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Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition
- Jarrod J Homer, Stuart C Winter, Elizabeth C Abbey, Hiba Aga, Reshma Agrawal, Derfel ap Dafydd, Takhar Arunjit, Patrick Axon, Eleanor Aynsley, Izhar N Bagwan, Arun Batra, Donna Begg, Jonathan M Bernstein, Guy Betts, Colin Bicknell, Brian Bisase, Grainne C Brady, Peter Brennan, Aina Brunet, Val Bryant, Linda Cantwell, Ashish Chandra, Preetha Chengot, Melvin L K Chua, Peter Clarke, Gemma Clunie, Margaret Coffey, Clare Conlon, David I Conway, Florence Cook, Matthew R Cooper, Declan Costello, Ben Cosway, Neil J A Cozens, Grant Creaney, Daljit K Gahir, Stephen Damato, Joe Davies, Katharine S Davies, Alina D Dragan, Yong Du, Mark R D Edmond, Stefano Fedele, Harriet Finze, Jason C Fleming, Bernadette H Foran, Beth Fordham, Mohammed M A S Foridi, Lesley Freeman, Katherine E Frew, Pallavi Gaitonde, Victoria Gallyer, Fraser W Gibb, Sinclair M Gore, Mark Gormley, Roganie Govender, J Greedy, Teresa Guerrero Urbano, Dorothy Gujral, David W Hamilton, John C Hardman, Kevin Harrington, Samantha Holmes, Jarrod J Homer, Deborah Howland, Gerald Humphris, Keith D Hunter, Kate Ingarfield, Richard Irving, Kristina Isand, Yatin Jain, Sachin Jauhar, Sarra Jawad, Glyndwr W Jenkins, Anastasios Kanatas, Stephen Keohane, Cyrus J Kerawala, William Keys, Emma V King, Anthony Kong, Fiona Lalloo, Kirsten Laws, Samuel C Leong, Shane Lester, Miles Levy, Ken Lingley, Gitta Madani, Navin Mani, Paolo L Matteucci, Catriona R Mayland, James McCaul, Lorna K McCaul, Pádraig McDonnell, Andrew McPartlin, Valeria Mercadante, Zoe Merchant, Radu Mihai, Mufaddal T Moonim, John Moore, Paul Nankivell, Sonali Natu, A Nelson, Pablo Nenclares, Kate Newbold, Carrie Newland, Ailsa J Nicol, Iain J Nixon, Rupert Obholzer, James T O'Hara, S Orr, Vinidh Paleri, James Palmer, Rachel S Parry, Claire Paterson, Gillian Patterson, Joanne M Patterson, Miranda Payne, L Pearson, David N Poller, Jonathan Pollock, Stephen Ross Porter, Matthew Potter, Robin J D Prestwich, Ruth Price, Mani Ragbir, Meena S Ranka, Max Robinson, Justin W G Roe, Tom Roques, Aleix Rovira, Sajid Sainuddin, I J Salmon, Ann Sandison, Andy Scarsbrook, Andrew G Schache, A Scott, Diane Sellstrom, Cherith J Semple, Jagrit Shah, Praveen Sharma, Richard J Shaw, Somiah Siddiq, Priyamal Silva, Ricard Simo, Rabin P Singh, Maria Smith, Rebekah Smith, Toby Oliver Smith, Sanjai Sood, Francis W Stafford, Neil Steven, Kay Stewart, Lisa Stoner, Steve Sweeney, Andrew Sykes, Carly L Taylor, Selvam Thavaraj, David J Thomson, Jane Thornton, Neil S Tolley, Nancy Turnbull, Sriram Vaidyanathan, Leandros Vassiliou, John Waas, Kelly Wade-McBane, Donna Wakefield, Amy Ward, Laura Warner, Laura-Jayne Watson, H Watts, Christina Wilson, Stuart C Winter, Winson Wong, Chui-Yan Yip, Kent Yip
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- Journal:
- The Journal of Laryngology & Otology / Volume 138 / Issue S1 / April 2024
- Published online by Cambridge University Press:
- 14 March 2024, pp. S1-S224
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- April 2024
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Inducible nitric oxide releasing poly-(ethylene glycol)-fibrinogen adhesive hydrogels for tissue regeneration
- Margaret Brunette, Hal Holmes, Michael G. Lancina, Weilue He, Bruce P. Lee, Megan C. Frost, Rupak M. Rajachar
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- Journal:
- MRS Online Proceedings Library Archive / Volume 1569 / 2013
- Published online by Cambridge University Press:
- 25 June 2013, pp. 39-44
- Print publication:
- 2013
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Nitric oxide (NO) release can promote healthy tissue regeneration. A PEG-fibrinogen adhesive hydrogel that would allow for inducible NO release was created with mechanical properties that could be tailored to specific applications and tissue types. PEG (4-arm)-fibrinogen hydrogels of varying ratios were derivatized with S-nitroso-N-acetyl-D, L-penicillamine (SNAP)-thiolactone to create an active NO donor material. Controlled release from gels was established using light as the activating source, although temperature, pH, and external mechanical loading are also means to induce active NO release. Gels with varying ratios of fibrinogen to PEG were made, derivatized, and tested. Gels below a ratio of 1.5:1 (fibrinogen:PEG) did not gel, while at ratio of 1.5:1 gelation occurs and NO release can be induced. Interestingly, the release from 1.5:1 gels was significantly lower compared to 2:1 and 3:1 gel formulations. Rheometric data show that lower ratio gels are more elastic than viscous. Derivatized gels exhibited linear elastic moduli, behaving more like other more synthetic hydrogels. Swelling data indicates that as the ratio of fibrinogen to PEG increases the swelling ratio decreases, likely due to the hydrophobic nature of the NO donor. Cells remain viable on both derivatized and non-derivatized gels.
The distribution of carriers of Streptococcus pyogenes among 2,413 healthy children
- Margaret C. Holmes, R. E. O. Williams
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- Journal:
- Journal of Hygiene / Volume 52 / Issue 2 / June 1954
- Published online by Cambridge University Press:
- 15 May 2009, pp. 165-179
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Nose and throat swabs were collected from 2413 healthy children aged 2 weeks to 14 years and examined for Streptococcus pyogenes. The children came from different social levels in three boroughs in Middlesex.
Standardized carrier rates were used to compare the individual effects of age, borough, family age, family size, sex, social class and tonsils on the nose and throat carrier rates.
Community life appeared to facilitate the spread of streptococcal infection: young children aged less than 5 who attended nurseries had higher carrier rates than those of the same age who did not attend day-nurseries. The highest nasal carrier rates were found in the 3- and 4-year-old children attending the day-nurseries. The degree of crowding within the community units did not appear to affect the rates.
The three boroughs had significantly different carrier rates.
Boys were more often carriers than girls.
The unstandardized carrier rates were highest in the lowest social class but this could be explained by the differences in the age, sex and borough distribution of the children sampled in the three social classes, and by the fact that tonsillectomy was, on the average, undertaken later in the lower social classes than in the higher. When these factors were allowed for by standardization, there was no residual difference which could be attributed to social class or housing.
Children with tonsils were more often nose and throat carriers than children who had had their tonsils removed; this was true for all ages, for each of the three boroughs and in each social class.
We are indebted to the Area Medical Officers in Enfield, Southgate and Willesden for their co-operation in the planning of the survey and to the staff in the schools, day-nurseries and clinics where the swabbing was carried out. We are most grateful to Dr P. Armitage for help with the statistical methods and to Miss Eileen Cole for much help with the computing.
Streptococcal infections among children in a residential home: I. Introduction and definitions: the incidence of infection
- Margaret C. Holmes, R. E. O. Williams, C. V. Bloom, Ann Hirch, Ann Lermit, Eileen Woods
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- Journal:
- Journal of Hygiene / Volume 56 / Issue 1 / March 1958
- Published online by Cambridge University Press:
- 15 May 2009, pp. 43-61
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1. In a children's home with an average population of about 460 children aged from 0 to 15 years, 473 attacks of acute sore throat, 354 attacks of otitis and 314
attacks of other acute febrile respiratory tract illness were recorded in the 30 months from November 1950 to April 1953.
2. The attack rate for all forms of illness and at all ages was higher among children in a reception group, who were mostly recently arrived in the home, than it was in the permanent residents.
3. Of all ifinesses with the principal signs or symptoms referable to the throat, the proportion that yielded Streptococcus pyogenes rose from about 34 % in the 1–2-year- old children to about 74% in the children aged 10 years or more. Streptococcal sore throats made up about 8% and about 38 % of all febrile respiratory tract illnesses in the same two age groups.
4. The attack rate for streptococcal sore throat varied from month to month between 0 and 6 5 % of the children at risk; only one period of substantially increased prevalence was observed and there was no indication of any seasonal trend. Non-streptococcal sore throat varied between FO and 20 % per month. It was not possible to recognize any epidemics of streptococcal otitis; non-strepto coccal otitis had a definite winter prevalence associated with the rise in the total of non-streptococcal respiratory disease.
5. There was a slight indication that tonsillectomized children had rather milder attacks of sore throat than non-tonsifiectomized under the routine sulphamezathine treatment adopted. About 86 % of all children stifi harboured the causative streptococcus in their throat on discharge from hospital. The tonsifiectomized children lost their throat, but not their nose, streptococci in convalescence more rapidly that the non-tonsillectomized. Among throat carriers, the tonsifiectomized children carried streptococci in their nose more often than the non-tonsilectomjzed at all stages in their illness and convalescence.
6. Bacteriological examination of excised tonsils did not often reveal the presence of streptococci that had been undetected in throat swabs. Twenty-one of twenty- two children who had had a streptococcal respiratory tract ifiness treated with suiphamezathine within the 3 months preceding their tonsifiectomy were found to harbour the same streptococcus in their tonsifiar tissue; only four of eighteen children whose illness had been treated with penicillin still harboured the streptococcus.
Streptococcal infections in children. I 61
Streptococcal infections among children in a residential home: IV. Outbreaks of infection
- Margaret C. Holmes, R. E. O. Williams, C. V. Bloom, Ann Hirch, Ann Lermit, Eileen Woods
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- Journal:
- Journal of Hygiene / Volume 56 / Issue 2 / June 1958
- Published online by Cambridge University Press:
- 15 May 2009, pp. 211-237
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In a residential home for children, 367 cases of streptococcal illness were observed in a period of 30 months. The children lived in groups of about twelve in separate cottages. There were 194 occasions on which a streptococcus was thought to have been newly introduced into and produced illness in a cottage; on 132 of these 194 occasions there were no secondary cases of illness. The remaining 62 cottage introductions were followed by one or more secondary cases.
In 27% of the 194 introductions, the primary case of illness seemed to have been infected from a healthy person in the cottage. In all, 30% of introductions of a new streptococcus into a cottage could be attributed to recognized contacts with one or more known infected children.
The most important factor determining spread within the cottage seemed to be the carrier state of the primary case, spread following more often when the primary case had streptococci in the nose either on admission to hospital, or in convalescence.
There was no evidence that spread within cottage bedrooms was of great importance.
In about 35% of the incidents with spread, the initial spread to secondary cases seemed to be from the incubation-stage carriage of the introducer; in 42% it was from his or her convalescent carriage.
The carrier rate in the healthy cottage-contacts was generally higher in cottages experiencing clinical spread of infection than in those that had single-case introductions. There was a strong correlation between the carrier rate in the first week after an introduction and the final bacteriological attack rate, and a weaker correlation with the final clinical attack rate.
Continued spread of infection in a cottage was commonly due to the arrival of new children and was almost always associated with the presence of nasal carriers of streptococci.
The 194 cottage introductions could be grouped into sixty-three overlapping Village epidemics, each apparently derving from a new importation of the particular type into the Village, although the evidence for this was often merely the absence of known infections within the previous few months. Only 13% of the introductions resulted in more than 10 cases, and some 80% had 5 or fewer. Introductions were more frequent in the cottages receiving children new to the homes than in those for the more permanent residents.
The principal factor found as determining the spread from the first cottage to others was the attack rate in the first cottage. Introductions in cottages for school-age children, and especially those in which a child attending the school in the Village grounds was the first to be attacked, also seemed to lead to spread more often than others.
The interval between successive Village introductions of one type did not appear to affect the extent of spread at the second; but the number of cases occurring in the first of two introductions had a notable effect: in no case did two successive introductions both result in a large number of cases of illness.
A study of rheumatic fever and streptococcal infection in different social groups in Melbourne
- Margaret C. Holmes, Sydney D. Rubbo
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- Journal:
- Journal of Hygiene / Volume 51 / Issue 4 / December 1953
- Published online by Cambridge University Press:
- 15 May 2009, pp. 450-457
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1. Hospital records of 1469 cases of rheumatic fever (including chorea) up to the age of 14 years were used to study the social distribution of the disease in Melbourne. On this evidence the incidence of rheumatic fever was three times greater in low than in high rental districts.
2. The results of throat-swab surveys and Dick tests on schoolchildren living in different districts showed that children in the poor districts contracted streptococcal infections more frequently than those in well-to-do districts.
3. One factor associated with the carrier rate of Streptococcus pyogenes in the various social groups was the incidence of tonsillectomy. In the better class districts where the tonsillectomy rate was high (60%) the Str. pyogenes carrier rate was 12.5%, whereas the rates in poor areas were 35 and 25.3% respectively.
4. Differences in social incidence of rheumatic fever might therefore be explained by differences in social incidence of streptococcal infection, which, in turn, might be influenced by the incidence of tonsillectomy.
We wish to thank the many persons who so willingly assisted in the collection of data for this study, particularly Dr H. L. Stokes and Dr M. M. Wilson, and Dr R. E. O. Williams for advice on presentation. This work was supported by a grant to one of us (Dr M. C. Holmes) from the Commonwealth Research Fund from the University of Melbourne.
Streptococcal infections among children in a residential home: III. Some factors influencing susceptibility to infection
- Margaret C. Holmes, R. E. O. Williams, C. V. Bloom, Ann Hirch, Lermit, Eileen Woods
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- Journal:
- Journal of Hygiene / Volume 56 / Issue 2 / June 1958
- Published online by Cambridge University Press:
- 15 May 2009, pp. 197-210
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Children in a residential home whose tonsils had been removed had lower attack rates for streptococcal sore throat than tonsillectomized children. Tonsillectomy did not have a consistent effect on respiratory tract illness.
Tonsillectomy has a similar effect on the outcome of individual exposures to streptococcal infection; the difference was more marked for illness than for simple colonization.
The apparent benefit from tonsillectomy could not be attributed to the ageing of the child, and was considered real. Its magnitude did not seem, however, great enough to justify a policy of extensive tonsillectomy, particularly in view of the possible risks to the child.
A child who had been ill with infection due to one streptococcal type rarely became ill when re-exposed to the same type. In addition there was some evidence in children with tonsils of an immunity, perhaps short lived, which was clearly not type-specific.
Streptococcal infections among children in a residential home: II. Potential sources of infection for individuals
- Margaret C. Holmes, R. E. O. Williams, C. V. Bloom, Ann Hirch, Ann Lermit, Eileen Woods
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- Journal:
- Journal of Hygiene / Volume 56 / Issue 1 / March 1958
- Published online by Cambridge University Press:
- 15 May 2009, pp. 62-72
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1. For each case of streptococcal illness—sore throat, otitis, or other respiratory tract illness—observed in a 30-month study in a large children's home an attempt was made to enumerate the infected contacts from whom the infection might have been derived.
2. Of 459 illnesses, 10·5% seemed to be relapses of a previous illness, and in 10·0% the child was known to have been carrying streptococci for more than 7 days before sickening, so that the causal relation of the streptococcus is in doubt.
3. Of the 365 other illnesses, 31·5% could be attributed with varying degrees of confidence to infection from one specified carrier, 36·8% could have been derived from one or more recognized contacts although there was not sufficient evidence to specify one in particular. For 17·5% no infected contacts were recognized, but infection with the particular streptococcus was known to be present in the community; and for 9·3% there were no contacts and the streptococcus was not known to be present in the Village.
4. Of the ninety-four illnesses for which the source could be specified as one particular carrier, 66% were derived from heavy nasal, 19% from light nasal, and 15% from throat carriers. Persons incubating a streptococcal illness and healthy carriers were each responsible for 31% of the illnesses and convalescent carriers for 38%.
5. It seemed that at least 50% of all illnesses could have been contracted from contacts within the cottage; the proportion due to school infection was much more difficult to estimate but was at least 12%.