Associations between antibiotic prescriptions and recurrent urinary tract infections in female college students.

Urinary tract infections (UTIs) are common among college-aged women and often recur. Some antibiotics recommended to treat UTIs trigger dysbiosis of intestinal and vaginal microbiomes - where uropathogens originate, though few studies have investigated associations between these therapies with recurrent infections. We retrospectively analysed the electronic medical records of 6651 college-aged women diagnosed with a UTI at a US university student health centre between 2006 and 2014. Women were followed for 6 months for incidence of a recurrent infection. In a secondary analysis, associations in women whose experienced UTI recurrence within 2 weeks were also considered for potential infection relapse. Logistic regression was used to assess associations between infection recurrence or relapse and antibiotics prescribed, in addition to baseline patient characteristics including age, race/ethnicity, region of origin, year of encounter, presence of symptomology, pyelonephritis, vaginal coinfection and birth control consultation. There were 1051 instances of infection recurrence among the 6620 patients, indicating a prevalence of 16%. In the analysis of patient characteristics, Asian women were statistically more likely to experience infection recurrence whereas African American were less likely. No significant associations were identified between the antibiotic administered at the initial infection and the risk of infection recurrence after multivariable adjustment. Treatment with trimethoprim-sulphamethoxazole and being born outside of the USA were significantly associated with increased odds of infection relapse in the multivariate analysis. The results of the analyses suggest that treatment with trimethoprim-sulphamethoxazole may lead to an increased risk of UTI relapse, warranting further study.

Arsenic in Groundwater: The Deep Late Pleistocene Aquifers of the Western Bengal Basin.

in groundwaters from 145 wells across central West Bengal, India, those from Pleistocene aquifers at depths >70 m beneath paleo-interfluves contain <10 µg/L As. Pleistocene aquifers beneath deep paleo-channels typically host groundwaters containing 10-100 µg/L As at depths between 120 and 180 m. The depth profiles of As and SO4 and the conservative tracers Cl/Br, δ(18)O, and δ(2)H show that the As in Pleistocene groundwater beneath deep paleo-channels is relict and does not arise from migration downward of As-polluted groundwater in overlying aquifers. We postulate that the As was liberated in situ by reduction of minimal iron oxyhydroxides in the gray Pleistocene sands by organic matter infiltrating from riverbeds during late Pleistocene or earliest Holocene times. Mitigation of the widespread As-pollution in shallow aquifers through exploitation of deep Pleistocene aquifers would improve if guided by an understanding of the distribution of buried paleo-channels and paleo-interfluves and the knowledge that As may be present naturally in groundwater at depths >150 m beneath deep paleo-channels.

Special Section: Relationships Between Executive Function and Sports / Exercise.

This short article is a commentary on this special section of Perceptual and Motor Skills entitled Relationships between Executive Function and Sports/Exercise. Given the vast executive function research in sports already published, this moment is opportune for highlighting (a) progress to date, (b) research limitations yet to address, and (c) inspirational new findings. The articles that follow illustrate these themes.

Professional development: mine and theirs.

This paper is based on an invited address for the Association of Psychologists in Academic Health Centers (APAHC) at the 2010 American Psychological Association (APA) Convention in San Diego, California. It is in response to the Ivan Mensh Award for Distinguished Achievement in Teaching presented to the author at the 2009 APA Convention. This article addresses two key themes in the instruction and professional development of clinical psychologists: internalization and management matters. The author asserts that these process and content topics characterize critical training ingredients in preparing students for the future practice of clinical psychology within modern academic health care settings.

The utility of the rorschach coping deficit index as a measure of depression and social skills deficits in children and adolescents.

Little research has evaluated the validity of the Coping Deficit Index (CDI) of the Rorschach Comprehensive System (CS). Because the CS Depression Index (DEPI) has frequently been found to yield false negatives, the CDI has been proposed as an alternative means of assessing social coping skills that may relate to depression. This study examined potential correlates of the CDI using the Personality Inventory for Children-Second Edition (PIC-2). Sixty-five children and adolescents were assessed with the Rorschach CS and the PIC-2. None of the PIC-2 clinical scales or subscales measuring withdrawal or social skills predicted a positive CDI, and none of the depression-related PIC-2 scales predicted a positive CDI or DEPI. The only significant relationship found was a negative relationship between the CDI and a PIC-2 subscale measuring sleep problems and preoccupation with death. Implications of these findings for clinicians and further research are discussed.

Comparison of Tc-99m pyrosphosphate and Tc-99m hydroxymethylene diphosphonate in acute myocardial infarction: concise communication.

A clinical comparison between a new bone seeking radiopharmaceutical, Tc-99m hydroxymethylene diphosphonate (TcHMDP) and the standard agent, Tc-99m pyrophosphate (TcPPi), was performed in 18 patients with acute myocardial infarction. Each patient was imaged initially with either TcHMDP or TcPPi, and imaged 24 hr later with the other tracer. All 18 patients had images positive for acute myocardial infarction with TcPPi, whereas 16 of 18 patients (89%) had positive studies with TcHMDP. The TcPPi images were graded significantly superior to those obtained with TcHMDP in 61% of the patients, and they were equal in 33%. In only one patient (6%) was TcHMDP better. The results indicate that compared with TcHMDP, TcPPi not only has a superior sensitivity for acute myocardial infarction but also has a significantly increased intensity of uptake in positive areas. TcPPi remains the agent of choice for myocardial infarct imaging.

Comparison of Tc-99m pyrophosphate and Tc-99m methylene diphosphonate in acute myocardial infarction: concise communication.

This study compared Tc-99m pyrophosphate (PPi) and Tc-99m methylene diphosphonate (MDP) for myocardial infarct imaging in 24 patients with diagnosed acute myocardial infarction. The radiopharmaceuticals were administered randomly and interpreted without knowledge of the sequence used. Twenty-three patients (96%) had positive Tc-99m PPi scintigrams, but only 17 (71%) had a positive Tc-99m MDP study (P less than 0.05). In addition, a comparison of the relative intensity with each agent revealed greater intensity with Tc-99m in 21 cases, equal intensity in two cases, and less intensity in only one case (p less than 0.001). These findings support the superiority of Tc-99m PPi as the agent of choice for myocardial scintigraphy in acute infarction.

Relative lesion detection ability of Tc-99m HMDP and Tc-99m MDP: concise communication.

To compare the efficacy of Tc-99m HMDP and Tc-99m MDP to define skeletal lesions, 28 adult patients were examined in a double-blind, randomized, crossover study. Each patient was imaged with both agents over a period of 7-14 days. Both quantitative and qualitative evaluations were performed on the resulting images. Both agents detected the same number of skeletal lesions, and the number of lesions detected was the same whether the imaging was performed 2 or 4 hr after injection. Relative uptake of the tracer in the lesion relative to normal bone was also the same for both agents. Lesions were easier to see at 4 hr after injection than at 2 hr, presumably because soft-tissue levels were lower. Retention of tracer in bone compared with soft tissue was greater, and image quality was judged to be better, with Tc-99m HMDP than with Tc-99m MDP.

Cohort studies of health effects among people exposed to estuarine waters: North Carolina, Virginia, and Maryland.

A variety of human symptoms have been associated with exposure to the dinoflagellate Pfiesteria and have been grouped together into a syndrome termed "possible estuary-associated syndrome." Prospective cohort studies of health effects associated with exposure to estuarine waters that may contain Pfiesteria spp. and related organisms are in progress in North Carolina, Virginia, and Maryland. The three studies recruited cohorts of 118-238 subjects who work or engaged in recreation in estuary waters. Baseline health and neuropsychological evaluations are conducted, and study subjects are followed prospectively for 2-5 years with periodic assessments of health and performance on a battery of neuropsychological tests. Health symptoms and estuary water exposure are recorded by telephone interviews or diaries every 1-2 weeks. Water quality information, including measurements of Pfiesteria spp., is collected in the areas where the subjects are working. Because it is not possible to measure individual exposure to Pfiesteria or a toxin produced by this organism, these studies examine surrogate exposure measures (e.g., time spent in estuary waters, in a fish kill area, or in waters where Pfiesteria DNA was detected by molecular amplification). Preliminary analyses of the first 2 years (1998-2000) of data indicate that none of the three ongoing cohorts have detected adverse health effects. However, there have not been any reported fish kills associated with Pfiesteria since the studies began, so it is possible that none of the study subjects have been exposed to toxin-producing Pfiesteria spp.

Nuclear imaging in urology.

Over the past 10 years nuclear renal imaging has proved to be a valuable diagnostic tool. The information derived from such studies must be correlated with all other imaging procedures now available, i.e., ultrasound and computed tomography. Prior to performing a study, the physician should focus carefully on what information is desired and whether or not it can be acquired. Once that is done, the use of these procedures in urology is extremely helpful and their aid in a given instance is limited only by the creative mind of the physicianuser.

Conventional radionuclide cardiac imaging.

For more than two decades, conventional radionuclide techniques have been employed for the noninvasive evaluation of cardiac function. Standardized techniques have been developed and are widely available. Extensive clinical experience has confirmed the reliability of these techniques and has established important roles in providing diagnostic and prognostic information. Conventional radionuclide cardiac imaging currently emphasizes the demonstration of abnormalities in myocardial perfusion and ventricular function. Myocardial and radionuclide studies are infrequently employed but can offer helpful information in specific clinical situations.

Grief reactions of mothers of adolescents and young adults with traumatic brain injury.

One hundred and two mothers of adolescents and young adults with traumatic brain injury completed a modified Grief Experience Inventory (GEI) (Sanders, Mauger, & Strong, 1985) and rated their child's functioning on a modified Neurobehavioral Rating Scale (NRS) (Levin et al., 1987). More severe grief was reported by mothers who rated their children as having poor neurobehavioral functioning and by mothers of young adult rather than adolescent patients. The guilt component of grief varied significantly across the 3-year post-injury period measured in the study. Historical comparisons of these respondents with other bereaved populations showed that mothers of adolescent and young adults with head injury reported more intense grief than parents who had experienced other significant non-death losses.

Wechsler Verbal-Performance IQ discrepancies among psychiatric inpatients: implications for subtle neuropsychological dysfunctioning.

One hundred seventy-nine psychiatric inpatients were administered the WAIS-R and several neuropsychological and academic achievement tests. All subjects were assigned to three groups based on their WAIS-R's VIQ-PIQ discrepancy scores: (i) Low Verbal (Verbal IQ < Performance IQ. by at least 13 points); (ii) Low Performance (Performance IQ < Verbal IQ by at least 13 points); and (iii) Equal (Verbal IQ-Performance IQ within 13 points). The Low Verbal group made significantly more errors on the Speech Sounds Perception Test, demonstrated lower spelling scores, evinced more aphasic signs, and had had more special education placements than did the Equal or Low Performance groups. The Low Performance subjects demonstrated significantly more signs of constructional dyspraxia and performed more poorly on the Grooved Pegboard test. The neuropsychiatric patients who had Verbal-Performance IQ discrepancies of at least one standard deviation may be at risk for specific, subtle neuropsychological deficits.

Comparative efficiency of a discrepancy analysis for the classification of Attention-Deficit/Hyperactivity Disorder in adults.

The present study evaluated an alternative method of neuropsychological test interpretation for the classification of Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. Specifically, an intra-individual discrepancy analysis was implemented in which differences between intellectual functioning and performance on a battery of six frontal/executive tests were examined within a homogeneous group of ADHD adults and matched normal controls. Significant group differences were identified between the ADHD adults and control sample on each of the dependent measures, with moderate diagnostic efficiency rates for the individual measures and a Discrepancy Impairment Index (DII). The discrepancy analysis approach generated significantly greater sensitivity in detecting the presence of ADHD as compared to a level of performance interpretive approach. Overall, these results provide support for the consideration of discrepancies between intellectual ability and frontal/executive functioning for the assessment of adult ADHD.

Periventricular leukomalacia (PVL): an identical twin case study illustration of white matter dysfunction and nonverbal learning disability (NLD).

This paper discusses the implications of Periventricular Leukomalacia (PVL) lesions for the development of Nonverbal Learning Disabilities (NLD) as illustrated through an identical twin case study. PVL lesions were identified in an 8-year-old child, but were not detected in his identical twin brother who served as a matched comparison. While the nonclinical twin displayed a largely unremarkable neuropsychological profile, the clinical twin evidenced a distinct pattern of social, intellectual, academic, and neuropsychological test results often identified among children with PVL and those with the NLD syndrome. The clinical and theoretical implications for this case study are discussed.

Implications of developmental theories for counseling adolescents in groups.

This paper presents a rationale for the use of group techniques in counseling adolescents, based on selected developmental theories. In addition, it delineates specific practical implications and guidelines for group counselors to consider. Specifically, group selection, group size and composition, and topical content are discussed as they relate to developmental issues during adolescence.

Effectiveness of a program using a vehicle tracking system, incentives, and disincentives to reduce the speeding behavior of drivers with ADHD.

OBJECTIVE: In this article, the authors investigated the effectiveness of a behavior modification program using global positioning system (GPS) vehicle tracking devices with contingency incentives and disincentives to reduce the speeding behavior of drivers with ADHD. METHOD: Using an AB multiple-baseline design, six participants drove a 5-mile stable driving route weekly while GPS devices recorded speeds. The dependent variable was percentage of feet speeding. Following an initial baseline period, five participants received treatment. One participant remained at baseline. RESULTS: Visual inspection of individual participant graphs, reductions in mean percentages of speeding from baseline to treatment across participants (M = 82%), C-statistic analyses, and visual graphs with applied binomial formula supported a treatment effect. The between-participant analysis using R n Test of Ranks was significant, R n = 6, p < .01, and complemented a clean multiple-baseline result. CONCLUSION: Results indicated that this treatment program was effective in reducing speeding by drivers with ADHD and warrants replication.