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The authors examined the association between living learning communities (LLCs) and undergraduates' sense of community and belonging to their university and residence halls. LLC students scored higher on sense of belonging in residence, but not on campus, than did students in non-LLCs. Analysis of open- ended responses suggested that LLC students found meaning in their LLCs with regard to obtaining social and academic support, engaging in multicultural experiences, and becoming leaders. Implications for practice are discussed.

IN BRIEF Patients, payers, and providers of health care are all interested in good quality of care. A plethora of guidelines and quality standards are currently being used, but consensus [...]

It has been suggested that the decreases in perinatal and neonatal mortality observed in the United States may be due to the increased use of regionalized facilities. These facilities employ more highly skilled staff and advanced technology (neonatal intensive care units and auxiliary equipment) for care of high-risk mothers and babies. The added patient load is also believed to contribute to the skill of the professional staff. It has further been suggested that high technology and volume result in benefits to obstetrical outcome. This report attempts to establish the relationship between hospital obstetrical volume and neonatal technology and obstetrical outcome, using perinatal mortality as the quality measure. The population studied comprised white singleton births whose records were drawn from the Washington State birth-death linked records and the fetal death records for 1980 to 1983. All full-term births over 1,000 grams (2.2 pounds) in hospitals regularly providing obstetrical care were included. Perinatal mortality was defined as all deaths of fetuses over 1,000 grams and all live births greater than 1,000 grams who died within one week (the criteria used by the World Health Organization). High-risk status was determined on the basis of maternal risk factors, including diabetes, hypertension, kidney disease, Rh sensitization, urinary tract infection, pregnancy-induced hypertension, eclampsia and pre-eclampsia. Facilities were classified by the level of nursery care, as Levels I (normal; 73 facilities), II (intermediate; 11 facilities), or III (high technology and neonatal intensive care; 6 facilities). The total study group included 226,164 births and 1,372 perinatal deaths. The lower the birth weight, the more likely the birth occurred in a Level III facility. Twenty-two percent of all births and most of the low-birth-weight babies (under 2,500 grams) were born in Level III facilities. This category of births benefitted most from these hospitals, showing a twofold improvement in the perinatal mortality over Level I and II facilities. Babies weighing less than 2,000 grams did as well in Level I as in Level II institutions. Hospital technology appears to exert a more favorable impact on perinatal mortality than does the additional experience gained from increased volume. Regionalization and the closure of smaller, local facilities, may not provide the advantages expected. The normal babies born in an uneventful delivery derive no benefit from advanced facilities and may even be at a disadvantage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Type 2 diabetes is characterized by progressive beta-cell failure. Indications for exogenous insulin therapy in patients with this condition include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy. Augmentation therapy with basal insulin is useful if some beta-cell function remains. Replacement therapy with basal-bolus insulin is required for beta-cell exhaustion. Rescue therapy using replacement regimens for several weeks may reverse glucose toxicity. Replacement insulin therapy should mimic normal release patterns. Basal insulin, using long-acting insulins (i.e., neutral protamine Hagedorn [NPH ], ultralente, glargine) is injected once or twice a day and continued on sick days. Bolus (or mealtime)insulin, using short-acting or rapid-acting insulins (i.e., regular, aspart, lispro) covers mealtime carbohydrates and corrects the current glucose level. The starting dose of 0.15 mg per kg per day for augmentation or 0.5 mg per kg per day for replacement can be increased several times as needed. About 50 to 60 percent of the total daily insulin requirement should be a basal type, and 40 to 50 percent should be a bolus type. The mealtime dose is the sum of the corrective dose plus the anticipated requirements for the meal and exercise. Adjustments should be made systematically, starting with the fasting, then the preprandial and, finally, the postprandial glucose levels. Basal therapy with glargine insulin provides similar to lower A1C levels with less hypoglycemia than NPH insulin. Insulin aspart and insulin lispro provide similar A1C levels and quality of life, but lower postprandial glucose levels than regular insulin. [ABSTRACT FROM AUTHOR]

Abstract--Objective: To assess trends in peripheral vascular procedures performed in Veterans Health Administration (VHA) facilities. Methods: All discharges with peripheral vascular procedures recorded for 1989-1998 were analyzed. The VHA user population was used to calculate age-specific rates. Trends were evaluated using frequency tables and Poisson regression. Results: The VHA had 55,916 discharges with peripheral vascular procedures performed almost exclusively in men. Indications included peripheral vascular disease (53.7%), gangrene (19.3%), surgical complications (13.3%), and ulcers and infection (9.6%). The VHA age-specific rates were higher than US population rates for persons 45 to 64 years, similar for those 65 to 74 years, and lower for those 75 years and older. The age-specific rates declined slightly over the 10 years of observation, with the greatest decline noted in men age 45 to 65. Conclusion: The VHA provides almost 8% of all US peripheral vascular procedures in males. The VHA age-specific rates differ from the US rates with a shift to younger patients. The rates decreased for all age groups between 1989-1998. [ABSTRACT FROM AUTHOR]

Abstract--Goal: We sought to describe the common demographic and comorbid conditions that affect survival following nontraumatic amputation. Methods: Veterans Administration hospital discharge records for 1992 were linked with death records. The most proximal level during the first hospitalization in 1992 was used for analysis. Demographic information (age, race) and comorbid diagnosis (cardiovascular, cerebrovascular, and renal disease) were used for Kaplan-Meier curves to describe survival following amputation. Main Outcome Measure: Death. Results: Mortality risk increased with advanced age, more proximal amputation level, and renal and cardiovascular disease, and decreased for African Americans. No increased risk for persons with diabetes was noted in the first year following amputation but the risk increased thereafter. A higher risk of mortality in the first year was noted for renal disease, cardiovascular disease, and proximal amputation level. Conclusion: Survival following lowerlimb amputation is impaired by advancing age, cardiovascular and renal disease, and proximal amputation level. Also, a small survival advantage is seen for African Americans and those with diabetes. [ABSTRACT FROM AUTHOR]

Abstract--Objective: To assess trends in lower limb amputation performed in Veterans Health Administration (VHA) facilities. Methods: All lower limb amputations recorded in the Patient Treatment File for 1989-1998 were analyzed using the hospital discharge as the unit of analysis. Age-specific rates were calculated using the VHA user-population as the denominator. Frequency tables and linear, logistic, and Poisson regression were used respectively to assess trends in amputation numbers, reoperation rates, and age-specific amputation rates. Results: Between 1989-1998, there were 60,324 discharges with amputation in VHA facilities. Over 99.9% of these were in men and constitute 10 percent of all US male amputations. The major indications were diabetes (62.9%) and peripheral vascular disease alone (23.6%). The age-specific rates of major amputation in the VHA are higher than US rates of major amputation. VHA rates of major and minor amputation declined an average of 5% each year, while the number of diabetes-associated amputations remained the same. Conclusion: The number and age-specific rates of amputations decreased over 10 years despite an increase in the number of veterans using VHA care. [ABSTRACT FROM AUTHOR]

Studies the recommendations for the classification and diagnosis of diabetes mellitus, which is a group of metabolic disorders with one common manifestation, hyperglycemia. Previous classification of diabetes mellitus; Four types of diabetes mellitus; Simplification of the diagnostic criteria for diabetes mellitus; Discussion on glycated hemoglobin.

Type 2 diabetes is characterized by progressive beta-cell failure. Indications for exogenous insulin therapy in patients with this condition include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy. Augmentation therapy with basal insulin is useful if some beta-cell function remains. Replacement therapy with basal-bolus insulin is required for beta-cell exhaustion. Rescue therapy using replacement regimens for several weeks may reverse glucose toxicity. Replacement insulin therapy should mimic normal release patterns. Basal insulin, using long-acting insulins (i.e., neutral protamine Hagedorn [NPH], ultralente, glargine) is injected once or twice a day and continued on sick days. Bolus (or mealtime) insulin, using short-acting or rapid-acting insulins (i.e., regular, aspart, lispro) covers mealtime carbohydrates and corrects the current glucose level. The starting dose of 0.15 units per kg per day for augmentation or 0.5 units per kg per day for replacement can be increased several times as needed. About 50 to 60 percent of the total daily insulin requirement should be a basal type, and 40 to 50 percent should be a bolus type. The mealtime dose is the sum of the corrective dose plus the anticipated requirements for the meal and exercise. Adjustments should be made systematically, starting with the fasting, then the preprandial and, finally, the postprandial glucose levels. Basal therapy with glargine insulin provides similar to lower A1C levels with less hypoglycemia than NPH insulin. Insulin aspart and insulin lispro provide similar A1C levels and quality of life, but lower postprandial glucose levels than regular insulin.