Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines"

BACKGROUND Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n=5) were reviewed and compared to the results of the survey. RESULTS 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for five to seven days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

Shirking and Motivation in Firms: Survey Evidence on Worker Attitudes

In an extensive national survey, 82.7% of the respondents report that they are very likely to keep an agreement to work hard if they agreed to, even if it was almost impossible for their employer to monitor them. Based on mean responses, the rank order of motivations in descending importance is: moral, intrinsic, peer-pressure, and positive incentives. Respondents also report that fairness considerations are important and that they are especially likely to keep agreements to do a good job with honest employers. Logit analysis indicates that increases in moral and intrinsic motivations increase the likelihood of keeping agreements to provide effort. The evidence suggests that we need to re-examine a foundational assumption underlying the theory of the firm.

Na 1 Nachlass Max Horkheimer, 695 - "The Collapse of German Democracy and the Expansion of National Socialism", "Cultural Aspects of National Socialism" u.a. (p. IX 169.1a - IX 170.1-4)

"The Collapse of German Democracy and the Expansion of National Socialism" (1940):; 1. Darstellung des Forschungsprojekts (15.9.1940), b. Typoskript mit handschriftlichen Korrekturen, 78 Blatt; 2. "Research work on recent trends in the history of ideas (parts of the Research project on the Collapse of German Democracy would be included)". Als Memorandum zur Eröffnung zur Eröffnung einer Zweigstelle des Instituts in Los Angeles (12.12.1940): a) Typoskript, 2 Blatt, b) Teilstück, Typoskript mit handschriftlichen Korrekturen, 1 Blatt, c) Teilstück, Typoskript mit handschriftlichen Korrekturen, 1 Blatt, d) Teilstück, Typoskript, 1 Blatt, e) Teilstück, Typoskript, 1 Blatt, f) Entwurf, Typoskript mit handschriftlichen Korrekturen und Manuskript, 3 Blatt; 3. University of California, Los Angeles: 2 Briefe (Abschrift) von Max Horkheimer, o.O., 1940, 2 Briefe (Abschrift) an Max Horkheimer, 1940, 2 Blatt; A.R.L. Gurland: "Survey of Structural Changes in the German Economy, 1933 to 1939. Technological Bases and Organizational Forms of the National Socialist Economic System". Typoskript mit handschriftlichen Korrekturen unter anderem von Theodor W. Adorno, 48 Blatt (formal nicht identisch mit "Technological Trends and Economic Structure under National Socialism", Studies in Philosophy and Social Science, Bd. IX, 1941, S. 226ff.); "Cultural Aspects of National Socialism. A Research Project" (1941):; 1. Institute of Social Research: Mitteilung über das Forschungsprojekt und das 'Supplementary Statement', Typoskript, englisch, 4 Blatt; 2. Supplementary Statement to the Research Project, a) Typoskript, 14.4.1941, 63 Blatt, b) Typoskript, 12.4.1941, mit handschriftlichen Korrekturen, 35 Blatt; 3. "Cultural Aspects of National Socialism. A Research Project" (24.2.1941), a) als Typoskript vervielfältigt, 54 Blatt, b) Typoskript mit handschriftlichen Korrekturen, 34 Blatt, c) Fassung Januar 1941, Typoskript mit handschriftlichen Korrekturen, 40 Blatt; 4. Inhaltsverzeichnisse, mit handschriftlichen Korrekturen, 3 Blatt;

Na 1 Nachlass Max Horkheimer, 700 - "Labor Under National Socialism" "Notes on a Study in News Commentators" Forschungsprojekte und Memoranden zur Umgestaltung Nachkriegs-Deutschlands, besonders zur Umerziehung (p. IX 170a - IX 172.2-8)

Neumann, Franz L.: "Labor Under National Socialism", 19.03.1942. Typoskript, 66 Blatt; Löwenthal, Leo: "Notes on a Study in News Commentators" 23.01.1943; "Notes on a Study on News Commentators". Typoskript, 34 Blatt; "Treatment of Selected New Topics in News and News Commentator Programs". Typoskript, 53 Blatt; Forschungsprojekte und Memoranden zur Umgestaltung Nachkriegs-Deutschlands, besonders zur Umerziehung, 1942-1949; 1. "Project To Survey Present German Educational Practices in the Field of Social Sciences as a Means for Democratization. Supplementary Statements" 28.02.1949; a) Teilstück, Typoskript, 1 Blatt; b)-f) Typoskripte, zum Teil mit eigenhändigen Korrekturen von Max Horkheimer, 21 Blatt; g) Eigenhändige Notizen von Max Horkheimer, 1 Blatt; h) Eigenhändige Notizen von Theodor W. Adorno, 1 Blatt; 2. Marcuse, Herbert: 2 Briefe mit Unterschrift an Max Horkheimer und Beil, ohne Ort, 1949; 1 Brief mit Unterschrift von Max Horkheimer, Pacific Palisades, 25.02.1949; 3. "German Project" a) Typoskript mit handschriftlichen Korrekturen, 12 Blatt; b) Typoskript mit eigenhändigen Korrekturen von Max Horkheimer, 12 Blatt; c) Typoskript mit eigenhändigen Korrekturen von Max Horkheimer, 5 Blatt; d) Eigenhändige Notizen von Max Horkheimer, 1 Blatt; 4. Emhardt, K.H.: 1 Briefabschrift an Max Horkheimer, München, 20.06.1948, 1 Blatt; 5. "Untersuchunge über die Durchführung und das Ergebnis der politischen Säuberung an den Hochschulen der Westzone" a) Typoskript, 4 Blatt; b) Typoskript mit handschriftlichen Korrekturen, 2 Blatt; 6. Über Antisemitismus und politische Fragen im Nachkriegsdeutschland. Auszug aus einem Brief von "F.L.", 1949, Typoskirpt, 9 Blatt; 7. "Liste of Signers of the 1933 manifesto". 1 Blatt; 8. Marcuse, Herbert: Über Probleme der Demokratisierung und des Chauvinismus im Nachkriegsdeutschland. Teilstück eines Typoskripts, 4 Blatt, mit einem eigenhändigen Brief mit Unterschrift an Leo Löwenthal, ohne Ort, 25.11.1948, 1 Blatt;

Youth population's health issues in Comal County, Texas

This study assesses adolescent's health issues in Comal County, TX. Adolescents are defined as youth between the ages of 12 to 17 years of age, who resided in Comal County during the time period of 2000 to 2007. The analysis focused on high risk behaviors including use of gateway drugs—tobacco and alcohol; illegal substance use; and reproductive health related indicators, including sexual activity, sexually transmitted diseases, and pregnancy. This study is based on the primary and secondary data collected as part of the 2008 Comal County Community Assessment. It compares findings from the primary data sources to extant data from four secondary data sources including: (1) The Centers for Disease Control & Prevention (national) Healthy People 2010; (2) The Centers for Disease Control & Prevention, Youth Risk Behavior Surveillance Survey, 2007; (3) The Texas Department of State Health Services, 2000 to 2007; and The Pride Survey (Local and Statewide). The methods are drawn from the literature on "rapid epidemiologic appraisal" (Annett H. & Rifkin S. B., 1988). The study focus on corroborating the perceptions, subjective concerns, opinions and beliefs of the Comal County key stakeholders and community participants with qualitative and quantitative indicators of health and well being. The value of this approach is to inform community leaders using a public health perspective and evidence in their decisions about priority setting and resources allocation activities for prevention of high risk behaviors and promotion of adolescent health and well being. ^

The Comal County Needs Assessment Youth Survey

A crucial link in preserving and protecting the future of our communities resides in maintaining the health and well being of our youth. While every member of the community owns an opinion regarding where to best utilize monies for prevention and intervention, the data to support such opinion is often scarce. In an effort to generate data-driven indices for community planning and action, the United Way of Comal County, Texas partnered with the University Of Texas - Houston Health Science Center, School Of Public Health to accomplish a county-specific needs assessment. A community-based participatory research emphasis utilizing the Mobilization for Action through Planning and Partnership (MAPP) format developed by the National Association of City and County Health Officials (NACCHO) was implemented to engage community members in identifying and addressing community priorities. The single greatest area of consensus and concern identified by community members was the health and well being of the youth population. Thus, a youth survey, targeting these specific areas of community concern, was designed, coordinated and administered to all 9-11th grade students in the county. 20% of the 3,698 completed surveys (72% response rate) were randomly selected for analysis. These 740 surveys were coded and scanned into an electronic survey database. Statistical analysis provided youth-reported data on the status of the multiple issues affecting the health and well being of the community's youth. These data will be reported back to the community stakeholders, as part of the larger Comal County Needs Assessment, for the purposes of community planning and action. Survey data will provide community planners with an awareness of the high risk behaviors and habit patterns amongst their youth. This knowledge will permit more effective targeting of the means for encouraging healthy behaviors and preventing the spread of disease. Further, the community-oriented, population-based nature of this effort will provide answers to questions raised by the community and will provide an effective launching pad for the development and implementation of targeted, preventive health strategies. ^

Ethnographic and epidemiologic approaches for the programming of prenatal and birth services in Mesa los Hornos, Mexico

The investigator conducted an action-oriented investigation of pregnancy and birth among the women of Mesa los Hornos, an urban squatter slum in Mexico City. Three aims guided the project: (1) To obtain information for improving prenatal and maternity service utilization; (2) To examine the utility of rapid ethnographic and epidemiologic assessment methodologies; (3) To cultivate community involvement in health development.^ Viewing service utilization as a culturally-bound decision, the study included a qualitative phase to explore women's cognition of pregnancy and birth, their perceived needs during pregnancy, and their criteria of service acceptability. A probability-based community survey delineated parameters of service utilization and pregnancy health events, and probed reasons for decisions to use medical services, lay midwives, or other sources of prenatal and labor and delivery assistance. Qualitative survey of service providers at relevant clinics, hospitals, and practices contributed information on service availability and access, and on coordination among private, social security, and public assistance health service sectors. The ethnographic approach to exploring the rationale for use or non-use of services provided a necessary complement to conventional barrier-based assessment, to inform planning of culturally appropriate interventions.^ Information collection and interpretation was conducted under the aegis of an advisory committee of community residents and service agency representatives; the residents' committee formulated recommendations for action based on findings, and forwarded the mandate to governmental social and urban development offices. Recommendations were designed to inform and develop community participation in health care decision-making.^ Rapid research methods are powerful tools for achieving community-based empowerment toward investigation and resolution of local health problems. But while ethnography works well in synergy with quantitative assessment approaches to strengthen the validity and richness of short-term field work, the author strongly urges caution in application of Rapid Ethnographic Assessments. An ethnographic sensibility is essential to the research enterprise for the development of an active and cooperative community base, the design and use of quantitative instruments, the appropriate use of qualitative techniques, and the interpretation of culturally-oriented information. However, prescribed and standardized Rapid Ethnographic Assessment techniques are counter-productive if used as research short-cuts before locale- and subject-specific cultural understanding is achieved. ^

A survey of statural changes with age in the adult population of the United States

A study of the patterns of height loss with age in the Anglo, black, and Mexican-American populations of the United States has been undertaken. The study was based on data gathered by the United States Public Health Service in the Second National Health and Nutrition Examination Survey and the Hispanic Health and Nutrition Examination Survey. Estimates of height loss were obtained by subtracting present stature from a calculated maximum attained height derived from sex- and race/ethnic-specific regression equations relating stature to subischial length. Anglo women have greater height losses than Anglo, black, or Mexican-American males, and black or Mexican-American females. Between 24 and 74 years of age, Anglo women average 3.8 cm. loss in stature. The black populations lose less height than Anglos or Mexican-Americans. Mexican-Americans lose less height than Anglos from 24 to 54 years and then have a greatly increased height loss so that by age 74 their total height loss is the same as Anglos. Standing height, sitting height, body mass index, and the Poverty Index were found to be negatively correlated with height loss. Age was positively correlated to height loss. The most important determinants of the magnitude of height loss with age were sex and ethnicity. ^

PREPAID MENTAL HEALTH SERVICES: A NATIONAL PERSPECTIVE

The purpose of this 1982 national survey of all operational prepaid health plans, or PHPs (including health maintenance organizations), was to provide information on the current coverage of PHP mental health and substance abuse services, benefits and service provision, general and mental health organization characteristics, mental health service costs, and physical and mental health service utilization.^ Two survey instruments were designed, pretested and distributed to all operational PHPs throughout the United States. A total of 237 PHPs were surveyed, of which 205 (86.50 percent) completed and returned both questionnaires.^ One result of the rapid growth in the PHP field over the past ten years has been the expansion in both the number of PHPs as well as the organizational characteristics of these PHPs. However, little attention in the research literature has been given to the application of empirical results to the PHP arrangements. This project has attempted to contribute to current knowledge regarding prepaid mental health services from a national perspective, and explore, on a preliminary descriptive basis, the variety of potential service delivery arrangements for physical and mental health services (total services) and for mental health services.^ The study emphasized that PHPs must continue to monitor the costs and utilization of mental health services, particularly in light of the apparent elimination of data collection and statistical summary responsibilities within the federal government regarding PHP activities as well as the proposed legislation to eliminate mandated mental health and substance abuse services from basic health plan benefits for federally qualified PHPs. ^

BLOOD PRESSURE CHANGES IN RELATION TO DEMOGRAPHIC, ANTHROPOMETRIC, AND SEXUAL MATURATION VARIABLES IN U.S. HEALTH EXAMINATION SURVEY OF CHILDREN AND YOUTHS (UNITED STATES)

The determinants of change in blood pressure during childhood and adolescence were studied in a cohort of U.S. national probability sample of 2146 children examined on two occasions during the Health Examination Survey. Significant negative correlations between the initial level and the subsequent changes in blood pressure were observed. The multiple regression analyses showed that the major determinants of systolic blood pressure (SBP) change were change in weight, baseline SBP, and baseline upper arm girth. Race, time interval between examinations, baseline age, and height change were also significant determinants in SBP change. For the change in diastolic blood pressure (DBP), baseline DBP, baseline weight, and weight change were the major determinants. Baseline SBP, time interval and race were also significant determinants. Sexual maturation variables were also considered in the subgroup analysis for girls. Weight change was the most important predictor of the change in SBP for the group of girls who were still in the pre-menarchal or pre-breast maturation status at the time of the follow-up examination, and who had started to menstruate or to develop breast maturation at sometime between the two examinations. Baseline triceps skinfold thickness or initial SBP were more important variables than weight change for the group of girls who had already experienced menarche or breast maturation at the time of the initial survey. For the total group, pubic hair maturation was found to be a significant predictor of SBP change at the 5% significance level. The importance of weight change and baseline weight for the changes in blood pressure warrants further study. ^

Estimates of hospital and physician costs of epilepsy in the United States for 1995 comparing the provider -based survey method and a patient -based medical charts and billing method

This investigation compares two different methodologies for calculating the national cost of epilepsy: provider-based survey method (PBSM) and the patient-based medical charts and billing method (PBMC&BM). The PBSM uses the National Hospital Discharge Survey (NHDS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS) as the sources of utilization. The PBMC&BM uses patient data, charts and billings, to determine utilization rates for specific components of hospital, physician and drug prescriptions. ^ The 1995 hospital and physician cost of epilepsy is estimated to be $722 million using the PBSM and $1,058 million using the PBMC&BM. The difference of $336 million results from $136 million difference in utilization and $200 million difference in unit cost. ^ Utilization. The utilization difference of $136 million is composed of an inpatient variation of $129 million, $100 million hospital and $29 million physician, and an ambulatory variation of $7 million. The $100 million hospital variance is attributed to inclusion of febrile seizures in the PBSM, $−79 million, and the exclusion of admissions attributed to epilepsy, $179 million. The former suggests that the diagnostic codes used in the NHDS may not properly match the current definition of epilepsy as used in the PBMC&BM. The latter suggests NHDS errors in the attribution of an admission to the principal diagnosis. ^ The $29 million variance in inpatient physician utilization is the result of different per-day-of-care physician visit rates, 1.3 for the PBMC&BM versus 1.0 for the PBSM. The absence of visit frequency measures in the NHDS affects the internal validity of the PBSM estimate and requires the investigator to make conservative assumptions. ^ The remaining ambulatory resource utilization variance is $7 million. Of this amount, $22 million is the result of an underestimate of ancillaries in the NHAMCS and NAMCS extrapolations using the patient visit weight. ^ Unit cost. The resource cost variation is $200 million, inpatient is $22 million and ambulatory is $178 million. The inpatient variation of $22 million is composed of $19 million in hospital per day rates, due to a higher cost per day in the PBMC&BM, and $3 million in physician visit rates, due to a higher cost per visit in the PBMC&BM. ^ The ambulatory cost variance is $178 million, composed of higher per-physician-visit costs of $97 million and higher per-ancillary costs of $81 million. Both are attributed to the PBMC&BM's precise identification of resource utilization that permits accurate valuation. ^ Conclusion. Both methods have specific limitations. The PBSM strengths are its sample designs that lead to nationally representative estimates and permit statistical point and confidence interval estimation for the nation for certain variables under investigation. However, the findings of this investigation suggest the internal validity of the estimates derived is questionable and important additional information required to precisely estimate the cost of an illness is absent. ^ The PBMC&BM is a superior method in identifying resources utilized in the physician encounter with the patient permitting more accurate valuation. However, the PBMC&BM does not have the statistical reliability of the PBSM; it relies on synthesized national prevalence estimates to extrapolate a national cost estimate. While precision is important, the ability to generalize to the nation may be limited due to the small number of patients that are followed. ^

Table 5 Comparison of surface elevations by Seasat and optical survey along EGIG line

Surface elevation maps of the southern half of the Greenland subcontinent are produced from radar altimeter data acquired by the Seasat satellite. A summary of the processing procedure and examples of return waveform data are given. The elevation data are used to generate a regular grid which is then computer contoured to provide an elevation contour map. Ancillary maps show the statistical quality of the elevation data and various characteristics of the surface. The elevation map is used to define ice flow directions and delineate the major drainage basins. Regular maps of the Jakobshavns Glacier drainage basin and the ice divide in the vicinity of Crete Station are presented. Altimeter derived elevations are compared with elevations measured both by satellite geoceivers and optical surveying.

Annotated record of the Fe-Mn concretions recovered in the Kara sea during the M. Gorkiy survey in 1945

The Kara scientific expedition of 1945, using the fishing trawler M. Gorkiy and survey vessel Osetr, took sediment samples in the Kara Sea in addition to other oceanographic work. The investigations of sediments composition was compared with biological and hydrological data obtained in the same areas. The sediments sampled were subjected to mechanical, mineralogical, chemical and faunistic analyses. During this survey iron-manganese concretions were recovered.

Description of manganese nodules collected by the U.S.S. NERO during survey for a trans-pacific cable

In the early part of 1899 the U.S.S. Nero was dispatched from San Francisco to survey a route for a telegraph cable between the United States, the Philippines Islands and Japan. Concurent with meteorological and oceanographic observations, closely spaced samples of bottom material were systematically sampled. They have been carefully accounted and described by James M. Flint in this volume. On the way, numerous submarine peaks were discovered. During this voyage U.S.S. Nero also took a sounding in the area of the Challenger Deep, recording a depth of 5269 fathoms (9636 m), the greatest depth recorded at that time. Carefull study of the deep-sea deposits have also revealed a number of manganese nodules and encrustations as well as micronodules.