Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis.
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OBJECTIVE: To compare the Affirm VPIII Microbial Identification Test for detection and identification of Candida species, Gardnerella vaginalis and Trichomonas vaginalis to clinical and microscopic criteria commonly used to diagnose vaginitis. METHODS: Women that were symptomatic for vaginitis/vaginosis and asymptomatic women being seen for routine obstetric or gynecological care were included in this study. Women treated with antibiotics or antifungals within one week or women who had douched within 24 hours were excluded. Two vaginal swab specimens were simultaneously obtained from each patient, one swab was placed in sterile physiological saline for immediate microscopic wet mount examination and KOH testing. The other swab was placed in the Affirm collection tube for Affirm VPIII testing based on previously demonstrated methods. RESULTS: The Affirm assay was significantly more likely to identify Gardnerella and Candida than wet mount. 190 (45%) were positive for Gardnerella by Affirm compared to 58 (14%) by wet mount; 45 (11%) were positive for Candida by Affirm compared to 31 (7%) by wet mount; and 30 (7%) were positive for Trichomonas by Affirm compared to 23 (5%) by wet mount. Symptomatic women were significantly more likely to be positive by Affirm only (23% vs. 10%), wet mount only (3% vs. 2%) or Affirm and wet mount (15% vs. 1%). Asymptomatic women were significantly more likely to be negative for Affirm and wet mount (43% vs. 5%). CONCLUSIONS: The Affirm VPIII test is a more sensitive diagnostic test for detection and identification of symptomatic vaginitis/vaginosis than conventional clinical examination and wet mount testing. (+info)
Tuberculosis outbreak in a low-incidence state--Indiana, 2001-2004.
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States with fewer than 3.5 cases of tuberculosis (TB) per 100,000 population are designated as states with low incidence for TB, corresponding to CDC's interim target rate for 2000, with a goal to eliminate TB in the United States by 2010. Indiana is a low-incidence state, with a TB case rate of 2.3 per 100,000 population in 2003. However, during 2000-2002, Allen County, Indiana, exceeded the state TB case rate with a mean case rate of 2.9 (range: 2.7-3.0) per 100,000 population. The TB case rate in Allen County increased to 4.7 per 100,000 population (with 16 patients reported with TB disease) in 2003 and to 7.0 per 100,000 population (with 12 patients reported with TB disease) during the first half of 2004. The Allen County Department of Health (ACDH), the Indiana State Department of Health, and CDC are investigating this ongoing TB outbreak. This report describes the preliminary results of the investigation, the efforts of ACDH to restructure its TB program, and the importance of maintaining TB-control efforts in low-incidence states. (+info)
Vocal tract filtering and sound radiation in a songbird.
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Bird vocalizations resonate as they propagate through a relatively long trachea and radiate out from the oral cavity. Several studies have described the dynamics with which birds actively vary beak gape while singing and it has been hypothesized that birds vary beak gape as a mechanism for varying vocal tract resonances. Nevertheless, few studies have attempted to quantify the effects of beak gape on vocal tract resonances. We replaced eastern towhee, Pipilo erythrophthalmus L., syringes with a small speaker and obtained recordings of frequency sweeps while rotating each subject in a horizontal plane aligned with either the maxilla or mandible. We describe vocal tract resonances as well as how sound radiates as a function of beak gape. Results are inconsistent with the hypothesis that songbirds vary beak gape as a mechanism for 'tracking' fundamental frequencies in vocalizations. Instead, decreases in beak gape seem to attenuate resonances that occur between approximately 4 and 7.5 kHz. We propose that songbirds vary beak gape as a mechanism for excluding and/or concentrating energy within at least two distinct sound frequency channels. (+info)
Interorganizational relationships within state tobacco control networks: a social network analysis.
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INTRODUCTION: State tobacco control programs are implemented by networks of public and private agencies with a common goal to reduce tobacco use. The degree of a program's comprehensiveness depends on the scope of its activities and the variety of agencies involved in the network. Structural aspects of these networks could help describe the process of implementing a state's tobacco control program, but have not yet been examined. METHODS: Social network analysis was used to examine the structure of five state tobacco control networks. Semi-structured interviews with key agencies collected quantitative and qualitative data on frequency of contact among network partners, money flow, relationship productivity, level of network effectiveness, and methods for improvement. RESULTS: Most states had hierarchical communication structures in which partner agencies had frequent contact with one or two central agencies. Lead agencies had the highest control over network communication. Networks with denser communication structures had denser productivity structures. Lead agencies had the highest financial influence within the networks, while statewide coalitions were financially influenced by others. Lead agencies had highly productive relationships with others, while agencies with narrow roles had fewer productive relationships. Statewide coalitions that received Robert Wood Johnson Foundation funding had more highly productive relationships than coalitions that did not receive the funding. CONCLUSION: Results suggest that frequent communication among network partners is related to more highly productive relationships. Results also highlight the importance of lead agencies and statewide coalitions in implementing a comprehensive state tobacco control program. Network analysis could be useful in developing process indicators for state tobacco control programs. (+info)
Access to communication technologies in a sample of cancer patients: an urban and rural survey.
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BACKGROUND: There is a growing awareness among providers of the symptom burden experienced by cancer patients. Systematic symptom screening is difficult. Our plan was to evaluate a technology-based symptom screening process using touch-tone telephone and Internet in our rural outreach cancer program in Indiana. Would rural patients have adequate access to technologies for home-based symptom reporting? OBJECTIVES: 1) To determine access to touch-tone telephone service and Internet for patients in urban and rural clinics; 2) to determine barriers to access; 3) to determine willingness to use technology for home-based symptom reporting. METHODS: Patients from representative clinics (seven rural and three urban) in our network were surveyed. Inclusion criteria were age greater than 18, able to read, and diagnosis of malignancy. RESULTS: The response rate was 97%. Of 416 patients completing the survey (230 rural, 186 urban), 95% had access to touch-tone telephone service, while 46% had Internet access (56% of urban patients, 38% of rural patients). Higher rates of Internet access were related to younger patient age, current employment, and higher education and income. The primary barrier to Internet access was lack of interest. Use of the Internet for health related activities was less than 50%. The preferred means of symptom reporting in patients with internet access were the touch-tone telephone (70%), compared to reporting by the Internet (28%). CONCLUSION: Access to communication technologies appears adequate for home-based symptom reporting. The use of touch-tone telephone and Internet reporting, based upon patient preference, has the potential of enhancing symptom detection among cancer patients that is not dependent solely upon clinic visits and clinician inquiry. (+info)
The Indianapolis Vocational Intervention Program: a cognitive behavioral approach to addressing rehabilitation issues in schizophrenia.
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Despite wishing to return to productive activity, many individuals with schizophrenia enter rehabilitation with severe doubts about their abilities. Negative beliefs in schizophrenia have been linked with poorer employment outcome. Accordingly, in this paper, we describe efforts to synthesize vocational and cognitive behavior therapy interventions into a 6-month manualized program to assist persons with schizophrenia spectrum disorders overcome negative beliefs and meet vocational goals. This program, the Indianapolis Vocational Intervention Program (IVIP), includes weekly group and individual interventions and is intended as an adjunct to work therapy programs. The IVIP was initially developed over a year of working with 20 participants with Structured Clinical Interview for the Diagnostic and Statistical Manual-I (SCID-I) confirmed diagnoses of schizophrenia or schizoaffective disorder who were actively engaged in 20 hours per week of work activity. For this paper, we explain the development of the treatment manual and the group and individual interventions and present case examples that illustrate how persons with severe mental illness might utilize the manualized intervention. (+info)
The prevalence of chlamydia, gonorrhea, and trichomonas in sexual partnerships: implications for partner notification and treatment.
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BACKGROUND: Treatment of sex partners by patient-delivered partner therapy (PDPT) may prove to be an effective strategy in reducing reinfection and preventing the sequelae of sexually transmitted infections (STIs). However, limited data exists regarding STIs within sexual partnerships (dyads). OBJECTIVE: The objective of this study was to determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Trichomonas vaginalis (TV) in sexual dyads to estimate the potential yield and limitations of PDPT. METHODS: Male and female STI clinic attendees were invited to participate. Index subjects and partners were interviewed and tested for CT, GC, and TV. All partners were sought regardless of infection status of the index subject. RESULTS: Of 210 dyads, the prevalence in index subjects was CT, 46%; GC, 18%; and TV, 14%. Considering the partners of 72 CT-only-infected index subjects, 57% had CT, 6% had GC, and 11% had TV. Considering the partners of 35 index subjects with GC or GC-CT coinfection, 57% had GC and/or CT; however, in 20% of partners, unsuspected TV was present. Among 74 dyads with uninfected index subjects, 26% of partners had an STI. Among the partners of 19 index subjects with TV only, 11% had CT, 5% had GC, and 37% had TV. CONCLUSION: In our clinic population, a substantial number of partners had infections different from or in addition to those infections in the index. Many of these infected partners would not be diagnosed and treated using PDPT. Partners of index attendees without detected infection were at high risk (26%) for STI, mostly CT. (+info)
Pursuing integration of performance measures into electronic medical records: beta-adrenergic receptor antagonist medications.
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OBJECTIVE: Electronic medical records seldom integrate performance indicators into daily operations. Assessing quality indicators traditionally requires resource intensive chart reviews of small samples. We sought to use an electronic medical record to assess use of beta-adrenergic antagonist medications (beta-blockers) following myocardial infarction, to compare a standardized manual assessment with assessment using electronic medical records, and to discuss potential for future integration of performance indicators into electronic records. DESIGN: Cross-sectional data analysis. SETTING: An urban academic medical center. PARTICIPANTS: US Medicare beneficiaries 65 years of age or older, admitted to hospital with myocardial infarction between 1995 and 1999. MEASUREMENTS AND MAIN RESULTS: Manual chart review was compared with a computer driven assessment of electronic records. Administration of beta-blockers and cases excluded from use of beta-blockers were measured, based on Medicare criteria. Among 4490 older adults, 391 (4%) of 9018 hospital admissions contained codes for myocardial infarction. In 323 (83%) of the 391 hospital admissions, criteria for excluding beta-blockers were met; 235 (60%) were excluded due to heart failure. Of 68 hospital admissions for myocardial infarction that did not meet exclusion criteria, physicians prescribed beta-blockers in 49 (72%) on admission and 42 (62%) at discharge. Compared with manual chart review, electronic review had a sensitivity of 83-100% and led to fewer false negative findings. CONCLUSIONS: An electronic medical records system can be used instead of chart review to measure use of beta-blockers after myocardial infarction. This should lead to integration of real time automated performance measurement into electronic medical records. (+info)