A Randomized Clinical Trial of Standard versus Expanded Cultures to Diagnose Urinary Tract Infections in Women.

PURPOSE: We compared urinary tract infection (UTI) symptom resolution rates at 7-10 days in symptomatic women randomized to treatment based on standard urine culture (SUC) versus expanded quantitative urine culture (EQUC) results. MATERIALS AND METHODS: Women ≥18 years old who responded "yes" to "do you feel you have a UTI?" agreed to urethral catheterization and followup. Symptoms were assessed using the validated UTI Symptom Assessment (UTISA) questionnaire. Culture method was randomized 2:1 (SUC:EQUC); antibiotics were prescribed to women with positive cultures. The primary outcome, UTI symptom resolution, was determined 7-10 days following enrollment on all participants regardless of treatment. RESULTS: Demographic data were similar between groups. Of the SUC and EQUC groups 63% and 74% had positive cultures (p=0.10), respectively. Of participants with positive cultures 97% received antibiotics. Primary outcome data were provided by 215 of 225 participants (SUC 143 [95%], EQUC 72 [97%]). At the primary outcome assessment, 64% and 69% in the SUC and EQUC groups, respectively, reported UTI symptom resolution (p=0.46); UTISA scores improved from baseline in the EQUC arm compared to the SUC arm (p=0.04). In the subset of women predominated by non-Escherichia coli (76), there was a trend toward more symptom resolution in the EQUC arm (21%, p=0.08). CONCLUSIONS: Symptom resolution was similar for the overall population (E. coli and non-E. coli) of women treated for UTI symptoms based on SUC or EQUC. Although the sample size limits conclusions regarding the utility of EQUC in women with non-E. coli uropathogens, the detected trend indicates that this understudied clinical subset warrants further study.

Does Patient Education Augment Pelvic Floor Physical Therapy Preparedness and Attendance? A Randomized Controlled Trial.

OBJECTIVES: The objective of this study was to evaluate patient attendance and preparedness for pelvic floor physical therapy (PFPT) after comparing standard counseling versus standard counseling plus an educational video. METHODS: A randomized controlled trial of 200 patients in a Female Pelvic Medicine and Reconstructive Surgery practice was performed in a tertiary care referral center. Participants were randomized to 1 of 2 educational modalities after being prescribed PFPT. Women either received standard handout counseling or enhanced video counseling. A sample size of 96 per group (N = 192) was needed to detect a 20% difference in PFPT attendance corresponding to a priori estimates of 50% compliance for the standard counseling group (handout) versus 70% compliance for the enhanced counseling group (handout plus video). Compliance data were assessed at least 3 months after the initial referral to determine attendance at PFPT. RESULTS: Sixty-five percent of patients attended at least 1 PFPT visit, whereas 46.5% completed therapy. There was no difference between the standard and enhanced counseling groups in PFPT attendance (P = 0.056) or in completion of half the recommended visits (P = 0.17). Similarly, level of preparedness after viewing the assigned counseling modality did not differ between standard and enhanced counseling groups. For each additional completed visit, the odds of successfully completing PFPT increased by approximately 38% (odds ratio, 1.38; 95% confidence interval, 1.19-1.59). CONCLUSIONS: The addition of enhanced patient counseling did not improve patient preparedness or odds of attending PFPT. Adherence behaviors surrounding PFPT attendance are multifactorial and require further qualitative research to elucidate barriers to PFPT attendance.

Density and distribution of hippocampal neurotransmitter receptors in autism: an autoradiographic study.

Neuropathological studies in autistic brains have shown small neuronal size and increased cell packing density in a variety of limbic system structures including the hippocampus, a change consistent with curtailment of normal development. Based on these observations in the hippocampus, a series of quantitative receptor autoradiographic studies were undertaken to determine the density and distribution of eight types of neurotransmitter receptors from four neurotransmitter systems (GABAergic, serotoninergic [5-HT], cholinergic, and glutamatergic). Data from these single concentration ligand binding studies indicate that the GABAergic receptor system (3[H]-flunitrazepam labeled benzodiazepine binding sites and 3[H]-muscimol labeled GABA(A) receptors) is significantly reduced in high binding regions, marking for the first time an abnormality in the GABA system in autism. In contrast, the density and distribution of the other six receptors studied (3[H]-80H-DPAT labeled 5-HT1A receptors, 3[H]-ketanserin labeled 5-HT2 receptors, 3[H]-pirenzepine labled M1 receptors, 3[H]-hemicholinium labeled high affinity choline uptake sites, 3[H]-MK801 labeled NMDA receptors, and 3[H]-kainate labeled kainate receptors) in the hippocampus did not demonstrate any statistically significant differences in binding.

Frequency Stabilization of a Ho:Tm:YLF Laser to Absorption Lines of Carbon Dioxide.

A single-frequency Ho:Tm:YLF laser, operating at an eye-safe wavelength of 2 mum, has been developed with tuning characteristics optimized for spectroscopy of absorption features. The laser frequency was stabilized to three different absorption lines of carbon dioxide by a wavelength modulation technique. Long-term frequency drift has been eliminated from the laser, and shorter-term jitter has been reduced to within 13.5 MHz of the absorption line center. This stabilized laser is an ideal injection seed source for a differential absorption lidar system for measurement of atmospheric gases.

Prenatal availability of choline alters the development of acetylcholinesterase in the rat hippocampus.

Choline (Ch) supplementation during embryonic days (ED) 12-17 enhances spatial and temporal memory in adult and aged rats, whereas prenatal Ch deficiency impairs attention performance and accelerates age-related declines in temporal processing. To characterize the neurochemical and neuroanatomical mechanisms that may mediate these behavioral effects in rats, we studied the development [postnatal days (PD) 1, 3, 7, 17, 27, 35, 90, and 26 months postnatally] of acetylcholinesterase (AChE) activity in hippocampus, neocortex and striatum as a function of prenatal Ch availability. We further measured the density of AChE-positive laminae (PD27 and PD90) and interneurons (PD20) in the hippocampus as a function of prenatal Ch availability. During ED11-ED17 pregnant Sprague-Dawley rats received a Ch-deficient, control or Ch-supplemented diet (average Ch intake 0, 1.3 and 4.6 mmol/kg/day, respectively). Prenatal Ch deficiency increased hippocampal AChE activity as compared to control animals in both males and females from the 2nd to 5th week postnatally. Moreover, prenatal Ch supplementation reduced hippocampal AChE activity as compared to control animals over the same developmental period. There was no effect of prenatal Ch status on either cortical or striatal AChE activity at any age measured, and by PD90 the effect of Ch on hippocampal AChE was no longer observed. In order to localize the early changes in hippocampal AChE activity anatomically, frozen coronal brain sections (PD20, PD27, PD90) were stained histochemically for AChE. Consistent with biochemical results, the AChE staining intensity was reduced in PD27 hippocampal laminae in the Ch-supplemented group and increased in the Ch-deficient group compared to control animals. There was no effect of the diet on hippocampal AChE staining intensity on PD90. In addition, the prenatal Ch availability was found to alter the size and density of AChE-positive PD20 interneurons. These results show that prenatal Ch availability has long-term consequences on the development of the hippocampal cholinergic system.

Do enamel microstructures have regular time dependency? Conclusions from the literature and a large-scale study.

This paper is structured in two parts. The first briefly reviews a number of lines of published evidence, including direct experimental evidence, supporting the contention that enamel microstructures are time dependent and have a regular periodicity. The second presents the results of a large-scale study designed to test a central assumption underlying most histological ageing approaches in enamel: that the number of cross striations between adjacent striae of Retzius, called the circaseptan interval, are uniform within a tooth and between all teeth in the dentition of an individual. The study uses a sample of 158 anterior teeth from three modern human populations. Teeth were sectioned and circaseptan intervals were determined by dividing measurements of the distance between adjacent striae of Retzius, by cross-striation length. In order to exercise as much procedural rigour as possible, all measurements were made from photomicrographs. Two sections were taken from each tooth, the sampling location within each tooth was recorded, and all populations included multiple teeth from single individuals. Results statistically validate the uniformity hypothesis within the anterior dentition. These, together with the weight of published evidence, suggest that data derived from the use of enamel microstructures in age estimation techniques and growth and development studies, are valid.

A comparative assessment of vancomycin-associated nephrotoxicity in the young versus the elderly hospitalized patient.

The incidence of vancomycin-associated nephrotoxicity was determined in a younger (age < 60 y) versus elderly (age > or = 60 y) hospitalized adult population to identify associated drug- and nondrug-related risk factors. Nephrotoxicity was defined as an acute increase in serum creatinine of > or = 44.2 mumol/L if baseline serum creatinine was < or = 221 mumol/L or an increase in serum creatinine of > or = 88.4 mumol/L if baseline serum creatinine > 221 mumol/L. A total of 289 patients, 141 younger (mean age, +/- S.D. 37.9 +/- 12.4 y) and 148 elderly (73.6 +/- 8.5 years), was retrospectively reviewed. Nephrotoxicity occurred in 7.8% younger vs 18.9% elderly patients (P = 0.003). Using multivariate logistic regression models for the pooled patient population, concurrent loop diuretic use was significantly associated with vancomycin-associated nephrotoxicity (relative risk (R.R.) = 5.06); for the younger population, only concurrent amphotericin B use was significantly associated with vancomycin-associated nephrotoxicity (R.R. = 6.65); and for the elderly population, only concurrent loop diuretic use was significantly associated with vancomycin-associated nephrotoxicity (R.R. = 9.70). These data suggest that elderly patients are at significantly greater risk of vancomycin-associated nephrotoxicity than are younger patients. However, because age was not a significant risk factor for nephrotoxicity in comparing the pooled vancomycin-associated nephrotoxicity group compared to the non-nephrotoxicity group, the differences observed between age groups probably reflect differences in risk factor prevalence.

Utah dentists sealant usage survey.

After a statewide survey of dentists to determine how many were using sealants, the Utah Department of Health, Dental Health Bureau developed and began implementing a sealant-education program in 1982. The extent of reported usage increased from 48 percent in 1982 to 98 percent in 1987. Routine use increased from 10 percent to 48 percent.

Nausea and vomiting in pregnancy.

Prospective data on 86 pregnant women were analysed to investigate the relationship between the pregnancy symptoms of nausea and vomiting and various demographic, social and psychological factors. In contrast to previous research findings no significant differences were discovered along demographic or social dimensions between women reporting no nausea, mild nausea and severe nausea during the first trimester of pregnancy. Not surprisingly, those women experiencing severe nausea reported significantly more sleep disturbances, fatigue and irritability. Women having both nausea and vomiting during the first trimester, reported significantly more unplanned, undesired pregnancies and negative relationships with their own mothers, than first trimester groups experiencing nausea only or no symptoms. Finally, those with continuing nausea and vomiting in the third trimester, when compared with those having no symptoms, tended to have reported significantly more psychological/psychiatric problems in the first trimester and were significantly more negative in their assessment of their own maternal relationship.