Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in the emergency department

OBJECTIVES: 1) To quantify the frequency of underrecognized Neisseria gonorrhoeae and Chlamydia trachomatis cervical infections in women tested in the ED, 2) to describe and compare the characteristics of those treated and not treated during the initial visit, and 3) to quantify the delay interval until treatment was provided. METHODS: A 2-year, retrospective consecutive case series was performed from June 1, 1992, to May 31, 1994. There were 148 women with > or = 1 discrete occurrence of culture-proven cervical N. gonorrhoeae or C. trachomatis infection studied. All the patients were evaluated in a university-affiliated, tertiary care hospital-based ED with a large rural referral area. The main outcome measures were the proportions of patients with positive cultures both treated and not treated in the ED, the clinical characteristics of each group, and the proportion remaining untreated or experiencing treatment delays of > 2 weeks after attempted phone, mail, and public health follow-up. RESULTS: Of 157 occurrences of positive cultures for N. gonorrhoeae or C. trachomatis, 86 (53%) were treated with a regimen suggested by the CDC prior to ED release. The proportion of women with isolated C. trachomatis infections that were underrecognized and untreated initially was larger than the proportions with isolated N. gonorrhoeae or combined infections (79% vs 27% and 53%, respectively, p < 0.0001). Women with findings suggestive of advanced disease (history of fever or chills, or examination evidence of temperature > 38 degrees C, purulent vaginal discharge, or any uterine/salpinx/ovarian tenderness) were more often recognized and treated with appropriate antibiotics initially (p = 0.02 to < 0.00001 for all). After phone, mail, and public health follow-up, treatment could not be documented for 25% of the occurrences, in all cases due to an inability to locate the patient. An additional 20% of the women did not receive treatment for 14-60 days. CONCLUSIONS: In this population, both N. gonorrhoeae and C. trachomatis cervical infections are frequently underrecognized in the ED, with isolated C. trachomatis infections associated with significantly higher proportions of underrecognition. Many affected women remain untreated for extended intervals, creating public and individual health risks. Improved point of contact detection, follow-up, and treatment policies are needed to limit these risks.     

Rapidly tunable optical add-drop multiplexer utilising relaxed beam splitters

A polarisation-independent four-port electro-optic tunable filter in the 1530 nm wavelength regime utilising non-polarising relaxed beam splitters and strain-induced polarisation converters on LiNbO₃ with 16 nm tuning range and 46 ns tuning speed is reported.     

Fatigue crack propagation properties from small sized rod specimens

Mechanical properties characterization is needed in many industrial applications yet sufficient amount of material for fabricating standard-sized testing specimens is often not available. Techniques for testing miniaturized specimen must be adopted. Much effort has been made to develop techniques for impact, fracture toughness and tensile properties of sub-sized specimens. Work on the testing of fatigue properties is more limited. In this study, fatigue crack propagation behavior is evaluated from the growth of surface crack in a cylindrical rod under tension. Rods of various lengths and diameters were tested. As the size of the rod specimen is reduced, the fatigue crack growth rate tends to increase when correlated using the stress intensity factor range. This increase is explained largely by the decrease in the degree of premature crack closure in the small specimens. Valid fatigue crack growth data can be obtained among the specimens examined except on the crack growth on the surface of the smallest specimen, which has a length of 26 mm and diameter of 8 mm. Even so, valid data can still be elucidated on the latter specimen if the interior growth is considered. The dimensions of the latter specimen allow fatigue properties to be evaluated using broken remnants from impact or other test specimens.     

Chemical vapor deposition of amorphous ruthenium-phosphorus alloy films

Chemical vapor deposition growth of amorphous ruthenium-phosphorus films on SiO₂ containing ∼ 15% phosphorus is reported. cis-Ruthenium(II)dihydridotetrakis-(trimethylphosphine), cis-RuH₂(PMe₃)₄ (Me = CH₃) was used at growth temperatures ranging from 525 to 575 K. Both Ru and P are zero-valent. The films are metastable, becoming increasingly more polycrystalline upon annealing to 775 and 975 K. Surface studies illustrate that demethylation is quite efficient near 560 K. Precursor adsorption at 135 K or 210 K and heating reveal the precursor undergoes a complex decomposition process in which the hydride and trimethylphosphine ligands are lost at temperatures as low at 280 K. Phosphorus and its manner of incorporation appear responsible for the amorphous-like character. Molecular dynamics simulations are presented to suggest the local structure in the films and the causes for phosphorus stabilizing the amorphous phase.     

Congenic rats reveal three independent Copenhagen alleles within the Mcs1 quantitative trait locus that confer resistance to mammary cancer

It has previously been shown that the Copenhagen (COP) rat contains several genetic loci that contribute to its mammary tumor-resistant phenotype after 7,12-dimethylbenz(a)anthracene (DMBA) administration. One of these loci, mammary carcinoma susceptibility 1 (Mcs1), is located on the centromeric end of chromosome 2 and appears to act in a semidominant fashion. To confirm the existence and independent action of this locus and also aid in the identification of the physical location of the Mcs1 gene, congenic lines were generated by transferring the Mcs1 COP allele onto a Wistar Furth (WF) genetic background. Male carriers were genotyped using microsatellite markers spanning 20-30 cM of the Mcs1 locus. One of the congenic lines minimally retained the COP allele at D2Mit29 on the centromeric end of chromosome 2 and extended distally to D2Rat201. Heterozygous Mcs1 carrier rats were interbred, and the female offspring were treated with DMBA. The female rats from the Mcs1 congenic line that carried one or two COP alleles of the Mcs1 region had a significantly reduced (65 and 85%, respectively) tumor development (P < 0.001) compared with rats carrying zero COP alleles at this locus. A WF.COP-D2Mit29/D2Rat201 homozygous congenic strain derived at the N10 generation was treated with DMBA, and the COP homozygous rats developed 1.5 +/- 0.3 carcinomas/rat versus 6.3 +/- 0.5 in WF control rats (P < 0.0001). Fine mapping of this congenic interval using several recombinant lines identified three genetic loci within the Mcs1 congenic region that independently supported a tumor resistance phenotype. These genetic loci have been termed Mcs1a, Mcs1b, and Mcs1c. In rats for which each locus was homozygous for the COP allele, tumor development was reduced by approximately 60% compared with littermate controls. The identification of these independent loci within the Mcs1 COP allele provide a model of the genetic complexity of cancer.     

At least N+1 finite transmission zeros using frequency-variant negative source-load coupling

A second-order cross-coupled combline filter which has three finite transmission zeros is presented. The problem of the frequency-invariant coupling in a real circuit is introduced. To make extra transmission zeros, a top metalized dielectric block is used.     

The stress-whitened damage zone of PVC blends

The stress-whitened damage zone that formed ahead of a semicircular notch during slow tensile loading has been measured from optical micrographs of translucent blends of poly(vinyl chloride) (PVC) with experimental chlorinated polyethylene (CPE) resins. When the zone was small, the plane strain condition applied and from the elastic stress distribution a constant mean stress condition was found at the boundary of the crescent-shaped zone. The critical mean stress did not depend on the chlorine content or the chlorine distribution of the experimental CPE resin used in the blend. While the critical mean stress decreased as the amount of CPE in the blend was increased, the critical volume strain, calculated from the bulk modulus, was independent of composition and was thought to be the controlling parameter for stress-whitening. When the zone was larger, the shape was qualitatively described by concepts of stress redistribution in the presence of a plastic zone ahead of the notch. Macroscopic flow and necking were only detected near the maximum in the stress-displacement curve.     

DC and AC characteristics of sub-50-nm MOSFETs with source/drain-to-gate nonoverlapped structure

A MOSFET structure with a nonoverlapped source/drain (S/D) to gate region was proposed to overcome the challenges in sub-50-nm CMOS devices. Key device characteristics were investigated by extensive simulation study. Fringing gate electric field through the spacer induces an inversion layer in the nonoverlap region to act as an extended S/D region. An oxide spacer is used to reduce parasitic gate overlap capacitance. A reasonable amount of inversion electrons were induced under the spacers. Internal physics, speed characteristics, short channel effects, and RF characteristics were studied with the nonoverlap distance at a fixed metallurgical channel length of 40 nm. The proposed structure had good drain-induced barrier lowering and V/sub T/ rolloff characteristics and showed reasonable intrinsic gate delay and cutoff frequency compared to those of an overlapped structure.