission.
Clostridium difficile-Associated Diarrhea: Epidemiology, Risk Factors, and Infection Control
- Kwan Kew Lai, Zita S. Melvin, Mary Jane Menard, Helen R. Kotilainen, Stephen Baker
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 18 / Issue 9 / September 1997
- Published online by Cambridge University Press:
- 02 January 2015, pp. 628-632
- Print publication:
- September 1997
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Objectives:
To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development.
Setting:370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year.
Methods:Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD.
Results:From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P=.0001 and .0203, respectively) were found to be significant.
Conclusion:Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline.
Self-Generating Zeolite-Cement Composites
- Judith L. Larosa, Stephen Kwan, Michael W. Grutzeck
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- Journal:
- MRS Online Proceedings Library Archive / Volume 245 / 1991
- Published online by Cambridge University Press:
- 15 February 2011, 211
- Print publication:
- 1991
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Zeolites can be synthesized in mixtures containing 80 wt% Class F fly ash and 20 wt% ordinary Portland cement if they are mixed with a concentrated NaOH solution and cured at temperatures of 60–90° C. Zeolite Y and NaP-type zeolite were grown in situ in a coexisting calcium silicate hydrate matrix. Those samples made with NaOH, which contained the zeolites, had higher compressive and flexural strengths than equivalent samples made with water.