Sound localization with communications headsets: comparison of passive and active systems

Studies have demonstrated that conventional hearing protectors interfere with sound localization. This research examines possible benefits from advanced communications devices. Horizontal plane sound localization was compared in normal-hearing males with the ears unoccluded and fitted with Peltor H10A passive attenuation earmuffs, Racal Slimgard II communications muffs in active noise reduction (ANR) and talk-through-circuitry (TTC) modes and Nacre QUIETPRO TM communications earplugs in off (passive attenuation) and push-to-talk (PTT) modes. Localization was assessed using an array of eight loudspeakers, two in each spatial quadrant. The stimulus was 75 dB SPL, 300-ms broadband noise. One block of 120 forced-choice loudspeaker identification trials was presented in each condition. Subjects responded using a laptop response box with a set of eight microswitches in the same configuration as the speaker array. A repeated measures ANOVA was applied to the dataset. The results reveal that the overall percent correct response was highest in the unoccluded condition (94%). A significant reduction of 24% was observed for the communications devices in TTC and PTT modes and a reduction of 49% for the passive muff and plug and muff with ANR. Disruption in performance was due to an increase in front-back reversal errors for mirror image spatial positions. The results support the conclusion that communications devices with advanced technologies are less detrimental to directional hearing than conventional, passive, limited amplification and ANR devices.     

Fixed combination of losartan and hydrochlorothiazide and reduction of risk of stroke

A fixed-dose combination of losartan/hydrochlorothiazide (HCTZ) therapy may be a logical choice for antihypertensive treatment, including for initial therapy in patients with blood pressure elevation >20/10 mmHg above treatment target. The renin-angiotensin-aldosterone-system-activating effect of hydrochlorothiazide augments the efficacy of blocking the angiotensin II type 1 (AT1) receptor with losartan. Some adverse effects associated with hydrochlorothiazide, including increased risk for new-onset diabetes mellitus, may be offset by losartan. Losartan was frequently administered with hydrochlorothiazide in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, in which there was a 25% risk reduction for stroke in the losartan-based compared with the atenolol-based treatment group. The efficacy, tolerability, and convenience of losartan/HCTZ combination therapy may increase patient compliance and lower risk for stroke, a devastating outcome in patients with hypertension.     

Stress reinstates cocaine-seeking behavior after prolonged extinction and a drug-free period

 We have shown previously, using an animal model of relapse, that acute exposure to intermittent footshock stress induces reinstatement of heroin-taking behavior in rats. Here we report that in rats trained to self-administer cocaine, exposure to acute intermittent footshock stress induces reinstatement of cocaine-taking behavior after prolonged extinction sessions and after a 4- to 6-week drug-free period; an effect comparable to that induced by a priming injection of cocaine. Animals were initially allowed to self-administer cocaine HCl (1.0 mg/kg per infusion, IV) during one 3-h session/day for 12 days. Subsequently, extinction conditions were introduced by substituting saline for cocaine so that lever-pressing resulted in IV infusions of saline rather than of drug. Extinction conditions were maintained until animals made 15 responses or less in the 3 h, after which animals were given saline infusions at the start of each daily session to establish baseline responding of ten responses or less. Subsequently, animals were tested for reinstatement of responding for saline infusions following a non-contingent injection of cocaine (2.0 mg/kg, IV) and exposure to intermittent footshock (10 min, 0.5 mA, 0.5 s on, mean off period of 40 sec). After an additional 4- to 6-week drug-free period, tests for reinstatement were repeated. Reinstatement of cocaine-taking behavior was observed in both sets of tests in response to footshock and cocaine. These results extend previous reports from this laboratory that footshock stress is an effective stimulus for reinstatement of drug-taking behavior in the rat. Received: 21 March 1996 / Final version: 13 July 1996     

Public reporting of quality information on Medicaid health plans

Transparency through public reporting of quality data is key to achieving the Institute of Medicine's (IOM) vision for 21st century health care. This article reviews the status of States' voluntary public reporting of Medicaid managed care (MMC) quality data, and analyzes these data. Twenty-one States, including 17 of the 20 largest managed care States, have made plan-level data publicly available online, although the data are sometimes thin, with few measures reported, hard-to-access, and old. We conclude that CMS could better leverage the power of public reporting for quality improvement (QI) by increasing the visibility of health plan employer data and information set (HEDISV) data that States already collect.     

Adolescents' discussions about contraception or STDs with partners before first sex

CONTEXT: Limited research has examined the individual, family and relationship factors that determine whether teenagers discuss contraception or STDs with their sexual partners before having sex for the first time. METHODS: Logistic regression analyses of data from 1,426 teenagers who participated in Waves 1 (1995) and 2 (1996) of the National Longitudinal Study of Adolescent Health and who had first sex between waves examined factors influencing whether respondents discussed contraception or STDs with their partner before first sex, and whether these factors differ by gender. RESULTS: Fifty-three percent of females and 45% of males discussed contraception or STDs before having first sex. The greater respondents' perceived condom knowledge and the greater their communication with their parents about everyday life, the higher their odds of discussing contraception or STDs before first sex (odds ratio, 1.2 for each). Being black was positively associated with sexual communication before first sex (1.9); as the number of dating activities and score on a test of verbal ability increased, so did the odds of such communication (1.6 and 1.02, respectively). The predictors of discussions about contraception or STDs did not differ by gender. CONCLUSIONS: By increasing teenagers' knowledge about condoms and other methods of contraception, pregnancy and STD prevention programs can help to encourage communication among teenage partners before the initiation of sexual intercourse. Programs should also encourage conversations between parents and teenagers, even when not about sex.     

Are there racial differences in attitudes toward hospice care? A study of hospice-eligible patients at the Visiting Nurse Service of New York

Research on African American and white attitudes, perceptions, and knowledge of hospice care has focused predominantly on patients and providers in institutions and community-based care settings. Little is known about patients receiving home health services, despite growing trends toward noninstitutional care in the United States. This study of home health clients who are eligible for hospice, but not currently receiving it, found few differences between racial groups with regard to attitudes about end-of-life care. An alarming proportion of African American and white home health clients held erroneous ideas about hospice care and had not discussed this option with their providers. These findings suggest that increased referrals to home-based hospice care among home health clients depend on the availability and professional dissemination of accurate, spiritually sensitive information.     

Dietary sources and determinants of soy isoflavone intake among midlife Chinese Women in Hong Kong

The dietary sources, intake levels, and determinants of soy isoflavone intake were examined using 3217 dietary recalls (DR) collected from 141 Hong Kong Chinese women aged 50-61 y. Multiple-pass 24-h DR were administered by phone by trained interviewers on 23 random, nonconsecutive days to participants over a 12-mo period from 2001 to 2002. We calculated isoflavone intake using analytical values in the Chinese University of Hong Kong Soy Isoflavone Database. Results indicated that the daily intake of total isoflavones was 7.8 +/- 5.6 mg in the study population. Non-Cantonese women had a higher intake of 10.7 +/- 7.6 mg compared with 7.3 +/- 5.0 mg in Cantonese women (P = 0.04). Altogether, 22 foods contributed approximately 90% of the total isoflavone intake. Soft tofu alone accounted for approximately 21% of the isoflavone intake, followed by bean curd skin (7.1%), name-brand soybean milk (6.3%), homemade soybean milk (6.2%), and generic soybean milk (5.8%). Combined, these 5 food items contributed 46% of the total dietary isoflavones. Multiple linear regression analysis indicated dialect group, self-reported health, and age group were significant independent predictors of soy isoflavone consumption. The data provide the basis for elucidating the patterns, determinants, and assessment of dietary soy isoflavone intake in Asian women.     

High prevalence of tuberculosis in previously treated patients, Cape Town, South Africa

The tuberculosis (TB) notification rate is high and increasing in 2 communities in Cape Town, South Africa. In 2002, we conducted a prevalence survey among adults > or = 15 years of age to determine the TB prevalence rate; 15% of households in these communities were randomly sampled. All persons living in sampled households were eligible for chest radiography and sputum examination. Of the 3,483 adults who completed a questionnaire, 2,608 underwent chest radiography and sputum examination. We detected 26 bacteriologically confirmed TB cases and a prevalence of 10.0/1,000 (95% confidence interval [CI] 6.2-13.8 per 1,000). We found 18 patients with smear-positive TB, of whom 8 were new patients (3.1/1,000, 95% CI 0.9-5.1/1,000). More than half of patients with smear-positive TB (10, 56%) had previously been treated. Such patients may contribute to transmission of Mycobacterium tuberculosis and the high TB prevalence rate. Successful treatment of TB patients must be a priority.