Evaluation of the use of calendar blister packaging on patient compliance with STD syndromic treatment regimens.

BACKGROUND: Good compliance with antibiotic therapy is critical for successful management of sexually transmitted diseases (STDs). GOAL OF THIS STUDY: To evaluate the use of user-friendly drug packaging as a means of improving patient compliance with STD therapy and the acceptability of the packaging. STUDY DESIGN: Compliance of patients with STDs with treatment regimens for three different STD syndromes, using antibiotics packed in standard medicine packaging (SP), was compared to that of patients using calendar blister packaged drugs. Compliance was measured by counting the remaining pills at two return visits. Questionnaires were used to evaluate acceptability of the packs. RESULTS: Compliance was significantly better among patients using the calendar blister packs than among those using standard packs, irrespective of dosing frequency. The degree of poor compliance increased with increasing dosing frequency. There was a high level of satisfaction with the blister pack among patients and health care workers. CONCLUSION: Compliance can be improved by the introduction of user-friendly drug packaging, especially for more complex dosing regimens.

Reevaluation of the ambulatory pediatric patient whose blood culture is positive for Haemophilus influenzae type b.

We conducted a retrospective review of 60 patients with Haemophilus influenzae type b bacteremia initially treated as outpatients, to test the hypothesis that a subgroup of these patients is at low risk of continuing invasive infection and thus requires a less comprehensive reevaluation. These patients were 6% of the 975 patients with invasive H. influenzae type b infection identified by active surveillance in Dallas County, Texas, during a 6 1/2-year period. The clinical assessment of "ill" appearance and persistent fever (greater than or equal to 38.0 degrees C) on the return visit were the two most useful variables in identifying patients at risk of continuing infection. Among 25 (42%) patients who were considered "ill" (febrile or afebrile), 20 (80%) had continuing invasive infection and 14 (56%) had a subsequent culture that was positive for H. influenzae type b. Among 8 patients who were considered "well" but who remained febrile, 3 (38%) had continuing infection, including 1 (13%) patient with a second culture that was positive. By contrast, among 27 (45%) patients who were considered "well" and who were afebrile, continuing invasive infection was identified in only 2 (7%) patients, and all repeat cultures were negative. These results suggest that when patients return for reevaluation of H. influenzae type b bacteremia, clinical assessment by an experienced physician, together with the febrile status of the patient, can identify those at high versus low risk of continuing invasive infection and thus guide the extent of diagnostic reevaluation.

Quantitative evaluation of phase-conjugate novelty filters.

A Michelson interferometer whose signal arm is terminated by a self-pumped BaTiO(3) phase conjugator records phase-change distributions in times short compared with the conjugator rewrite time that correspond quantitatively to a single (not a double) traversal of the phase disturbance. The proffered explanation, which is experimentally substantiated, also places limitations on the pictorial accuracy of intensity-change novelty filters.

Multimode fiber interferometry with and without phase conjugation.

It is generally assumed that fiber interferometers must be constructed from single-mode fibers. An alternative is to employ phase conjugation mirrors on the arms of a multimode fiber interferometer so that the spatial scrambling of modes is reversed, and good fringe contrast is maintained. When several interferometers all share the same self-conjugating BaTiO(3) crystal, however, the results show crosstalk between the separate fibers ranging from negligible to prohibitively large depending on the precise spatial configuration within the conjugator. A model accounting for these results is proposed. In addition it was observed in control experiments with conventional Mach-Zehnder configurations that good data could be obtained despite reduced contrast with both graded and step index multimode fibers.

A student health HMO as a partnership model within an academic medical center.

The Department of Family Practice, College of Medicine, in partnership with the University of Illinois at Chicago, was responsible for the reorganization of the Student Health Service into a health maintenance organization (HMO), Campus Care. Historically, the two campuses of the University of Illinois at Chicago operated student health as an infirmary model. Reorganization of student health into the Campus Care HMO provided expanded health care services to students, preserved more health care dollars in the university system, and provided a nonincremental increase in the size and responsibility of the Department of Family Practice. One year's experience showed that while the capitation was low compared with standard HMOs, the variable and less frequent use of services by the student population resulted in a fiscally viable operation. Numerous transition difficulties were encountered, including the need for rapid systems conversion within a complex university system, reeducation of students as well as traditional university-based practitioners for operation in a managed care system, and the rapid expansion of a small family practice department. The positive experience of the University of Illinois at Chicago supports the notion that family practice is better suited to providing student health care than other primary care disciplines. Three issues are paramount to success: (1) approval, support, and protection by higher level administration from university territorialism, (2) a core family practice faculty with strong leadership and experience in high-volume clinical activity, and (3) a close examination of financial resources in light of expected utilization.

Linear birefringence effects on fiber-optic current sensors.

The occurrence of linear birefringence is inevitable when dealing with fiber optics. Intrinsic birefringence can be minimized, but deploying the fiber on an experiment will introduce stress birefringence due to bending and pressure. We have studied the effects of this extraneous linear birefringence on the measurement of current-induced circular birefringence in a fiber which also has a strong twist circular birefringence bias. Orienting the analyzing polarizer by a proscribed procedure gives minimum error. Quantitative error limits on the current for given fiber coil radii and winding tensile stress are calculated. Additional restrictions on the fiber lead-in and lead-out sections are discussed.

Fiber-optic heterodyne phase-shift easurement of plasma current.

By combining twisted optical sensing fiber and heterodyne phase detection of circular irefringence we have (a) overcome the distortion problem caused by residual linear birefringence in the Faraday rotation method of measuring enclosed current and (b) used only a single output detector without requiring intensity normalization. Resolution of 400 ampere-turns has been obtained in the hostile electromagnetic environment of a working thermonuclear fusion research device. The fiber was simply wound around the existing machine. The measured values are in excellent agreement with those of the electrical Rogowski coil installed when the machine was built.

Self-pumped phase conjugation in BaTiO(3) at 1.06 microm.

We report the first observation to our knowledge of self-pumped phase conjugation in BaTiO(3) at 1.06 microm. An essential feature is the lower threshold external ring configuration rather than total internal reflection geometry. Although the product of incident power (1 W/cm(2)) and formation time (600 sec) is much larger than the corresponding values at 0.80 microm (0.15 W/cm(2); 120 sec), the effect was observed in two crystals purchased more than a year apart and poled at separate facilities.

Electron microscopy of secondary structure in partially denatured Escherichia coli 16S rRNA and 30S subunits.

Loops observed in partially denatured 16S rRNA lie within three domains, each about 500 nucleotides long. The loops observed in the 5' and central domains agree well with features of the model proposed by Woese et al. [Woese, C. R., Gutell, R., Gupta, R., & Noller, H. F. (1983) Microbiol. Rev. 47, 621-669]. The structure in the 3' domain is more complex and variable but is still consistent with the model. Published psoralen cross-linking studies have reported one of the observed loops but have also identified loops other than those observed here or predicted by any secondary structure model. These loops are stabilized by increasing concentrations of Mg2+ ions and by bound ribosomal proteins. For example, protein S4 in LiCl core particles stabilizes a loop of 370 nucleotides which forms part of its putative binding site on rRNA. The loop structures are characteristic enough to permit an overall comparison of the most stable of the predicted and observed loops in 16S and 23S rRNAs. Both rRNAs show a stable 5'-terminal loop and a set of subterminal nested loops near the 3' end.