Electronic cigarette use and psychological distress in the Native Hawaiian and Pacific Islander adults compared with other racial/ethnic groups: Data from the National Health Interview Survey, 2014.

Document the prevalence of electronic cigarette (E-cigarette) use among the native Hawaiian and other Pacific Islander (NHPI) adults compared with other racial/ethnic groups, and examine associations between psychological distress and E-cigarette use. 2014 National Health Interview Survey (NHIS) and 2014 NHPI-NHIS were combined for comparisons. Data were analyzed using descriptive statistics, Rao-Scott χ2 test, and multivariable logistic regression. E-cigarette use among NHPI (5.6%) was significantly higher than among Blacks (2.1%), Hispanics (2.2%), and Asians (1.7%; p < .001). NHPI with Kessler 6 (K6) score of 11-24 had greater odds of using E-cigarettes (odds ratio [OR]: 3.90; 95% confidence intervals [CI]: 1.81-8.42) as compared to those with a K6 score of 0. Associations between having a K6 score of 11-24 and using E-cigarettes were also found for Whites (OR: 3.49; CI: 2.44-4.99), Asians (OR: 5.29; CI: 1.29-21.70), and Hispanics (OR: 6.14; CI: 2.72-13.83). E-cigarette use was higher among NHPI relative to other racial/ethnic groups. NHPI with K6 score of 11-24 had greater odds of using E-cigarettes as compared to those with a K6 score of 0. Policies and strategies to reduce E-cigarette use among NHPI should give careful consideration to the associations between E-cigarette use and psychological distress in the NHPI population.

A Serine12Stop mutation in PB1-F2 of the 2009 pandemic (H1N1) influenza A: a possible reason for its enhanced transmission and pathogenicity to humans

As the scientific community scrambles to define the ancestry and lineages of the eight segments of new pandemic H1N1 strain, we looked for unique genetic events in this virus's genome to explain the newly found enhanced virulence and transmissibility among humans. Genome annotations of this virus identified a stop mutation replacing serine at codon 12 (S12Stop) of the PB1-F2 protein, a virulence factor in influenza A viruses. Here, we discuss the significance of this finding and how it may contribute to host specialization, explaining the virtual absence of the H1N1 influenza A virus strain in pig populations. This finding is expected to lead to a better understanding of the transmission and pathogenesis of the 2009 pandemic strain.

Uterine artery aneurysm mimicking pelvic sarcoma. A case report and review of literature. raslanwf@aramco.com.sa.

We report a case of true uterine artery aneurysm in a 77-year-old diabetic woman, which was suspected radiologically as a pelvic sarcoma. The aneurysm was communicating with the atherosclerotic left uterine artery. Pelvic aneurysms carry the potential risk of massive intra-operative hemorrhage if the diagnosis was not established prior to operation.

Reliability of telemedicine examination.

OBJECTIVES: To assess the reliability of telemedicine examination and identify the issues to be addressed if the conduct of physical examination and the reading of images and tracings by telemedicine are to be as reliable as conventional examination and reading. METHODS: Patients were examined both conventionally and by telemedicine in 12 clinics, and the results were compared. There were 1826 matched pairs of observations. Cardiac auscultation, echocardiography, electrocardiography, electroencephalography, obstetric ultrasonography, ophthalmologic examination, physical therapy assessment, pulmonary auscultation, and the reading of chest radiographs with telemedicine cameras and monitors were studied. The main outcome measure was agreement between the telemedicine findings and a criterion standard. RESULTS: For ophthalmology, physical therapy, and cardiac auscultation, 91.2% of the conventional findings and 86.5% of the telemedicine findings were identical or similar to the criterion standard. The kappa coefficient on matched-pair analysis was 0.66. For pulmonary auscultation and reading of chest films with a telemedicine camera and monitor abnormalities were suppressed at default settings but subsequently revealed with extensive manipulation of system settings. For tracings and images, both conventional and telemedicine findings showed 92% reliability, with a kappa coefficient of 0.87. CONCLUSIONS: On the basis of these observations and the methods used, reliability varied with the type of examination, clinician experience with telemedicine, and participant knowledge of system limitations. Clinicians without experience or knowledge of system limitations missed findings of clinical importance. Improvements in equipment since the clinics were conducted in 1994 may have resolved some of these problems. Our findings raise doubts about the reliability of occasional telemedicine consultations by clinicians inexperienced in the technology.

Equating the MOS SF36 and the LSU HSI Physical Functioning Scales.

This study equates the physical functioning subscales of the Medical Outcomes Study Short Form 36 (SF36) and the Louisiana State University Health Status Instruments (LSU HSI). Data from the SF36's 10-item physical functioning scale, the PF10, and the LSU HSI's 29-item Physical Functioning Scale (PFS), were fit to separate and mixed Rasch rating scale models. Data were provided by a convenience sample of 285 patients waiting for appointments in a public hospital general medicine clinic. Difficulty estimates for a subset of similar items from the two instruments were highly correlated (.95), indicating that the items from the two scales are working together to measure the same variable. The measures from the two equated instruments correlate .80 (.86 when disattenuated for error). Of the two instruments, the PFS's error is lower, model fit is better, and reliability coefficients are higher. Both instruments measure physical functioning, and can do so in a common unit of measurement. Conversion tables are provided for transforming raw scores from either instrument into the common metric.

Comparison of the pharmacokinetics of parenteral parathyroid hormone-(1-34) [PTH-(1-34)] and PTH-related peptide-(1-34) in healthy young humans.

The amino-terminal fragments of human PTH [hPTH-(1-34)] and PTH-related peptide [PTHrP-(1-34)] appear to be equipotent in several rodent models. However, continuous i.v. infusions of these peptides to young human volunteers suggested that a 10-fold higher molar dose of PTHrP was required to produce comparable circulating levels of the peptide and biochemical responses similar to PTH. As PTHrP has a wide variety of target tissues in mammalian species and may, therefore, play a paracrine, rather than an endocrine, hormonal role in vivo, we evaluated whether enhanced metabolic clearance of injected PTHrP might explain its apparently reduced potency as a PTH-like hormone. Ten healthy subjects [age, 25 +/- 9 (+/- SD) yr] received in random order either hPTH-(1-34) or hPTHrP-(1-34) given by bolus i.v. injections in a dose of 10.7 nmol. Measurements of plasma immunoreactive peptide indicated a comparable volume of distribution for each, but the apparent t1/2 (8.3 +/- 1.6 min) and plasma clearance (4.0 +/- 1.4 L/min) for hPTHrP were significantly (P < 0.05) accelerated compared to those of hPTH (t1/2, 10.2 +/- 0.5 min; clearance, 2.0 +/- 0.4 L/min). Peak plasma cAMP levels were 9-fold lower in response to hPTHrP (29.5 +/- 19 vs. 190 +/- 63 pmol/L; P < 0.01), and increases in urinary cAMP excretion were 5-fold lower (2.1 +/- 1.1 vs. 11.2 +/- 3.7 nmol/mmol creatinine; P < 0.01). No major differences were observed in the urinary excretion of phosphate, calcium, or sodium between the two peptides. Although hPTHrP-(1-34) has a 2-fold higher MCR than hPTH-(1-34), this may not explain the more than 5-fold lower plasma or urinary cAMP response to PTHrP in humans. The comparable effects of PTH and PTHrP on urinary phosphate, calcium, and sodium may indicate a non-cAMP-dependent pathway for these responses, although the intracellular pool of cAMP generated to either peptide, and thus the local target tissue response, could not be estimated in the present study.

A ventilation-filtration unit for respiratory isolation.

OBJECTIVE: The development of a new method for achieving respiratory isolation in hospitals, clinics, and residential facilities, in response to the increasing risk of transmission of tuberculosis and the limitations of the currently available isolation systems. DESIGN: Ultraviolet (UV) light and ultra-low-penetration air filtration were combined with a ventilation unit and adapted for use in modular isolation rooms or for conversion of existing rooms. RESULTS: The ventilation-filtration unit efficiently cleared bacterial aerosols and particles > 0.2 microns from the air, maintained required negative pressures and airflows, and provided directional airflow within rooms.

Evaluation of a teaching skills improvement programme for residents.

This study addressed three evaluation questions about the effectiveness of a workshop to teach residents how to teach: (1) How do residents evaluate their own teaching skills? (2) How do students evaluate residents' teaching skills? (3) Do residents of various specialties differ in their teaching skills? One hundred and five residents rated their skills on the Inventory of Teaching Behavior significantly higher after attending the workshop than before it. Third-year students evaluated the teaching skills of both residents who had attended the workshop and those who had not. On four of the nine items of the Clinical Teaching Assessment Form, students rated residents who had attended significantly higher than the control residents. Some differences in teaching skills among the various specialties were found as were differences between resident self-rating and student rating. These data suggest that giving residents instruction can improve their teaching skills. By doing so, both the residents and the programme can benefit.

Study of teaching residents how to teach.

In the study reported here, the authors evaluated the effectiveness of a teaching skills program for residents. Twenty-two residents in obstetrics and gynecology, medicine, and family medicine were randomly assigned to control and experimental groups. The experimental groups received instruction and feedback about teaching skills during their first and second postgraduate years. Both groups were evaluated at three times: in the first year before the instructional program, in the second year during the instructional program, and in the third year six months after instruction. During each study phase, videotapes were made of each resident teaching a student in the context of a case presentation. Trained raters evaluated eight teaching skills exhibited in the videotapes. In general, there was greater increase and less decline in the scores of the experimental than the control groups. These data suggest that teaching skills can be improved by instruction and that without support residents' teaching skills do not improve in relation to their clinical competence.

Long-term evaluation of training residents in clinical teaching skills.

In the present study, the authors examined the long-term effectiveness of a course for residents on how to teach students, patients, and peers. Residents of various specialties attended a mandatory short course on clinical teaching skills in the middle of their first year of postgraduate medical training. Three types of evaluation data were collected at three times during a two-year period: self-ratings by the residents, questionnaires completed by the residents, and ratings completed by students taught by the residents. Complete data for 18 residents indicated that the residents rated their teaching skills significantly higher after the course (at the end of both the first year and the second year) than before it. At the end of the second year, 94 percent of the residents stated that the course was helpful, 67 percent could recall and explain specific principles of teaching, and 61 percent reported using principles from the course in their teaching. Students' ratings of these 18 residents were too scanty to be interpreted validly. The study suggests that residents of varying specialties can profit from an introductory course on teaching skills and that the effects endure for at least one and a half years.

Variation in the potentiation of beta-lactam antibiotic activity by clavulanic acid and sulbactam against multiply antibiotic-resistant bacteria.

Using a broth microdilution method, we studied 120 strains of beta-lactamase-producing clinical isolates to determine the potentiating effect of clavulanic acid and sulbactam (both beta-lactamase inhibitors) on the antibacterial activity of a variety of beta-lactam antibiotics. All antibiotics were tested alone and in combination with each inhibitor simultaneously using low (10(5) cfu/ml) and high (10(7) cfu/ml) inocula. Against the strains of Escherichia coli and Haemophilus influenzae the addition of both inhibitors significantly potentiated the activity of most antibiotics at the low inoculum. At the high inoculum, however, this effect was abrogated against E. coli and most strains of H. influenzae. Antibiotic activity was significantly enhanced by the inhibitors at both inoculum sizes with Bacteroides fragilis. Antibiotic resistance of Pseudomonas aeruginosa was little affected by the inhibitors. Among methicillin-resistant staphylococci, antibiotic potentiation by the inhibitors was more significant for Staphylococcus aureus than the coagulase-negative staphylococci.