Controlling use of antimicrobials in a community teaching hospital.

Objective: To test the hypothesis that antibiotic use could be controlled or improved in a community teaching hospital, with improvement defined as reductions in overall use, overall cost, and antimicrobial resistance.

Design: Interventional study with historical comparison.

Setting: A not-for-profit, 900-bed community general hospital with residents in medicine, surgery, obstetrics-gynecology, and psychiatry.

On prediction of epileptic seizures by means of genetic programming artificial features.

A general-purpose, systematic algorithm is presented, consisting of a genetic programming module and a k-nearest neighbor classifier to automatically create artificial features--computer-crafted features possibly without a known physical meaning--directly from the reconstructed state-space trajectory of intracranial EEG signals that reveal predictive patterns of epileptic seizures. The algorithm was evaluated with IEEG data from seven patients, with prediction defined over a horizon of 1-5 min before unequivocal electrographic onset. A total of 59 baseline epochs (nonseizures) and 55 preictal epochs (preseizures) were used for validation purposes.

Labor epidural placement in a woman with a cervical spinal cord stimulator.

A 37-year-old female, gravida 1 para 0, in active labor at term, with a cervical spinal cord stimulator in situ, presented for epidural analgesia for labor. She had received the cervical spinal cord stimulator some 30 months before, to treat chronic regional pain syndrome I. She was taking no medication, and was thin but otherwise healthy.

Adolescent sex differences in adiponectin are conditional on pubertal development and adiposity.

Objective: Adiponectin is an adipose tissue protein with important insulin-sensitizing, anti-inflammatory, and cardioprotective properties but is paradoxically lower in obese individuals. Sex differences in adiponectin have been reported in adults and adolescents but not in prepubertal children. In this study, we hypothesized that sex differences in adiponectin would develop during puberty and would be influenced by level of adiposity.

Trends in the use of psychotropic medications among adolescents, 1994 to 2001.

Objectives: Few psychotropic medications are approved for use among children younger than 18 years. Yet previous studies have shown an increase in the use of psychotropic medications among school-age children and adolescents. Most previous studies examined data only up to 1997; therefore, the results predate any impact of changing federal policies and newly marketed medications.

Physical stature of adult Tsimane' Amerindians, Bolivian Amazon in the 20th century.

We examine the association between exposure to the market and Western society on the height of adult Tsimane', a foraging-farming society in the Bolivian Amazon. As with other contemporary native peoples, we find little evidence of a significant secular change in height during 1920-1980. Female height bore a positive association with own schooling and fluency in spoken Spanish and with maternal modern human capital (schooling, writing ability, and fluency in spoken Spanish), but male heights bore no association with parental height or with modern human capital.

Social disadvantage and adolescent stress.

Purpose: Low socioeconomic status (SES) and minority race/ethnicity are both associated with chronic stress and co-vary in American society. As such, these factors are often used synonymously, without clear theoretical conceptualization of their roles in the development of stress-related health disparities. This study theorized that race/ethnicity and SES reflect social disadvantage, which is the underlying factor in the development of stress-related illness, and examined how social disadvantage, defined in terms of both race/ethnicity and SES, influences adolescents' stress.

Inadvertent administration of magnesium sulfate through the epidural catheter: report and analysis of a drug error.

We present two reports of pregnant women in labor who inadvertently received a magnesium sulfate solution in their epidural space. Both women received approximately 9 mg of magnesium sulfate, and neither of them demonstrated any signs or symptoms of focal neurological toxicity. Once the mistakes were discovered and appropriate medication was delivered, the patients attained an acceptable level of analgesia.

Pediatric faculty members' attitudes about part-time faculty positions and policies to support part-time faculty: a study at one medical center.

Purpose: To examine pediatric faculty members' attitudes about part-time faculty positions and policies to support part-time faculty.

Method: In 2001, an anonymous 26-item questionnaire assessing attitudes about part-time faculty was mailed to all 441 faculty members of Cincinnati Children's Hospital Medical Center. Multivariable analyses were used to determine faculty characteristics associated with specific attitudes, and qualitative methods were used to analyze responses to an open-ended item assessing beliefs about facilitating part-time careers.

Anthropometric variability in the USA: 1971-2002.

Aim: The study analysed variability in physical stature, weight, and body mass index (BMI) in the USA during 1971-2002.

Subjects: Subjects were non-Hispanic Blacks and Whites, 2-74 years of age from the National Health and Nutrition Examination Surveys (NHANES I-III and 1999-2002).

Methods: The coefficient of variation and the standard deviation of the logarithm of stature, weight, and BMI were used to assess anthropometric variability for groups defined by age, race, sex, income, and survey year.

Frequency of abnormal carbohydrate metabolism and diabetes in a population-based screening of adolescents.

Objective: To document the frequency of glucose intolerance in adolescents in a population-based study of primarily African-American/Non-Hispanic whites in an urban-suburban school district.

Study Design: Measurement of fasting and 2-hour post-glucose load plasma glucose concentrations.

Results: Carbohydrate intolerance (either impaired fasting glucose, impaired glucose tolerance, or both) was identified in 8.

The hierarchical fair competition (HFC) framework for sustainable evolutionary algorithms.

Many current Evolutionary Algorithms (EAs) suffer from a tendency to converge prematurely or stagnate without progress for complex problems. This may be due to the loss of or failure to discover certain valuable genetic material or the loss of the capability to discover new genetic material before convergence has limited the algorithm's ability to search widely. In this paper, the Hierarchical Fair Competition (HFC) model, including several variants, is proposed as a generic framework for sustainable evolutionary search by transforming the convergent nature of the current EA framework into a non-convergent search process.

The wound care team: a new source of group a streptococcal nosocomial transmission.

Background: In August 2001, the Centers for Disease Control and Prevention (CDC) notified the Texas Department of Health (TDH) of an unusually high number of wounds infected with group A streptococci (GAS) in an acute care facility. The TDH initiated an investigation, ultimately identifying 28 cases of non-pharyngeal, non-community-acquired GAS that had occurred between December 2000 and August 2001 and resulted in 3 deaths and 4 nonfatal cases of invasive disease. Ten specimens were sent to the CDC for emm typing; all isolates were emm type 114.

The relationships of adiponectin with insulin and lipids are strengthened with increasing adiposity.

Context: Adipose tissue inflammation has been implicated in the pathogenesis of obesity-related comorbidities. Adiponectin, an antiinflammatory protein, improves insulin sensitivity and lipid levels systemically. Because adiponectin is secreted by adipocytes, it may also act locally to counteract insulin resistance and dyslipidemia worsened by inflammation.

Factor analysis of clustered cardiovascular risks in adolescence: obesity is the predominant correlate of risk among youth.

Background: Clustering of cardiovascular (CV) risks begins in childhood, yet studies of the factor structure underlying this clustering have focused on adults. The increasing rates of obesity and type 2 diabetes and the growing importance of metabolic syndrome among adolescents make assessment of CV risk clustering even more urgent in this age group.

Methods And Results: Exploratory factor analysis (principal components analysis) was performed with data from 1578 healthy seventh to 12th graders from the Princeton School District Study, a school-based study in Cincinnati, Ohio.

Sexually transmitted infection testing and screening in hospital-based primary care visits by women.

Objective: To explore determinants of sexually transmitted infection screening of asymptomatic women and sexually transmitted infection testing of women with genitourinary symptoms, to investigate the effect of specific genitourinary symptoms on sexually transmitted infection testing, and to examine trends in screening.

Methods: We performed secondary data analysis of nationally representative data from the National Hospital Ambulatory Medical Care Surveys, using 17,458 visits by nonpregnant 15- to 44-year-old women seen in primary care clinics between 1997 and 2000. Point estimates, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are presented.

Social inequalities in biomarkers of cardiovascular risk in adolescence.

Objective: Cardiovascular disease, which begins early in life but often is not manifest until adulthood, is the nation's leading cause of mortality. Social inequalities in cardiovascular disease are pervasive, yet the process by which they accrue is poorly understood. The objective of this study was to explore the associations between socioeconomic status, a range of biomarkers reflective of cardiovascular risks, and a cumulative physiological risk score among adolescents.

Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents.

Objective: To determine prevalence of metabolic syndrome (MS) among adolescents by using definitions from the National Cholesterol Education Program Adult Treatment Panel III (NCEP) and World Health Organization (WHO) guidelines and to compare the populations identified by these definitions.

Study Design: School-based, cross-sectional study of 1513 black, white, and Hispanic teens who had a fasting morning blood sample drawn and a physical examination.

Results: Overall, the prevalence of NCEP-defined MS was 4.

Clinically significant concentrations of local anesthetics inhibit Staphylococcus aureus in vitro.

This study explores which concentrations of local anesthetics might be expected to inhibit the growth of Staphylococcus aureus. Serial dilutions were made of 0.5% and 0.

Statistical assessment of mediational effects for logistic mediational models.

The concept of mediation has broad applications in medical health studies. Although the statistical assessment of a mediational effect under the normal assumption has been well established in linear structural equation models (SEM), it has not been extended to the general case where normality is not a usual assumption. In this paper, we propose to extend the definition of mediational effects through causal inference.

Radiology of pulmonary vascular disease.

Diagnostic radiology plays an important role in the evaluation of suspected pulmonary vascular disease. This article discusses the use of various radiographic modalities and the radiographic features of several pulmonary vascular diseases.