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Group B streptococcus (GBS) is an increasing cause of disease in adults. We present long-term trends in incidence of overall infections and identify characteristics of patients with GBS cellulitis, bone and joint infections. Active, population-based surveillance was conducted from 1995-2012 in three California counties and the data were analysed retrospectively. All cases had isolation of GBS from a normally sterile site. Cases of cellulitis were classified based on clinical diagnosis. GBS bone or joint infection was defined as isolation of GBS from a bone or joint or a diagnosis of osteomyelitis or septic arthritis. Medical charts were reviewed for demographic and clinical information. There were 3917 cases of GBS; the incidence of disease increased from 5·8 to 8·3 cases/100 000 persons (P < 0·001) from 1995 to 2012. In adults aged ⩾40 years, the overall incidence of GBS increased from 8·5 to 14·2 cases/100 000 (P < 0·001) persons during the study period. The incidence of cellulitis increased from 1·6 to 3·8 cases/100 000 (P < 0·001), bone infection increased from 0·7 to 2·6 cases/100 000 (P < 0·001), and the incidence of joint infection remained approximately constant at an average rate of 1·0 case/100 000. The highest incidence rates were observed in men, persons aged ⩾80 years, non-Hispanic blacks and Hispanics. Diabetes was the most common underlying condition (51·2% cellulitis cases, 76·3% bone infections, 29·8% joint infections).

Tear production, evaluated every 2 hours from 8 AM to 8 PM by use of the Schirmer tear test over a 3-day period, was not significantly different between left and right eyes in 12 dogs. However, a significant diurnal pattern was evident. Tear production was lowest at midday and highest in the late afternoon/early evening. After pilocarpine HCl ophthalmic solution (0.25, 1.0, or 2.0%; 1 drop) was administered topically to the left eye of each dog at 7 AM on days 4, 6, and 8, respectively, tear production was determined for both eyes every 2 hours from 8 AM to 8 PM on the day of treatment. Analysis of tear values between eyes and between each eye's treatment and pretreatment values did not reveal significant change for the treated eye, but tear production was significantly less in the untreated eye, compared with its pretreatment values and with values in the treated eye. On day 10 (48 hours after the last treatment), tear production values were not significantly different between left and right eyes, and for both eyes, were not significantly different from the mean pretreatment tear production values. Topical application of 0.25, 1.0, or 2.0% pilocarpine HCl consistently caused blepharospasm, conjunctival hyperemia, and miosis of the treated eye, without significant increase in tear production. We concluded that topical application of pilocarpine, at the concentrations used, may have little value in treating disorders involving reduced tear production.

CONTEXT: The purpose of this case series study was to pilot test an evidence-based neuropathic pain (NP) treatment and referral algorithm for use by oncology nurses when managing cancer-related NP. OBJECTIVES: The primary study objective was to assess patient-reported outcomes (pain severity, changes in activities of daily living, and satisfaction) resulting from algorithm use. METHODS: Outpatients (n=20) with cancer-related NP scores >=4 on a 0-10 numeric rating scale participated in the study. NP assessment, treatment, and referral to ancillary providers were guided by an evidence-based NP algorithm that was implemented by oncology nurse practitioners. Based on efficacy evidenced through randomized clinical trials published at the time of study implementation, the following drugs were included in the algorithm: lidocaine patch, gabapentin, oxycodone, tramadol, morphine, methadone, duloxetine, pregabalin, and nortriptyline. Recommendations for starting dose, dose escalation, drug combinations, treatment duration, and contraindications were included for first-tier drugs. Patient-reported outcomes (pain severity, functional capacity, and satisfaction) were assessed monthly over 12 weeks. RESULTS: Average NP severity (P=0.001), general activity (P<0.001), mood (P=0.002), walking ability (P=0.01), ability to perform normal work (P=0.002), relationships (P=0.002), sleep (P=0.01), life enjoyment (P<0.001), and patient satisfaction (P=0.003) all improved by 12 weeks. CONCLUSION: Evidence from this pilot study suggests that NP evidence-based treatment may result in improved symptoms, function, and patient satisfaction. A randomized controlled trial is needed to further assess algorithm efficacy. [ABSTRACT FROM AUTHOR]

Development of head and neck cancer (HNC) is associated with human papillomavirus high-risk (HPV-HR) types. The HPV E7 oncoprotein inactivates the pRB protein increasing expression of p16(INK4a). p16 Expression and HPV status have been associated with differences in clinical outcomes for HNC. This study examined whether HNC prognosis was different when these biomarkers were examined as individual or joint molecular effects. Tumor tissue from 301 HNC patients were analyzed and sequenced for HPV types. p16 was evaluated by immunohistochemical staining. p16 was expressed in 35% and HPV-HR was detected in 27% of HNC patients. After adjustment for age, tobacco, and alcohol, p16+ tumors were statistically significantly associated with HPV-HR (OR=13.3, 7.1-24.9), histology, stage, grade, tumor site, and node involvement. Compared to p16+ HNC cases, those who did not express p16 had significantly worse disease-specific (DS) survival (Hazards Ratio, adj.HR=2.0. 1.0-3.9) and recurrence (adj.HR=3.6, 1.6-8.2); and HPV- cases had worse DS survival (adj.HR=2.8, 1.1-7.1) and recurrence (adj.HR=2.0, 0.8-4.8) compared to HPV-HR patients. Each of the p16/HPV groups had different survival outcomes: p16+/HPV-HR cases (referent) had the best and p16-/HPV- cases had the worst DS survival (adj.HR=3.6; 53% versus 13%, p=0.004) whereas p16+/HPV- and p16-/HPV-HR had similar DS survival (adj.HR=2.7/2.8). p16-/HPV-HR cases had a worse recurrence rate (adj.HR=7.0; 60% versus 0%, referent, p=0.08) than p16-/HPV- (adj.HR=4.5) or p16+/HPV- (adj.HR=1.8) cases. The combined p16/HPV biomarker data are associated with different survival outcomes of HNC compared to each marker evaluated separately, indicating that the two molecular mechanisms evaluated together may provide a more accurate prediction of clinical outcomes. [ABSTRACT FROM AUTHOR]

The long-term (10 years) multimodality distributed phased archive for the Medical Information, Communication and Archive System (MICAS) is being implemented in three phases. The selection process took approximately 10 months. Based on the mandatory archive attributes and desirable features, Cemax-Icon (Fremont, CA) was selected as the vendor. The archive provides for an open-solution allowing incorporation of leading edge, 'best of breed' hardware and software and provides maximum flexibility and automation of workflow both within and outside of radiology. The solution selected is media-independent, provides expandable storage capacity, and will provide redundancy and fault tolerance in phase II at minimum cost. Other attributes of the archive include scalable archive strategy, virtual image database with global query, and an object-oriented database. The archive is seamlessly integrated with the radiology information system (RIS) and provides automated fetching and routing, automated study reconciliation using modality worklist manager, clinical reports available at any Digital Imaging and Communications in Medicine (DICOM) workstation, and studies available for interpretation whether validated or not. Within 24 hours after a new study is acquired, four copies will reside within different components of the archive including a copy that can be stored off-site. Phase II of the archive will be installed during 1999 and will include a second Cemax-Icon archive and database using archive manager (AM) Version 4.0 in a second computer room. Copyright (c) 1999 by W.B. Saunders Company [ABSTRACT FROM AUTHOR]

The Medical Information, Communication and Archive System (MICAS) is a multivendor incremental approach to picture archiving and communications system (PACS). It is a multimodality integrated image management system that is seamlessly integrated with the radiology information system (RIS). Phase II enhancements of MICAS include a permanent archive, automated workflow, study caches, Microsoft (Redmond, WA) Windows NT diagnostic workstations with all components adhering to Digital Information Communications in Medicine (DICOM) standards. MICAS is designed as an enterprise-wide PACS to provide images and reports throughout the Strong Health healthcare network. Phase II includes the addition of a Cemax-Icon (Fremont, CA) archive, PACS broker (Mitra, Waterloo, Canada), an interface (IDX PACSlink, Burlington, VT) to the RIS (IDXrad) plus the conversion of the UNIX-based redundant array of inexpensive disks (RAID) 5 temporary archives in phase I to NT-based RAID 0 DICOM modality-specific study caches (ImageLabs, Bedford, MA). The phase I acquisition engines and workflow management software was uninstalled and the Cemax archive manager (AM) assumed these functions. The existing ImageLabs UNIX-based viewing software was enhanced and converted to an NT-based DICOM viewer. Installation of phase II hardware and software and integration with existing components began in July 1998. Phase II of MICAS demonstrates that a multivendor open-system incremental approach to PACS is feasible, cost-effective, and has significant advantages over a single-vendor implementation. Copyright (c) 1999 by W.B. Saunders Company [ABSTRACT FROM AUTHOR]

Previous work suggests that the population of homeless women is a heterogenous group, and that motherhood and the presence or absence of children define subgroups that may be distinct. The current study is a systematic study of 300 homeless women (90% of whom were mothers) according to these suggested subgroupings. Mothers whose children were with them, compared to other women, were younger and often unemployed and welfare dependent. Mothers without their children had higher rates of nonsubstance Axis I disorders (48%) and alcoholism (33%), and 72% had a lifetime psychiatric diagnosis. Homeless mothers whose children are not with them represent a deviant subgroup with more personal (and fewer social) vulnerabilities to homelessness and may represent a target population for focus of psychiatric treatment efforts. Mothers with their children may benefit more from increased attention to social services. [ABSTRACT FROM AUTHOR]

Homeless women are very different from homeless men, but few studies have reported data separately on them or compared them directly with men. This report on a study of 600 homeless men and 300 homeless women in St. Louis presents comparison data on these populations. The pivotal difference between homeless men and women was that unlike men, most women had young children in their custody. The women were also younger than men, more likely to be members of a minority group, and more often dependent on welfare. They had been homeless for a shorter period and spent less time in unsheltered locations. Compared to men, they had less frequent histories of substance abuse, incarceration, and felony conviction. Solitary women (without children with them), compared to women with children in their custody, were more likely to be white, had been homeless longer, and more often had a history of alcoholism or schizophrenia. On most variables, values for solitary women lay somewhere between those for men and for women with children. The population of homeless women is therefore heterogeneous, with at least two subgroups. These groups are likely to benefit from intervention programs that are designed to address their specific problems and needs, which are not necessarily the same as those of homeless men. [ABSTRACT FROM AUTHOR]

The majority of the homeless population are people of color. There has been little study of racial differences among the homeless population, and racial findings have not been reported separately for homeless men and women. This study investigated the differences between white and nonwhite homeless people in a randomly selected sample of 600 homeless men and 300 homeless women in St. Louis. The 900 homeless people were interviewed using the Diagnostic Interview Schedule and Homeless Supplement. About three-fourths of the sample were African Americans. The homelessness of the white people was more often internally related, for example, substance abuse in men and non-substance abuse psychiatric illness in women. The homelessness of nonwhite people was more often externally related, for example, socioeconomic problems caused by lower incomes for men and reliance on a failing welfare system by women and their dependent families. These differences point to potentially divergent emphases for intervention with these subpopulations. Because of the diversity within racial subgroups, however, all need a variety of interventions for both external and internal problems. [ABSTRACT FROM AUTHOR]

Although human papillomavirus (HPV), a sexually transmitted virus, is established as a necessary cause for more than 95% of cervical carcinomas, the association with oral squamous cell carcinoma is less well delineated. The purpose of this study was to determine the frequency and types of HPV in squamous cells of a group of patients with newly diagnosed oral or pharyngeal cancer (n = 93) compared with an age- and gender-frequency-matched control group of patients with no history of oral cancer (n = 205). HPV was evaluated from a mouth rinse collection of cells in the oral cavity and tested by 32P-labeled HPV generic probes and DNA sequencing for HPV types. HPV was identified in 15% of the oral cancer cases but in fewer than 5% of the controls (P < .05). The risk of cancer associated with HPV infection was independent of tobacco and alcohol use (adjusted odds ratio [OR] = 3.70; 95% confidence interval [CI]: 1.47-9.32; P < .05). HPV types included similar and other types not identified previously in the genital tract. There was no statistically significant increased risk of cancer among former tobacco users (former vs. never users: adjusted OR = 0.67, 95% CI: 0.31-1.44, P < .05), but the risk was significantly increased for current users (current vs. never: adjusted OR = 2.63; 95% CI: 1.22-5.71; P < .05). Likewise, former alcohol users were not at increased risk of disease (former vs. never: adjusted OR = 1.78; 95% CI: 0.87-3.67), whereas current alcohol users were (current vs. never: adjusted OR = 2.57; 95% CI: 1.22-5.42; P < .05). HPV-related genital lesions (14.3% vs. 10.6%), oral-genital sexual behavior (42.4% vs. 45.2%), and number (11 or more) of sexual partners (23% v. 17%) were not significantly different between cases and controls. These data suggest that in addition to tobacco and alcohol, HPV plays a role in the development of oral cancer. [ABSTRACT FROM AUTHOR]

This paper reviews the results of recent traffic systems research and concludes that the evidence shows that with sufficient ingenuity by farmers and their equipment suppliers to match operating and wheel track widths, the traffic management systems that reduce soil compaction should improve crop yield, reduce energy consumption and improve infiltration rates (which will reduce runoff, erosion and flooding). These together will improve agronomic, economic and environmental sustainability of agriculture. Low ground pressure alternatives may well be the option that best suits some farming enterprises and should not be discounted as viable traffic management methods. The paper also considers the implications for further work to improve the robustness of the experimental data.