Louis Area Research Articles

Carbon monoxide mass exposure in a pediatric population.

To describe the outcomes of a mass carbon monoxide (CO) intoxication, and to calculate the CO half-life in a pediatric school-aged population. A retrospective chart review was performed based on Regional Poison Center database information, hospital laboratory data, and medical records of the pediatric patients who sought care at one of 3 St. Louis area hospitals, after exposure to high levels of CO. Exposures occurred on January 5, 1996, after evidence of a CO leak was discovered at an area elementary school. Charts were reviewed for major demographics, symptoms reported, carboxyhemoglobin (COHb) levels and times, and level of effect. Information about 177 (35%) of the 504 children in attendance at school that day was available. Mean age was 8.7 +/- 1.8 years (range 4-12 years). Symptoms were present in 155 (88%) of the 177 children for whom data were available. Initial COHb levels were obtained for 147 (83.1%) of the 177 children. First mean COHb level was 7.0% (95% CI = 6.6-7.5%). Second COHb level was obtained for 26 children with a mean of 2.7% (95% CI = 2.2-3.2%). Calculated half-life of COHb, on 100% O2 at 1 atm, was 44.0 minutes (95% CI = 39.6-48.2 minutes). Some children had symptoms at COHb levels that traditionally have been considered nontoxic. The elimination of COHb was found to be more rapid in this population of children than reported in other studies.

Personality attributions based on speech samples of children with repaired cleft palates.

This study examined whether or not assumptions made about personality characteristics based on speech samples differed for children with repaired cleft palates (CP) versus unaffected children. Audiotapes of speech samples were presented in random order to blind raters. The subjects were 20 children (10 females, 10 males) with repaired CP and 16 control (i.e., unaffected) children (8 females, 8 males). All children were 8 to 12 years of age, Caucasian, living in the St. Louis area, and lower-middle to upper-middle class. The raters were 20 (13 females, 7 males) 6th grade Caucasian students who attend a private school in the area. Raters heard tapes in a group setting, but with individual headphones, in their school's cafeteria. Each speech sample was rated (7-point Likert scale) by each student rater on a variety of personality characteristics based on the "Big Five" personality factors. A factor analysis of the items revealed a two-factor solution, although the factors were highly negatively correlated. No significant differences were found between ratings for the CP sample and the control sample for either factor scale (ANOVA, p = .93; p = .67). Similarly, when the two factors were combined to form a single factor, no significant differences were found between the ratings for the CP sample and the control sample (ANOVA, p = .79). Overall, it does not appear that children differentially associated personality characteristics based on speech to children with repaired CP versus unaffected children, in the absence of visual input.

Building a Consensus: How Tos and How Not Tos

author of this feature article writes, The best technical solution in the world may never be used if it doesn't have public support. Building consensus is often the most challenging part of getting projects off the drawing board. This article describes a five-step process for building consensus. steps are: 1) fully understand your idea, 2) plan the process, 3) develop an awareness, 4) educate the target groups, and 5) get a buy-in by the target groups. Some common pitfalls to consensus building related to planning and execution are listed. An example of consensus building for the Bistate St. Louis Area Intelligent Vehicle Highway System is included.

Why the Gap Between Black and White Performance in School?: A Report on the Effects of Race on Student Achievement in the St. Louis Public Schools

This report, which was submitted to the court during the 1996 Liddell hearings, has been divided into two parts and revised to incorporate points raised during Trent's testimony on March 19, 1996. Part one analyzes the effects of on student achievement and is based on data supplied by the St. Louis Public School District, including its student master file for 1994-95, cohort files covering four cohorts of students, and call-in enrollment data files. Part two draws on national survey data, and focuses on the effects of on education, employment, and attitudes. The policy implications of both sets of findings are discussed. My analysis of the St. Louis school district data suggests conclusions that are consistent with the research literature, including my own research on the subject. I found a persistent race effect, by which I mean that Black students perform less well on the Stanford Achievement Test in both reading and mathematics than do their White peers. Using regression analysis, I attempted to see if the difference between Black and White students' scores could be explained in part by differences in the students` family backgrounds. For this analysis, I considered factors that are often associated with differences in achievement, and found that the effect persists even after introduction of several control measures. Among these controls were student background (age, sex, and socioeconomic status [SES], as represented by eligibility for free or reduced-price lunches), prior test scores (the earliest test score available in the same subject in kindergarten or first grade), and school characteristics (including school size-that is, total enrollment, and poverty concentration). In a separate analysis of the above data, I looked at poverty concentrations in the neighborhood where students live, as measured by U.S. Census tract. Again, the persistent, negative consequences of student race-or more precisely, being Black-remained, even after controlling for poverty concentration where students live. More important for educational policymakers, however, I found a consistently negative effect of high poverty concentrations in school on students' educational attainment. Black students are more likely to attend schools with higher concentrations of economically disadvantaged students than are White students. Thus, they are more likely to experience a quality of educational treatment that reduces their scores on the Stanford Achievement Test, even after factoring out the effects of other possible causes. Tables I and II present the evidence for these conclusions.1 For the benefit of nonsocial scientists, I will try to explain the meaning of these numbers. My analysis of the St. Louis school district data entailed merging the school system's master student file, four cohort files, and its call-in enrollment data to create a working file of 4,096 cases for individual students. I approached these data by means of regression analyses. To try to explain why there exists a gap between the achievement scores of Black and White students in the St. Louis area, I employed students' achievement test scores in reading and mathematics as dependent variables. I next introduced several independent variables to determine their effect on the difference. These factors included students race, age, sex, socioeconomic status (eligibility for free or reduced-price school lunches), prior test scores in the same subject, and school characteristics.2 Some of the independent variables were found to yield no difference, while others made a real difference. Some of these differences were statistically significant-that is, they evidenced a high likelihood that the difference resulting from a variable could not have occurred by chance. First, I determined, by use of regression analysis, the differences in achievement scores of Black and White students. To walk through Table I, the value for the unstandardized coefficient associated with (B) is -24. …

Why the Gap Between Black and White Performance in School? (Testimony of David James Armor, March 5, 6, & 22, 1996)

Municipal Separate School District [19691. He also held that 20% of St. Louis schools had not met the desegregation standards the city had agreed upon; each school's faculty, he stated, varied by no more than plus-or-minus 15% of the percentage offaculty of each race in the district as a whole, which is about 70% Black.1 Noting that the plaintiffs viewed such a flexible standard as rationalefor requiring stricter compliance, he contended, as did other witnessesfor the defendants, that the deviation by a few percentage points in several schools was trivial. - Armor also opined that resources in St. Louis area schools were allocated nondiscriminatorily. Indeed, he asserted that nonintegrated schools received more resources than did integrated schools, comparing,for example, the average number of years of experience of teachers in the city's integrated, nonintegrated (or all-Black), and magnet schools. Armor's data indicated no difference between schools in this area; however, he conceded that he agreed with the plaintiffs' attorney's assertion that equal averages of teacher experience do not necessarily indicate equal quality of instruction. In his view, a school with a faculty composed of 30- or 35-year veterans and some beginning teachers might not be of the same quality as one in which all teachers had around 11 or 12 years of experience. Armor's testimony turned next to the effects of class size on student achievement. Using teacherlpupil ratios as a surrogatefor class size, he presented data indicating that small class sizes favored St. Louis's nonintegrated elementary schools, where hefound an 11-to-i ratio. By contrast, he noted, the ratio in integrated schools was 14-to-1, while in magnet schools, it was 15-to-1.

R.D.s are “The Nutrition Experts” of a Community Based Food Program

LEARNING OUTCOME: To describe ways that RDs can provide meaningful support and expertise in community based food programs.Food Outreach, Inc. is a community based food program founded in 1988 to provide nutritional support to persons with HTV infection in order to enhance their quality of life. Every two weeks Food Outreach prepares nutritious food for men, women, and children living with HTV/AIDS in the metropolitan St Louis area. Menu items, selected by the clients, are prepared, frozen, and delivered by volunteers. Since its inception, the program has expanded from seven clients to currently over 600. Over 250,000 menu items are cooked and distributed annually.Recognizing the need for food service and nutrition expertise, a group of RDs was invited to form the Food Outreach Nutrition Advisory Committee. This committee has been active since 1990. The committee responds to immediate questions and needs posed by the growing organization. Expertise provided has included assistance with menu planning, recipe development, quantity food purchasing and production techniques, client nutrition information, and evaluation of nutritional supplements. Kitchen crew leaders have been trained by RDs and are certified in the Serv-Safe Program. RDs are members of the Board of Directors and the Risk Management Committee. Dietetic students and Interns also participate in programs during community service rotations. The Nutrition Committee is currently designing a research protocol to investigate correlation of nutrition intervention with weight maintenance and disease progression.The implications for RDs and DTRs are far reaching. As community based food programs continue to grow in number and size and as more medical care is provided outside the traditional hospital, opportunities for involvement by RDs in such programs will increase in scope. Professionals should seek out such opportunities and establish themselves as the Nutrition Expert in this rapidly growing segment.

A twin study of non-alcohol substance abuse

Except for alcohol abuse, little is known about the familial aggregation for substance abuse. Here we report twin resemblance for non-alcohol substance use in the Washington University Twin Series, wherein probands were identified by consecutive admission to psychiatric facilities in the St. Louis area. A 5-point substance abuse scale was constructed with values anchored by never used drugs (1) to drug dependence (5). Year of birth was the most powerful predictor of drug use — younger twins scored far higher than older twins. Either heritability or common environment had to be included in the regression model to avoid a significant drop in explained variance, but which was more important could not be resolved. The correlation for identical twins exceeded that for fraternal twins, suggesting the possibility of a heritable factor.

Narrowing of the drinking repertoire criterion: should it have been dropped from ICD-10?

To present data on the reliability of the narrowing of the drinking repertoire criterion in the ICD-10 substance use disorder nomenclature and possible justification for its exclusion from ICD-10. This criterion has been one of the hallmarks of the Edwards and Gross dependence concept. The sample of 318 consisted of 175 substance users from St. Louis area substance abuse treatment programs and 143 substance users from the St. Louis Epidemiologic Catchment Area Project, a general population survey. Respondents were interviewed about their substance use with the CIDI-SAM and reinterviewed approximately 1 week later. "Narrowing of the drinking repertoire" was reported by 24%. Overall, the agreement from interview 1 to interview 2 was fair to good (kappa = 0.5851). Men and drinkers in treatment were found to be more reliable reporters than women and drinkers recruited from the general population. The decision to drop the repertoire criterion seems justified, especially when non-clinical samples are interviewed. However, since our data found it highly associated with meeting criteria for a dependence disorder it is clinically valid. Additional research among varied populations is necessary to determine if the concept of narrowing is culture or gender specific and if its deletion affects rates of dependence.

Resistance to penicillin and non-beta-lactam antibiotics of Streptococcus pneumoniae at a childrenʼs hospital

During a 12-month period we tested all isolates of Streptococcus pneumoniae recovered from patients at St. Louis Children's Hospital for resistance to penicillin and other antibiotics. Twenty-seven (20%) of 136 had relative penicillin resistance (minimum inhibitory concentration 0.1 to 1.0 microgram/ml) and 8 (6%) were fully resistant (minimum inhibitory concentration > or = 2.0 micrograms/ml). Sixteen percent from blood and cerebrospinal fluid were resistant, compared with 30% from other body sites. The resistant isolates were of diverse serotypes and included 38% intermediate and 6% resistant to cefotaxime, 40% resistant to trimethoprim-sulfamethoxazole and 20% resistant to erythromycin. Patients with resistant isolates were more likely to have taken antibiotics of the aminopenicillin class and to be of the white race. We conclude that penicillin-resistant pneumococci, including some with resistance to third generation cephalosporins and some with multidrug resistance to non-beta-lactam antibiotics, are widespread in the St. Louis area. The presence of these stains requires reconsideration of current approaches to the antibiotic therapy of a variety of infectious diseases in which pneumococci play a prominent role.

Safety Officer Accounts of Earthquake Preparedness at Riverside Industrial Sites

The Iben Browning pseudoscientific forecast of a major earthquake in the New Madrid seismic zone around December 3, 1990, provoked considerable talk and some concern around the midwest, and especially in the St. Louis area. Much local media attention focused on the state of earthquake preparedness in the area, and a proactive approach to preparedness was advocated for residents and businesses alike. This paper describes the state of earthquake preparedness among twenty older industrial plants located along the banks of the Mississippi River as reported by plant safety officers. While most safety officers were skeptical of Browning's forecast, most also believed that a major earthquake would hit the St. Louis area in the not too distant future. Nevertheless, earthquake preparedness was minimal or nonexistent at most of the plants, and a follow-up survey two years later showed little change in this state of affairs. Also unchanged was the striking lack of communication between these businesses and emergency management officials. These and other findings are discussed in light of proactive earthquake mitigation efforts.

Fly Ash Analysis Supports Emergent Mississippian Agricultural Features at the Lunsford-Pulcher Site (11-S-40) In the American Bottom, Illinois

The Lunsford-Pulcher site in the American Bottom of Illinois was suggested by Melvin Fowler to include a buried agricultural ridged field system. An alternative hypothesis suggests that the apparent ridges andfurrows are the result of a contemporary agricultural soil horizon buried by aeolian loess in 1954 windstorms. Soils recovered from test excavations in the putative garden beds at the site were subjected to techniques developed by agronomists at the University of Illinois to recover diagnostic magnetite spherules that constitute a fraction of the fly ash output from high temperature industrial processes. The presence of fly ash magnetite in a sample would indicate that the soil was at the surface during the industrial era, which began in the St. Louis area around 1850. Samples from the putative agricultural layer at Lunsford-Pulcher yielded little or no fly ash, suggesting that they were laid down and buried before the industrial era. This does not constitute absolute proofthat the features were garden beds. We must, however, reject the alternative hypothesis that the features were created in the twentieth century.

Pertussis in Missouri: evaluation of nasopharyngeal culture, direct fluorescent antibody testing, and clinical case definitions in the diagnosis of pertussis.

No diagnostic test for pertussis in routine use in the United States has both high sensitivity and high specificity. During a statewide increase in the incidence of pertussis in Missouri, we studied the clinical features of 153 patients with suspected pertussis in the Greater St. Louis area from whom a specimen for pertussis culture had been taken between 15 May and 19 September 1989. In this cross-sectional study, nasopharyngeal cultures were more likely to be positive for persons whose specimens were collected < 21 days after cough onset (adjusted rate ratio [RRa] and 95% confidence interval = 3.4; 1.5-8.0) and who were not receiving erythromycin/sulfamethoxazole prior to the culture [RRa = 5.8; 0.8-40.6], who had received fewer than three prior doses of pertussis vaccine [RRa = 1.8; 0.8-4.2], and whose specimen was in transit to the laboratory for < 4 days [RRa = 2.0; 0.8-5.5]. Among children < 5 years of age, spasmodic cough plus a lymphocytosis of > 10,000/mm3 was the acute symptom complex associated with the highest predictive value for a positive culture result (67%). Cough for > or = 14 days plus whoop was sensitive (81%) and specific (58%) for identifying children with culture-confirmed pertussis. Direct fluorescent antibody staining performed well as a screening test for pertussis but requires substantial commitment of personnel and resources. In the absence of a positive culture result, clinical case definitions should be used for decision making (e.g., initiation of antimicrobial therapy and routine case reporting).

Temperature-Sensitive Variants of Histoplasma capsulatum Isolated from Patients with Acquired Immunodeficiency Syndrome

Histoplasma capsulatum isolates from three St. Louis area AIDS patients with disseminated histoplasmosis were found to be closely related to the temperature-sensitive, previously unique, Downs strain based on growth phenotype and restriction fragment length polymorphisms (RFLP) involving mitochondrial DNA, ribosomal DNA, and the yps-3 gene. H. capsulatum isolates from five non-AIDS patients in the St. Louis area with disseminated histoplasmosis or chronic pulmonary histoplasmosis had the growth phenotype and RFLP pattern characteristic of most strains isolated from other regions of the USA.

Is emergency department resuscitation of out-of-hospital cardiac arrest victims who arrive pulseless worthwhile?

It is still a common practice to continue unsuccessful field resuscitations in the emergency department (ED) even after prolonged estimated down times. The authors studied patients who arrested in the field and did not regain a pulse before their arrival in the ED to determine if any ever leave the hospital neurologically intact. All cardiac arrests in the urban St Louis area that were brought to our facility over a 2 1/2-year period by advanced life support units (excluding all patients with hypothermia, drug overdose, near drowning, and traumatic cardiac arrest) were reviewed. Of 243 such patients 32 (13%) arrived with a pulse. Twenty-three of these patients were admitted and 10 discharged alive, 7 were neurologically intact. Out of 211 patients who arrived without a pulse, 24 (11%) developed a pulse with further resuscitative efforts in the ED. Eighteen of these patients were admitted but only one was discharged neurologically intact. The only survivor in the group without a pulse arrested while en route to the ED. It is concluded that cardiac arrest victims who arrive in the ED without a pulse on arrival or en route have almost no chance of functional recovery.

Alpha-1-Antitrypsin Deficiency: High Prevalence in the St. Louis Area Determined by Direct Population Screening

Considerable attention has been focused upon alpha-1-antitrypsin deficiency because of the insights into the pathogenesis of human pulmonary emphysema that may derive from study of deficient subjects, and because of evolving therapeutic strategies that may slow the progression of lung disease in affected persons. We have applied an automated immunoassay for alpha-1-antitrypsin to plasma samples from 20,000 blood donors. Seven PI Z antitrypsin-deficient persons were identified and confirmed; this is more than twice the number predicted from previous estimates of the Z allele frequency in the St. Louis area. Five of the subjects were further evaluated. We anticipate that this assay, if utilized to screen large populations, could identify many alpha-1-antitrypsin-deficient persons for study of the natural history of lung and liver disease associated with the deficiency. These subjects would be potential candidates for early intervention strategies to prevent the development of lung disease. The surprisingly high prevalence of deficient persons indicates that direct screening is the best method for prevalence estimation of genetic disorders.

Bigger is Better, or is it Smaller?

St. Louis has a long-standing tradition as an urban workshop for academic analysis in part because small local governments in St. Louis County have provided units of analysis for a wide range of topics related to urban service provision and urban development. Recently, a federal commission and a board authorized by the Missouri constitution separately studied governmental fragmentation and how it relates to the long-term viability of St. Louis County. The federal commission praised the existing arrangement as a model for urban America to consider. The Missouri board proposed dramatic changes in local governmental structure and finance. Reorganization for the St. Louis area is discussed in the context of these two starkly contrasting studies.

Three types of obsessive compulsive disorder in a community sample.

Until recently, prior estimates of the prevalence of obsessive compulsive disorder (OCD) have been based on clinical data. The present investigation studied point prevalence and demographic data that pertain to three ritual-based forms of OCD in a sample of the adult general population of the greater St. Louis area. Two hundred fifty male and 247 female subjects were administered a structured interview designed to identify the presence of symptoms associated with OCD according to DSM-III criteria. The overall prevalence rate of OCD was 2.8%. The most prevalent form of OCD involved checking (1.6%), followed by a miscellaneous category that included repeating, counting and collecting rituals (1.0%) and, finally, washing compulsions (.8%). Subjects with OCD did not differ demographically from the rest of the sample except that they were more likely to live in the city. Results indicate that OCD is more prevalent than previously supposed and that checking compulsions may be the most common form of ritual in nonclinical samples.

Four types of social phobia in a community sample.

Point prevalence rates and demographic characteristics associated with four specific forms of social phobia (public speaking/performing, writing in front of others, eating in restaurants, and use of public restrooms) were examined in a sample of adult residents of the greater St. Louis area. Diagnoses were determined by structured interview in accordance with DSM-III criteria. An unadjusted prevalence rate of 22.6% was found for all four social phobias combined. Application of DSM-III significant distress criteria resulted in a prevalence rate of 2.0%. Public speaking/performing phobias were by far the most common (20.6%). Prevalence rates of 2.8%, 1.2%, and 0.2% were found for phobias related to writing, eating, and use of public restrooms, respectively. Social phobias were more common among women than men. No other demographic differences were found between social phobics and the rest of the sample. Results of this study suggest a higher prevalence of social phobia than has been indicated by prior research. Explanations for and implications of these findings are discussed.

Book Review

Abstract Black Economic Progress: The Rand Corporation Speaks Closing the Gap: Forty Years of Economic Progress for Blacks: James P. Smith and Finis R. Welch. Rand Corporation, Santa Monica, California, 1986. 128 pp. $10.00 (paperback). Planning in Government: Shaping Programs That Succeed: Melvin R. Levin. Planners Press, American Planning Association, Chicago, 1987. 257 pp. $39.95 (cloth), $27.95 (paperback). Critical Rationalism and Planning Methodology: Andreas Faludi. Pion Ltd., London, 1986. 144 pp. about $17.00 (£8). The Symbolic Construction of Community: Anthony P. Cohen. Ellis Horwood/Tavistock/Methuen, New York, 1985. 128 pp. $13.95 (cloth), $6.50 (paperback). Symbolizing America: Herve Varenne, editor. University of Nebraska Press, Lincoln, 1986. 290 pp. $23.95 (cloth), $10.95 (paperback). Culture and Class in Anthropology and History: A Newfoundland Illustration: Gerald M. Sider. Cambridge University Press, New York, 1986. 205 pp. $34.50. Rural Community in the Appalachian South: Patricia Duane Beaver. University Press of Kentucky, Lexington, 1986. 182 pp. $18.00. Planning with the Small Computer: An Applications Reader: Mathew E. MacIver and Jan Schreiber, editors. Oelgeschlager, Gunn & Hain in association with the Lincoln Institute of Land Policy. Boston, 1986. 168 pp. $30.00 Cartography and Site Analysis with Microcomputers: A Programming Guide for Physical Planning, Urban Design and Landscape Architecture: N. Brito Mutunayagam and Ali Bahrami. Van Nostrand Reinhold Company, New York, 1987. 184 pp. $34.95. Regional Dynamics: Studies in Adjustment Theory: Gordon L. Clark, Meric S. Gertler, and John Whiteman. Allen and Unwin, Boston, 1986. 342 pp. $39.95 (cloth), $19.95 (paperback). Villages in the IJsselmeer Polders from Slootdorp to Zeewolde: C. Van der Wal. IJsselmeer Polders Development Authority, Lelystad, The Netherlands, 1986. 112 pp. $12.00 (paperback). The Tenant Movement in New York City, 1904-1984: Ronald Lawson, editor. Rutgers University Press, New Brunswick, New Jersey, 1986. 289 pp. $35.00 (cloth), $15.00 (paperback). The Geography of Urban Transportation: Susan Hanson, editor. Guilford Press, New York, 1986. 424 pp. $35.00. Metropolitan School Desegregation: A Case Study of the St. Louis Area Voluntary Transfer Program: Michael K. Grady and Charles V. Willie. Wyndham Hall Press, Bristol, Indiana, 1986. 88 pp. $9.95 (paperback). The Health Economy: Victor R. Fuchs. Harvard University Press, Cambridge, Massachusetts, 1986. 401 pp. $25.00. Technology and Employment: Concepts and Clarifications: Eli Ginzberg, Thierry J. Noyelle, and Thomas M. Stanback, Jr. Westview Press, Boulder, Colorado, 1986. 111 pp. $27.50.

A multispectral study of the St. Louis area under snow-covered conditions using NOAA-7 AVHRR data

Albedos and equivalent blackbody temperatures from the 5-channel Advanced Very High Resolution Radiometer (AVHRR) on board the NOAA-7 satellite have been examined for two consecutive passes of the satellite over the St. Louis area when snow was on the ground. The albedo difference for channel 1 (visible) between St. Louis and a typical rural area was − 16%, much larger than urban-rural albedo differences found in previous studies under snow-free conditions. The albedo difference between channel 1 and channel 2 (near-infrared) appears to be a better indicator of the snow boundary than either channel alone. The channel 4 (11 μm) equivalent blackbody temperature difference between the warmest part of St. Louis and a typical rural area was 3 K during the day and 2.5 K at night, about the same as urban-rural temperature differences found under snow-free conditions. Day-night temperature differences were nearly the same in urban as in rural areas. Largest day-night differences were found in forested portions of the snow-covered area. Slightly larger (about 0.5 K) day-night differences were observed in the commercial-industrial area of St. Louis than in the residential area. This may be caused by residential heating. Finally, hot industrial targets were easily observed in 3.7 μm images. These targets may be useful for accurate registration of AVHRR images.