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Adolescents (N = 392) attending 2 urban adolescent health clinics in 2010 were surveyed regarding likelihood completing expedited partner therapy (EPT), by bringing a partner exposed to chlamydia a prescription. Eighty-five percent (330/387; 95% confidence interval, 81%-89%), reported acceptance of EPT. Adjusted analyses showed higher education, notification self-efficacy, and romantic partner were associated with EPT acceptance. [ABSTRACT FROM AUTHOR]

Sexually transmitted diseases (STDs) are a major health problem among adolescents. In 2000, adolescent females 15 to 19 years old had the highest reported rates of chlamydia and gonorrhea. Adolescent biologic, cognitive, social, and behavioral developmental circumstances contribute to the high rate of adolescent STDs. New sensitive and noninvasive STD tests greatly improve our ability to diagnose asymptomatic infections. In May 2002, the Centers for Disease Control and Prevention (CDC) published revised guidelines for the treatment of STDs. The CDC's Treatment of Sexually Transmitted Diseases Guidelines 2002 is based on evidence from published literature and expert opinion. In this article, we review selected new recommendations that impact adolescent STD care. Providing care to adolescents can be a challenging but rewarding experience for primary care pediatric nurse practitioners. Nurses can be instrumental in reducing STD prevalence through screening interventions, prevention counseling, and health education. [ABSTRACT FROM AUTHOR]

Assesses the incremental cost-effectiveness of a school-based sexually transmitted disease screening program in New Orleans. Comparison of costs and cases of pelvic inflammatory disease in the school-based screening scenario against a non-school-based screening scenario; Construction of a decision-analysis model; Screening for Chlamydia.

Goal: To determine chlamydia screening practices and the resulting positive test results for adolescents enrolled in a large nonprofit managed care organization.Study Design: The electronic medical records of all 12- to 19-year-olds enrolled in a large nonprofit managed care organization serving a demographically diverse patient population from January 1998 through December 1999 were reviewed retrospectively.Results: Among the 43,205 female and 44,133 male managed care organization members, ages 12 to 19 years in 1998-1999, 7575 adolescents (8.7%) (6914 females [16%] and 661 males [1.5%]) were tested for chlamydia. Among the members tested, chlamydia was diagnosed in 1109 adolescents (14.6%) (983 females [14.2] and 126 males [19.1%]); 761 (68.6%) adolescents were retested for chlamydia; and 182 (16.4%) had repeat positive test results. The median time to diagnosis of a repeat infection was 6 months.Conclusions: Chlamydia imposes a large disease burden in the private, organized healthcare sector. Managed care organizations can use operational data to enhance chlamydia prevention services by defining testing practices and local disease prevalence. [ABSTRACT FROM AUTHOR]

Investigates the prevalence and incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection, while assessing the risk factors for these infections in a middle school-based clinic. Methods used to conduct studies among middle school students; Types of persons who are at risk of contracting sexually transmitted diseases (STDs); Identification of STDs; Provisions of school-based health centers.

Purpose of Review: The aim of this review is to define the "state-of-the-art" in artificial intelligence (AI)-enabled devices that support the management of retinal conditions and to provide Vision Academy recommendations on the topic., Recent Findings: Most of the AI models described in the literature have not been approved for disease management purposes by regulatory authorities. These new technologies are promising as they may be able to provide personalized treatments as well as a personalized risk score for various retinal diseases. However, several issues still need to be addressed, such as the lack of a common regulatory pathway and a lack of clarity regarding the applicability of AI-enabled medical devices in different populations., Summary: It is likely that current clinical practice will need to change following the application of AI-enabled medical devices. These devices are likely to have an impact on the management of retinal disease. However, a consensus needs to be reached to ensure they are safe and effective for the overall population., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose of Review: The application of artificial intelligence (AI) technologies in screening and diagnosing retinal diseases may play an important role in telemedicine and has potential to shape modern healthcare ecosystems, including within ophthalmology., Recent Findings: In this article, we examine the latest publications relevant to AI in retinal disease and discuss the currently available algorithms. We summarize four key requirements underlining the successful application of AI algorithms in real-world practice: processing massive data; practicability of an AI model in ophthalmology; policy compliance and the regulatory environment; and balancing profit and cost when developing and maintaining AI models., Summary: The Vision Academy recognizes the advantages and disadvantages of AI-based technologies and gives insightful recommendations for future directions., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose of Review: Partner notification is an essential element of sexually transmitted disease infection control. Patients may be interviewed by public health staff, followed by public health staff notification of those partners (provider referral), or they receive some form of instruction to notify and refer their own partners (patient referral). In this review, we review partner notification and current research and programmatic activity., Recent Findings: Resource limitations restrain provider referral to a minority of cases. Patient referral is far more widely practiced and is the subject of some recent enhancements. Foremost among these is the growing practice of expedited partner therapy, in which partner treatment may occur through the provision of medications or prescriptions prior to a clinical evaluation. Trials in which patients took medications to their partners have been supported, and the practice is gaining acceptance nationally. Other counseling also increases patient referral efficacy. Finally, the role of the internet in both provider and patient referral has received increasing attention and is being incorporated into program practice., Summary: Clinical providers can intervene at the point of care to serve both patients as individuals and infection control more broadly. Cooperation between public health agencies, other organizations and clinical providers can facilitate both goals.

Purpose: To evaluate the refractive, keratometric, and visual outcomes of a modified Ruiz procedure in patients with high astigmatism after penetrating keratoplasty (PKP)., Methods: Retrospective cohort study with 26 eyes of 24 patients. A modified Ruiz incision pattern was used. Two paired arcuate incisions, centered on the preoperative cylinder axis, were performed over 2 o'clock hours (60 degrees) within the graft. The median optical zone was 4.5 mm (range, 3-5 mm). Subsequently, 4 radial cuts were made. The depth of all cuts was 90%-95% of the central corneal thickness. The follow-up time was 3 months., Results: The mean preoperative subjective cylinder was 8.75 +/- 3.05 D, decreasing to 5.31 +/- 3.12 D postoperatively. Three months after the procedure, 53.8% of the eyes had <5.0 D of refractive astigmatism and 47% of eyes had <5.0 D of keratometric astigmatism. For the refractive data, the mean correction index was 1.95; the mean index of success was 1.27. The mean reduction in spherical equivalent was 1.95 D (60.5%). The mean best-corrected visual acuity (BCVA) was 0.61 and did not change significantly. Three eyes gained 2 or more lines of BCVA, and 1 eye lost 2 or more lines of BCVA. There was no difference in subgroup analysis of eyes treated with 4- (13 eyes) or 5-mm (12 eyes) optical zones., Conclusions: The modified Ruiz procedure is an effective method to reduce high astigmatism after PKP. However, the results were widely scattered, and the patients need to be informed about the unpredictable outcome and its consequences.

Objective: To evaluate chlamydia-screening policies, testing practices, and the proportion testing positive in response to the new Health Plan Employer Data and Information Set (HEDIS) chlamydia-screening performance measure in a large commercial health plan., Methods: We interviewed health plan specialty departmental chiefs to describe interventions used to increase chlamydia screening and examined electronic medical records of 15- to 26-year-old female patients--37,438 from 1998 to 1999 and 37,237 from 2000 to 2001--who were classified as sexually active by HEDIS specifications to estimate chlamydia testing and positive tests 2 years before and after the HEDIS measure introduction., Results: In January 2000, the obstetrics and gynecology department instituted a policy to collect chlamydia tests at the time of routine Pap tests on all females 26 years old or younger by placing chlamydia swabs next to Pap test collection materials. Other primary care departments provided screening recommendations and provider training. During 1998-1999, 57% of eligible female patients seen by obstetrics and gynecology exclusively and 63% who were also seen by primary care were tested for chlamydia; in 2000-2001 the proportions tested increased to 81% (P < .001) and 84% (P < .001). Proportions tested by other primary care specialists did not increase substantially: 30% in 1998-1999 to 32% in 2000-2001. The proportion of females testing positive remained high after testing rates increased: 8% during 1998-1999 and 7% during 2000-2001, and the number of newly diagnosed females increased 10%., Conclusion: After the obstetrics and gynecology department introduced a simple systems-level change in response to the HEDIS measure, the proportion of females chlamydia-tested and number of newly diagnosed females increased.

Quantification of the biologically relevant dose is required for the establishment of cause-and-effect between radiation detriment or burden and important biological outcomes. Most epidemiological studies of unanticipated radiation exposure fail to establish cause and effect because of an inability to construct a valid quantification of dose for the exposed population. No one biodosimetric technique (biophysical or biological) meets all the requirements of an ideal dosimeter and thus qualify as a "gold standard." This report combines new results with previously published data in order to establish a collective biodosimetry as a dosimetric "gold standard" for the victims of three radiation accidents. Combining new and previously published data is necessary as execution and planning of a comprehensive dosimetry is rarely done at the initial stages of a radiation accident. The first subject was a fireman during the initial moments of the Chernobyl nuclear accident; the second was the victim of an unspecified occupational accident; and the third was exposed to a 60Co sterilization source. There was generally good agreement among the various biodosimetric techniques used for the three accident victims.

Objective: To assess the cognitive and academic performance of adolescents who were born small for gestational age (SGA) at term., Methods: A 17-year historical prospective study was done by matching neonatal data of 1758 infants to the results of the medical and intelligence assessment performed at age 17 years at the army draft board medical examination in Israel. The results of children born SGA (weight at term birth below the third percentile) were compared to those of children who were born appropriate for gestational age (AGA)., Results: After adjustment by a multiple linear regression analysis, the mean (+/- standard error of the mean) intelligence test scores were 103.1 +/- 2.9 versus 105.8 +/- 1.5 (P = 0.3) for the males and 100.3 +/- 2.5 versus 104.7 +/- 1.6 (P < .03) for the females. Males born SGA at term were found to have lower educational achievements (having less than 12 years of schooling or attending a vocational school) compared with the AGA group. The odds ratio for this finding after adjustment by a logistic regression analysis was 2.40 (95% confidence interval 1.07-5.39; P < .03). Intranatal events were not found to have an effect on the measured neurodevelopmental outcome., Conclusion: Infants born SGA at term have an increased risk for lower cognitive performance and schooling achievements than those born AGA; this result seems to be unrelated to their intranatal course.

The impact of birth weight on cognitive performance in late adolescence was assessed in a study of 20,567 male infants born in Jerusalem between 1964-1970. The 17-year follow-up was performed by matching computerized data base records. Stepwise multiple regression analysis was used to estimate the effect of birth weight on intelligence test scores, adjusting for the influence of ethnic origin, maternal and paternal education, social class (determined by area of residence), maternal age, and birth order. These confounders explained 22% of the variance in intelligence test scores. The adjusted differences in intelligence test scores were significantly lower for groups with birth weight less than 2000 g (-6.5 points), 2000-2499 g (-3.6 points), and 2500-2999 g (-1.6 points) compared with the group weighing 3000-3499 g. Most low birth weight infants achieved intellectual performance within the normal range. However, despite this reassuring finding, low weight at birth in male subjects was found to have a statistically significant independent association with inferior intelligence test achievements in late adolescence.

The association between low Apgar scores (7 or less) at 1 and 5 minutes and cognitive performance in late adolescence was assessed. A 17-year follow-up of 1942 subjects was performed. The intelligence test scores at 17 years of age were matched with 1- and 5-minutes Apgar scores. A multiple linear regression analysis was used to control for the possible confounding effect of perinatal factors (birth weight, gestational age, serum bilirubin levels, birth order) and demographic characteristics (ethnic origin, paternal education, social class). The sensitivity and positive predictive value of a low 1-minute Apgar score were 8 and 8% and of a low 5-minute Apgar score 1.5 and 5%, respectively. Low Apgar scores are poorly correlated with long-term intellectual outcome.

A Royal College of Pathologists of Australasia (RCPA) sponsored Quality Assurance Program (QAP) in Clinical Immunology, involving 128 laboratories over a 1 yr period, revealed the following: successful participation in the program by 16 overseas laboratories (distant from Australia); only 30% of laboratories succeeded in returning their results by the scheduled date on every occasion; quantitation of urinary total protein and Bence Jones protein was poor and varied over a log scale; immunofixation was more successful in characterizing urinary paraprotein than immunoelectrophoresis; densitometry of protein electrophoresis appeared the method of choice in quantitating serum paraproteins accurately; nephelometric techniques gave better concordance between laboratories than turbidometric, radial immunodiffusion or agglutination techniques; poor concordance between laboratories in detecting weakly positive antinuclear antibodies (ANA); some laboratories had difficulties in identifying ANA patterns (only 60% of laboratories correctly identified the anticentromere pattern); few laboratories could correctly identify antibodies to extractable nuclear antigens (ENA); flow cytometry gave a smaller dispersion of lymphocyte subpopulation percentages than microscopy. A method was established to rank laboratory performance of selected tests over the 1 yr period. Such a comparative ranking scheme may alert laboratories in identifying specific or generalized deficiencies in performance.

The incidence of congenital anomalies was examined by the level of maternal and paternal smoking during pregnancy for 17,152 infants. A multiple regression analysis was used to control for the possible confounding effects of maternal age, formal education, ethnic origin, religion, marital status, parity, social class, and work outside the home. Neither maternal nor paternal smoking habits were significantly associated with the occurrence of congenital malformations. Maternal age was significantly (P less than .005) related to the incidence of major anomalies. Mothers aged 35 years and older who smoked were found to have a significantly (P less than .002) higher risk for minor malformations and a nonsignificantly increased rate of major malformations. Maternal cigarette smoking may be an important preventable risk factor for congenital anomalies among mothers aged 35 years or older.

Of 10,122 singleton babies born from January 1, 1984 to March 31, 1988, we compared 1,154 term infants with high serum bilirubin levels (greater than 12.9 mg/dl) to 1,154 infants with low serum bilirubin levels (less than or equal to 12.9 mg/dl) randomly selected from the remaining 8,968 subjects. We found that a high bilirubin level was significantly associated with male sex; maternal diabetes (chronic and gestational); pregnancy-induced hypertension; previous sibling with neonatal jaundice; delivery by cesarean section, vacuum, or forceps; epidural anesthesia; mother with blood type O; first delivery; cephalohematoma; short gestation; lower birth weight; and lower birth order (p less than 0.01); and older maternal age, low percentile for birth weight, and the percentage of weight loss during hospitalization (p less than 0.05). Variables with significantly different frequencies in control and study groups were used in a multivariate analysis, thus further refining the data by the use of logistic regression. Teenage mothers (less than or equal to 19 years old) had the lowest risk, whereas older mothers (greater than 35 years old) had the highest risk of all age groups for having an infant with neonatal jaundice. First delivery and previous sibling with neonatal jaundice were also risk factors. Male sex, short gestation, and delivery by vacuum extraction were other notable risk factors. Our results suggest that, even among industrialized Western societies, risk factors may interact differently to produce higher neonatal serum bilirubin levels. The importance of a risk factor may also be dependent upon its relative prevalence in a parturient population.

The association between maternal weight gain during pregnancy and the infant's birth weight was studied in 14,121 term singleton births. The parturients were stratified into four body-mass categories, three age groups, four parity groups, and three levels of educational attainment. A separate multiple regression analysis was performed for each category to control for the confounding effect of gestational age, maternal social class, ethnicity, cigarette consumption, marital status, age, parity, education, and weight for height. A significant positive influence of prenatal weight gain on birth weight was found for all subgroups. The effect varied depending on maternal pre-pregnancy body mass, age, parity, and the level of formal education.

A 13-year-old boy with acute myelogenous leukemia resistant to conventional chemotherapy received a bone marrow transplant from his HL-A-identical, mixed lymphocyte culture-reactive sister. The recipient was prepared for transplantation with cyclophosphamide and total body irradiation. Despite cytogenetic evidence of engraftment, graft-versus-host disease was not observed. The patient died 38 days post-transplantation of Gram-negative bacteremia sepsis and recurrent leukemia of recipient origin.

Requirements for sustained engraftment of fetal liver hematopoietic stem cells were evaluated in 45 dogs. Pretransplant preparative treatment with total-body irradiation, 14.7 Gy, permitted engraftment of DLA-compatible fetal liver cells. Radiation alone was inadequate in DLA-haploidentical or DLA-mismatched transplants; none of 5 dogs had engraftment. Addition of cyclosporine facilitated engraftment. The combination of 14.7 or 16.1 Gy total-body irradiation (TBI) and cyclosporine allowed engraftment in 15 of 19 (78%) dogs receiving DLA-histoincompatible grafts and 11 Gy TBI plus cyclosporine allowed engraftment in 4 of 10 dogs. Restoration of granulopoiesis and thrombopoiesis was rapid; recovery of lymphocytes was relatively delayed, especially in recipients of incompatible fetal liver cells. Cumulative one-year survival was decreased in recipients of incompatible grafts due to early posttransplant infections. These data suggest that fetal liver transplantation is a potential approach in patients who lack an HLA-identical donor for bone marrow transplantation.

The effect of antithymocyte globulin (ATG) treatment on T cell precursors was investigated in an in vitro model of E rosette induction by thymic factors. Approximately 8% of bone marrow mononuclear cells can be induced to form E rosettes following incubation with thymosin or with conditioned medium from cultured thymic epithelium (CM-CTE). Treatment of bone marrow mononuclear cells with ATG alone markedly reduced but did not eliminate precursors of E rosette-forming cells (E-RFCs), whereas treatment with ATG and complement completely inhibited these bone marrow E-RFC precursors. E-RFCs already present in peripheral blood and bone marrow were completely inhibited by treatment with ATG alone. E-RFCs induced by treatment of bone marrow cells with thymosin or CM-CTE were also completely inhibited by ATG alone. These data indicate that bone marrow precursors of E-RFCs are less sensitive to ATG inhibition than are peripheral blood and bone marrow E-RFCs. When bone marrow precursor T cells are induced to become E-RFCs by the treatment with thymic factors, they acquire comparable sensitivity to ATG. A similar disparity in sensitivity to ATG treatment was observed when ATGs absorbed with human fetal liver cells or granulocytes were studied. These data suggest that ATG treatment of bone marrow cells may have different effects on mature and precursor T cells. It is important to consider these factors in attempts to use ATG treatment in clinical bone marrow transplantation trials.

Nonmajor histocompatibility complex (non-MHC) antigens are important targets of graft rejection and graft-versus-host disease in clinical transplantation. Little is known regarding immunity to non-MHC antigens. To study this problem we evaluated the effect of antihuman thymocyte globulin (ATG) on reactivity in autologous and allogeneic mixed lymphocyte cultures and activity in a model of immunity to non-MHC antigens, the response to trinitrophenyl (TNP)-modified autologous cells. Primary proliferative responses to autologous B lymphocytes, allogeneic cells, and TNP-modified autologous cells were all inhibited by ATG treatment. Secondary proliferative responses and cytotoxicity to TNP-modified autologous cells were also inhibited as was cross-reactive cytotoxicity to TNP-modified allogeneic cells. These data indicate that both MHC-restricted and MHC-nonrestricted immune responses to modified self-antigens and possibly to non-MHC antigens are sensitive to ATG treatment. ATG may be useful in clinical situations where the objective of immunosuppression is to inhibit immunity to non-MHC antigens such as after HLA-matched kidney grafting or bone marrow transplantation.

We studied three potential mechanisms that might account for the difficulty in detecting non-HLA antigenic disparities between HLA-identical siblings: (1) a low frequency of antigen-reactive cells; (2) the failure of antigen recognition to trigger proliferation or cytotoxicity; and (3) the development of suppressor cells or factors. In vitro sensitization was used to increase the frequency of antigen-reactive cells. Allogeneic lymphocytes or supernatants from mixed lymphocyte cultures were used to provide nonspecific proliferative signals. Neither approach was successful in facilitating the detection of proliferation or cytotoxicity between HLA-identical siblings. Furthermore, we found no evidence for the development of antigen-specific suppressor cells or factors. These data indicate that other mechanisms must underlie the difficulty in detecting non-HLA antigens in vitro.

Myasthenia gravis and focal polymyositis occurred in a dog following successful transplantation of DLA-identical fetal liver hematopoietic cells. There was no evidence of acute or chronic graft-versus-host disease. Antibodies to acetylcholinesterase receptor and immune complexes reactive with myoneural junctions were demonstrated, as well as focal inflammation with perifascicular and type 2 muscle atrophy. The dog responded to treatment with prednisolone and pyridostigmine.

We studied the longitudinal association of birth order and birth weight in two series of very large sibships, each consisting of at least seven children, and compared the findings with those based on analysis of cross-sectional data from a large population-based survey, the Jerusalem Perinatal Study. The birth weights of the cross-sectional sample were adjusted by multiple linear regression for a number of factors known to confound cross-sectional studies, including maternal age, education, marital status, religion, smoking, height and prepregnant weight, gestational age, and sex of the newborn. Birth weight increased with increasing birth order in both adjusted cross-sectional and socioeconomically homogeneous longitudinal data.

Most individuals with diseases potentially treatable by bone marrow transplantation lack an HLA-identical sibling donor. The annual incidence of 11 diseases probably or possibly benefitted by bone marrow transplantation was corrected for patient and disease characteristics to determine annual adjusted incidences. These data were used to project the number of individuals who might receive transplants using an HLA-typed national bone marrow donor pool. Estimates of transplant outcome were then utilized to predict potential annual benefit. Approximately 12,000 individuals annually are predicted to be candidates for transplantation from a national donor pool. Using indicated projected benefits, this could result in benefit to approximately 5000 individuals. Such a pool may also be useful for individuals accidently exposed to radiation.