Resistance of urinary tract isolates of Escherichia coli to cotrimoxazole, sulphonamide, trimethoprim and ampicillin: an 11-year survey

The susceptibility of urinary tract Escherichia coli isolates to cotrimoxazole, sulphonamide, trimethoprim, and ampicillin was monitored over an 11-year period. A trend in increasing resistance to cotrimoxazole and trimethoprim was observed, but there was no comparable alteration in sulphonamide resistance. Ampicillin resistance was high at the beginning of the survey period and continued to rise.     

The agreement and repeatability of tear meniscus height measurement methods.

PURPOSE: This study investigated the agreement and repeatability of five techniques of measuring tear meniscus height (TMH). METHODS: Pairs of TMH measurements were obtained from one eye of 25 normal subjects with five techniques: optical coherence tomography in cross-section (OCT) and optical pachymetry in cross-section (PACH), without fluorescein; and 5 minutes after the instillation of fluorescein, optical pachymetry en-face (SL-F) and in cross-section (SL-X), and video capture en-face (VC). These 10 measurements were taken on different days within a period of 21 days. Additionally, immediately successive replicates were taken at the first visit when VC was used, allowing for the separation of technique repeatability from true day-to-day variation in TMH. RESULTS: Ninety-five percent confidence intervals for the mean TMH and 95% repeatability coefficients for repeated testing on separate occasions were: 0.25 to 0.29 mm, 0.14 mm--OCT, 0.30 to 0.36 mm, 0.13 mm--PACH, 0.27 to 0.34 mm, 0.092 mm--SL-F, 0.35 to 0.41 mm, 0.19 mm--SL-X, and 0.30 to 0.38 mm, 0.088 mm--VC. Reported repeatability coefficients are averages because, despite a relatively narrow experimental range, the measurements of low TMH were generally more repeatable than those of large TMH. Ninety-five percent limits of agreement were wide for all pairwise comparisons and included zero, indicating that the methods used in this study are interchangeable when taking single recordings, at least on subjects without dry eye. CONCLUSIONS: The average TMH of the five techniques was similar, although OCT and SL-X tended to record lower and higher values, respectively. However, their agreement for single recordings was poor, an inevitable consequence of the low intertest repeatability found for all methods. A much improved repeatability for immediate replicates indicated that this, in turn, was principally caused by a large day-to-day variation in TMH rather than measurement error.     

Perceived control of asthma and quality of life among adults with asthma.

BACKGROUND: Perceived control of certain chronic conditions influences health status outcomes. OBJECTIVE: To explore the impact of perceived control of asthma on asthma-specific and generic health status outcomes among adults with asthma. Perceived control was defined as individuals' perceptions of their ability to deal with asthma and its exacerbations. METHODS: Data were drawn from the baseline and first two followups of a longitudinal study of adults with asthma surveyed by telephone at 18-month intervals. An 11-item questionnaire (Perceived Control of Asthma Questionnaire [PCAQ]) was developed and validated. RESULTS: The PCAQ demonstrated high internal consistency (Cronbach's alpha = 0.79). Greater perceived control was associated with less severe asthma, greater asthma self-efficacy, lower perceived asthma severity, lower perceived danger from asthma, and greater perceived usefulness of asthma medicines. Greater perceived control was significantly associated with better asthma-specific quality of life concurrently and 18 and 36 months later, after controlling for demographics, smoking, and severity of asthma. Greater perceived control as also significantly associated with generic mental health outcomes concurrently and 18 and 36 months later, after controlling for covariates. Perceived control was associated with physical function concurrently and 18 months later, but not 36 months later. CONCLUSIONS: The PCAQ is a reliable and valid measure of perceived control of asthma. Perceived control of asthma was associated with both asthma-specific and generic health status outcomes, concurrently and predictively. If perceived control could be modified, better outcomes, particularly better psychologic outcomes, might be achieved for individuals with asthma.     

Adolescent Immunization: Focus on Implementation

ABSTRACT: On March 11–12, 1996, a workshop on how to implement new adolescent immunization (AI) recommendations was held in Atlanta, Ga. Sponsored by the Centers for Disease Control and Prevention, it was a collaborative effort of the National Immunization Program, the Division of Adolescent and School Health/National Center for Chronic Disease Prevention and Health Promotion, and the Hepatitis Branch/National Center for Infectious Diseases. The workshop brought together organizations and individuals interested in adolescent health and immunizations so they could address how new Al recommendations can be implemented most effectively. This article offers an overview of their discussions and suggestions, including issues of cooperation, education, legislation, and Al program development among health provider organizations, health departments, schools, community groups and various other agencies relating to adolescent health services.     

Intrinsic resistance to anticancer agents in the murine pancreatic adenocarcinoma PANC02

Summary PANC02 is a ductal adenocarcinoma of the pancreas that is resistant to every known class of clinically active antitumor agent. To study the mechanism(s) underlying the intrinsic drug resistance of this tumor, a mammary adenocarcinoma (CA-755) that also grows in C57/BL mice and is known to be drugsensitive was used for comparison. PANC02 resistance and CA-755 sensitivity to several antitumor agents and to X-ray therapy was confirmed in mice, and PANC02 also demonstrated relative resistance in tissue culture. Relative to Chinese hamster ovary (CHO) and CA-755 cells, PANC02 did not appear to show a higher rate of mutation to drug resistance in culture as based on the 6-thioguanine resistance marker. Although P-glycoprotein characteristic of the multidrug resistance (MDR) phenomenon could be demonstrated at the mRNA level using a sensitive RNAse protection assay, the level of expression found was several orders of magnitude lower than that observed in phenotypic MDR cell lines. Furthermore, quinidine failed to increase the sensitivity of PANC02 cells to Adriamycin under conditions that clearly potentiated the toxicity of the drug to a CHO cell line exhibiting classic MDR traits. The heterogeneity in the distribution of drugs was inferred as being significantly greater in PANC02 versus CA-755 cells in vivo as based on measurements of within-animal, within-tumor variance in the distribution of the marker compounds inulin and antipyrine. Although it may not be the only mechanism involved, this greater intratumor heterogeneity in drug distribution could theoretically play a major role in the intrinsic drug resistance of PANC02 in vivo.Supported by grant CH-458 from the American Cancer Society, by grant CA-28034 from the National Cancer Institute, and in part by Cancer Center Core Support grant, NIH-NCI-CA-16672. Animals were maintained in facilities approved by the American Association for Accreditation of Laboratory Animal Care and in accordance with current United States Department of Agriculture, Department of Health and Human Services, and National Institutes of Health regulations and standards     

Subtypes of schizophrenia: a cluster analytic approach.

OBJECTIVES: To identify empirical subtypes of schizophrenia, based upon the symptoms recorded over the duration of the illness, and to validate the resulting clusters against other systems that are used for subtyping schizophrenia. METHOD: Data for 55 symptoms of schizophrenia over the history of the illness from 107 chronic schizophrenia patients were analyzed using hierarchical cluster analysis with Euclidean distance and Ward's method. Except for 1 patient, all met DSM-III criteria. There were 40 men and 67 women, average (SD) age of 38.2 (9.91) years, with a mean (SD) hospitalization of 27.9 (27.35) months. RESULTS: No clear and unambiguous solution for the number of clusters was evident. Examination of the clusters led to further analysis of 2- and 6-cluster solutions. These were contrasted with DSM-III, DSM-III-R, and DSM-IV criteria and with the subtypes taken from the literature. There was limited support for any of these types, with none replicating, including the paranoid-nonparanoid distinction. CONCLUSIONS: Empirical clusters derived from lifetime symptom data failed to agree with either the established DSM or other empirically derived subtypes. Subtypes may have little utility when the variability of symptoms over the longitudinal course of the illness is considered.     

Recovery from infectious mononucleosis after altitude training in an elite middle distance runner.

OBJECTIVES: This investigation was designed to monitor altitude acclimatisation in an elite cohort of distance runners and follow the subsequent recovery from infectious mononucleosis which developed in one of these athletes. METHODS: Twenty six national standard distance runners performed treadmill tests 24 days before they travelled to an altitude camp (1500 to 2000 m). One of these athletes was diagnosed as suffering from infectious mononucleosis 14 days after return to sea level. A physician prescribed an individualised training programme which was designed to maximise recovery from the condition, which was monitored on days 16 and 147 after altitude training. RESULTS AND CONCLUSIONS: The data suggest that the athlete was in a state of over-reaching during the altitude sojourn. After return to sea level, the early stages of infectious mononucleosis resulted in a marked impairment in physiological response to endurance exercise, which improved over time. Longitudinal physiological monitoring in conjunction with a carefully prescribed training programme made recovery from this condition possible.