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Introduction: Kyphoplasty is a minimally invasive treatment for chronic refractory pain secondary to spinal compression fracture. This study investigates racial and socioeconomic disparities in kyphoplasty among the Medicare population. Materials and Methods: This study utilized data from the Medicare Limited Data Sets (LDS), a CMS administrative claims database. Patients aged 18 and older with ICD code consistent with spinal pathology and compression fractures were included. Outcome was defined as kyphoplasty by race and socioeconomic status (SES) with low SES defined by dual enrollment in Medicare/Medicaid. Results: There was a total of 215,502 patients gathered from CMS data, and 717 (0.33%) of these patients underwent kyphoplasty during the study period. Of these patients, 458 (63.8%) were female, the average age was 76.5 years old, 655 (91.3%) were White, 20 (2.7%) were Black, 9 (1.3%) were Hispanic, and 98 (13.7%) were Medicare/Medicaid dual eligible. White patients (32,317/157,177 [20.6%]) were less likely to be dual enrollment eligible in Medicare and Medicaid than Black (5407/13,522 [39.9%]), Hispanic (2833/3675 [77.1%]), Asian (2087/3312 [63.0%]), or North American Native patients (778/1578 [49.1%]). Multivariate regression (MVR) analysis was performed and showed that Blacks were less likely than Whites to have a kyphoplasty performed (OR 0.46 [95% CI: 0.29–0.72], p‐value <0.001). Although Hispanics (OR 0.95 [0.49–1.86]), North American Native (OR 0.82 [0.3–2.19]), and unknown race had a decreased odd of undergoing kyphoplasty, it was not statistically significant. Conclusion: Our study showed after adjustment for pertinent comorbidities, Medicare/Medicaid dual‐eligible patients and Black patients were significantly less likely to receive kyphoplasty than White patients with Medicare. [ABSTRACT FROM AUTHOR]

Introduction: Characterization of the clinical and economic impact of opioid-related adverse drug events (ORADEs) after total knee arthroplasty (TKA) may guide provider and hospital system approach to managing postoperative pain after TKA. Our analysis quantifies the rate of potential ORADEs after TKA, the impact of potential ORADEs on length of stay (LOS) and hospital revenue, as well as their association with specific patient risk factors and comorbid clinical conditions.Methods: We conducted a retrospective study using the Centers for Medicare and Medicaid Services administrative database to analyze Medicare discharges involving two knee replacement surgery diagnosis-related groups (DRGs) in order to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed.Results: The potential ORADE rate in patients who underwent TKA was 25,523 out of 316,858 records analyzed (8.0%). The mean LOS for patients who experienced a potential ORADE was 1.04 days longer than those without an ORADE. The mean hospital revenue per day with a potential ORADE was $1334 (USD) less than without an ORADE. Potential ORADEs were significantly associated with poor patient outcomes such as pneumonia, septicemia, and shock.Conclusion: Potential ORADEs in TKA are associated with longer hospitalizations, decreased hospital revenue, and poor patient outcomes. Certain risk factors may predispose patients to experiencing an ORADE, and thus perioperative pain management strategies that reduce the frequency of ORADEs particularly in at-risk patients can improve patient satisfaction and increase hospital revenue following TKAs. [ABSTRACT FROM AUTHOR]

The formal opportunity to learn geography in the United States is unevenly distributed across space, creating possible geography deserts. Data on the number of exams taken in Advanced Placement Human Geography (APHG) and bachelor's degrees earned in geography are mapped at the state and regional scales. Normalized rates are ranked and grouped into quintiles. For APHG exams, states in the southeastern region of the United States are in the uppermost quintiles while states in the northeastern region are in the lowermost quintiles. The pattern for bachelor's degrees in geography is somewhat the spatial inverse of that for APHG. [ABSTRACT FROM AUTHOR]

The article discusses resources available in the Connecticut State Archives and State Library concerning religion and society in Connecticut. It comments on sources related to temperance and prohibition as well as abortion and birth control, examining specific sources including records of the Connecticut General Assembly, Attorney General, and Governors, as well as newspapers and manuscripts. The authors also explore digital collections concerning Connecticut church history, which include records related to the Great Awakening, the First Baptist Church of Meriden, Connecticut, and Roman Catholicism.

In this article, the author offers information on the law school curriculum and associated professionalism required for delivering legal education in the U.S. He focuses on addressing the legal courses which deals with the cultural dimensions of law and the transnational dimensions of law. He discusses the Wooddruff Curriculum which was reviewed by the Mercer University School of Law.

The article discusses the actions of Connecticut governors during World War II and immediately thereafter to oppose racial segregation in the U.S. military, culminating in the integration of the Connecticut National Guard in 1949. The policy of the U.S. Army regarding African American troops during the war is discussed, as are the policies and actions opposing racial discrimination of Connecticut governors Raymond E. Baldwin, Robert A. Hurley, James L. McConaughy, James Shannon, and Chester Bowles.

We use bill cosponsorship and roll-call vote data to compare legislators' revealed preferences in the U.S. House of Representatives and the Argentine Chamber of Deputies. We estimate ideal points from bill cosponsorship data using principal-component analysis on an agreement matrix that included information on all bills introduced in the U.S. House (1973-2000) and Argentine Chamber (1983-2002). The ideal-point estimates of legislators' revealed preferences based on cosponsorship data strongly correlate with similar estimates derived from roll-call vote data. Also, cosponsorship activity in the U.S. House has lower dimensionality than cosponsorship has in the Argentine Chamber. We explain this lower discrimination as a function of individual- and district-level factors in both countries. [ABSTRACT FROM AUTHOR]

Cartel Theory (and partisan theory more generally) expertly explains the functioning of the U.S. Congress. However, as a theory originally developed to study a single legislature where the institutional context differs greatly from that found in other presidential democracies, its applicability to these democracies has been questioned. Between one extreme represented by the United States (where legislators control their own political future) and the other represented by centralized party systems (where the national party leadership controls legislators' future) exists an intermediate group of democracies where subparty bosses are the key actors, controlling the future of subsets of a party's legislative delegation. We analyze one of these intermediate democracies, Argentina, and demonstrate the general applicability of Cartel Theory to an institutional context that differs notably from that found in the United States. We highlight how the theory can be adapted to a political system where subparty bosses, not individual legislators, are the most relevant political actors. [ABSTRACT FROM AUTHOR]

From 2001 to 2003, rates of susceptibility to piperacillin-tazobactam (86%), ceftazidime (80%), ciprofloxacin (68%), and levofloxacin (67%) did not decrease or decreased by <1.5%, whereas the rate of susceptibility to gentamicin decreased by 3.2% (from 75.5% to 72.3%) and the rate of susceptibility to imipenem decreased by 5.6% (from 84.4% to 78.8%), for 2394 clinical isolates of Pseudomonas aeruginosa collected in the Tracking Resistance in the United States Today surveillance studies. Rates of multidrug resistance (i.e., resistance to ⩾3 antimicrobial agents) increased from 7.2% in 2001 to 9.9% in 2003 and were significantly higher for isolates from the East North Central and Mid-Atlantic regions of the United States than for isolates from other regions. Analysis of minimum inhibitory concentrations (MICs) suggested that combining an antipseudomonal β-lactam with ciprofloxacin or levofloxacin would yield a 3.4%–7.1% increase in the percentage of isolates susceptible to the combination, compared with the β-lactam alone. Ratios of the area under the serum concentration-time curve values for free drug to modal MICs for ciprofloxacin and levofloxacin were similar and were >125 (target ratio), whereas those ratios for gatifloxacin and moxifloxacin were significantly lower. Ongoing surveillance of P. aeruginosa is essential. [ABSTRACT FROM AUTHOR]

Bone infections, which can be acute or chronic, often require aggressive antibiotic therapy, whether treated at home or in the community. Surveillance programmes are essential tools in the monitoring of antimicrobial resistance and can act as a resource to maintain effective prescribing. The Surveillance Network® (TSN®), which collects organism and patient-specific data from a network of laboratories across the United States, was used to analyse susceptibility of common bacterial species isolated from bone infections during 2000–2002. Narrow-spectrum antimicrobials such as vancomycin, quinupristin-dalfopristin and linezolid demonstrated good activity against Staphylococcus aureus and streptococci, and were active against 100% of isolates. However, Gram-negative species were also commonly isolated from these sites of infection. Later-generation cephalosporins, represented by ceftriaxone, cefotaxime and cefepime, exhibited a broad spectrum of activity including Enterobacteriaceae, streptococci and methicillin-susceptible S. aureus, but they were not active against methicillin-resistant S. aureus (MRSA) and showed variable activity against Pseudomonas aeruginosa. Using ceftazidime as a marker for extended spectrum β-lactamase (ESBL) expression, less than 3% of Escherichia coli or Klebsiella pneumoniae expressed this phenotype. Based on current in vitro activity, the third-generation cephalosporins provide broad-spectrum coverage useful for the empirical therapy of suspected bone infections, especially for patients treated in the community or hospitalised with community-acquired infections. [Copyright &y& Elsevier]

Background: Bloodstream infections are associated with significant patient morbidity and mortality. Antimicrobial susceptibility patterns should guide the choice of empiric antimicrobial regimens for patients with bacteremia. Methods: From January to December of 2002, 82,569 bacterial blood culture isolates were reported to The Surveillance Network (TSN) Database-USA by 268 laboratories. Susceptibility to relevant antibiotic compounds was analyzed using National Committee for Clinical Laboratory Standards guidelines. Results: Coagulase-negative staphylococci (42.0%), Staphylococcus aureus (16.5%), Enterococcus faecalis (8.3%), Escherichia coli (7.2%), Klebsiella pneumoniae (3.6%), and Enterococcus faecium (3.5%) were the most frequently isolated bacteria from blood cultures, collectively accounting for >80% of isolates. In vitro susceptibility to expanded-spectrum β-lactams such as ceftriaxone were high for oxacillin-susceptible coagulase-negative staphylococci (98.7%), oxacillin-susceptible S. aureus (99.8%), E. coli (97.3%), K. pneumoniae (93.3%), and Streptococcus pneumoniae (97.2%). Susceptibilities to fluoroquinolones were variable for K. pneumoniae (90.3-91.4%), E. coli (86.0- 86.7%), oxacillin-susceptible S. aureus (84.0-89.4%), oxacillin-susceptible coagulase-negative staphylococci (72.7-82.7%), E. faecalis (52.1%), and E. faecium (11.3%). Combinations of antimicrobials are often prescribed as empiric therapy for bacteremia. Susceptibilities of all blood culture isolates to one or both agents in combinations of ceftriaxone, ceftazdime, cefepime, piperacillin-tazobactam or ciprofloxacin plus gentamicin were consistent (range, 74.8-76.3%) but lower than similar β-lactam or ciprofloxacin combinations with vancomycin (range, 93.5-96.6%). Conclusion: Ongoing surveillance for antimicrobial susceptibility remains essential, and will enhance efforts to identify resistance and attempt to limit its spread. [ABSTRACT FROM AUTHOR]

Background: Bacterial infections of the central nervous system, especially acute infections such as bacterial meningitis require immediate, invariably empiric antibiotic therapy. The widespread emergence of resistance among bacterial species is a cause for concern. Current antibacterial susceptibility data among central nervous system (CNS) pathogens is important to define current prevalence of resistance. Methods: Antimicrobial susceptibility of pathogens isolated from CNS specimens was analyzed using The Surveillance Database (TSN®) USA Database which gathers routine antibiotic susceptibility data from >300 US hospital laboratories. A total of 6029 organisms derived from CNS specimen sources during 2000-2002, were isolated and susceptibility tested. Results: Staphylococcus aureus (23.7%) and Streptococcus pneumoniae (11.0%) were the most common gram-positive pathogens. Gram-negative species comprised approximately 25% of isolates. The modal patient age was 1 or <1 year for most organisms. Prevalence of MRSA among S. aureus from cerebrospinal fluid (CSF) and brain abscesses were 29.9-32.9%. Penicillin resistance rates were 16.6% for S. pneumoniae, 5.3% for viridans group streptococci, and 0% for S. agalactiae. For CSF isolates, ceftriaxone resistance was S. pneumoniae (3.5%), E. coli (0.6%), Klebsiella pneumoniae (2.8%), Serratia marcescens (5.6%), Enterobacter cloacae (25.0%), Haemophilus influenzae (0%). Listeria monocytogenes and N. meningitidis are not routinely susceptibility tested. Conclusions: Resistance is commonly detected, albeit still at relatively low levels for key drugs classes such as third-generation cephalosporins. This data demonstrates the need to consider predominant resistance phenotypes when choosing empiric therapies to treat CNS infections. [ABSTRACT FROM AUTHOR]

Background: The Performance Standards for Antimicrobial Susceptibility Testing, Twelfth Informational Supplement, M100-S12, published by the National Committee for Clinical Laboratory Standards (NCCLS) in January 2002 introduced distinct minimum inhibitory concentration (MIC) interpretative breakpoints for ceftriaxone, cefotaxime, and cefepime for nonmeningeal isolates of Streptococcus pneumoniae. Previously, a single set of interpretative breakpoints was used for both meningeal and nonmeningeal isolates. Methods: To estimate the rate of adoption of the M100-S12 interpretive breakpoints by clinical laboratories, antimicrobial susceptibility test results for ceftriaxone and cefotaxime from nonmeningeal S. pneumoniae isolates were studied using data collected from January 2002 to June 2003 by The Surveillance Network® Database -- USA (TSN®), an electronic surveillance database. Results: Of the 262 laboratories that provided data that could be evaluated, 67.6% had adopted the M100-S12 breakpoints one and one-half years after they were published. Conclusions: The NCCLS M100-S12 recommendation to interpret MICs to expanded-spectrum cephalosporins using two distinct sets of breakpoints for meningeal and nonmeningeal isolates of S. pneumoniae was steadily implemented by clinical microbiology laboratories in the United States following their initial publication in January 2002. The use of these new breakpoints more accurately reflects the clinical activities of expanded-spectrum cephalosporins than did the single set of interpretative breakpoints previously used for both meningeal and nonmeningeal isolates. [ABSTRACT FROM AUTHOR]

Susceptibility data for all organisms associated with a range of skin and soft tissue infections (SSTI) in hospitalised patients were studied. Data were reported by clinical laboratories in the USA, France, Germany, Italy and Spain during 2001 which participate in The Surveillance Network (TSN). Staphylococcus aureus, Enterococcus spp. and coagulase-negative staphylococci (CNS), Escherichia coli and Pseudomonas aeruginosa were the most prevalent pathogens in all countries. MRSA was detected in 44.4, 34.7, 12.4, 41.8 and 32. 4% of S. aureus in each country, respectively. The majority of MRSA were cross resistant to other compound classes tested except for vancomycin (100% susceptible) trimethoprim–sulphamethoxazole with range 1.7% (France) to 15.9% (Italy) resistant, and gentamicin with range 12.2% (France) to 87.0% (Italy) resistant. More than 99.0% of MSSA tested susceptible to ceftriaxone and >94.9% to trimethoprim–sulphamethoxazole. 87.2% (France) to 94.6% of MSSA (Germany) were ciprofloxacin susceptible; 73.2% (USA) to 86.6% (Spain) were erythromycin susceptible; 85.4% (Italy) to 99.2% (France) were gentamicin susceptible. MSSA were more frequently found and generally more antibiotic susceptible from out patients. Overall, 100% of Streptococcus agalactiae and Streptococcus pyogenes were susceptible to penicillin, ceftriaxone and cefotaxime. Macrolide resistance was common among S. agalactiae (20.7%, Germany to 10%, Italy and Spain), S. pyogenes (19.2%, France to 11.1%, USA) and viridans streptococci (25.7%, France to 14.1%, Germany). Vancomycin-resistant Enterococcus spp. were uncommon outside the USA (17.5%) and Italy (7.4%). For all countries susceptibility of E. coli was 100% to imipenem, >98.7% to amikacin, >96.0% to ceftriaxone and cefotaxime. Susceptibility of E. coli isolates to ciprofloxacin was 77.6% in Spain to 94.3% in Germany. Klebsiella spp., Proteus spp., Citrobacter spp. and Enterobacter spp. displayed varying susceptibilities between countries to drugs tested. Putative extended spectrum β-lactamase expression in E. coli remained rare comprising 4–5% of isolates in USA, Italy and Spain and in France and Germany <2%. For P. aeruginosa piperacillin–tazobactam, amikacin, imipenem and ceftazidime were the most active compounds tested irrespective of region. Surveillance data should be considered when selecting empirical therapy for treating SSTI. [Copyright &y& Elsevier]

In vitro surveillance data from across the United States indicate that ∼10%-20% of urinary Escherichia coli isolates from female outpatients are resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Alternative therapies for uncomplicated urinary tract infections in women include fluoroquinolones and nitrofurantoin, but the activities of these agents against TMP-SMX-resistant isolates are rarely reported. Among TMP-SMX-resistant urinary E. coli isolates tested in US laboratories from 1998 through 2001, 9.5% (5767 of 60,414) were resistant to ciprofloxacin and 1.9% (1214 of 63,817) were resistant to nitrofurantoin; 10.4% of ciprofloxacin-resistant isolates (683 of 6560) were resistant to nitrofurantoin. An association between resistance to fluor-oquinolones and nitrofurantoin in E. coli has not been previously reported and warrants further study. [ABSTRACT FROM AUTHOR]

Focuses on a study which examined the opinions of Afro-Americans religious groups toward the acceptance of gratuities by police officers. Related literature on police gratuities; Race and demographics in Eastern North Carolina; Religious groups included in the study.

During the recent war on drugs, large numbers of drug offenders were sentenced to probation. Critics of this policy argued that drug offenders belonged in prison. This analysis uses logistic regression to compare 1993 individual level data on felony and non-drug felony probationers. The results of this analysis provide some justification for the general fear presented in the public media that felony drug probationers threaten communities. However, when the performance of African-American men on probation for felony drug offenses is partitioned, analysis results indicate that they are not the threat to public safety to the extent indicated by the media or envisioned by the American public. [ABSTRACT FROM AUTHOR]

A national antimicrobial resistance surveillance study was conducted from December 1997 to May 1998 to determine the prevalence of antimicrobial resistance in 6620 clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. In this centralized study, which involved 163 institutions located in 43 states, we determined MICs for representatives of five antimicrobial classes: β-lactams (penicillin, co-amoxiclav, cefuroxime, ceftriaxone), macrolides (azithromycin, clarithromycin), co-trimoxazole, glycopeptides (vancomycin) and fluoroquinolones (levofloxacin). In most S. pneumoniae isolates, all antimicrobials were to be found active, but amongst penicillin-resistant isolates (MICs ≥ 2 mg/L), resistance to other β-lactams, macrolides and co-trimoxazole was common. For vancomycin and levofloxacin, however, activity was not associated with penicillin resistance. The prevalence of penicillin-nonsusceptible (intermediate and resistant) pneumococci was highest in the South Atlantic (44%) and East South Central (43%) regions and lowest in the Mid-Atlantic (28%) and New England (28%) regions. Resistance to β-lactams, macrolides and co-trimoxazole was more commonly found amongst respiratory isolates than blood isolates and in strains from patients ≤ 12 years old than from older patients. β-lactamase, which was detected in 33% of H. influenzae and 92% of M. catarrhalis strains, did not affect the activity of the β-lactams under study other than ampicillin. Certain agents, such as vancomycin and the fluoroquinolones, remain highly active, and well-designed surveillance systems that monitor MIC distributions would be needed to detect a potential for reduced susceptibility. In addition, surveillance programmes should be designed to collect information about associated resistance as well as differences in prevalence associated with region, specimen source and patient age. [ABSTRACT FROM PUBLISHER]

Provides information on the tests carried out to determine the gender differences in legislator priorities in the national lower houses of Argentina and the United States. Methodology used in the tests; Details on gender differences in policy priorities; Reference made to the Platform for Action of the United Nations Fourth World Conference on Women which was held in Beijing; Implications of the findings.

Examines the types of defenses a probation or parole officer enjoys in civil liability suits. Focus on the concept of absolute, quasi-judicial and qualified immunity; Indications of a shift toward quasi-judicial immunity for officers performing intimate association with the judicial process.

Compares the rearrest statistics of males and female released from prison in North Carolina between July 1, 1992 and June 30, 1993. Prior recidivism research on males and females; Descriptive indicators; Comparison of recidivism indicators.

Compares probationary prisoners at the North Carolina Department of Correction who opted to serve the remaining portion of their sentences in incarceration with those opting for probation supervision. Review of previous study on the matter; Variables correlated with choosing elect-to-serve option; Factors for consideration for future researches.

The article comments on the importance for secondary school students in the U.S. to take a geography course. The author states that the relative success or failure of the teacher in offering an interesting, relevant and well-taught class may strongly influence whether the student takes additional geography courses later in his or her educational career. He also suggests ways for making a positive impression on students in their first geography class.

The authors examine the potential side effects of the antiviral drug oseltamivir, which has been a successful drug in the U.S. because of ease of administration and storage. They present the findings of two prospective cohort studies funded by the Japanese Ministry of Health, Labour, and Welfare on the use of the drug in children and adolescents aged 10 to 19 years. They enumerate several side effects of the drug, such as abnormal behaviour and headache. The authors also favor the establishment of large multicentre studies on the drug's adverse effects.

Highlights the Royal College of Nursing Nurse Practitioner Association conference in Grantham, Pennsylvania. Implications of the document "Liberating the Talents"; Definition of nurse practitioner practice; Dismissal of title as reflection of the competency set.

Examines the mortality and industrial hygiene study of workers exposed to polychlorinated biphenyls in the United States. Determination of vital status of cohorts; Statistics on all-cause mortality and cancer mortality; Statistics on excess mortality for rectal cancer and liver cancer.