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Background: In the United States (US), urinary tract infections (UTI) lead to more than 10 million office visits each year. Temperature and season are potentially important risk factors for UTI, particularly in the context of climate change. Methods: We examined the relationship between ambient temperature and outpatient UTI diagnoses among patients followed from 2015 to 2017 in two California healthcare systems: Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. We identified UTI diagnoses in adult patients using diagnostic codes and laboratory records from electronic health records. We abstracted patient age, sex, season of diagnosis, and linked community-level Index of Concentration at the Extremes (ICE-I, a measure of wealth and poverty concentration) based on residential address. Daily county-level average ambient temperature was assembled from the Parameter-elevation Regressions on Independent Slopes Model (PRISM). We implemented distributed lag nonlinear models (DLNM) to assess the association between UTI and lagged daily temperatures. Main analyses were confined to women. In secondary analyses, we stratified by season, healthcare system, and community-level ICE-I. Results: We observed 787,186 UTI cases (89% among women). We observed a threshold association between ambient temperature and UTI among women: an increase in daily temperature from the 5th percentile (6.0 ˚C) to the mean (16.2 ˚C) was associated with a 3.2% (95% CI: 2.4, 3.9%) increase in same-day UTI diagnosis rate, whereas an increase from the mean to 95th percentile was associated with no change in UTI risk (0.0%, 95% CI: −0.7, 0.6%). In secondary analyses, we observed the clearest monotonic increase in the rate of UTI diagnosis with higher temperatures in the fall. Associations did not differ meaningfully by healthcare system or community-level ICE-I. Results were robust to alternate model specifications. Discussion: Increasing temperature was related to higher rate of outpatient UTI, particularly in the shoulder seasons (spring, autumn).

Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes.

Tightening social norms is thought to be adaptive for dealing with collective threat yet it may have negative consequences for increasing prejudice. The present research investigated the role of desire for cultural tightness, triggered by the COVID-19 pandemic, in increasing negative attitudes towards immigrants. We used participant-level data from 41 countries (N = 55,015) collected as part of the PsyCorona project, a cross-national longitudinal study on responses to COVID-19. Our predictions were tested through multilevel and SEM models, treating participants as nested within countries. Results showed that people's concern with COVID-19 threat was related to greater desire for tightness which, in turn, was linked to more negative attitudes towards immigrants. These findings were followed up with a longitudinal model (N = 2,349) which also showed that people's heightened concern with COVID-19 in an earlier stage of the pandemic was associated with an increase in their desire for tightness and negative attitudes towards immigrants later in time. Our findings offer insight into the trade-offs that tightening social norms under collective threat has for human groups.

This study investigated the influence of mineral tailings’ mineralogy on hydration behaviour and phase assemblage of cured cement in ternary blends comprising Ordinary Portland cement (OPC), blast furnace slag (BFS) and tailings. The identification and quantification of mineral phases was achieved through Quantitative X-ray diffraction (QXRD) analysis, while the evaluation of mineral thermal stability was conducted using thermogravimetric analysis with mass spectrometry (TGA-MS). Isothermal calorimetry revealed that the tailings influenced the OPC heat flow profile during early-stage hydration, with minerals like dehydroxylated Fe-chlorite and alunite hydraulic properties contributing to the early-stage reaction mechanism. The bulk slow-reacting minerals in the tailings affected both the phase assemblage and the hydration mechanism of OPC by releasing elemental species that could be incorporated in the C-S-H phases. The chemical composition of the C-S-H formed in the blended cement varied and had a low Ca/Si ratio

Objectives: The research summarises the findings from a three-year pilot delivered through the EFL Trust and eleven Club Community Organisations. The aim was to create local social Hubs for older adults, to bring together local people to increase social connections, which may lead to additional physical activity, rather than a targeted physical activity intervention. Study design: The study was a three-year evaluation of the pilot, to track changes in attitudes and behaviours of participants, and gather feedback on the delivery mechanism and the service providers. Methods: The study included participant tracking surveys alongside interviews and focus groups with participants and service providers over the three-year pilot. Results: The greatest impact was on participants’ mental wellbeing as opposed to their physical activity levels or attitude/motivation for physical activity. Covid-19 restrictions were felt particularly hard by the most vulnerable in society and the tracking of participants quantified the negative impact of lockdown on life satisfaction and happiness, which the presence of the Hubs helped to redress. Conclusions: The Hubs model can offer a relatively low cost community based solution which adds to the menu of options in local health systems. The Hubs can help to tackle loneliness, enhance social interactions using the power of the football club to generate demand. The learning showed how to recruit, retain, and sustain networks of older adults using Hubs. The pilot showed the value CCOs can have in local service delivery for older adults, providing semi-structured Hubs which act as a conduit to wider engagement.

A mid-2017 survey shows that 28 energy system modeling projects have made public their source code, up from six in 2010, and none in 2000. Another six web-based energy sector database projects and nine hybrid projects were established during this same period, some explicitly to service open modeling.Three distinct yet overlapping drivers can explain this shift in paradigm towards open methods: a desire for improved public transparency, the need for genuine scientific reproducibility, and a nascent experiment to see whether open source development methods can improve academic productivity and quality and perhaps also public trust.The associated source code, datasets, and documentation need suitable open licenses to enable their use, modification, and republication. The choice for software is polarized: teams need only consider maximally permissive (ISC, MIT) or strongly protective (GPLv3) licenses. Selection is influenced by whether code adoption or freedom from capture is uppermost and by the implementation language, distribution architecture, and use of third-party components. Permissive data licenses (CC BY 4.0) are generally favored for datasets to facilitate their recombination and reuse. Official and semi-official energy sector data providers should also prefer permissive licensing for copyrightable material. Keywords: Copyright law, Crowdsourcing, Energy sector database, Energy system model, Open source development

The global energy system is undergoing a major transition, and in energy planning and decision-making across governments, industry and academia, models play a crucial role. Because of their policy relevance and contested nature, the transparency and open availability of energy models and data are of particular importance. Here we provide a practical how-to guide based on the collective experience of members of the Open Energy Modelling Initiative (Openmod). We discuss key steps to consider when opening code and data, including determining intellectual property ownership, choosing a licence and appropriate modelling languages, distributing code and data, and providing support and building communities. After illustrating these decisions with examples and lessons learned from the community, we conclude that even though individual researchers' choices are important, institutional changes are still also necessary for more openness and transparency in energy research. Keywords: Open source, Open data, Energy modelling

Background: Despite plausible behavioral and physiological pathways, limited evidence exists on how daily temperature variability is associated with acute mental health-related episodes., Objectives: We aimed to explore associations between daily temperature range (DTR) and mental health-related hospital visits using data of all hospital records in New York State during 1995-2014. We further examined factors that may modify these associations, including age, sex, hospital visit type and season., Methods: Using a case-crossover design with distributed lag non-linear DTR terms (0-6 days), we estimated associations between ZIP Code-level DTR and hospital visits for mood (4.6 million hospital visits), anxiety (2.4 million), adjustment (∼368,000), and schizophrenia disorders (∼211,000), controlling for daily mean temperature, via conditional logistic regression models. We assessed potential heterogeneity by age, sex, hospital visit type (in-patient vs. out-patient), and season (summer, winter, and transition seasons)., Results: For all included outcomes, we observed positive associations from period minimum DTR (0.1 °C) until 25th percentile (5.2 °C) and between mean DTR (7.7 °C) and 90th percentile (12.2 °C), beyond which we observed negative associations. For mood disorders, an increase in DTR from 0.1 °C to 12.2 °C was associated with a cumulative 16.0% increase (95% confidence interval [CI]: 12.8, 19.2%) in hospital visit rates. This increase was highest during transition seasons (32.5%; 95%CI: 26.4, 39.0%) compared with summer (10.7%; 95%CI: 4.8, 16.8%) and winter (-1.6%; 95%CI: -7.6, 4.7%). For adjustment and schizophrenia disorders, the strongest associations were seen among the youngest group (0-24 years) with almost no association in the oldest group (65+ years). We observed no evidence for modification by sex and hospital visit type., Discussion: Daily temperature variability was positively associated with mental health-related hospital visits within specific DTR ranges in New York State, after controlling for daily mean temperature. Given uncertainty on how climate change modifies temperature variability, additional research is crucial to comprehend the implications of these findings, particularly under different scenarios of future temperature variability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

For Microcystis aeruginosa PCC 7806, temperature decreases from 26 °C to 19 °C double the microcystin quota per cell during growth in continuous culture. Here we tested whether this increase in microcystin provided M. aeruginosa PCC 7806 with a fitness advantage during colder-temperature growth by comparing cell concentration, cellular physiology, reactive oxygen species damage, and the transcriptomics-inferred metabolism to a non-toxigenic mutant strain M. aeruginosa PCC 7806 ΔmcyB. Photo-physiological data combined with transcriptomic data revealed metabolic changes in the mutant strain during growth at 19 °C, which included increased electron sinks and non-photochemical quenching. Increased gene expression was observed for a glutathione-dependent peroxiredoxin during cold treatment, suggesting compensatory mechanisms to defend against reactive oxygen species are employed in the absence of microcystin in the mutant. Our observations highlight the potential selective advantages of a longer-term defensive strategy in management of oxidative stress (i.e., making microcystin) vs the shorter-term proactive strategy of producing cellular components to actively dissipate or degrade oxidative stress agents., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Our relationships with other animals are governed by how we view their capacity for sentience and suffering. However, there is currently little agreement as to whether people's beliefs about animal minds are largely accurate or inaccurate. We used an innovative task to examine how people update their beliefs in response to noisy but informative clues about animal minds. This allowed us to compare participants' posterior beliefs to what a normative participant ought to believe if they conform to Bayes' theorem. Five studies (four pre-registered; n = 2417) found that participants shifted their beliefs too far in response to clues that suggested animals do not have minds (i.e., overshooting what a normative participant ought to believe), but not far enough in response to clues that suggested animals have minds (i.e., falling short of what a normative participant ought to believe). A final study demonstrated that this effect was attenuated when humans were the targets of belief. The findings demonstrate that people underestimate animal minds in a way that can be said to be inaccurate and highlight the role of belief updating in downplaying evidence of animal minds. The findings are discussed in relation to speciesist beliefs about the supremacy of humans over animals., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

There is mounting anecdotal evidence that some individuals fall into conspiracy "rabbit holes" causing harms ranging from social isolation to violence. We propose a hypothetical Rabbit Hole Syndrome in which some individuals' subscription to conspiracy beliefs is initially inadvertent, accelerates recursively, then becomes difficult to escape. This proposal is distinguished by a person-centered and dynamic perspective on conspiracy beliefs. It aims to provide a theoretical foundation for research that (a) illuminates the rabbit hole phenomenon, (b) is pluralistic, spanning diverse subdisciplines (e.g., social and clinical psychology), and methods (e.g., qualitative, longitudinal, and case studies), and (c) informs theory and practice by uncovering discontinuities between committed believers and other populations in the causes, consequences, and "remedies" of conspiracy beliefs., Competing Interests: Conflict of interest statement Nothing declared., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Short-term temperature variability has been consistently associated with mortality, with limited evidence for cardiovascular outcomes. Previous studies have used multiple metrics to measure temperature variability; however, those metrics do not capture hour-to-hour changes in temperature., Objectives: We assessed the correlation between sub-daily temperature-change-over-time metrics and previously-used metrics, and estimated associations with myocardial infarction (MI) hospitalizations., Methods: Hour-to-hour change-over-time was measured via three metrics: 24-hr mean absolute hourly first difference, 24-hr maximum absolute hourly first difference, and 24-hr mean hourly first difference. We first assessed the Spearman correlations between these metrics and four previously-used metrics (24-hr standard deviation of hourly temperature, 24-hr diurnal temperature range, 48-hr standard deviation of daily minimal and maximal temperatures, and 48-hr difference of daily mean temperature), using hourly data from the North America Land Data Assimilation System-2 Model. Subsequently, we estimated the association between these metrics and primary MI hospitalization in adult residents of New York State for 2000-2015 using a time-stratified case-crossover design., Results: The hour-to-hour change-over-time metrics were correlated, but not synonymous, with previously-used metrics. We observed 809,259 MI, 45% of which were among females and the mean (standard deviation) age was 70 (15). An increase from mean to 90th percentile in mean absolute first difference of temperature was associated with a 2.04% (95% Confidence Interval [CI]: 1.30-2.78%) increase in MI rate. An increase from mean to 90th percentile in mean first difference also yielded a positive association (1.86%; 95%CI: 1.09-2.64%). We observed smaller- or similar-in-magnitude positive associations for previously-used metrics., Discussion: First, short-term hour-to-hour temperature change was positively associated with MI risk. Second, all other variability metrics yielded positive associations with MI, with varying magnitude. In future research on temperature variability, researchers should define their research question, including which aspects of variability they intend to measure, and apply the appropriate metric., Alternative: All metrics of temperature variability, including short-term hour-to-hour temperature changes, were positively associated with MI risk, though the magnitude of effect estimates varied by metric., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Field and Christiansen (2012) comment on the importance of establishing and understanding the internal reliability of measures of substance-related cognitive bias, and suggest potential reasons for the poor reliability of some task variants. We agree that the impact of using stimuli personalized to the participant on the reliability of cognitive bias tasks is worthy of systematic investigation. However, some tasks may still be inherently less reliable than others. Ultimately, this debate should be framed within the wider debate on the validity of laboratory models and methods used to assess real-world phenomena., (Copyright © 2012. Published by Elsevier Ireland Ltd.)

Aims: There is growing interest in cognitive biases related to substance use, but evidence from the anxiety literature suggests that tasks commonly used to assess these may suffer from low internal reliability. We examined the internal reliability of the visual probe and modified Stroop tasks., Design: Secondary analysis of visual probe and modified Stroop task data collected across seven independent studies., Setting: Human laboratory study., Participants: Healthy volunteers (n=408 across seven independent studies) recruited from the general population on the basis of alcohol or tobacco use., Measurements: Visual probe and modified Stroop task measures of substance-related cognitive bias., Findings: Measures of cognitive bias for substance-related cues, as assayed by the visual probe and the modified Stroop tasks, may not be reliable. In particular, the visual probe task showed poor internal reliability, as did unblocked versions of the modified Stroop task., Conclusions: The modified Stroop task is preferable to the visual probe task as a measure of substance-related cognitive bias, on the basis of its psychometric properties. Studies using cognitive bias tasks should not assume they are reliable, and should routinely report reliability estimates where possible., (Copyright © 2011. Published by Elsevier Ireland Ltd.)

Methamphetamine, a commonly seen substance of abuse, has been reported to exert detrimental effect on bodily function including the cardiovascular system although its mechanism of action is poorly understood. This study was designed to examine the direct impact of methamphetamine on isolated whole heart and single cardiomyocyte contractile function. Murine hearts and isolated cardiomyocytes from adult FVB mice were exposed to various concentrations of methamphetamine for 30min prior to the assessment of mechanical function using a Langendroff apparatus and an IonOptix Myocam system, respectively. Cardiac contractile properties analyzed included maximal velocity of left ventricular pressure development and decline (+/-dP/dt), peak shortening amplitude (PS), maximal velocity of shortening/relengthening (+/-dLdt), time-to-PS (TPS), time-to-90% relengthening (TR(90)), resting and electrically stimulated increase of intracellular Ca(2+) as well as intracellular Ca(2+) decay. Our results revealed that acute methamphetamine exposure depressed +/-dP/dt, PS and rise of intracellular Ca(2+) without affecting +/-dLdt, TPS, TR(90), resting intracellular Ca(2+) and intracellular Ca(2+) decay. Furthermore, methamphetamine nullified the adrenergic agonist norepinephrine-elicited positive cardiomyocyte contractile response, including elevated PS, +/-dLdt and shortened TR(90) without affecting TPS. Western blot analysis showed unchanged expression of sarco(endo)plasmic reticulum Ca(2+)-ATPase (SERCA2a) and phospholamban, associated with upregulated Na(+)-Ca(2+) exchanger levels following acute methamphetamine exposure. In addition, methamphetamine promoted overt cardiomyocyte protein damage evaluated by carbonyl formation. Taken together, these results demonstrate direct cardiac depressant effect of methamphetamine in myocardium and isolated cardiomyocytes, possibly associated with protein damage and dampened adrenergic response.

Previous work has suggested that elevated levels of trait anxiety are associated with an increased ability to accurately recognize the facial expression of fear. However, to date, recognition has only been assessed after viewing periods of 10s, despite the fact that the process of emotion recognition from faces typically takes a fraction of this time. The current study required participants with either high or low levels of non-clinical trait anxiety to make speeded emotional classification judgments to a series of facial expressions drawn from seven emotional categories. Following previous work it was predicted that recognition of fearful facial expressions would be more accurate in the high-trait anxious group compared with the low-trait anxious group. However, contrary to this prediction, no anxiety-related differences in emotion perception were observed across all seven emotions. This suggests that anxiety does not influence the perception of fear as has been previously proposed.

Mass lesions were observed on the tricuspid valve by cross-sectional echocardiography in 5 neonates, 4 of whom presented with fetal distress. Four went on to develop severe respiratory distress, 3 from meconium aspiration and 1 from hyaline membrane disease, with 2 deaths despite intensive treatment. Autopsy confirmed meconium aspiration pneumonia. Sterile, unorganised vegetations were seen on the tricuspid valve (and in 1 infant the mitral valve too). Perinatal factors such as hypoxia, haemodynamic and coagulation disturbances may have contributed to the formation of the vegetations and may reflect the severity and refractoriness of persistent pulmonary hypertension.

The clinical efficacy and safety of ampicillin/sulbactam versus metronidazole-gentamicin were evaluated in a comparative, randomized, prospective study. Forty-four patients were enrolled: 22 received the ampicillin/sulbactam regimen, and 22 received the metronidazole-gentamicin combination. There were 33 cases of severe acute pelvic inflammatory disease, two tuboovarian abscesses, five cases of endomyometritis, and two cases of posthysterectomy pelvic cellulitis. Aerobic and anaerobic cultures from the infection sites yielded 447 microorganisms from 44 patients (an average of 10 bacteria per infection; 6.4 anaerobes and 3.7 aerobes). The most frequent isolates were Bacteroides sp., 54; Bacteroides bivius, 17; black-pigmented Bacteroides, 12; Bacteroides disiens, 11; Fusobacterium, 13; Peptostreptococcus anaerobius, 24; Peptostreptococcus asaccharolyticus, 21; anaerobic gram-positive cocci, 34; Gardnerella vaginalis, 29; Neisseria gonorrhoeae, 17; alpha-hemolytic streptococci, 15; and Escherichia coli, five. Clinical cure was noted in 19 of 20 patients treated with ampicillin/sulbactam and 18 of 21 patients treated with metronidazole-gentamicin. One treatment failure occurred in the ampicillin/sulbactam group in a patient who required antichlamydial therapy and had a complex left adnexal mass consistent with an abscess. The cases of metronidazole-gentamicin failure included two patients initially diagnosed as having tuboovarian abscesses who required a change in antibiotic therapy to control the infections. The third patient had postabortion endomyometritis that did not respond to metronidazole-gentamicin therapy within 48 hours, and required a change of medication. No adverse hematologic, renal, or hepatic effects were noted in either group of patients.

Because of the reported use of yogurt douches for the treatment of vaginitis, the adherence of Lactobacillus species to normal human vaginal epithelial cells was tested by in vitro methods. L. acidophilus and L. bulgaricus isolated from three commercial yogurts were compared to L. acidophilus, L. fermentum, L. cellobiosus, and L. casei isolated from clinical specimens and from American Type Culture Collection cultures. L. acidophilus isolated from Lactinex tablets was also tested. No significant difference was found among the 19 clinical isolates, the American Type Culture Collection cultures, and the Lactinex isolate, but all showed significantly higher (p less than 0.01) adherence than any Lactobacillus isolated from yogurt. The presence of Gardnerella vaginalis, which adheres strongly to vaginal epithelial cells, was found to interfere with the adherence of lactobacilli from all sources studied.

A number of intercalating drugs have been found capable of causing site-specific inhibition of nick-translation in a DNA template of known sequence. Compounds of the 4'-(9-acridinylamino) methanesulphonanilide (AMSA) series cause selective inhibition in regions of G-C base pairs. Other intercalating drugs including ethidium bromide, adriamycin and actinomycin D also exhibited a G-C base pair preference although bisantrene-induced inhibition tended to be in regions of A-T base pairs. Diacridine compounds were more effective in inhibiting polymerase action as the linker chain was increased from 4 to 8 carbons. Results with mitonafide , anthracene derivatives, mithramycin and distamycin A are also presented. Inhibition caused by a given drug varied significantly from site to site in the DNA but apart from a preference for G-C or A-T rich regions, there seemed no preference for certain base sequences per se. Rather, it was felt that secondary structures, such as hairpins, in DNA might be of importance. The hypothesis is advanced that inhibition of polymerase action in this in vitro system may provide a useful and biologically relevant measure of the strength of drug binding at various DNA sites.

To determine the microbiologic etiology of acute salpingitis, laparoscopy was used in 26 patients to obtain specimens for a variety of microorganisms directly from the fallopian tube. Simultaneous culdocentesis was performed to obtain peritoneal fluid for microbiologic analysis. A variety of microorganisms were isolated from the fallopian tubes and cul-de-sac aspirate. However, the organisms isolated from the fallopian tube were not consistent with the cul-de-sac isolates. It appears that direct culture from the fallopian tube may be necessary to determine the microbiologic etiology and pathogenesis of acute salpingitis. N. gonorrhoeae was isolated from the cul-de-sac in 32 per cent of cases and the fallopian tube in 19 per cent. In patients with endocervical gonorrhea, the gonococcus was isolated from the fallopian tube in 38.5 per cent of cases. Aerobic and/or anaerobic bacteria were present in the cul-de-sac aspirate in 46 per cent of patients and in the fallopian tube in 38 per cent.

Piperacillin sodium (Pipracil, Lederle Laboratories, Wayne, New Jersey), a new semisynthetic penicillin, demonstrated in vitro activity against a broad spectrum of clinical pathogens. It is active against most strains of the clinically important gram-negative aerobic or facultative bacteria and against virtually all the clinically important anaerobic organisms, including Bacteroides fragilis and Bacteroides bivius. This broad antibacterial spectrum suggested that piperacillin might be an effective single antimicrobial agent for the treatment of mixed aerobic/anaerobic infections in obstetric and gynecologic patients. In this study, the clinical efficacy and safety of piperacillin was compared with that of cefoxitin in the management of pelvic infections. There were 23 patients in the piperacillin group (acute salpingitis, 12; endomyometritis, 7; pelvic cellulitis, 2; tuboovarian abscess, 2) and 25 patients in the cefoxitin group (acute salpingitis, 13; endomyometritis, 10; tuboovarian abscess, 2). An average of six bacteria were isolated from each patient. Aerobic bacteria only were recovered from 12.5%, anaerobic bacteria only in 6.5%, and both aerobic and anaerobic bacteria were present in 82.5% of patients. Overall, 21 of 23 (91%) of the piperacillin treatment group and 23 of 25 (92%) of the cefoxitin group responded to therapy with antimicrobial agents alone. The major cause of failure was the presence of an abscess. Piperacillin was shown to be an effective single agent for the management of pelvic infections caused by mixed aerobic and anaerobic bacteria. In addition, piperacillin proved to be safe and well tolerated.

Acute pelvic inflammatory disease remains the major medical and economic consequence of sexually transmitted diseases among young women. The polymicrobial origins of pelvic inflammatory disease have been well documented and the major organisms recovered from the upper genital tract in patients with pelvic inflammatory disease include Chlamydia trachomatis, Neisseria gonorrhoeae, and mixed anaerobic and aerobic bacteria. This study was undertaken to compare the efficacy and safety of cefotetan plus doxycycline with that of cefoxitin plus doxycycline in the treatment of hospitalized patients with acute pelvic inflammatory disease. A total of 68 hospitalized patients with acute pelvic inflammatory disease were entered and randomized into two treatment groups: cefotetan (n = 32) and cefoxitin (n = 36). There were six tuboovarian abscesses in each group. C. trachomatis was recovered from 7 (10%) and N. gonorrhoeae from 48 (71%) of the patients. Anaerobic and aerobic bacteria were recovered from the upper genital tract in 53 (78%) of the patients. Cefotetan plus doxycycline and cefoxitin plus doxycycline demonstrated high rates of initial clinical response in the treatment of acute pelvic inflammatory disease. Clinical cure was noted in 30 (94%) of the cefotetan plus doxycycline group and 33 (92%) of the cefoxitin plus doxycycline group. Four failures were sonographically diagnosed tuboovarian abscesses that responded to clindamycin plus gentamicin therapy. The fifth failure was an uncomplicated case that did not respond to cefoxitin and doxycycline and required additional therapy. At 1 week and 3 weeks, respectively, the posttreatment cultures demonstrated eradication, in all instances, of N. gonorrhoeae and C. trachomatis. These regimens also were very effective in eradicating anaerobic and aerobic pathogens from the endometrial cavity. Both regimens were well tolerated by the patients, and few adverse drug affects were noted.

The clinical efficacy of moxalactam versus clindamycin/tobramycin was evaluated in a comparative, randomized, prospective study. Sixty patients were treated: 30 with moxalactam and 30 with clindamycin/tobramycin. There were 15 cases of tuboovarian abscess, 36 cases of severe pelvic inflammatory disease with peritonitis, eight cases of endomyometritis, and one wound abscess. Aerobic and anaerobic cultures from the sites of infection yielded 441 microorganisms from 53 patients; an average of 8.3 bacteria per infection (4.5 anaerobes and 3.8 aerobes). The infections tended to be mixed aerobic-anaerobic with anaerobes isolated in 90% of cases. The most frequently isolated possible pathogens were Bacteroides sp. (37), Bacteroides bivius (23), Bacteroides asaccharolyticus (12), Peptococcus asaccharolyticus (29), Peptostreptococcus anaerobius (19), unidentified anaerobic gram-positive cocci (18), Escherichia coli (17), nonhemolytic streptococci (16), Neisseria gonorrhoeae (13), and Gardnerella vaginalis (38). Clinical cure was noted in 29 of 30 moxalactam-treated and 29 of 30 clindamycin/tobramycin-treated patients. Moxalactam was effective in five of six cases of tuboovarian abscess, all 22 cases of pelvic inflammatory disease with peritonitis, the one case of endomyometritis and the one wound abscess. Clindamycin/tobramycin was effective in eight of nine cases of tuboovarian abscess, all 14 cases of pelvic inflammatory disease with peritonitis, and all seven cases of endomyometritis. No adverse hematologic, renal, or hepatic effects were noted with either regimen.