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.     

Effects of high oxygen concentrations on microbial biosensor signals. Hyperoxygenation by means of perfluorodecalin

Amperometric biosensors register oxygen depletion in response to analyte catabolism, and thus are limited by the availability of dissolved oxygen. Microbial sensors containing immobilized cells of Gluconobacter oxydans were hyperoxygenated to 400% of control levels and the effects on sensor responses to glucose were determined. Oxygenated perfluorodecalin (a completely fluorinated organic substance) was as effective in hyperoxygenation as direct sparging with O2, increasing sensor base medium oxygen concentrations from 9.3 to 37 mg/l. Hyperoxygenation enhanced maximal biosensor response amplitudes, particularly at high cell loading densities. Maximal response rates were also improved, although less dramatically. Results suggest that hyperoxygenation may be a new general approach for modulating biosensor responses.     

Pronoun resolution without pronouns: some consequences of memory-based text processing

A memory-based processing approach to discourse comprehension emphasizes the rapid deployment of information in memory to facilitate understanding of the text that is currently being read. S. B. Greene, R. J. Gerrig, G. McKoon, and R. Ratcliff (1994) demonstrated that when a text described the reunion of 2 characters who had previously discussed a 3rd character, the accessibility of the 3rd character increased, and the use of an unheralded pronoun (R. J. Gerrig, 1986) to refer to that character was felicitous. In experiments in this article, the authors demonstrate that concepts related to the unheralded pronoun also increase in accessibility and that those concepts form associations in memory with concepts present in the discourse at the time the pronoun is used. The authors also show that the increase in accessibility for the referent of the pronoun, as well as the appropriate long-term memory associations, occurs even in the absence of the pronoun.     

Lexical familiarity and processing efficiency: Individual differences in naming, lexical decision, and semantic categorization.

College students were separated into 2 groups (high and low) on the basis of 3 measures: subjective familiarity ratings of words, self-reported language experiences, and a test of vocabulary knowledge. Three experiments were conducted to determine if the groups also differed in visual word naming, lexical decision, and semantic categorization. High Ss were consistently faster than low Ss in naming visually presented words. They were also faster and more accurate in making difficult lexical decisions and in rejecting homophone foils in semantic categorization. Taken together, the results demonstrate that Ss who differ in lexical familiarity also differ in processing efficiency. The relationship between processing efficiency and working memory accounts of individual differences in language processing is also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)