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Objective: This study describes the characteristics of emergency room staffing at rural hospitals in Kansas., Methods: Administrators at 84 rural hospitals in communities of less than 5,000 were surveyed by telephone using a scripted interview., Results: Seventy-seven hospitals provided physician-staffed emergency room services. Their average daily emergency room census was 4.4. The average hospital medical staff consisted of 2.9 physicians. Eighty-six percent of all hospital staff physicians were family physicians. Ninety-six percent of all hospital emergency room staffing was provided by the local medical staff. Fee-for-service was the only method of reimbursement to physicians in 44 hospitals. Alternatives to emergency room staffing by local physicians included contracted part-time emergency room physicians, locum tenens physicians, mid-level practitioners, or emergency room closure., Conclusions: Rural family physicians have considerable responsibility for providing emergency care. Physicians must have adequate training in emergency medical care to practice in communities such as these.

Congenital malformations of the craniofacial region represent an important class of human developmental disorders. Abnormalities of speech and hearing frequently occur in this vast array of conditions. Knowledge of the diagnostic criteria, genetics, and natural history of these conditions is important for audiologists and speech-language pathologists because of their close involvement with the children and families in their care-providing role. Awareness of the important distinction between individuals with isolated defects vs. individuals who have their facial defect as part of a syndrome is important in diagnosis and management. Referral for genetic counseling is always indicated in families who have questions about these issues. The dysmorphologist, genetics professional, and speech-language pathologists are among those who play key roles in the care of persons with these disorders.

Carbon in the form of 8-micron fibers induces growth of connective tissue. The purpose of this study was to measure and histologically characterize tissue ingrowth occurring in carbon fibers implanted for up to 12 months in abdominal-wall defects in rats, compared with polypropylene mesh. Carbon fibers induced significantly more tissue ingrowth than polypropylene mesh at 6 to 12 months postoperatively. The predominant tissues associated with carbon fibers and polypropylene mesh were dense connective tissue and fat, respectively. Fragmentation of the implants did not occur, and implant debris was not found in the regional lymph nodes. Carbon fibers are potentially useful for reinforcing abdominal-wall defects.

The purpose of this study was to evaluate a partially automated sphygmomanometer for accuracy in the ambulatory care setting. Patients seen in 80 consecutive office visits served as subjects. Blood pressures were measured simultaneously under standard conditions. The oscillometric test instrument and a standard mercury manometer were connected with a Y tube. Paired t-tests were used to determine statistical differences between values obtained from the two instruments. Analyses were done by age, sex, and blood pressure range. While mean differences in blood pressure values were statistically significant in almost every instance, the quantitative differences were 5 mmHg or less with one exception. The differences, although statistically significant, were not great enough to be clinically important. We conclude that the Marshall 85 oscillometric sphygmomanometer is sufficiently accurate for limited use in the ambulatory care setting.

59 children with varying amounts and types of day-care experience were followed over their first 2 or 3 years of public schooling. Schoolteachers rated aggressiveness of several types and in several situations by these children, and also supplied information about managing the children, about children's use of strategies to avoid conflict, and about several associated skills and behaviors. Multivariate analyses indicated that children who had attended a cognitively oriented day-care program beginning in infancy were more aggressive than all other groups of children who had attended day care. Aggression among these children, however, declined over time, the children were not considered difficult to manage, and they were well liked by teachers. It was speculated that the increased aggressiveness among children attending cognitively oriented day care may have been caused by several problems of adaptation to the school setting.

Parents, pediatricians, social scientists, and policymakers have become increasingly concerned that infants and children in day care, especially those younger than 3 years of age, are at risk for morbidity associated with several types of acute illness. We have examined the empirical evidence on the impact of day-care attendance on frequency of respiratory illnesses, diarrhea, hepatitis A, meningitis, and cytomegalovirus disease in children, day-care staff, and household contacts. The short- and long-term costs of day-care-associated illnesses were assessed, wherever possible within a benefit-cost framework. Available evidence suggests that children in day care, and sometimes their teachers and household contacts, have higher rates of diarrhea, hepatitis A, meningitis, and possible otitis media than children not in day care. There is only weak or moderate evidence that children and their families are at risk for high rates of respiratory illness (other than otitis media) or cytomegalovirus infection. Taken together, the excess of these illnesses among children in day care may impose moderate net costs on families and on society. Revisions of state regulatory policy regarding health practices in day care and policy initiatives designed to provide parents with more information and authority are recommended to protect the health and development of children in day care.

Infant-intervention programs that evaluate their effectiveness by repeatedly testing infants with standardized tests may confound intervention effects with repeated-testing effects. Further, maternal participation in testing may increase infants' test scores, either directly by giving infants practice with test-like items at home between test administrations or indirectly by helping infants adapt to the test setting. Thirty-five infants were tested at 3-month intervals between 4 and 28 months of age with the Bayley Scales of Infant Development and at 31 months of age with the Stanford-Binet; 25 infants were tested with the Bayley at 4 months and the Stanford-Binet at 31 months. Mothers of some infants in each group participated in the testing process. Between-subjects analysis on the Stanford-Binet revealed no effects for repeated testing or maternal participation. Within-subjects analyses for repeatedly tested groups demonstrated that maternal presence during testing, but not repeated testing, was associated with significantly higher Bayley scores. It was concluded that maternal presence is a potent influence on Bayley performance, that repeated experience with the Bayley biased neither performance on another standardized test of development nor subsequent Bayley performance, and that infant intervention programs are not likely to confound their evaluation designs by testing infants repeatedly.

A fungus of Pythium species survives high and low temperatures longer when a suitable sterol is added to the growth medium.