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APPENDIX A Glossary and Acronyms This glossary is intended to define terms commonly encountered throughout this report as well as some terms that are commonly used in the public health industry. This glossary is not all-inclusive. New terms and new usages of exist- ing terms will emerge with time and advances in technology. Definitions for the tennis presented here were compiled from a multitude of sources, which are listed at the end of the glossary. AAFP (American Academy of Family Physicians): A national, nonprofit medical association founded to promote and maintain high-quality standards for family doctors who are providing continuing comprehensive health care to the public (www.aatp.org). AA1\]C (Association of American Medical Colleges): A nonprofit asso- ciation whose purpose is to improve the nation's health (www.aamc.org). AHCPR (Agency for Health Care Policy and Research): An agency of the U.S. Department of Health and Human Services that is charged with sup- porting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services (www.ahcpr.gov). Academic Health Centers (AHCs): Academic health centers, or AHCs, consist of health care institutions that are owned by or closely affiliated with a university or medical school. AHCs also have at least one additional health pro- fessional program, and are engaged in undergraduate and graduate medical edu- cation, biomedical research, and delivery of patient care. 77

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78 PUBLIC HEALTH SYSTEMS AND EMERGING INFECTIONS Antibiotic: Class of substances or chemicals that can kill or inhibit the growth of bacteria. Originally antibiotics were derived from natural sources (e.g., penicillin from molds), but many currently used antibiotics are semisyn- thetic and are modified by the addition of artificial chemical components. Antibiotic resistance: Property of bacteria that confers the capacity to in- activate or exclude antibiotics or a mechanism that blocks the inhibitory or kill- ing effects of antibiotics. Antimicrobial agents: Class of substances that can destroy or inhibit the growth of pathogenic groups of microorganisms, including bacteria, viruses, parasites, and fungi. ASM (American Society for Microbiology): The oldest and largest mem- bership organization in the world devoted to a single life science. ASM repre- sents 24 disciplines of microbiological specializations plus a division for micro- biology educators (www.asmusa.org). Bacteria: Microscopic, single-celled organisms that have some biochemical and structural features different from those of animal and plant cells. Basic research: Fundamental, theoretical, or experimental investigation to advance scientific knowledge, with immediate practical application not being a direct objective. Benchmark: For a particular indicator or performance goal, the industry measure of best performance. The benchmarking process identifies the best per- formance in the industry (health care or non-health care) for a particular process or outcome, determines how that performance is achieved, and applies the les- sons learned to improve performance. Broad-spectrum antibiotic: An antibiotic effective against a large number of bacterial species. It generally describes antibiotics effective against both gram-positive and gram-negative classes of bacteria. CDC (Centers for Disease Control and Prevention): A public health agency of the U.S. Department of Health and Human Services whose mission is to promote health and quality of life by preventing and controlling disease, in- jury, and disability (www.cdc.gov). Clinical practice guidelines: Systematically developed statements that as- sist practitioners and patients with decision making about appropriate health care for specific clinical circumstances. Clinical research: Investigations aimed at translating basic, fundamental science into medical practice. Clinical trials: As used in this report, research with human volunteers to establish the safety and efficacy of a drug, such as an antibiotic or a vaccine. Clinicians: One qualified or engaged in the clinical practice of medicine, psychiatry, or psychology, as distinguished from one specializing in laboratory or research techniques in the same fields.

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APPENDIXA 79 DHHS (U.S. Department of Health and Human Services): The U.S. government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves (www.os.dhhs.gov). Disease: The condition in which the functioning of the body or a part of the body is interfered with or damaged. In a person with an infectious disease, the infectious agent that has entered the body causes it to function abnormally in some way or ways. The type of abnormal functioning that occurs is the disease. Usually the body will show some signs and symptoms of the problems that it is having with functioning. Disease should not be confused with infection. Emerging infections: Any infectious disease that has come to medical atten- tion within the last two decades or threatens to increase in the near future (IOM, 19924. Many times, such diseases exist in nature as zoonoses and emerge as hu- man pathogens only when humans come in contact with a formerly isolated ani- mal population, such as monkeys in a rain forest that are no longer isolated be- cause of deforestation. Drug-resistant organisms could also be included as emerging infections since they exist because of human influence. Some recent examples of agents responsible for emerging infections include human immunode- ficiency virus, Ebola virus, and multidrug-resistant Mycobacter~um tuberculosis. Encephalitis: An acute inflammatory disease of the brain due to direct viral invasion or to hypersensitivity initiated by a virus or other foreign protein. Endemic: Disease that is present in a community or common among a group of people; said of a disease continually prevailing in a region. EPED: Epidemiologist's editor as a general word processor. EPIAIDS: A programmable word processing program within the Epidemi- ologist's Editor (EPED) word processor. EPIAIDS programs are provided to guide one through tutorials on the use EPED and other programs and to assist in constructing memoranda, questionnaires, and epidemiological study designs. Etiology: Science and study of the causes of diseases and their mode of op- eration. FDA (U.S. Food and Drug Administration): A public health agency of the U.S. Department of Health and Human Services charged with protecting American consumers by enforcing the Federal Food, Drug, and Cosmetic Act and several related health laws (www.fda.gov). FoodNet: A set of activities designed to determine and monitor the burden of foodborne diseases and improve understanding of the proportion of foodborne diseases attributable to various pathogens. It is an example of population-based surveillance in the Emerging Infections Programs. Formulary: List of drugs approved for the treatment of various medical in- dications. It was originally created as a cost-control measure, but it has been

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80 PUBLIC HEALTH SYSTEMS AND EMERGINrG INFECTIONS used more recently to guide the use of antibiotics on the basis of information about resistance patterns. HMO (health maintenance organization): A health care service plan that requires its subscriber members, except in a medical emergency, to use the services of designated physicians, hospitals, or other providers of medical care. HMOs typically use a capitation payment system that rewards providers for cost-effective management of patients. Immunogenicity: The property that endows a substance with the capacity to provoke an immune response or the degree to which a substance possesses this property. Incidence: The frequency of new occurrences of disease within a defined time interval. Incidence rate is the number of new cases of a specified disease divided by the number of people in a population over a specified period of time, usually 1 year. Infection: The entry and development of an infectious agent in the body of a person or animal. In an apparent, "manifest" infection, the infected person outwardly appears to be sick. In an unapparent infection, there is no outward sign that an infectious agent has entered that person at all. Infection should not be confused with disease. Invasive isolates: A pure culture of a microorganism that is capable of (1) penetrating the host's defenses, (2) entering host cells, or (3) passing through mucosal surfaces and spreading in the body. MCO (managed care organization): An organization that arranges for health care delivery and financing and that is designed to provide appropriate, effective, and efficient health care through organized relationships with provid- ers. Includes formal programs for ongoing quality assurance and utilization re- view, financial incentives for covered members to use the plan's providers, and financial incentives for providers to contain costs. Managed care plans vary greatly in the degree to which benefit coverage is offered, monitored, and con- ditioned upon certain criteria being met by the subscriber member and the mem- ber's primary care physician. Meningitis: An infection of the fluid of a person's spinal cord and the fluid that surrounds the brain. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. Methicillin-resistant Staphylococcus aureus (MRSA): Strictly speaking, a Staphylococcus aureus strain resistant to the antibiotic methicillin. In practice, MRSA strains are generally resistant to many antibiotics and some are resistant to all antibiotics except vancomycin, such that the acronym is now generally used to mean "multidrug-resistant S. aureus."

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APPENDIXA 81 MIC (minimum inhibitory concentration): The lowest antibiotic concen- tration that prevents bacterial growth. NCID (National Center for Infectious Diseases): The division of the Centers for Disease Control and Prevention whose mission is to prevent illness, disability, and death caused by infectious diseases in the United States and around the world. NCID accomplishes its mission by conducting surveillance, epidemic investigations, epidemiological and laboratory research, training, and public education programs to develop, evaluate, and promote prevention and control strategies for infectious diseases (www.cdc.gov/ncidod/ncid.htm). NIAID (National Institute of Allergy and Infectious Diseases): A divi- sion of the National Institutes of Health that provides the major support for sci- entists conducting research aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunological, and allergenic diseases that afflict people worldwide (www.niaid.nih.gov). NIH (National Institutes of Health): A public health agency of the U.S. Department of Health and Human Services whose goal is to acquire new knowl- edge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold (www.nih.gov). Nosocomial infection: An infection that is acquired during hospitalization but that was neither present nor incubating at the time of hospital admission, unless it is related to a prior hospitalization, and that may become clinically manifest after discharge from the hospital. Outpatient services: Medical and other health care services not requiring hospitalization. These services may be provided by a hospital or other qualified facility or supplier, such as mental health clinics, rural health clinics, mobile X- ray units, or freestanding dialysis units. Such services include outpatient physical therapy services, diagnostic X-ray and laboratory tests, and radiation therapy. Primary care: Basic or general health care, traditionally provided by fam- ily practice, pediatric, and internal medicine physicians. Program Announcement (PA): A public announcement describing the goals and scope of a proposed scientific project awaiting approval from a spe- cific scientific organization. Prophylactic antibiotics: Antibiotics that are administered before evidence of infection with the intention of warding off disease. Public Health Service Act of 1944: An act to consolidate and revise the laws relating to the U.S. Public Health Service. Sepsis: The presence of pathogenic microorganisms or their toxins in blood or other tissues.

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82 PUBLIC HEALTH SYSTEMS AND EMERGING INFECTIONS Sentinel Surveillance Systems (SSS): A type of surveillance which relies on reports of cases of disease whose occurrence suggests that the quality of pre- ventive or therapeutic medical care needs to be improved. Surveillance systems: Used in this report to refer to data collection and re- cordkeeping to track the emergence and spread of disease-causing organisms such as antibiotic-resistant bacteria. Vaccine: A preparation of living, attenuated, or killed bacteria or viruses, fractions thereof, or synthesized or recombinant antigens identical or similar to those found in the disease-causing organisms that is administered to raise im- munity to a particular microorganism. Zoonotic disease or infection: An infection or infectious disease that may be transmitted from vertebrate animals (e.g., a rodent) to humans. Definitions for this glossary were compiled from the following sources: American Academy of Family Physicians, Federal Advocay Sites, (date of last update: January 17, 2000~. Available at: www.aatp.orglfpnet/guide/append_d.html. American Academy of Pediatrics (date of last update: March 26, 1999~. Available at: www.aap.org/advocacy/washing/fedinfo.htm. American Association of Health Plans, Network-Based Health Plans Definitions (date of last update: July 19, 1998~. Available at: www.aahp.org/menus/indexl.cim. American College of Obstetricians and Gynecologists: Women's Health Care Physicians. Available at: www.acog.com/. American Medical Association. Manual of Style, 9th ed. Chicago: American Medical Association, 1998. Association of American Medical Colleges (date of last update: December 7, 1999~. Available at: www.aamc.org/. Centers for Disease Control and Prevention.Available at: www.cdc.gov/. Dorland's Illustrated Medical Dictionary, 28th ed. Philadelphia: W.B. Saunders Co., 1994. Health Care Quality Glossary. (date of last update: February 8, 2000) Overview. The Russia-United States of America Joint Commission on Economic and Technological Cooperation, The Health Committee, Access to Quality Health Care, 1999. Agency for Health Care Policy and Research, Rockville, Md. Available at: www.ahrq.gov/ qual/hcqgloss.htm Institute of Medicine. Orphans and Incentives: Developing Technologies to Address Emerging Infections. Workshop Report. Washington, D.C.: National Academy Press, 1997. Institute of Medicine. Antimicrobial Resistance: Issues and Options. Workshop Report. Washington, D.C.: National Academy Press, 1998.

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APPENDIXA 83 Institute of Medicine. Managed Care Systems and Emerging Infections: Challenges and Opportuniteis for Strengthening Surveillance, Research, and Prevention. Workshop Summary. Washington, D.C.: National Academy Press, 2000. McGraw-Hill Dictionary of Scientific and Technical Terms, 5th ed. Washington, D.C.: McGraw-Hill, Inc., 1994. Medline Plus (date of last update: May 3, 2000~. Available at: www.nlm.nih.gov/ medlineplus/ National Cancer Institute. Available at: www.nci.nih.gov/. National Center for Infectious Diseases (date of last update: May 3, 2000~. Available at: www.cdc.gov/ncidod/index.htm/. National Institute of Allergy and Infectious Diseases (date of last update: March 10, 1999~. Available at: www.niaid.nih.gov/. National Institutes of Health. Available at: ww~v.nih.gov/. National Human Genome Research Institute, Glossary of Genetic Terms (date of last update: December 29, 1999~. Available at: www.nhgri.nih.gov/DIR/VIP/Glossa~y/. OneLook Dictionaries. Available at: www.onelook.com/. U.S. Department of Health and Human Services. Available at: www.os.dhhs.gov/. U.S. Food and Drug Administration. Available at: www.fda.gov/. Webster's Third New International Dictionary. Springfield, Mass.: Merriam-Webster, Inc., 1986.