Length of stay for specialized pediatric urologic care

BACKGROUND: Pediatric urologic specialists have been excluded from many recent managed care contracts because they are believed to be more expensive and of no better quality than general urologists in managing common urologic problems in children. We believed this to be inaccurate. OBJECTIVES: To compare the length of stay at the University of California, San Francisco Medical Center for 2 common pediatric urologic operative procedures with data from other northern California hospitals and to document our results and patient satisfaction. DESIGN: Retrospective analysis of HCIA statewide database (HCIA Inc, Orange, Conn). SETTING: Northern California, 1995. SUBJECTS: Children younger than 12 years undergoing surgery for repair of an obstruction of the ureteropelvic junction or vesicoureteral reflux. MAIN OUTCOME MEASURE: Length of stay. RESULTS: The length of stay in our hospital was similar to that observed in other hospitals in which other full-time pediatric urologic specialists practiced and was significantly less than that observed in other northern California hospitals, even when adjusted for risk. In fact, a savings of 279 hospital days would have been realized if all patients had the same length of stay as that achieved at University of California, San Francisco Medical Center. In the 38 patients operated on at our center, there was uniform surgical success. Of the parents, 92% (11/ 12) were satisfied with their child's care and 92% (11/ 12) believed they received enough information to know what to expect and how to care for their child at home. There were no data available evaluating quality from other northern California hospitals for comparison. CONCLUSIONS: Our finding that actual and risk-adjusted length of stay were shorter when patients were treated by full-time pediatric urologists, while excellent quality was maintained, suggests that these specialists achieve their results with more efficiency and lower resource utilization than do general urologists. The implication of these results is that exclusive contracting that prevents patients from receiving care from full-time specialists results in overuse of valuable resources and possibly reduced quality. If our results are generalizable, they have important implications for health care reform in the United States.     

Performance evaluation of disinfectant formulations using poloxamer-hydrogel biofilm-constructs

Etoposides block cell division by interfering with the action of topoisomerase II, leaving enzyme-DNA double-strand breaks. We found that certain components of the trimeric DNA-dependent protein kinase influence cell survival following etoposide damage. Interestingly, either Ku70- or Ku80-deficient cell lines, but not mutant cell lines of the DNA-PK catalytic sub-unit (DNA-PKcs), were found to be hypersensitive to the effects of etoposide VP16. Ku70- and Ku80-deficient cells can be complemented to an etoposide resistant phenotype by introducing wildtype Ku70 or Ku80 cDNAs. Mutational analysis of introduced Ku70 cDNAs into murine embryonic stem cells deleted for Ku70 (-/-) showed that mutants where heterodimerization and DNA binding functions of Ku were disrupted, also blocked the restoration of etoposide resistance. In contrast with the differential etoposide sensitivity of DNA-PK mutants, both Ku- and DNA-PKcs-deficient cell lines showed G2 ionizing radiation-induced delays, a cell cycle phase where topoisomerase II function is critical. Thus, the topoisomerase II cleaved complexes may be an example of DNA lesions requiring the Ku heterodimer, but not DNA-PK for DNA repair.     

The effect of matrix microstructure on the tensile and fatigue behavior of SiC particle-reinforced 2080 Al matrix composites

The effect of matrix microstructure on the stress-controlled fatigue behavior of a 2080 Al alloy reinforced with 30 pct SiC particles was investigated. A thermomechanical heat treatment (T8) produced a fine and homogeneous distribution of S′ precipitates, while a thermal heat treatment (T6) resulted in coarser and inhomogeneously distributed S′ precipitates. The cyclic and monotonic strength, as well as the cyclic stress-strain response, were found to be significantly affected by the microstructure of the matrix. Because of the finer and more-closely spaced precipitates, the composite given the T8 treatment exhibited higher yield strengths than the T6 materials. Despite its lower yield strength, the T6 matrix composite exhibited higher fatigue resistance than the T8 matrix composite. The cyclic deformation behavior of the composites is compared to monotonic deformation behavior and is explained in terms of microstructural instabilities that cause cyclic hardening or softening. The effect of precipitate spacing and size has a significant effect on fatigue behavior and is discussed. The interactive role of matrix strength and SiC reinforcement on stress within “rogue” inclusions was quantified using a finite-element analysis (FEA) unit-cell model.     

Parental reports of coparenting and observed coparenting behavior during the toddler period.

Fifty-two married partners played with their 30-mo-olds in both dyadic (parent–child) and whole family contexts and reported on their own coparenting activities (family integrity-promoting behavior, conflict, disparagement, and reprimand). Coparenting behavior observed in the whole family context was evaluated for antagonism, warmth and cooperation, child–adult centeredness, balance of positive involvement, and management of toddler behavior. Parallel balance and management scores were also formed using dyadic session data. Men's reported family integrity-promoting activities and women's reported conflict and reprimand activities were reliable correlates of family group process in both bivariate and discriminant analyses, with links enduring even after controlling for marital quality. Whole family- and dyad-based estimates of coparenting were altogether unrelated, and reported coparenting was tied only to behavior in family context, not to family measures created from dyad-based data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized trial of breast self-examination in Shanghai: methodology and preliminary results

BACKGROUND: The efficacy of breast self-examination in helping to reduce mortality from breast cancer has not been rigorously demonstrated. PURPOSE: To assess efficacy, a large, randomized trial was initiated in Shanghai, China. METHODS: From October 1989 to October 1991, 267040 current and retired female employees associated with 520 factories in the Shanghai Textile Industry Bureau were randomly assigned on the basis of factory to either a self-examination instruction group (133375 women) or a control group (133665 women). The women were born within the period from 1925 through 1958. Women in the instruction group were given intensive training in breast self-examination, including the use of silicone breast models and personalized instruction, plus two subsequent reinforcement sessions and multiple reminders to practice the technique. Women in the control group were asked to attend training sessions on the prevention of low back pain. All women have been followed for the development of breast diseases and for death from breast cancer. RESULTS: A high level of participation during the first 4-5 years of the trial was documented among women in the instruction group. Randomly sampled women in this group demonstrated greater proficiency in detecting lumps in breast models than did randomly sampled women in the control group. Approximately equal numbers of breast cancers were detected in the two groups (331 in the instruction group and 322 in the control group) through 1994, which is the last year for which case-finding efforts have been completed. The breast cancers detected in the instruction group were not diagnosed at an appreciably earlier stage or smaller size than those in the control group. More benign breast lesions were detected in the instruction group than in the control group (1457 versus 623, respectively), suggesting a higher index of suspicion for women who received training. Cumulative breast cancer mortality rates through 5 years from entry into the study were nearly equivalent for the two groups. CONCLUSIONS: Breast self-examination has not led to a reduction in mortality from breast cancer in this study cohort in the first several years since the trial began. A shift toward the diagnosis of disease at a less advanced stage in women given instruction has also not been demonstrated. Longer follow-up of participants in this trial is required before final assessment can be made of the efficacy of breast self-examination. IMPLICATIONS: At this time, there is insufficient evidence to recommend for or against the teaching of breast self-examination.     

Estimating the Removal of Anthropogenic Organic Chemicals from Raw Drinking Water by Coagulation Flocculation

A mathematical model was developed to estimate the efficacy of coagulation–flocculation treatment for removing neutral hydrophobic organic chemicals from raw drinking water. The model assumed that the only significant removal mechanism was the destabilization and settling of organic matter containing sorbed anthropogenic organic compounds. The model was validated with standard jar tests using compounds with a range of hydrophobicities (log?Kow = 1.89?to?5.48), including contaminant candidate list chemicals, pesticides, pharmaceuticals, and endocrine disrupting chemicals. Final concentrations of test compounds after coagulation and flocculation were in good agreement with model estimations for synthetic waters composed of Aldrich (Milwaukee, WI) humic acid solutions. The final compound concentrations in coagulated natural waters from two drinking water reservoirs were about 80% lower than those estimated with the model. Overestimations of treated water concentrations by the model were attributed to an increase in sorption by natural organic matter when coiled in aluminum hydroxide flocs, compared to sorption to dispersed natural organic matter in untreated water.     

The Effectiveness of Early Head Start for 3-Year-Old Children and Their Parents: Lessons for Policy and Programs.

Early Head Start, a federal program begun in 1995 for low-income pregnant women and families with infants and toddlers, was evaluated through a randomized trial of 3,001 families in 17 programs. Interviews with primary caregivers, child assessments, and observations of parent-child interactions were completed when children were 3 years old. Caregivers were diverse in race-ethnicity, language, and other characteristics. Regression-adjusted impact analyses showed that 3-year-old program children performed better than did control children in cognitive and language development, displayed higher emotional engagement of the parent and sustained attention with play objects, and were lower in aggressive behavior. Compared with controls, Early Head Start parents were more emotionally supportive, provided more language and learning stimulation, read to their children more, and spanked less. The strongest and most numerous impacts were for programs that offered a mix of home-visiting and center-based services and that fully implemented the performance standards early. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of relatedness and number of distractors on attribute judgments in Alzheimer's disease.

Participants made judgments about the relative salience of category exemplars (e.g., fruit: apple or grape) or parts (e.g., plane: wings or seats). Mildly affected Alzheimer's disease (AD) patients were as accurate but slower than normal controls, and their response times increased more for related (e.g., apple, grape, or fig) than unrelated (e.g., apple, gym, bandit) choices as the number of alternatives was increased from 2 to 3. Performance (accuracy and response times) of moderate-severely affected patients was poorer still, but number of distractors and relatedness did not interact. In combination with previous findings (e.g., M. K. Johnson, A. M. Hermann, & J. L. Bonilla, 1995), these results suggest that the reflective processes necessary for deciding among competing alternatives show disruption early in the disease process. Such processing deficits would compound any difficulties arising from a degrading semantic structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early intervention for spelling problems: Teaching functional spelling units of varying size with a multiple-connections framework.

Poor spellers in 2nd grade (n?=?128) participated in 24 20-min sessions that included (a) direct instruction in the alphabet principle (most frequent phoneme-spelling connections); (b) modeling of different approaches, singly and in combination, for developing connections between spoken and written words for 48 words ordered by sound-spelling predictability; and (c) practice in composing. Results of this multilayered intervention showed that (a) more than 1 way of developing sound-spelling connections is effective in teaching spelling but that after training in the alphabet principle, combining whole word and onset-rime training is most effective in achieving transfer of the alphabet principle across word contexts; (b) functional spelling units of not only a single letter but also 2 or more letters are important in beginning spelling; and (c) training in spelling transfers to composition and word recognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Scanning tunnelling microscopy of tobacco mosaic virus on evaporated and sputter-coated palladium/gold substrates

We present scanning tunnelling microscope (STM) images of untreated tobacco mosaic virus (TMV) deposited on thermally evaporated and on sputter-coated palladium/gold 40:60 (Pd/Au) substrates, and imaged under ordinary atmospheric conditions. The TMV imaged on both evaporated and sputter-coated substrates was consistently several times wider than the known diameter of the virus. TMV on evaporated Pd/Au became overcoated with Pd/Au material during sample preparation and appeared elevated in STM images, whereas TMV on sputter-coated Pd/Au appeared as depressions. When naked TMV were intentionally overcoated with Pd/Au, the STM images were found to be similar to those for TMV on evaporated Pd/Au.