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1.  Pandemic Influenza Planning: Shouldn’t Swine and Poultry Workers Be Included? 
Vaccine  2007;25(22):4376-4381.
Recent research has demonstrated that swine and poultry professionals, especially those who work in large confinement facilities, are at markedly increased risk of zoonotic influenza virus infections. In serving as a bridging population for influenza virus spread between animals and man, these workers may introduce zoonotic influenza virus into their homes and communities as well as expose domestic swine and poultry to human influenza viruses. Prolonged and intense occupational exposures of humans working in swine or poultry confinement buildings could facilitate the generation of novel influenza viruses, as well as accelerate human influenza epidemics. Because of their potential bridging role, we posit that such workers should be recognized as a priority target group for annual influenza vaccines and receive special training to reduce the risk of influenza transmission. They should also be considered for increased surveillance and priority receipt of pandemic vaccines and antivirals.
doi:10.1016/j.vaccine.2007.03.036
PMCID: PMC1939697  PMID: 17459539
influenza; zoonoses; occupational exposure; communicable diseases; emerging; agriculture
2.  Natural History, Microbes and Sequences: Shouldn't We Look Back Again to Organisms? 
PLoS ONE  2011;6(8):e21334.
The discussion on the existence of prokaryotic species is reviewed. The demonstration that several different mechanisms of genetic exchange and recombination exist has led some to a radical rejection of the possibility of bacterial species and, in general, the applicability of traditional classification categories to the prokaryotic domains. However, in spite of intense gene traffic, prokaryotic groups are not continuously variable but form discrete clusters of phenotypically coherent, well-defined, diagnosable groups of individual organisms. Molecularization of life sciences has led to biased approaches to the issue of the origins of biodiversity, which has resulted in the increasingly extended tendency to emphasize genes and sequences and not give proper attention to organismal biology. As argued here, molecular and organismal approaches that should be seen as complementary and not opposed views of biology.
doi:10.1371/journal.pone.0021334
PMCID: PMC3156702  PMID: 21857904
3.  Evidence-based ethics – What it should be and what it shouldn't 
BMC Medical Ethics  2008;9:16.
Background
The concept of evidence-based medicine has strongly influenced the appraisal and application of empirical information in health care decision-making. One principal characteristic of this concept is the distinction between "evidence" in the sense of high-quality empirical information on the one hand and rather low-quality empirical information on the other hand. In the last 5 to 10 years an increasing number of articles published in international journals have made use of the term "evidence-based ethics", making a systematic analysis and explication of the term and its applicability in ethics important.
Discussion
In this article four descriptive and two normative characteristics of the general concept "evidence-based" are presented and explained systematically. These characteristics are to then serve as a framework for assessing the methodological and practical challenges of evidence-based ethics as a developing methodology. The superiority of evidence in contrast to other empirical information has several normative implications such as the legitimization of decisions in medicine and ethics. This implicit normativity poses ethical concerns if there is no formal consent on which sort of empirical information deserves the label "evidence" and which does not. In empirical ethics, which relies primarily on interview research and other methods from the social sciences, we still lack gold standards for assessing the quality of study designs and appraising their findings.
Conclusion
The use of the term "evidence-based ethics" should be discouraged, unless there is enough consensus on how to differentiate between high- and low-quality information produced by empirical ethics. In the meantime, whenever empirical information plays a role, the process of ethical decision-making should make use of systematic reviews of empirical studies that involve a critical appraisal and comparative discussion of data.
doi:10.1186/1472-6939-9-16
PMCID: PMC2576300  PMID: 18937838
9.  “Shouldn't we do something about the fire?” 
BMJ : British Medical Journal  2000;320(7243):1196.
PMCID: PMC1127587  PMID: 10784549
15.  If I shouldn't spank, what should I do? Behavioural techniques for disciplining children. 
Canadian Family Physician  2000;46:1119-1123.
OBJECTIVE: To provide family physicians with a guide for evaluating discipline problems, giving suggestions for parental guidance, and diagnosing problems when discipline guidance fails. QUALITY OF EVIDENCE: A MEDLINE and PsycINFO search from 1990 to the present produced articles reviewing research on aspects of discipline. Case-control studies, expert opinion, and position statements published by the American Academy of Pediatrics and the Canadian Paediatric Society were chosen as a basis for this article. In a special supplement in 1996, a pediatric journal reviewed the controversy of spanking as an effective disciplinary method, with comments by noted researchers and clinicians. Other authors reviewed research evaluating discipline techniques. MAIN MESSAGE: Discipline problems require evaluation of children, parents, and parent-child relationships, including assessment of child development and evaluation of parenting skills and parental stressors. Parents can learn techniques more effective than spanking. Physicians can review discipline strategies and guide parents through difficult situations. Monitoring progress is important, and immediate reassessment of the situation if techniques are failing or referral to a specialist will increase the chances of a successful intervention. CONCLUSION: Discipline problems are complex and require careful assessment. Guiding parents during these types of problems requires close follow up and reevaluation when methods do not have the expected effect.
PMCID: PMC2144894  PMID: 10845138
17.  Confidentiality: what everyone should know, or, rather, shouldn't … 
doi:10.3399/bjgp08X277131
PMCID: PMC2233971  PMID: 18307866
21.  Who Is Monitoring Your Infections: Shouldn't You Be?* 
Surgical Infections  2009;10(1):59-64.
Abstract
Background
In the era of pay for performance and outcome comparisons among institutions, it is imperative to have reliable and accurate surveillance methodology for monitoring infectious complications. The current monitoring standard often involves a combination of prospective and retrospective analysis by trained infection control (IC) teams. We have developed a medical informatics application, the Surgical Intensive Care-Infection Registry (SIC-IR), to assist with infection surveillance. The objectives of this study were to: (1) Evaluate for differences in data gathered between the current IC practices and SIC-IR; and (2) determine which method has the best sensitivity and specificity for identifying ventilator-associated pneumonia (VAP).
Methods
A prospective analysis was conducted in two surgical and trauma intensive care units (STICU) at a level I trauma center (Unit 1: 8 months, Unit 2: 4 months). Data were collected simultaneously by the SIC-IR system at the point of patient care and by IC utilizing multiple administrative and clinical modalities. Data collected by both systems included patient days, ventilator days, central line days, number of VAPs, and number of catheter-related blood steam infections (CR-BSIs). Both VAPs and CR-BSIs were classified using the definitions of the U.S. Centers for Disease Control and Prevention. The VAPs were analyzed individually, and true infections were defined by a physician panel blinded to methodology of surveillance. Using these true infections as a reference standard, sensitivity and specificity for both SIC-IR and IC were determined.
Results
A total of 769 patients were evaluated by both surveillance systems. There were statistical differences between the median number of patient days/month and ventilator-days/month when IC was compared with SIC-IR. There was no difference in the rates of CR-BSI/1,000 central line days per month. However, VAP rates were significantly different for the two surveillance methodologies (SIC-IR: 14.8/1,000 ventilator days, IC: 8.4/1,000 ventilator days; p = 0.008). The physician panel identified 40 patients (5%) who had 43 VAPs. The SICIR identified 39 and IC documented 22 of the 40 patients with VAP. The SIC-IR had a sensitivity and specificity of 97% and 100%, respectively, for identifying VAP and for IC, a sensitivity of 56% and a specificity of 99%.
Conclusions
Utilizing SIC-IR at the point of patient care by a multidisciplinary STICU team offers more accurate infection surveillance with high sensitivity and specificity. This monitoring can be accomplished without additional resources and engages the physicians treating the patient.
doi:10.1089/sur.2008.056
PMCID: PMC2963596  PMID: 19250007
22.  Editorial: The Tail Shouldn’t Wag the Dog 
Journal of Digital Imaging  2004;17(3):147-148.
doi:10.1007/s10278-004-1011-9
PMCID: PMC3046607  PMID: 15534749
24.  Pest and Disease Management: Why We Shouldn't Go against the Grain 
PLoS ONE  2013;8(9):e75892.
Given the wide range of scales and mechanisms by which pest or disease agents disperse, it is unclear whether there might exist a general relationship between scale of host heterogeneity and spatial spread that could be exploited by available management options. In this model-based study, we investigate the interaction between host distributions and the spread of pests and diseases using an array of models that encompass the dispersal and spread of a diverse range of economically important species: a major insect pest of coniferous forests in western North America, the mountain pine beetle (Dendroctonus ponderosae); the bacterium Pseudomonas syringae, one of the most-widespread and best-studied bacterial plant pathogens; the mosquito Culex erraticus, an important vector for many human and animal pathogens, including West Nile Virus; and the oomycete Phytophthora infestans, the causal agent of potato late blight. Our model results reveal an interesting general phenomenon: a unimodal (‘humpbacked’) relationship in the magnitude of infestation (an index of dispersal or population spread) with increasing grain size (i.e., the finest scale of patchiness) in the host distribution. Pest and disease management strategies targeting different aspects of host pattern (e.g., abundance, aggregation, isolation, quality) modified the shape of this relationship, but not the general unimodal form. This is a previously unreported effect that provides insight into the spatial scale at which management interventions are most likely to be successful, which, notably, do not always match the scale corresponding to maximum infestation. Our findings could provide a new basis for explaining historical outbreak events, and have implications for biosecurity and public health preparedness.
doi:10.1371/journal.pone.0075892
PMCID: PMC3786923  PMID: 24098739
25.  Intensive medicine – Guidelines on Parenteral Nutrition, Chapter 14 
In intensive care patients parenteral nutrition (PN) should not be carried out when adequate oral or enteral nutrition is possible. Critically ill patients without symptoms of malnutrition, who probably cannot be adequately nourished enterally for a period of <5 days, do not require full PN but should be given at least a basal supply of glucose. Critically ill patients should be nourished parenterally from the beginning of intensive care if they are unlikely to be adequately nourished orally or enterally even after 5–7 days. Critically ill and malnourished patients should, in addition to a possible partial enteral nutrition, be nourished parenterally. Energy supply should not be constant, but should be adapted to the stage, the disease has reached. Hyperalimentation should be avoided at an acute stage of disease in any case. Critically ill patients should be given, as PN, a mixture consisting of amino acids (between 0.8 and 1.5 g/kg/day), carbohydrates (around 60% of the non-protein energy) and fat (around 40% of the non-protein energy) as well as electrolytes and micronutrients.
doi:10.3205/000073
PMCID: PMC2795375  PMID: 20049075
substrate supply; critically ill; sepsis; intensive care

Results 1-25 (38849)