Beta blocker treatment following acute myocardial infarction: an effective but underutilized intervention.

For the past six years, the Arkansas Foundation for Medical Care, Inc. (AFMC), Health Care Quality Improvement Program (HCQIP), has focused primarily on inpatient projects. In 1996, we began expanding project information to include outpatient issues. Earlier ambulatory topics included management of thyroid disease, diabetes and flu immunization. This AFMC project focuses on the prevalence of facility resources to manage hypertension and asthma as part of quality improvement efforts for Medicare and Medicaid patients in Arkansas. AFMC understands that outpatient facilities frequently lack an infrastructure to conduct outpatient chart audits in an efficient and effective fashion. This difficulty in data acquisition reflects a significant barrier. Nevertheless, certain processes and structural elements can be assessed to improve management of common outpatient conditions.

Antenatal corticosteroids for the prevention of neonatal respiratory distress in a predominantly rural state Medicaid population.

OBJECTIVE: To examine the use of prenatal intramuscular steroids in a community setting as outlined in National Institutes of Health (NIH) guidelines to reduce respiratory distress syndrome in premature infants. METHODS: We performed a complete chart review for 1 year of deliveries to Medicaid mothers at 25-34 weeks' gestation at all obstetric units in Arkansas, analyzing time of arrival to the hospital, time of delivery, and dosage, and route of steroid administration to compare processes between community and teaching center sites, and general performance with NIH guidelines. RESULTS: Of 191 deliveries at 25-34 weeks' gestation, 63.4% of mothers received at least one dose of corticosteroids before delivery. Only 124 (65%) of these mothers presented to the hospital more than 4 hours before delivery and 87% of these mothers received at least one dose of corticosteroids before delivery. Ninety percent of women who were transferred after presenting in labor and 94.9% of women who delivered at the tertiary care referral center received corticosteroids. There was no statistically significant difference in corticosteroid administration rates for women with or without preterm premature rupture of membranes. Many women received corticosteroids at dosages and intervals disparate with NIH guidelines. CONCLUSION: Obstetric providers in Arkansas administered antenatal steroids to Medicaid women in preterm labor at a rate higher than stated in previous literature. Delivery at a nonreferral center or within 4 hours of arrival to the hospital were associated with reduced antenatal corticosteroid administration. Improved performance efforts should target institutional usage and behavior of mothers at risk for premature delivery.

Comprehensive evaluation of a model alcohol education curriculum.

A comprehensive evaluation was conducted of a representative alcohol education program designed to enhance knowledge and self-esteem, instill appropriate attitudes and teach the decision-making skills necessary for youth to make responsible decisions about the use of alcohol. The curriculum was implemented approximately as intended. The immediate, cumulative and longer-term effects of curriculum exposure on the variables thought to mediate alcohol use were modest or unsystematic. There was no consistent evidence of carryover effects from curriculum exposure on subsequent use of alcohol, cigarettes or other drugs. The curriculum was ineffective in attaining its goals.

The problematic prospects for prevention in the classroom: should alcohol education programs be expected to reduce drinking by youth?

Junior and senior high-school students completed a questionnaire, either once or twice (in successive years), providing measures of variables in three principal sets: (1) curricular variables, those typically addressed in contemporary alcohol education programs (knowledge about alcohol, attitudes toward alcohol, decision-making skills and self-esteem); (2) drinking behavior; and (3) noncurricular variables (demographic and social-psychological traits that typically characterize students before they are exposed to alcohol education programs). Bivariate analyses suggested that the curricular variables are related to drinking behavior, whereas multivariate analyses indicated that these same variables contribute little to the explanation of adolescent drinking when adjusted for the noncurricular variables, most of which are logically and/or chronologically prior to curriculum exposure. It is concluded that contemporary alcohol education programs do address variables that, when considered alone, appear to be related to drinking. However, these same variables make such a small independent contribution to drinking behavior that it is unlikely even a highly successful classroom intervention directed at these variables would do much to prevent alcohol use or abuse by youth.

Self-generated identification codes for anonymous collection of longitudinal questionnaire data.

The success of a self-generated identification code for linking longitudinal questionnaire data was examined. The matching procedure developed for linking questionnaires, including a simple technique to compensate for nonidentical codes, yielded a high success rate (92% linkage of cases over a one-month interval and 78% over a one-year interval) and very few incorrectly linked cases. The procedure worked equally well with elementary and high school students, and the resulting samples were representative of the student population on a wide range of measures. Some suggestions are offered regarding the elements comprising self-generated codes.

Moisture resistant optical films: their production and characterization.

We have used an accelerated humidity test consisting of a 24-h cycle between 27-50 degrees C at 95% relative humidity to rate the moisture resistance of typical protective films such as CaF(2), LaF(3), and fluorinated polymers (TFE, FEP) deposited on BaF(2) and NaCl substrates. The test life of BaF(2) specimens was increased from about 4 cycles to over 9, 26, and 42 cycles when protected by CaF(2), TFE, and LaF(3), respectively. Heat treating the as-deposited CaF(2) films further improved specimen life by a factor of 2. The lifetime of NaCl specimens was improved from a fraction of a cycle to 1 and 3 cycles, respectively, by CaF(2) and TFE coatings. No adherent LaF(3) films could be deposited on the salt. Microhardness measurements of the CaF(2) films showed a direct correlation with humidity resistance. The effect of heat treatment was apparently to sinter the fine CaF(2) particles composing the film, thus increasing film density, refractive index,and hardness while reducing moisture permeability. Caf(2) and TFE films function as antireflective, as well as protective layers, on BaF(2) and NaCl.

Presentation modality and proactive interference in short-term retention using a mixed-morality distractor task.

Two experiments investigated the release from PI following a shift in mode of presentation of the study words. In each experiment, the interpolated task required processing of both auditory (A) and visual (V) information. The results were the same with mixed lists (Experiment I) and with independent groups (Experiment II): A release from PI was obtained following an A to V shift but not following a V to A shift. It was concluded that the mixed-modality filler task has functional characteristics very similar to those of an A filler and that the filler task influences the memory code for study items.

Laser properties of nd(+3) and ho(+3) doped crystals with the apatite structure.

A great variety of compounds occur in nature or have been synthesized in the laboratory that crystallize with the apatite structure. We have investigated a number of the apatites and found them to be excellent laser hosts for neodymium and holmium. The apatites described in this paper were grown using the Czochralski method, have low optical losses in the pump and emission spectral regions for neodymium and holmium, and the hosts have been developed to readily accept large concentrations of doping ions. This paper describes the crystal growth, physical properties, spectroscopy, and laser performance of this family of new laser materials.