National trends in the use of antibiotics by primary care physicians for adult patients with cough

BACKGROUND: Increased antibiotic use for outpatient illnesses has been identified as an important determinant of the recent rise in antibiotic resistance among common respiratory pathogens. Efforts to reduce the inappropriate use will need to be evaluated against current trends in the outpatient use of antibiotics. OBJECTIVES: To examine national trends in the use of antibiotics by primary care physicians in the care of adult patients with cough and identify patient factors that may influence antibiotic use for these patients. METHODS: This study was based on a serial analysis of results from all National Ambulatory Medical Care Surveys beginning in 1980 (when therapeutic drug use was first recorded) to 1994 (the most recent survey year available). These surveys are a random sampling of visits to US office-based physicians in 1980, 1981, 1985, and annually from 1989-1994. Eligible visits included those by adults presenting to general internists, family practitioners, or general practitioners with a chief complaint of cough. A total of 3416 visits for cough were identified over the survey years. Survey results were extrapolated, based on sampling weights in each year, to project national rates of antibiotic use for patients with cough. Additional analyses examined the rates of antibiotic use stratified by patient age, race, and clinical diagnosis. RESULTS: Overall, an antibiotic was prescribed 66% of the time during office visits for patients with cough: 59% of patient visits in 1980 rising to 70% of visits in 1994 (P = .002 for trend). In every study year, white, non-Hispanic patients and patients younger than 65 years were more likely to receive antibiotics compared with nonwhite patients and patients 65 years or older, respectively. CONCLUSIONS: The rate of antibiotic use by primary care physicians for patients with cough remained high from 1980 to 1994, and was influenced by nonclinical characteristics of patients.     

A desk-top personal computer for finite element post-processing

There is low cost, effective software for data processing available for use with desk-top personal computers. One such software package, called VisiCalc, is used on a TRS80 personal computer as a complement to some mainframe finite element post-processing. The TRS80 was attached to a time-sharing computer system to transfer some ADINA data to the TRS80's diskettes so that the data could then be reviewed with VisiCalc after disconnecting from the time-sharing system. VisiCalc post-processing was limited to review and graphical display of data that represented the contact pressure between a tire model and a road surface. However, the techniques and specialized programming can be easily extended to provide other types of data reduction and review. Also, the procedures are directly extendable to other desk-top personal computers.     

Architectures for exponentiation in GF(2m)

Several VLSI architectures for performing exponentiation in GF(2 ^m) are presented. Two approaches to the architecture design are taken. In the first, all intermediate products of the exponentiation are computed in a sequential fashion to minimize the silicon area. In the second approach, all values of raised to the 2^ei power, O⩽i⩽m-1, are precomputed and stored so that the intermediate product terms can be calculated in a parallel fashion. For the two approaches, both synchronous and asynchronous implementations are presented using standard and normal bases. The discussion emphasizes the design and performance tradeoffs incurred in developing such architectures     

To be born, to live and to die with lead

Fulminant hepatic failure is a severe impairment of liver function in someone who has had previously normal liver function. The patients presenting to intensive therapy units have generally had a rapid deterioration which requires prompt intervention and treatment. The first part of this paper gives a detailed review of the aetiology, physiology and management of the disease process. Medical and nursing care of these patients is critical; any adverse intervention may affect outcome. A literature review and small study of the intervention of endotracheal suctioning and its effects on intracranial pressure and cerebral perfusion pressure is described.     

An electron microscope investigation of phases in the system LaNiO

The system La-Ni-O has been studied by electron microscopy. Evidence is given for the existence of an homologous series, La_n+1Ni_nO_3n?1. The previously unreported phase La₃Ni₂O₇ was prepared and fully characterized.     

Serum triiodothyronine determination in clinical use

Two radioimmunassays for the determination of serum triiodothyronine (T3) were developed. The assay of T3 in unextracted serum had several advantages over the assay on extracted serum and was chosen for the routine determination of T3 in serum from 117 patients requiring assessment of their thyroid status. In 53 subjects considered retrospectively not to have thyroid dysfunction nor to have been on steroid contraceptives or therapy, the pooled mean serum T3 concentration was 1-92 (actual range 0-88-2-62) nmol/l. A significant inverse relationship was observed between the serum T3 level and the age of the subject. Serum total T3 levels discriminate clearly between hypo-,eu- and hyperthyroid patients and provide a rather more sensitive index of hyperthyroid function than total serum T4. In the face of normal serum T4 the T3 level was depressed in five patients with marked hypoproteinaemia and elevated in two patients taking heroin.     

A perturbation approach to non-newtonian lubrication theory

The hydrodynamic effects arising from non-Newtonian lubricants are investigated for a Rivlin-Ericksen third order fluid. The proposed perturbation expansion agrees with Reynolds original lubrication approximation, and a consistent series of differential equations are obtained. For small Reynolds numbers the equations are linear, and the effects produced by normal-stress-differences are shown to be dependent on boundary conditions. Nonlinear equations corresponding to large Reynolds numbers are solved numerically, and the influence of convective acceleration on non-Newtonian effects is illustrated.