anjum khan | London College of Fashion (original) (raw)

Papers by anjum khan

Research paper thumbnail of From club to classroom: toward a unified framework for developing virtual environment applications

ICC 2001. IEEE International Conference on Communications. Conference Record (Cat. No.01CH37240)

Research paper thumbnail of Studies on winding number and Cauchy integral formula

Research paper thumbnail of Image De-noising with a New Threshold Value Using Wavelets

Journal of Data Science, 2021

The image de-noising is the process to remove the noise from the image naturally corrupted by the... more The image de-noising is the process to remove the noise from the image naturally corrupted by the noise. The wavelet method is one among the various methods for recovering infinite dimensional objects like curves, densities, images etc. The wavelet techniques are very effective to remove the noise because of its ability to capture the energy of a signal in few energy transform values. The wavelet methods are based on shrinking the wavelet coefficients in the wavelet domain. This paper concentrates on selecting a threshold for wavelet function estimation. A new threshold value is proposed to shrink the wavelet coefficients obtained by wavelet decomposition of a noisy image by considering that the sub band coefficients have a generalized Gaussian distribution. The proposed threshold value is based on the power of 2 in the size 2 J × 2 J of the data that can be computed efficiently. The experiment has been conducted on various test images to compare with the established threshold parameters. The result shows that the proposed threshold value removes the noise significantly.

Research paper thumbnail of Abstract #915: Positive Positron Emission Tomographic Scan in a Patient with Papillary Thyroid Cancer and Cervical Lymphadenopathy: An Unusual Diagnosis of Scrofula

Research paper thumbnail of Poor English Skills among Visually Impaired Students, Overall Growth Retardation

Shanlax International Journal of English, 2020

The present paper identifies ‘poor English skills’ among visually impaired students as one of the... more The present paper identifies ‘poor English skills’ among visually impaired students as one of the most drastic challenges at the higher education level. It attempts to cogitate on the factors which pave the way for this stark condition. To analyze the causes for this stipulation, two relevant case studies are furnished. An appraisal of these cases facilitates in understanding the downside of the existing systems in schools. The magnitude of the problem advocates intervention at the basic and early levels.

Research paper thumbnail of Preoperative Parathyroid Localization: Prospective Evaluation of Technetium 99m Sestamibi

Otolaryngology–Head and Neck Surgery, 1994

The utility of preoperative parathyroid localization remains controversial. The gold standard for... more The utility of preoperative parathyroid localization remains controversial. The gold standard for Identification of abnormal parathyroid glands is exploration of the neck by an experienced surgeon. However, both for the experienced and less experienced surgeon. It may be desirable to localize the abnormality before surgery. Such a study would not only direct the surgeon to the site of the lesion but also would help reduce unnecessary dissection, the number of negative explorations, and operative anesthesia time. Unfortunately, currently used noninvasive techniques including ultrasonography, thalllum-technetium subtraction, computed tomography scan, and magnetic resonance Imaging have had only limited success (35% to 78%) In demonstrating abnormal parathyroid glands. Thirty patients with proven hyperparathyroidism were enrolled to compare a new imaging agent, technetium 99m sestamibi, as an alternative to thallium 201 for subtraction scintigraphy with technetium 99m pertechnetate. On...

Research paper thumbnail of Computer Implemented Reporting System and Method

Research paper thumbnail of Lateral dissemination and inter-patient transmission of blaKPC-3: role of a conjugative plasmid in spreading carbapenem resistance

The Journal of antimicrobial chemotherapy, Jan 30, 2015

The objective of this study was to describe the nosocomial spread of carbapenemase-producing ente... more The objective of this study was to describe the nosocomial spread of carbapenemase-producing enterobacteria and characterize a plasmid involved in KPC dissemination. Two Klebsiella pneumoniae, one Escherichia coli and one Citrobacter freundii isolated from two patients were studied. Susceptibility profiles were obtained using Etest. Carbapenemase activity was detected using the Carba NP test. β-Lactamase gene content was screened by PCR and sequencing. K. pneumoniae isolates were genotyped by MLST and PFGE. KPC plasmid sizes were estimated by S1-DNA digestion and PFGE-Southern blot. Plasmids were sequenced using Illumina's technology and Sanger sequencing. Two patients sharing a room on a surgical unit were positive for carbapenemase-producing K. pneumoniae. One patient was also colonized with carbapenemase-producing C. freundii and E. coli. Neither patient had known risk factors for carbapenemase acquisition, although one patient had recent surgery at another Toronto hospital; ...

Research paper thumbnail of Rapid control of a methicillin resistant Staphylococcus aureus (MRSA) outbreak in a medical surgical intensive care unit (ICU)

The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prévention des infections / Association pour la prévention des infections a l'hôpital et dans la communaute-Canada ; CHICA-CANADA, 2009

Outbreaks of methicillin resistant Staphylococcus aureus in the intensive care unit setting can b... more Outbreaks of methicillin resistant Staphylococcus aureus in the intensive care unit setting can be prolonged and difficult to control. This report describes the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a 24-bed open-concept medical surgical intensive care unit with a baseline methicillin resistant Staphylococcus aureus acquisition rate of 1.5 cases per 1000 patient days. This institution's infection control policy mandates an outbreak investigation if two cases of hospital-acquired methicillin resistant Staphylococcus aureus colonization or infection are identified in an intensive care unit within a four-week period. In July 2007, methicillin resistant Staphylococcus aureus was identified in the sputum of two patients within a one-week period. Screening of all patients in the intensive care unit identified one additional case and a fourth case was identified from a clinical specimen before control measures were implemented. Initial control m...

Research paper thumbnail of Abdominoplasty Technique: A Personal Approach

Aesthetic Surgery of the Abdominal Wall

The abdominoplasty procedure needs to be tailored to the trunk anatomy and to the aesthetic goals... more The abdominoplasty procedure needs to be tailored to the trunk anatomy and to the aesthetic goals. Those with a small amount of infraumbilical protuberance without excess skin may be treated with endoscopic muscle plication and abdominal liposuction [1, 2]. An open approach is used when the skin tone is poor. There is a moderate to large amount of excess fat and moderate to severe abdominal wall laxity. Procedures range from amini-abdominoplasty with inferior translation of the umbilicus with or withoutmuscle plication to the most extensive version with massive dermatolipectomy, plication of the rectus sheath (for the treatment of the muscle diastasis) and transposition of the umbilicus to a new location in the abdominal wall skin [3, 4]. High lateral tension with fascial suspension, advancement of the external oblique fascia and liposuction have been useful additional maneuvers to define the waistline further, especially when dealing with severe abdominal wall deformities [5–7]. All the functional and cosmetic concerns of the abdominal wall may be met by utilizing our comprehensive approach. A significant elevation of the mons pubis and the upper anterolateral thigh occurs with this technique. By restoring appropriate tension to the abdominal musculature, the individual’s posture improves and tension is diminished in the lumbar spinal muscles [8].

Research paper thumbnail of Persistent Primary Hyperparathyroidism Caused by Adenomas Identified in Pharyngeal or Adjacent Structures

World Journal of Surgery, 2003

Abnormalities in the normal migration of the parathyroid glands during embryological development ... more Abnormalities in the normal migration of the parathyroid glands during embryological development of the head and neck may result in considerable variability in the location of parathyroid tissue. Ectopic parathyroid adenomas present diagnostic and technical challenges and are frequently the cause of persistent primary hyperparathyroidism (HPT) after unsuccessful initial parathyroid surgery. We report a series of eight patients with persistent primary HPT who had adenomas in rare and unusual locations associated with various pharyngeal structures. Four were located within the epineurium of the vagus nerve at or above the level of the carotid bifurcation, and four were located within the paranasopharyngeal space or oropharynx. Noninvasive and invasive preoperative imaging studies were crucial in localizing the neoplasms in these patients and permitted the use of a direct surgical approach, resulting in cure in all patients and a low complication rate. The location of parathyroid glands in high pharyngeal and cervical structures is a consequence of anomalous or arrested descent through developing pharyngeal structures and illustrates the remarkable spectrum of ectopic parathyroid adenomas that occur secondary to this phenomenon.

Research paper thumbnail of Clinical evoked electromyography for recurrent laryngeal nerve preservation: Use of an endotracheal tube electrode and a postcricoid surface electrode

Research paper thumbnail of P052Diagnosis & Recurrence of Follicular Dendritic Cell Sarcoma

Otolaryngology - Head and Neck Surgery, 2006

Research paper thumbnail of The cardiac atria are chambers of active remodeling and dynamic collagen turnover during evolving heart failure

Journal of the American College of Cardiology, 2004

The role of atrial myocytes and extracellular matrix (ECM) changes in atrial chamber remodeling w... more The role of atrial myocytes and extracellular matrix (ECM) changes in atrial chamber remodeling was studied in a canine model of heart failure (HF). BACKGROUND Cardiac remodeling is a key process mediating the progression of HF. Studies of the structural mechanisms of cardiac remodeling have been limited to the left ventricle. The structural alterations associated with atrial chamber remodeling in evolving HF have not been studied. METHODS Age-and weight-matched dogs were subjected to right ventricular pacing (240 beats/min) for one and three weeks to produce early and severe HF, respectively. Atrial tissues were assessed for myocyte and ECM changes. RESULTS Right atrial and left atrial (LA) pressures were significantly increased in early and severe HF. The LA wall tension index was significantly increased at both HF stages by 116% and 443%, respectively. Atrial collagen synthesis and degradation were significantly increased in severe HF. Gelatinase activity was significantly increased at both early and severe stages of HF. Gelatin zymography showed increased matrix metalloproteinases (MMP)-9 with early HF and increased MMP-2 with severe HF. The LA wall tension index was significantly correlated with gelatinase activity and collagen synthesis. Although total atrial collagen content was not changed, disarray of collagen fibers was observed. Atrial myocyte hypertrophy without evidence of apoptosis was also present in severe HF. CONCLUSIONS There is marked atrial chamber remodeling in canine pacing-induced HF, which is characterized by myocyte hypertrophy and dynamic collagen turnover. Atrial remodeling may contribute to the development of atrial arrhythmias and pulmonary hypertension and could offer a novel therapeutic target.

Research paper thumbnail of On the use of electrical-resistance foil strain gages for plastic-wave studies in solids

Experimental Mechanics, 1988

The use of electrical-resistance foil strain gages for the measurement of plastic-wave profiles i... more The use of electrical-resistance foil strain gages for the measurement of plastic-wave profiles is investigated. It is shown that the wave speeds and maximum strains are obtained to about the same accuracy as optical techniques. It should be noted that the plastic wave speed and the maximum strain are the two most important parameters which are used to infer dynamic response of a material.

Research paper thumbnail of Unilateral vs Bilateral Parathyroid Gland Exploration

Archives of Otolaryngology–Head & Neck Surgery, 1998

Research paper thumbnail of Rapid control of a scabies outbreak at a tertiary care hospital without ward closure

American Journal of Infection Control, 2012

Background: Although scabies outbreaks in hospitals are frequent, the optimal approach to managem... more Background: Although scabies outbreaks in hospitals are frequent, the optimal approach to management of these outbreaks has not yet been defined. We describe a hospital scabies outbreak that was successfully controlled without ward closure. Methods: An outbreak of scabies at a teaching hospital and subsequent control measures were investigated. Outcomes included the number of cases affecting patients and staff, number of patients and staff requiring prophylaxis, duration of the outbreak, and cost of the outbreak. Outcomes were compared with those in a similar outbreak occurring at the same hospital 20 years earlier and with other published descriptions of hospital scabies outbreaks. Results: In January 2010, a patient who had undergone renal transplantation was admitted 3 times to St. Michael's Hospital, but a diagnosis of scabies was not considered until the final admission. Widespread exposure of patients and staff on 2 wards prompted the establishment of an outbreak management team. Initial interventions focused on isolation and treatment of the index case and on contact tracing to identify and treat secondary cases and to offer prophylaxis to direct contacts. Five symptomatic staff members and 2 patient cases were quickly identified, an outbreak was declared, and mass simultaneous prophylaxis was initiated on the 2 involved wards. A single case occurred 2 weeks after the mass prophylaxis program in a staff member who had not received the prophylaxis. Six weeks after the onset of symptoms, the end of the outbreak was declared. No additional cases have been reported up to the time of publication. The total cost of the outbreak was $20,000. Conclusions: Early recognition of crusted scabies is essential to prevent outbreaks. Once an outbreak occurs, prompt control of the index patient and rapid tracing of contacts to identify secondary cases are necessary. When prolonged exposure to a case of crusted scabies results in multiple secondary cases, institution of simultaneous mass prophylaxis is the most efficient strategy for terminating the outbreak and can be implemented without ward closure.

Research paper thumbnail of Use of audit and feedback with fluorescent targeting to achieve rapid improvements in room cleaning in the intensive care unit and ward settings

American Journal of Infection Control, 2012

Environmental contamination of high-touch surfaces in patient rooms can lead to the transmission ... more Environmental contamination of high-touch surfaces in patient rooms can lead to the transmission of clinically significant pathogens; thus, such surfaces should be cleaned routinely and thoroughly. Fluorescent targeting can be used to provide feedback to frontline cleaning staff on the thoroughness of room cleaning, which can result in substantial improvements in performance. We demonstrate that auditing with fluorescent targeting can be implemented in both the ward and intensive care unit settings using only modest resources, resulting in rapid improvements in cleaning thoroughness.

Research paper thumbnail of Diagnosis and recurrence of follicular dendritic cell sarcoma

Otolaryngology - Head and Neck Surgery, 2007

Research paper thumbnail of From club to classroom: toward a unified framework for developing virtual environment applications

ICC 2001. IEEE International Conference on Communications. Conference Record (Cat. No.01CH37240)

Research paper thumbnail of Studies on winding number and Cauchy integral formula

Research paper thumbnail of Image De-noising with a New Threshold Value Using Wavelets

Journal of Data Science, 2021

The image de-noising is the process to remove the noise from the image naturally corrupted by the... more The image de-noising is the process to remove the noise from the image naturally corrupted by the noise. The wavelet method is one among the various methods for recovering infinite dimensional objects like curves, densities, images etc. The wavelet techniques are very effective to remove the noise because of its ability to capture the energy of a signal in few energy transform values. The wavelet methods are based on shrinking the wavelet coefficients in the wavelet domain. This paper concentrates on selecting a threshold for wavelet function estimation. A new threshold value is proposed to shrink the wavelet coefficients obtained by wavelet decomposition of a noisy image by considering that the sub band coefficients have a generalized Gaussian distribution. The proposed threshold value is based on the power of 2 in the size 2 J × 2 J of the data that can be computed efficiently. The experiment has been conducted on various test images to compare with the established threshold parameters. The result shows that the proposed threshold value removes the noise significantly.

Research paper thumbnail of Abstract #915: Positive Positron Emission Tomographic Scan in a Patient with Papillary Thyroid Cancer and Cervical Lymphadenopathy: An Unusual Diagnosis of Scrofula

Research paper thumbnail of Poor English Skills among Visually Impaired Students, Overall Growth Retardation

Shanlax International Journal of English, 2020

The present paper identifies ‘poor English skills’ among visually impaired students as one of the... more The present paper identifies ‘poor English skills’ among visually impaired students as one of the most drastic challenges at the higher education level. It attempts to cogitate on the factors which pave the way for this stark condition. To analyze the causes for this stipulation, two relevant case studies are furnished. An appraisal of these cases facilitates in understanding the downside of the existing systems in schools. The magnitude of the problem advocates intervention at the basic and early levels.

Research paper thumbnail of Preoperative Parathyroid Localization: Prospective Evaluation of Technetium 99m Sestamibi

Otolaryngology–Head and Neck Surgery, 1994

The utility of preoperative parathyroid localization remains controversial. The gold standard for... more The utility of preoperative parathyroid localization remains controversial. The gold standard for Identification of abnormal parathyroid glands is exploration of the neck by an experienced surgeon. However, both for the experienced and less experienced surgeon. It may be desirable to localize the abnormality before surgery. Such a study would not only direct the surgeon to the site of the lesion but also would help reduce unnecessary dissection, the number of negative explorations, and operative anesthesia time. Unfortunately, currently used noninvasive techniques including ultrasonography, thalllum-technetium subtraction, computed tomography scan, and magnetic resonance Imaging have had only limited success (35% to 78%) In demonstrating abnormal parathyroid glands. Thirty patients with proven hyperparathyroidism were enrolled to compare a new imaging agent, technetium 99m sestamibi, as an alternative to thallium 201 for subtraction scintigraphy with technetium 99m pertechnetate. On...

Research paper thumbnail of Computer Implemented Reporting System and Method

Research paper thumbnail of Lateral dissemination and inter-patient transmission of blaKPC-3: role of a conjugative plasmid in spreading carbapenem resistance

The Journal of antimicrobial chemotherapy, Jan 30, 2015

The objective of this study was to describe the nosocomial spread of carbapenemase-producing ente... more The objective of this study was to describe the nosocomial spread of carbapenemase-producing enterobacteria and characterize a plasmid involved in KPC dissemination. Two Klebsiella pneumoniae, one Escherichia coli and one Citrobacter freundii isolated from two patients were studied. Susceptibility profiles were obtained using Etest. Carbapenemase activity was detected using the Carba NP test. β-Lactamase gene content was screened by PCR and sequencing. K. pneumoniae isolates were genotyped by MLST and PFGE. KPC plasmid sizes were estimated by S1-DNA digestion and PFGE-Southern blot. Plasmids were sequenced using Illumina's technology and Sanger sequencing. Two patients sharing a room on a surgical unit were positive for carbapenemase-producing K. pneumoniae. One patient was also colonized with carbapenemase-producing C. freundii and E. coli. Neither patient had known risk factors for carbapenemase acquisition, although one patient had recent surgery at another Toronto hospital; ...

Research paper thumbnail of Rapid control of a methicillin resistant Staphylococcus aureus (MRSA) outbreak in a medical surgical intensive care unit (ICU)

The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prévention des infections / Association pour la prévention des infections a l'hôpital et dans la communaute-Canada ; CHICA-CANADA, 2009

Outbreaks of methicillin resistant Staphylococcus aureus in the intensive care unit setting can b... more Outbreaks of methicillin resistant Staphylococcus aureus in the intensive care unit setting can be prolonged and difficult to control. This report describes the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a 24-bed open-concept medical surgical intensive care unit with a baseline methicillin resistant Staphylococcus aureus acquisition rate of 1.5 cases per 1000 patient days. This institution's infection control policy mandates an outbreak investigation if two cases of hospital-acquired methicillin resistant Staphylococcus aureus colonization or infection are identified in an intensive care unit within a four-week period. In July 2007, methicillin resistant Staphylococcus aureus was identified in the sputum of two patients within a one-week period. Screening of all patients in the intensive care unit identified one additional case and a fourth case was identified from a clinical specimen before control measures were implemented. Initial control m...

Research paper thumbnail of Abdominoplasty Technique: A Personal Approach

Aesthetic Surgery of the Abdominal Wall

The abdominoplasty procedure needs to be tailored to the trunk anatomy and to the aesthetic goals... more The abdominoplasty procedure needs to be tailored to the trunk anatomy and to the aesthetic goals. Those with a small amount of infraumbilical protuberance without excess skin may be treated with endoscopic muscle plication and abdominal liposuction [1, 2]. An open approach is used when the skin tone is poor. There is a moderate to large amount of excess fat and moderate to severe abdominal wall laxity. Procedures range from amini-abdominoplasty with inferior translation of the umbilicus with or withoutmuscle plication to the most extensive version with massive dermatolipectomy, plication of the rectus sheath (for the treatment of the muscle diastasis) and transposition of the umbilicus to a new location in the abdominal wall skin [3, 4]. High lateral tension with fascial suspension, advancement of the external oblique fascia and liposuction have been useful additional maneuvers to define the waistline further, especially when dealing with severe abdominal wall deformities [5–7]. All the functional and cosmetic concerns of the abdominal wall may be met by utilizing our comprehensive approach. A significant elevation of the mons pubis and the upper anterolateral thigh occurs with this technique. By restoring appropriate tension to the abdominal musculature, the individual’s posture improves and tension is diminished in the lumbar spinal muscles [8].

Research paper thumbnail of Persistent Primary Hyperparathyroidism Caused by Adenomas Identified in Pharyngeal or Adjacent Structures

World Journal of Surgery, 2003

Abnormalities in the normal migration of the parathyroid glands during embryological development ... more Abnormalities in the normal migration of the parathyroid glands during embryological development of the head and neck may result in considerable variability in the location of parathyroid tissue. Ectopic parathyroid adenomas present diagnostic and technical challenges and are frequently the cause of persistent primary hyperparathyroidism (HPT) after unsuccessful initial parathyroid surgery. We report a series of eight patients with persistent primary HPT who had adenomas in rare and unusual locations associated with various pharyngeal structures. Four were located within the epineurium of the vagus nerve at or above the level of the carotid bifurcation, and four were located within the paranasopharyngeal space or oropharynx. Noninvasive and invasive preoperative imaging studies were crucial in localizing the neoplasms in these patients and permitted the use of a direct surgical approach, resulting in cure in all patients and a low complication rate. The location of parathyroid glands in high pharyngeal and cervical structures is a consequence of anomalous or arrested descent through developing pharyngeal structures and illustrates the remarkable spectrum of ectopic parathyroid adenomas that occur secondary to this phenomenon.

Research paper thumbnail of Clinical evoked electromyography for recurrent laryngeal nerve preservation: Use of an endotracheal tube electrode and a postcricoid surface electrode

Research paper thumbnail of P052Diagnosis & Recurrence of Follicular Dendritic Cell Sarcoma

Otolaryngology - Head and Neck Surgery, 2006

Research paper thumbnail of The cardiac atria are chambers of active remodeling and dynamic collagen turnover during evolving heart failure

Journal of the American College of Cardiology, 2004

The role of atrial myocytes and extracellular matrix (ECM) changes in atrial chamber remodeling w... more The role of atrial myocytes and extracellular matrix (ECM) changes in atrial chamber remodeling was studied in a canine model of heart failure (HF). BACKGROUND Cardiac remodeling is a key process mediating the progression of HF. Studies of the structural mechanisms of cardiac remodeling have been limited to the left ventricle. The structural alterations associated with atrial chamber remodeling in evolving HF have not been studied. METHODS Age-and weight-matched dogs were subjected to right ventricular pacing (240 beats/min) for one and three weeks to produce early and severe HF, respectively. Atrial tissues were assessed for myocyte and ECM changes. RESULTS Right atrial and left atrial (LA) pressures were significantly increased in early and severe HF. The LA wall tension index was significantly increased at both HF stages by 116% and 443%, respectively. Atrial collagen synthesis and degradation were significantly increased in severe HF. Gelatinase activity was significantly increased at both early and severe stages of HF. Gelatin zymography showed increased matrix metalloproteinases (MMP)-9 with early HF and increased MMP-2 with severe HF. The LA wall tension index was significantly correlated with gelatinase activity and collagen synthesis. Although total atrial collagen content was not changed, disarray of collagen fibers was observed. Atrial myocyte hypertrophy without evidence of apoptosis was also present in severe HF. CONCLUSIONS There is marked atrial chamber remodeling in canine pacing-induced HF, which is characterized by myocyte hypertrophy and dynamic collagen turnover. Atrial remodeling may contribute to the development of atrial arrhythmias and pulmonary hypertension and could offer a novel therapeutic target.

Research paper thumbnail of On the use of electrical-resistance foil strain gages for plastic-wave studies in solids

Experimental Mechanics, 1988

The use of electrical-resistance foil strain gages for the measurement of plastic-wave profiles i... more The use of electrical-resistance foil strain gages for the measurement of plastic-wave profiles is investigated. It is shown that the wave speeds and maximum strains are obtained to about the same accuracy as optical techniques. It should be noted that the plastic wave speed and the maximum strain are the two most important parameters which are used to infer dynamic response of a material.

Research paper thumbnail of Unilateral vs Bilateral Parathyroid Gland Exploration

Archives of Otolaryngology–Head & Neck Surgery, 1998

Research paper thumbnail of Rapid control of a scabies outbreak at a tertiary care hospital without ward closure

American Journal of Infection Control, 2012

Background: Although scabies outbreaks in hospitals are frequent, the optimal approach to managem... more Background: Although scabies outbreaks in hospitals are frequent, the optimal approach to management of these outbreaks has not yet been defined. We describe a hospital scabies outbreak that was successfully controlled without ward closure. Methods: An outbreak of scabies at a teaching hospital and subsequent control measures were investigated. Outcomes included the number of cases affecting patients and staff, number of patients and staff requiring prophylaxis, duration of the outbreak, and cost of the outbreak. Outcomes were compared with those in a similar outbreak occurring at the same hospital 20 years earlier and with other published descriptions of hospital scabies outbreaks. Results: In January 2010, a patient who had undergone renal transplantation was admitted 3 times to St. Michael's Hospital, but a diagnosis of scabies was not considered until the final admission. Widespread exposure of patients and staff on 2 wards prompted the establishment of an outbreak management team. Initial interventions focused on isolation and treatment of the index case and on contact tracing to identify and treat secondary cases and to offer prophylaxis to direct contacts. Five symptomatic staff members and 2 patient cases were quickly identified, an outbreak was declared, and mass simultaneous prophylaxis was initiated on the 2 involved wards. A single case occurred 2 weeks after the mass prophylaxis program in a staff member who had not received the prophylaxis. Six weeks after the onset of symptoms, the end of the outbreak was declared. No additional cases have been reported up to the time of publication. The total cost of the outbreak was $20,000. Conclusions: Early recognition of crusted scabies is essential to prevent outbreaks. Once an outbreak occurs, prompt control of the index patient and rapid tracing of contacts to identify secondary cases are necessary. When prolonged exposure to a case of crusted scabies results in multiple secondary cases, institution of simultaneous mass prophylaxis is the most efficient strategy for terminating the outbreak and can be implemented without ward closure.

Research paper thumbnail of Use of audit and feedback with fluorescent targeting to achieve rapid improvements in room cleaning in the intensive care unit and ward settings

American Journal of Infection Control, 2012

Environmental contamination of high-touch surfaces in patient rooms can lead to the transmission ... more Environmental contamination of high-touch surfaces in patient rooms can lead to the transmission of clinically significant pathogens; thus, such surfaces should be cleaned routinely and thoroughly. Fluorescent targeting can be used to provide feedback to frontline cleaning staff on the thoroughness of room cleaning, which can result in substantial improvements in performance. We demonstrate that auditing with fluorescent targeting can be implemented in both the ward and intensive care unit settings using only modest resources, resulting in rapid improvements in cleaning thoroughness.

Research paper thumbnail of Diagnosis and recurrence of follicular dendritic cell sarcoma

Otolaryngology - Head and Neck Surgery, 2007