Differences between completers and early dropouts from 2 HIV intervention trials: a health belief approach to understanding prevention program attrition

OBJECTIVES: The purpose of this study was to identify factors predicting program attrition among participants in human immunodeficiency virus (HIV) risk reduction trials. METHODS: Participants were gay/bisexual men and severely mentally ill adults recruited to take part in HIV risk reduction small-group interventions. Program completers were compared with participants who were assessed at baseline but then failed to attend any sessions. The health belief model provided a framework for selection of possible predictors of program attrition. RESULTS: Younger age was associated with early dropout in both samples. Other predictors among gay/bisexual men included involvement in an exclusive sexual relationship, minority ethnicity, injection drug use, and higher perceived severity of AIDS. Severely mentally ill dropouts were less knowledgeable about safer sex methods and more likely to hold positive outcome expectancies for condom use. CONCLUSIONS: Evaluation of intervention effectiveness among vulnerable population segments is threatened if there is selective attrition. Better methods are needed to attract and maintain participation in HIV prevention programs. Alternatively, wider application of "intention to treat" analysis of intervention outcomes is recommended to minimize selection bias due to program dropout.     

Refining the level for anticipated hepatotoxicity in acetaminophen poisoning

Treatment of an acetaminophen overdose with N-acetyl cysteine usually is based on the position of the 4-h acetaminophen (APAP) level on the Rumack-Matthew nomogram; however, there is disagreement on the level at which clinically relevant hepatotoxicity occurs. A retrospective review of all acute adult formulation APAP exposures reported to our poison center between 1986 and 1993 was performed and cases corresponding to the "possible risk or toxicity" range on the nomogram were identified. Our current poison center protocol for APAP poisoning does not recommend treatment with N-acetylcysteine (NAC) in low-risk patients if the 4-h serum APAP level or the extrapolated equivalent falls within the possible toxicity range on the nomogram. Seventeen cases met the inclusion criteria for the study and received no NAC; six additional patients met inclusion criteria but received one or two doses of NAC before therapy was discontinued. No patients in either group demonstrated clinical evidence of hepatotoxicity. This pilot study suggests that patients with no risk factors and APAP levels in the "possible risk" range may not require NAC therapy.     

Perinuclear antineutrophil cytoplasmic antibodies in patients with Crohn's disease define a clinical subgroup

BACKGROUND & AIMS: Antineutrophil cytoplasmic antibodies (ANCA) have been consistently detected in a subgroup of patients with Crohn's disease (CD). This study was designed to determine whether serum ANCA expression in patients with CD characterizes an identifiable clinical subgroup. METHODS: The study population consisted of 69 consecutive patients with an established diagnosis of CD as determined by a combination of characteristic clinical, radiographic, endoscopic, and histopathologic criteria. Sera from the patients were analyzed for the presence of ANCAs using the fixed neutrophil enzyme-linked immunosorbent assay (ELISA) assay. Perinuclear ANCA (pANCA)-positive and cytoplasmic ANCA (cANCA)-positive results by ELISA were confirmed by indirect immunofluorescence staining. Clinical profiles of the ANCA-positive patients with CD were compared with those of patients with CD not expressing ANCA (ANCA-negative). RESULTS: pANCA-positive patients with CD have endoscopically and/or histopathologically documented left-sided colitis and symptoms of left-sided colonic inflammation, clinically reflected by rectal bleeding and mucus discharge, urgency, and treatment with topical agents. One hundred percent of patients with CD expressing pANCA had "UC-like" features. CONCLUSIONS: In patients with CD, serum pANCA expression characterizes a UC-like clinical phenotype. Stratification of CD by serum pANCA provides evidence of heterogeneity within CD and suggests a common intestinal mucosal inflammatory process among a definable subgroup of patients with CD and UC expressing this marker.     

Free-living inferential modeling of blood glucose level using only noninvasive inputs

The goal of this work is to present a causation modeling methodology with the ability to accurately infer blood glucose levels using a large set of highly correlated noninvasive input variables over an extended period of time. These models can provide insight to improve glucose monitoring, and glucose regulation through advanced model-based control technologies. The efficacy of this approach is demonstrated using real data from a type 2 diabetic (T2D) subject collected under free-living conditions over a period of 25 consecutive days. The model was identified and tested using eleven variables that included three food variables as well as several activity and stress variables. The model was trained using 20 days of data and validated using 5 days of data. This gave a fitted correlation coefficient of 0.70 and an average absolute error (AAE) (i.e., the average of the absolute values for the measured glucose concentration minus modeled glucose concentration) of 13.3 mg/dL for the validation data. This AAE result was significantly better than the subject’s personal glucose meter AAE of 15.3 mg/dL for replicated measurements.     

<Emphasis Type="Italic">A Midsummer Night’s Dream</Emphasis> (with flying robots)

Seven flying robot “fairies” joined human actors in the Texas A&;M production of William Shakespeare’s A Midsummer Night’s Dream. The production was a collaboration between the departments of Computer Science and Engineering, Electrical and Computer Engineering, and Theater Arts. The collaboration was motivated by two assertions. First, that the performing arts have principles for creating believable agents that will transfer to robots. Second, the theater is a natural testbed for evaluating the response of untrained human groups (both actors and the audience) to robots interacting with humans in shared spaces, i.e., were believable agents created? The production used two types of unmanned aerial vehicles, an AirRobot 100-b quadrotor platform about the size of a large pizza pan, and six E-flite Blade MCX palm-sized toy helicopters. The robots were used as alter egos for fairies in the play; the robots did not replace any actors, instead they were paired with them. The insertion of robots into the production was not widely advertised so the audience was the typical theatergoing demographic, not one consisting of people solely interested technology. The use of radio-controlled unmanned aerial vehicles provides insights into what types of autonomy are needed to create appropriate affective interactions with untrained human groups. The observations from the four weeks of practice and eight performances contribute (1) a taxonomy and methods for creating affect exchanges between robots and untrained human groups, (2) the importance of improvisation within robot theater, (3) insights into how untrained human groups form expectations about robots, and (4) awareness of the importance of safety and reliability as a design constraint for public engagement with robot platforms. The taxonomy captures that apparent affect can be created without explicit affective behaviors by the robot, but requires talented actors to convey the situation or express reactions. The audience’s response to robot crashes was a function of whether they had the opportunity to observe how the actors reacted to robot crashes on stage, suggesting that pre-existing expectations must be taken into account in the design of autonomy. Furthermore, it appears that the public expect robots to be more reliable (an expectation of consumer product hardening) and safe (an expectation from product liability) than the current capabilities and this may be a major challenge or even legal barrier for introducing robots into shared public spaces. These contributions are expected to inform design strategies for increasing public engagement with robot platforms through affect, and shows the value of arts-based approaches to public encounters with robots both for generating design strategies and for evaluation.     

Using cross-layer metrics to improve the performance of end-to-end handover mechanisms

Network centric handover solutions for all IP wireless networks usually require modifications to network infrastructure which can stifle any potential rollout. This has led researchers to begin looking at alternative approaches. Endpoint centric handover solutions do not require network infrastructure modification, thereby alleviating a large barrier to deployment. Current endpoint centric solutions capable of meeting the delay requirements of Voice over Internet Protocol (VoIP) fail to consider the Quality of Service (QoS) that will be achieved after handoff. The main contribution of this paper is to demonstrate that QoS aware handover mechanisms which do not require network support are possible. This work proposes a Stream Control Transmission Protocol (SCTP) based handover solution for VoIP called Endpoint Centric Handover (ECHO). ECHO incorporates cross-layer metrics and the ITU-T E-Model for voice quality assessment to accurately estimate the QoS of candidate handover networks, thus facilitating a more intelligent handoff decision. An experimental testbed was developed to analyse the performance of the ECHO scheme. Results are presented showing both the accuracy of ECHO at estimating the QoS and that the addition of the QoS capabilities significantly improves the handover decisions that are made.     

Laparoscopic vs. open wedge biopsy of the liver

The number of people smoking free-base cocaine, or "crack," has increased dramatically in recent years. Concomitantly, the literature describing complications of such use has grown as well. Adverse pulmonary effects are being increasingly noted, such as respiratory symptoms, pulmonary hemorrhage, pulmonary edema, asthma, and pulmonary barotrauma. These and other pulmonary effects are reviewed.     

After-hours telephone coverage: the application of an area-wide telephone triage and advice system for pediatric practices

BACKGROUND: After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. OBJECTIVES: This report describes the AHP, presents data from 4 years' experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. METHODS: After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. RESULTS: In 4 years, 107,938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phoen calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician's office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient's initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. CONCLUSIONS: Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.     

Determinants of temperature in small coastal embayments of Lake Ontario

Along 25 km of the Lake Ontario shoreline near Toronto, Ontario, small coastal embayments (0.4–32 ha) have been constructed or modified by lake-infilling to restore warmwater fish habitat. The variation in thermal habitat quality for warmwater fishes among these embayments is very high; temperatures range from those found within a small pond to those of much cooler Lake Ontario. Since meteorological conditions and surface heat fluxes are almost identical, the temperature variation among embayments must be caused by differences in bathymetry or exchange with Lake Ontario. However, a previous study on these embayments found paradoxically that temperatures were not strongly associated with channel size or embayment bathymetry. This paper resolves the paradox by showing that flushing times for almost all of the constructed embayments were less than 1 day, and often less than 12 h. With so little time to warm within the embayments, water temperatures of almost all embayments remained very close to the temperatures of the adjacent lake waters. The coldest embayments connected directly to open Lake Ontario and warmer embayments connected to Lake Ontario through other embayments or protected harbors, where the inflowing water from Lake Ontario had already substantially warmed. To allow embayments along the exposed shoreline of Toronto to reach acceptable temperatures for warmwater fish, we use heat budgets to calculate that average summer flushing times must be increased from their current length of 1.5 to 5.5 h to approximately 30 h. Such changes could be achieved through large reductions in the channel cross section.