The predictive utility of the Teller acuity cards for assessing visual outcome in children with preterm birth and associated perinatal risks.

We assessed binocular grating visual acuity with the Teller acuity cards (TAC) in 3-36-month-olds at risk for visual disorders. After 3-8 years, each child was assessed with the TAC and with a battery of tests of spatial and non-spatial vision. The initial TAC score: (1) was uncorrelated with any of the later measures; (2) had low positive, but high negative predictive value for the later tests; (3) had low sensitivity, but high specificity for identifying children with and without visual disorders, respectively. We concluded that early TAC grating acuity predicts visual outcome, but perhaps only for children with initially normal grating acuity.

Highway cowboys, old hands, and Christian truckers: risk behavior for human immunodeficiency virus infection among long-haul truckers in Florida.

This paper reports the results of ethnographic research to describe risk for human immunodeficiency virus (HIV) infection among long-haul truck drivers and the contexts and factors that influence risk and protective behaviors. Drivers were selected using purposive and snowball sampling at trucking-related businesses along major truck routes in Florida. Interview information was used to categorize truckers' levels of potential risk, describe behavioral characteristics of each group, identify sex partners, and assess perceptions of the risk of HIV infection. One-third of the 71 men interviewed had frequent sexual intercourse on the road with multiple partners, but few ever used condoms. Commercial sex workers were their most frequent partners for on-the-road sex. The risk was compounded by occupational conditions, which motivated truckers to drive long hours, often using drugs to stay alert. Sex, alcohol, and drugs were perceived as quick, effective stress relievers during downtime on long, lonely trips. Despite their high-risk behaviors, truckers tended to consider themselves at low risk for HIV infection and expressed a number of misconceptions regarding HIV transmission. For example, many truckers did not associate HIV risk with heterosexual contact or think that condoms were effective in preventing HIV transmission. In addition, many truckers maintained strong homophobic and anti-government opinions that reinforced their suspicion of safe-sex messages. These findings suggest that high-risk sexual behavior is common among long-haul truckers in the US, who may be at risk for HIV infection primarily because of unprotected sexual intercourse with multiple sex partners. Also, drug use may be associated with HIV risk behavior. The authors recommend establishing prevention programs that are developed by and for truckers, determining HIV seroprevalence rates of truckers, addressing drug and alcohol abuse among truckers, and altering industry policy that keeps truckers on the road too long for their own and others' safety.

Effects of intensified training and detraining on testicular function.

OBJECTIVE: To examine the effects of an increased training load and period of detraining on testicular function in male distance runners. DESIGN: Multiple-group time-series design using a control group. SETTING: University of Toledo and Toledo Hospital. PARTICIPANTS: Eight male runners and eight age-matched sedentary control subjects. Subjects were considered fit for participation after a physical and genital examination conducted by a physician. INTERVENTION: Subjects provided blood and semen samples every 2 weeks for 8 weeks. The training regimen for the runners consisted of 2 weeks at normal training (NT), 2 weeks at 143% of NT (IT1), 2 weeks at 186% of NT (IT2), and 2 weeks at 50% of NT (RT). These percentages represent increases in training distance (volume). MAIN OUTCOME MEASURES: Within the context of this investigation, the following hypothesis was developed: increases or decreases in training would not significantly alter sperm count, density, motility, or morphology, or concentrations of reproductive hormones or cortisol in runners. RESULTS: There were no statistically significant differences observed between runners and control subjects for any of the reproductive hormones or cortisol. In addition, there was no significant treatment effect for sperm count, motility, or morphology. The sperm levels in two runners in this investigation dropped to oligospermatic levels after IT2; however, total sperm count increased in both runners after 2 weeks of RT. CONCLUSION: Four weeks of increased training and 2 weeks of reduced training did not significantly affect the subjects in this investigation. It is possible that a particular level or degree of training must be surpassed before any clinical alterations are evident. Future longitudinal studies are necessary to identify the extent to which endurance training may alter reproductive hormones and testicular function.

Cross training: indices of training stress and performance.

Twenty well-trained runners (VO2max 4.6+/-0.5 L x min[-1]) were age and ability matched and assigned to either a cross training (CT) or run only group (RT). All subjects maintained normal running distance and intensity for 6 wk and reported for three additional training sessions per week. These workouts were performed outdoors on a 400-m track or measured road course (RT) or on a bicycle ergometer (CT). The sessions were as follows: (work x rest(-1) ratio = 1): 5 x 5 min at >95% VO2max/peak (Monday), 50-60 min at 70% VO2max/peak (Wednesday), and 3 x 2.5 min at >105% VO2max/peak, plus 6 x 1.25 min at >115% VO2max/peak (Friday). Subjects were tested before (PRE), after 3 wk (MID), and after 6 wk (POST) of intensified training. Blood samples were obtained from RT, CT, and ten controls (CON) at each time point (0600 h). Runners also completed a 10-min submaximal run at the same absolute intensity (velocity to elicit 75% of initial V02max) during which heart rate, RPE, and VO2 were measured. Each runner then completed a simulated 5-km race (time trial) on a treadmill. Total testosterone (TT), free testosterone (FT), cortisol (C), and creatine kinase activity (CK) were determined. Running economy was similar between RT and CT; however, RPE decreased significantly at MID and POST compared with that at PRE (P < 0.05; time effect). There were no significant differences among groups for TT, FT, or CK, but C was significantly lower in CON than in RT and CT. Performance was significantly faster (P < 0.05; time effect) in the 5-km race at MID (1076.1+/-81.4 s) and POST (1068.6+/-83.9) compared with PRE (1096.6+/-79.5) but was not different between CT and RT. In conclusion, RT and CT responded similarly to 6 wk of increased training, and both groups improved 5-km performance to a similar extent.

Quantification of the Brückner test for strabismus.

PURPOSE: To measure quantitatively the change in the coaxial fundus reflex with varying degrees of ocular misalignment. METHODS: The coaxial fundus reflex was imaged with a charge coupled device camera under conditions of simulated ocular misalignment ranging from 0 degrees to 7 degrees of fixation eccentricity. The effects of refractive error and pupil size were controlled. Average gray scale brightness values were calculated for each bright pupil image after some image processing was performed on the raw images. RESULTS: A reliable, sharply delineated, minimum brightness at foveal fixation was observed. CONCLUSIONS: It is estimated that this technique can be automated to detect the presence of 2 degrees to 3 degrees of ocular misalignment based on the difference in brightness of the bright pupil images between the two eyes.

The triple option choice: self-selection bias in traditional coverage, HMOs, and PPOs.

Health care costs and utilization by salaried employees and their dependents at a large self-insured midwestern industrial manufacturing corporation were analyzed for the year before employees were first offered a triple option choice. Members had the option of retaining traditional Blue Cross and Blue Shield of Michigan (BCBSM) coverage or switching to either a number of health maintenance organizations (HMOs) or a number of preferred provider organizations (PPOs). Members who switched to HMOs or PPOs were generally younger and had lower average expenses and utilization rates than those who retained the traditional BCBSM plan. The results suggest that a selection bias does occur in this population, as lower cost members were more attracted to the HMOs and PPOs than were more expensive members. Implications for the corporation as well as for the drive toward managed care alternatives are discussed.

Vibrio cincinnatiensis sp. nov., a new human pathogen.

A halophilic gram-negative rod was isolated from blood and cerebrospinal fluid collected from a 70-year-old male having no known contact with seafood or salt water. Positive biochemical tests included oxidase, sensitivity to 0/129, O-nitrophenyl-beta-D-galactopyranoside, lysine decarboxylase and fermentation of glucose, salicin, n-inositol, sucrose, L-mannose, L-arabinose, and arbutin. Negative tests included indole, ornithine decarboxylase, arginine dihydrolase fermentation of lactose, and production of gelatinase and urease. The DNA base composition was 45.0 mol% guanine plus cytosine. Numerical taxonomy indicated 70% similarity with known reference Vibrio sp. strains. The 5S rRNA sequence for this strain has been determined: 5'-U G C C U G G C G A C C A U A G C G U U U U G G A C C C A C C U G A U U C C A U G C C G A A C U C A G U A G U G A A A C G A A A C A G C G U C G A U G G U A G U G U G G G G U C U C C C C A U G U G A G A G U A G A A C A U C G C C A G G C A U-3'. Based on the phenetic, molecular genetic, and nucleic acid sequencing data, it is concluded that Vibrio cincinnatiensis represents a new species of the genus Vibrio sensu strictu (as defined by 5S rRNA sequencing results). On a basis of 5S rRNA comparative sequence analysis, the organism appears to share a recent common ancestor with V. gazogenes (98% homology) and close ancestry with V. mimicus, V. fluvialis, and V. metschnikovii.