Antibiotic resistance in Neisseria gonorrhoeae: genetics and mechanisms of resistance.

In recent years the emergence and spread of antibiotic resistance in Neisseria gonorrhoeae has increased markedly. Chromosomal resistance to penicillin and tetracycline is due to the effects of one or more mutations and is generally low-level. However, the effects of these mutations are additive.

An empirical specification of residency performance dimensions.

A critical aspect of any residency is the process of selection and evaluation. However, the research literature has failed to provide an adequate behavioral specification of performance components to assist in selection and evaluation decisions. In this investigation, we applied a widely accepted method of job analysis from personnel psychology, the critical incident technique, to define those behaviors and attitudes necessary for successful resident performance in obstetrics and gynecology.

High-level tetracycline resistance resulting from TetM in strains of Neisseria spp., Kingella denitrificans, and Eikenella corrodens.

Similar to Neisseria gonorrhoeae, tetracycline-resistant isolates of N. meningitidis, Kingella denitrificans, and Eikenella corrodens contained 25.2-megadalton plasmids carrying the TetM determinant.

Epidemiology of premenstrual symptoms in a nonclinical sample. I. Prevalence, natural history and help-seeking behavior.

A stratified sample of 996 nursing school graduates from 1963 to 1984 was surveyed by mail regarding menstrual cycle characteristics. The 730 respondents reported an 87% overall lifetime prevalence of premenstrual symptoms. When the symptoms were categorized according to severity, only 3.

Ski injuries, the significance of flake fractures.

All patients returning from skiing holidays who had sustained injuries of the knee ligaments were assessed. Thirteen patients had radiologically evident flake fractures around the knee. Of these, all had marked laxity when examined under anaesthetic.

Silastic foam in injured patients.

Four dressing techniques are described; these techniques enable patients with granulating wounds complicating skeletal injuries to be treated as outpatients. The patients perform their own dressings, thus reducing demands on nursing services and freeing hospital beds. In a study of 63 patients there was no problem in managing the wounds from weekly outpatient clinics; good wound healing was achieved.

Missed carpometacarpal dislocation of the thumb in motorcyclists.

Three cases of missed dislocation of the thumb's metacarpal in major motorcycle injury are presented. We postulate a mechanism of injury and discuss the significance.

Comparison of gynecologic health care problems between lesbians and bisexual women. A survey of 2,345 women.

A survey of reproductive system problems was conducted in a large group of lesbians (n = 1,921) and bisexual women (n = 424) in a nonclinical setting. Demographically the groups were similar: the majority of respondents were white, urban and well educated. A history of heterosexual coitus was common in both groups (bisexuals, 95%; lesbians, 77%).

Variability of food intakes. An analysis of a 12-day data series using persistence measures.

Data from the US Department of Agriculture's Exploratory Study of Longitudinal Measures of Individual Food Intake, conducted in 1982, were used to evaluate individual intakes for day-to-day patterns and to relate these patterns to the reliability of estimated daily energy and nutrient intake means. Generalized least squares estimators incorporating a simple persistence hypothesis showed the importance of including day-to-day patterns in estimating mean daily intake levels. The simple persistence hypothesis was that day-to-day intakes follow a first-order autoregressive process.

Collection of food intake data: an evaluation of methods.

Using USDA's recently completed methodological survey designed to evaluate longitudinal measures of food intake, the authors assessed nine methods for measuring dietary status. Methods evaluated included various combinations of prospective and retrospective recording of daily intake; personal, telephone, and mail- and telephone-assisted reporting; semistructured and open-ended recording documents; and number and spacing of days for recording intakes. Results from tabular and regression analyses indicated that the most effective and least costly methods for assessing mean intakes for groups of individuals were those using telephone and/or personal contact and collecting 24-hour recalls for several selected nonconsecutive days during the survey period.

Maternal obesity and pregnancy.

We examined the risk of maternal obesity in 588 pregnant women weighing at least 113.6 kilograms (250 pounds) during pregnancy. Compared with a control group matched for age and parity, we found a significantly increased risk in the obese patient for gestational diabetes, hypertension, therapeutic induction, prolonged second stage of labor, oxytocin stimulation of labor, shoulder dystocia, infants weighing more than 4,000 grams and delivery after 42 weeks gestation.

Artifact associated with the use of strong iodine solution (Lugol's) in cone biopsies.

The preoperative application of strong iodine solution (USP), commonly referred to as Lugol's solution, induces a histologic artifact in epithelial cells of cone biopsy material, most pronounced in dysplastic cells. Cellular shrinkage, cytoplasmic eosinophilia and vacuolization, development of visible intercellular space, and nuclear pyknosis with loss of chromatin detail are the major findings. Since the use of strong iodine solution (USP) is a common practice for delineating the ectocervical extent of disease prior to cone biopsy, the pathologist should recognize the artifact since its presence can make histologic interpretation difficult.

Computer-based monitoring of clinical care in a public psychiatric hospital unit.

A computer-based clinical monitoring system on a 40-bed university hospital psychiatric unit provides documentation to justify clinicians' diagnosis and choice of treatment and facilitates evaluation of patients' progress at scheduled intervals. The microcomputer system was developed to meet state guidelines for monitoring patients receiving neuroleptic drug treatment. A weekly status report generated for each patient alerts the treating physician to cases in which data do not justify clinical decisions, identifies potential problems, and suggests considering for discharge patients whose symptoms have sufficiently abated.

External fixation of Colles' fractures. An anatomical study.

In a prospective, controlled study 58 patients aged under 60 years with Colles' fractures were treated either by a forearm plaster or by the application of an external fixator. In 94% of those treated by a fixator it was possible to insert the distal pins of the frame into the fracture fragment, the fixation obtained being sufficient to forgo additional splintage. The external fixator proved more effective at holding the manipulated position, and the radiological loss of position during fracture union was minimal compared with that seen in patients treated in plaster.

Parenting desires among bisexual women and lesbians.

Parenting desires were ascertained among a large group of lesbians (n = 1,921) and bisexual women (n = 424) recruited in a nonclinical setting. More than 50% of each sexual-orientation group had considered having a child since recognizing their current sexual identity. Lesbians were more likely than bisexuals to favor adoption and donor insemination as options, whereas bisexuals were more likely to consider intercourse with either a cooperative or unsuspecting man.

High-level tetracycline resistance in Neisseria gonorrhoeae is result of acquisition of streptococcal tetM determinant.

Recently, strains of Neisseria gonorrhoeae have been isolated which are highly resistant to tetracycline (MICs of 16 to 64 micrograms/ml). This resistance was due to the acquisition of the resistance determinant tetM, a transposon-borne determinant initially found in the genus Streptococcus and more recently in Mycoplasma hominis, Ureaplasma urealyticum, and Gardnerella vaginalis. In N.

Obstetric decision-making: responses to patients who request cesarean delivery.

The right of patients to be actively involved in treatment decisions is now widely accepted. A survey of 112 obstetricians was conducted to determine their responses to several cases in which a laboring woman asks for a cesarean section, even though the obstetrician has recommended a continued trial of labor/vaginal delivery. In 12 of the 19 cases there was substantial variation among respondents in the decision to agree with the patient.