Yates Continuity Correction Research Articles

Level of emotion comprehension in children with mid to long term cochlear implant use: How basic and more complex emotion recognition relates to language and age at implantation

ObjectivesThe current study was designed with three main aims: To document the level of emotional comprehension skills, from basic to more complex ones, reached by a wide sample of cochlear implant (CI) deaf children with at least 36 months of device use; To investigate subjective and audiological factors that can affect their emotional development; To identify, if present, a “critical age”, in which early intervention might positively affect adequate emotional competence development. DesignThis is an observational cohort study. Children with congenital severe/profound deafness were selected based on: aged by 4–11 years, minimum of 36 months of CI use, Italian as the primary language in the family; normal cognitive level and absence of associated disorders or socio-economic difficulties. Audiological characteristics and language development were assessed throughout standardized tests, to measure speech perception in quiet, lexical comprehension and production. The development of emotions' understanding was assessed using the Test of Emotion Comprehension (TEC) of Pons and Harris, a hierarchical developmental model, where emotion comprehension is organized in 3 Stages (external, mental and reflective). Statistical analysis was accomplished via the Spearman Rank Correlation Coefficient, to study the relationship between the personal and audiological characteristics; a multivariate linear regression analysis was carried out to find which variables were better associated with the standardized TEC values; a chi-squared test with Yate's continuity correction and Mann-Whitney U test were used to account for differences between continuous variables and proportions. Results72 children (40 females, 32 males) with a mean age of 8.1 years were included. At TEC score, 57 children showed normal range performances (79.17% of recipients) and 15 fell below average (20.83% of recipients). The 16.63% of older subjects (range of age 8–12 years) didn't master the Stage 3 (reflective), which is normally acquired by 8 years of age and failed 2 or all the 3 items of this component. Subjects implanted within 18 months of age had better emotion comprehension skills. TEC results were also positively correlated with an early diagnosis, a longer implant use, better auditory skills and higher scores on lexical and morphosintactic tests. On the contrary, it was negatively correlated with the presence of siblings and the order of birth. The gender, the side and the severity of deafness, type of implant and strategy were not correlated. ConclusionsEarly implanted children have more chance to develop adequate emotion comprehension, especially when the complex aspects are included, due to the very strong link between listening and language skills and emotional development. Furthermore, longer CI auditory experience along with early intervention allows an adequate communication development which positively influences the acquisition of such competencies.

Clinical parameters associated with absence of endocervical/transformation zone component in conventional cervical Papanicolaou smears

ObjectiveTo study clinical factors predicting the absence of endocervical/transformation zone (EC/TZ) components of conventional cervical Papanicolaou (Pap) smears. Materials and methodsThe medical charts of patients who received Pap smears between March 2006 and August 2006 in the hospital were reviewed. The results of their Pap smears were retrieved while their demographic and clinical information were obtained from the medical charts. After excluding 378 cases with incomplete demographic data and 1397 cases with a history of pelvic irradiation, pelvic malignancy, and hysterectomy, 5662 cases were enrolled for data analysis. The relationship between clinical parameters and the absence of EC/TZ component was analyzed by Pearson Chi-square tests with Yates continuity correction and binary logistic regression tests. ResultsThe incidence of satisfactory but absence of EC/TZ component was 8.7% (491/5662). Pregnancy increased the absence of EC/TZ component [odds ratio (OR}: 2.84, 95% confidence interval (CI): 2.14–3.77, p<0.0001]. Postpartum status and endocervical polyps decreased incidence (OR: 0.61, 95% CI: 0.38–0.98, p = 0.043 and OR: 0.33, 95% CI: 0.25–0.44, p<0.0001, respectively). ConclusionsPregnancy is the only clinical factor associated with increased incidence of absence of EC/TZ cells. For these pregnant women undergoing a Pap smear, a more effective strategy may be needed to get a satisfactory smear with adequate EC/TZ components.

Genotypic distribution of common variants of endosomal toll like receptors in healthy Spanish women. A comparative study with other populations

Genetic variants of endosomal toll like receptors (TLR) have been associated with many infectious, autoimmune and inflammatory diseases, but few studies have been reported in the Spanish population. The aim of this study was to describe the allelic and genotypic distributions of some common nucleotide substitutions of endosomal TLRs in healthy Spanish women and to compare them with those already published in other population groups. Nine substitutions were analysed in 150 DNA samples from 150 Spanish, non-related healthy females: TLR3 rs3775291 and rs5743305; TLR7 rs179008 and rs5743781; TLR8 rs3764880 and TLR9 rs187084, rs5743836, rs352139 and rs352140.Genotyping was carried out by real time PCR and melting curve analysis in a LightCycler 480. A systematic review was performed in order to compare the genotypic distributions in our cohort with those previously published in other population groups. The comparative study was performed with the two tailed Fisher's test or the Yates continuity correction for the Chi-square test when appropriate. No homozygotes for rs5743781 in TLR7 were found, and rs352139 and rs352140 of TLR9 were in strong linkage disequilibrium. Genotype distributions in endosomal TLR are similar to other Spanish series previously reported. As expected, most differences were found when comparing our distributions with Asiatics, but differences were also found with other Caucasian populations. Since there are significant variations in genotypic distributions of TLRs in both interracial groups and within the same ethnic group, to carry out studies of disease susceptibility in more restricted groups is mandatory.

Expression of Girdin in brain tissues of Alzheimer's disease

To investigate the expression of Girdin and its significance in Alzheimer's disease (AD). Fifty-nine autopsy cases from Department of Pathology, Beijing Hospital from January 1988 to December 2013, including 35 AD cases and 24 non-AD cases as control. Girdin and amyloid β-protein (Aβ) expression was evaluated immunohistochemically by EnVision method. The correlation between Girdin and Aβ was analyzed. Girdin expression was localized in the nucleus and/or cytoplasm. The expression rates of Girdin were 20.0% (7/35) in the AD group and 83.3% (20/24) in the non-AD group, respectively. The difference was significant (Yates's correction for continuity χ(2)=20.527, P<0.05). Girdin expression and Aβ deposition also correlated significantly (P<0.05). Girdin shows reduced expression in AD, and is correlated positively with Aβ deposition. This suggests that Girdin may play an important role in the occurrence and development of AD.

Impact of formal teaching on medical documentation by interns in an emergency department in a Queensland teaching hospital.

This study's objective was to determine whether tuition in medical documentation enhanced the ability of emergency medicine interns to produce effective medical records. The study adopted a case control design, using a retrospective document audit methodology, following an education intervention during the 'More Learning for Interns in Emergency' (MoLIE) programme. It was conducted in a tertiary hospital that supports five 10 week rotations of 12 interns each year (n = 60). Controls were drawn from records written in March 2012 and cases from March 2013. A total of 250 medical records written by interns were audited, 125 from each year. Three categories of documentation were investigated: patient characteristics, clinical impressions and management plan using a purpose-designed score sheet. Three individual items (differential diagnosis [DDX], Support and Impressions [Impress]) showed significant improvement. The proportion of excellent scores for DDX increased by 50% from 40.8% to 61.6%. A χ(2) test for independence (with Yates continuity correction) indicated a significant association between the intervention and subsequent score (X(2) [1, n = 250] = 10.006, P < 0.001, phi -0.208). For Impress, a 48% increase in excellent scores was seen (39.2% to 58.4%). A χ(2) test for independence indicated a significant association between the intervention and subsequent score (X(2) [2, n = 250] = 11.249, P = 0.004, Cramer's V 0.212). The variable Support also improved (X(2) [2, n = 250] = 8.297, P = 0.012, Cramer's V 0.189) with the number of excellent scores increasing from 37.6% to 48.0%. The study demonstrated that documentation of clinical notes by interns can be enhanced by formal tuition.

Pure tone audiometry and otoacoustic emissions in hypertensive subjects

Pure tone audiometry and otoacoustic emissions in hypertensive subjects

High Rate of Unemployment After Kidney Transplantation: Analysis of the United Network for Organ Sharing Database

IntroductionDespite an increased quality of life after transplant, in the United States, recipients participate less in employment compared to the general population. Employment after kidney transplantation is an important marker of clinically significant individual health recovery. Furthermore, it has been shown that employment status in the post-transplant period has a strong and independent association with patient and graft survival. Materials and MethodsUsing the United Network for Organ Sharing (UNOS) database, we identified all adults (between 18 and 64 years of age) who underwent kidney transplantation between 2004 and 2011. Patients with a stable renal allograft function and with full 1-, 3-, and 5-year follow-up were included. For recipients of multiple transplants, the most recent transplant was considered the target transplant. The data collected included employment rate after kidney transplantation in recipients employed and unemployed before transplant. The employment data were stratified for insurance payer (private, Medicaid, and Medicare). The results of categorical variables are reported as percentages. Comparisons between groups for categorical data were performed using the χ2 test with Yates continuity correction or Fisher test when appropriate. ResultsThe UNOS database available for this study included a total of 100,521 patients. The employment rate at the time of transplant was 23.1% (n = 23,225) under private insurance and 10% (n = 10,032) under public insurance (Medicaid and Medicare, P < .01, compared to private insurance). Over a total of 29,809 recipients analyzed, alive and with stable renal allograft function who were working at time of transplantation, the employment rate was 47% (n = 14,010), 44% (n = 13,115), and 43% (n = 12,817) at 1, 3, and 5 years after transplant under private insurance and 16% (n = 4769), 14% (n = 4173), and 12% (n = 3567), respectively, under public insurance (P < .01, compared to private insurance). Over a total of 46,363 recipients alive and with stable renal function who were not working at time of transplant, the employment rate was 5.3% (n = 2457), 5.6% (n = 2596), and 6.2% (n = 2874) at 1, 3, and 5 years after transplant under private insurance and 6.5% (n = 3013), 7.8% (n = 3616), and 7.5% (n = 3477), respectively, under public insurance (P < .01, compared to private insurance). ConclusionThe employment rates at the time of transplant in the United States are generally low, although privately insured patients are significantly more likely than patient with public insurance to have employment. Only a portion of these patients returns to work after transplantation. For the patients unemployed at the time of transplantation, the chance to find a job afterward is quite low even in privately insured patients. A concerted effort should be made by the transplant community to improve the ability of successful kidney transplant recipients to return to work or find a new employment. It had been shown that employment status in the post-transplant period has a strong and independent association with the graft and recipient survival.

An analysis of pregnancy outcome in dichorionic and monochorionic twins given special antenatal and intranatal care: a four-year survey.

The present study aims to analyze perinatal outcomes in twins given special care during pregnancy and labor and to compare fetal and neonatal outcomes in dichorionic twins with monochorionic twins. Eighty eight (88) twin pregnancies booked for care at a tertiary care Fetal Medicine centre were included in this study. The maternal demographic variables, course of pregnancy, fetal problems, and specialized fetal therapeutic and diagnostic interventions were noted. The above parameters were compared in the sub-groups of dichorionic and monochorionic twin pregnancies and related to the perinatal outcome. Statistical analysis was done using the student's t test and the two-tailed chi sqaure tests with Yate's continuity correction. A p value <0.05 was considered as significant. Mean maternal age was 30.34+4.81years (range 19-48). 81% of the twins were DCDA, and 19% were MCDA. The mean gestational age at delivery was 34.4±3.5weeks, and this was not significantly different in MCDA and DCDA groups. Serious fetal problems warranting intervention at the time of initial referral were significantly higher in MCDA twins although overall perinatal outcome in both groups were not different. Specialized care during pregnancy and labor including active fetal surveillance and therapeutic intervention when indicated improves the perinatal outcome in twin pregnancies and ensured at least one healthy live birth in over 90% cases, although with an increase in late prematurity.

ARE THUMB INJURIES BECOMING MORE FREQUENT IN MEN'S LACROSSE?

Men's lacrosse is a rapidly growing sport. The authors were concerned by the number of thumb injuries sustained while working with an international team at the 2012 European Championships. To...

Six-Month Progression-Free Survival as the Primary Endpoint to Evaluate the Activity of New Agents as Second-line Therapy for Advanced Urothelial Carcinoma

ObjectiveSecond-line systemic therapy for advanced urothelial carcinoma (UC) has substantial unmet needs, and current agents show dismal activity. Second-line trials of metastatic UC have used response rate (RR) and median progression-free survival (PFS) as primary endpoints, which may not reflect durable benefits. A more robust endpoint to identify signals of durable benefits when investigating new agents in second-line trials may expedite drug development. PFS at 6 months (PFS6) is a candidate endpoint, which may correlate with overall survival (OS) at 12 months (OS12) and may be applicable across cytostatic and cytotoxic agents. MethodsTen second-line phase II trials with individual patient outcomes data evaluating chemotherapy or biologics were combined for discovery, followed by external validation in a phase III trial. The relationship between PFS6/RR and OS12 was assessed at the trial level using Pearson correlation and weighted linear regression, and at the individual level using Pearson chi-square test with Yates continuity correction. ResultsIn the discovery dataset, a significant correlation was observed between PFS6 and OS12 at the trial (R2 = 0.55, Pearson correlation = 0.66) and individual levels (82%, Қ = 0.45). Response correlated with OS12 at the individual level less robustly (78%, Қ = 0.36), and the trial level association was not statistically significant (R2 = 0.16, Pearson correlation = 0.37). The correlation of PFS6 (81%, Қ = 0.44) appeared stronger than the correlation of response (76%, Қ = 0.17) with OS12 in the external validation dataset. ConclusionsPFS6 is strongly associated with OS12 and appears more optimal than RR to identify active second-line agents for advanced UC.

Surgical management and outcome of blunt major liver injuries: Experience of damage control laparotomy with perihepatic packing in one trauma centre

IntroductionThis retrospective study aimed to assess the clinical experience and outcome of damage control laparotomy with perihepatic packing in the management of blunt major liver injuries. Materials and methodsFrom January 1998 to December 2006, 58 patients of blunt major liver injury, American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) equal or greater than III, were operated with perihepatic packing at our institute. Demographic data, intra-operative findings, operative procedures, adjunctive managements and outcome were reviewed. To determine whether there was statistical difference between the survivor and non-survivor groups, data were compared by using Mann–Whitney U test for continuous variables, either Pearson's chi-square test or with Yates continuity correction for contingency tables, and results were considered statistically significant if p<0.05. ResultsOf the 58 patients, 20 (35%) were classified as AAST-OIS grade III, 24 (41%) as grade IV, and 14 (24%) as grade V. At laparotomy, depending on the severity of injuries, all 58 patients underwent various liver-related procedures and perihepatic packing. The more frequent liver-related procedures included debridement hepatectomy (n=21), hepatorrhaphy (n=19), selective hepatic artery ligation (n=11) and 7 patients required post-laparotomy hepatic transarterial embolization. Of the 58 patients, 28 survived and 30 died with a 52% mortality rate. Of the 30 deaths, uncontrolled liver bleeding in 24-h caused 25 deaths and delayed sepsis caused residual 5 deaths. The mortality rate versus OIS was grade III: 30% (6/20), grade IV: 54% (13/24), and grade V: 79% (11/14), respectively. On univariate analysis, the significant predictors of mortality were OIS grade (p=0.019), prolonged initial prothrombin time (PT) (p=0.004), active partial thromboplastin time (APTT) (p<0.0001) and decreased platelet count (p=0.005). ConclusionsThe mortality rate of surgical blunt major liver injuries remains high even with perihepatic packing. Since prolonged initial PT, APTT and decreased platelet count were associated with high risk of mortality, we advocate combination of damage control resuscitation with damage control laparotomy in these major liver injuries.

Can the Use of an Early Mobility Program Reduce the Incidence of Pressure Ulcers in a Surgical Critical Care Unit?

The Agency for Healthcare Research and Quality has defined pressure ulcers (PUs) an important patient safety indicator (#3). Despite the existence of evidence-based guidelines for PU prevention and treatment from the United States Department of Health and Human Services, the sustained success in reducing the development of PUs is elusive in many acute care hospitals. The specific aim of the study was to determine whether the implementation of an early standardized process for mobility could reduce or eliminate the development of PUs in a surgical intensive care unit. Patient data were collected pre- and postimplementation of the early mobility protocol. The mobility compliance for patients postimplementation was 71.30% (SD = 12.73), with a range of 25% to 100%. A χ² test for independence (with Yates continuity correction) indicated a significant association between unit-acquired PUs and the pre- and postimplementation mobility groups (χ²(1,1051) = 6.86, P = .009). Specifically, patients in the intervention group had significantly more unit-acquired PUs than the control group. No significant differences were identified between the 2 groups. Despite implementation of the early mobility protocol, we did not see an improvement in the PU rate overall or with time as protocol compliance improved.

Diarrhoeal episodes in travellers suffering from IBD

Background and aimsThere is limited data on the risk of developing diarrhoea in travelling patients with inflammatory bowel disease (IBD). We analysed the rate of developing diarrhoea among travellers suffering...

787O - External Validation of the Association of Progression-Free Survival at 6 Months (PFS6) with Overall Survival at 12 Months (OS12) in Second-Line Therapy for Advanced Urothelial Carcinoma (UC)

ABSTRACT Background We hypothesized that PFS at 6 months (PFS6) correlates with OS12 and may be a robust intermediate endpoint for phase II trials of second-line therapy for advanced UC. Methods Ten phase II trials of second-line chemotherapy and/or biologics were pooled. Progression was defined as tumor progression or death from any cause. Adjustment of PFS6 and OS12 were performed for variability between trials using random effects models. The relationship between PFS6 and OS12 was assessed at the trial level using Pearson correlation and weighted linear regression. The relationship between PFS6 and OS12 at the individual level was assessed using Pearson chi-square test with Yates continuity correction. Statistical analyses employed “R” statistical computing software, version 2.8.0. External validation was conducted in a phase III trial comparing best supportive care (BSC) with vinflunine plus BSC. Results Results from the pooled phase II dataset (n = 646) have been reported (ASCO 2012): the Pearson correlation between trial level PFS6 and OS12 was 0.66 (p = 0.037), and individual level agreement was seen in 82% of patients (kappa = 0.45), Pearson correlation between trial level response and OS12 was 0.37 (p = 0.30) and individual level agreement was seen in 78% (kappa = 0.36). Of the 357 patients in the external validation dataset, 17 had PFS censored before 6 months or OS censored before 12 months, leaving 340 evaluable patients. Of the progression events, 231 were objective progression, 104 were deaths and 5 were alive with PFS > 6 months and OS > 12 months. The PFS6 was 13.25% with BSC and 26.48% with vinflunine plus BSC. The individual level agreement of PFS6 and OS12 was 81% (κ= 0.44, p Conclusion PFS6 is robustly associated with OS12 at the trial and individual levels in the setting of second-line therapy for advanced UC. Given the suboptimal association of response and OS12 at the trial level, PFS6 may be a more optimal endpoint to capture the durable benefits of agents. Disclosure R. Fougeray: Employee of Pierre Fabre. T.K. Choueiri: Research support from Astrazeneca. Y. Wong: Research support from Imclone. S.S. Sridhar: Research support from Celgene. J. Bellmunt: Research support to institution from Pierre Fabre. All other authors have declared no conflicts of interest.

Correlation of progression-free survival at 6 months (PFS6) with overall survival at 12 months (OS12) in an analysis of 10 trials of second-line therapy for advanced urothelial carcinoma (UC).

4525 Background: Second-line therapy of advanced UC is a significant unmet need. While phase II trials have relied on response rate (RR) as a primary endpoint, response may not be suitable for assessing cytostatic agents and does not capture duration of benefit. We hypothesized that PFS6 correlates with OS12 and may be a robust intermediate endpoint for phase II trials. Methods: Ten trials with individual patient progression and survival data (n=646) evaluating chemotherapy and/or biologics following chemotherapy were combined. Progression was defined as tumor progression (RECIST 1.0 in 9 trials, WHO in 1 trial), or death from any cause. Unadjusted and adjusted binomial confidence intervals for PFS6, OS12 and response were reported, with adjustment for variability between trials using random effects models. The relationship between PFS6 and OS12 was assessed at the trial level using Pearson correlation and weighted linear regression with larger studies having more influence. The relationship between PFS6 and OS12 at the individual level was assessed using Pearson chi-square test with Yates continuity correction. Statistical analyses employed “R” statistical computing software, version 2.8.0. Results: 59% had visceral metastasis and performance status was 0, 1 and 2 in 50, 39 and 8%, respectively. Median age was 65 years (31-88) and 77% were male. PFS6 was 22% (95% CI: 17-24%), and adjusted PFS6 was 23% (95% CI: 15-34%). The OS12 was 20% (95% CI: 17-24%), and adjusted OS12 was 21% (95% CI: 15-29%). The Pearson correlation between trial level PFS6 and OS12 was 0.66 (p = 0.037). The individual level agreement between PFS6 and OS12 was seen in 82% of patients (kappa = 0.45). Among 560 patients evaluable for response and OS, the RR was 22% (95% CI: 18-25%) and adjusted RR was 21% (95% CI: 13-32%). Trial level Pearson correlation between response and OS12 was 0.37 (p = 0.30), and individual level agreement was seen in 78% (kappa=0.36). Conclusions: PFS6 is associated with OS12 at the trial and individual levels in patients receiving second-line therapy for advanced UC. The association of response with OS was suboptimal. Validation of PFS6 is warranted.

The accuracy of the electrocardiogram during exercise stress test based on heart size.

BackgroundMultiple studies have shown that the exercise electrocardiogram (ECG) is less accurate for predicting ischemia, especially in women, and there is additional evidence to suggest that heart size may affect its diagnostic accuracy.HypothesisThe purpose of this investigation was to assess the diagnostic accuracy of the exercise ECG based on heart size.MethodsWe evaluated 1,011 consecutive patients who were referred for an exercise nuclear stress test. Patients were divided into two groups: small heart size defined as left ventricular end diastolic volume (LVEDV) <65 mL (Group A) and normal heart size defined as LVEDV ≥65 mL (Group B) and associations between ECG outcome (false positive vs. no false positive) and heart size (small vs. normal) were analyzed using the Chi square test for independence, with a Yates continuity correction. LVEDV calculations were performed via a computer-processing algorithm. SPECT myocardial perfusion imaging was used as the gold standard for the presence of coronary artery disease (CAD).ResultsSmall heart size was found in 142 patients, 123 female and 19 male patients. There was a significant association between ECG outcome and heart size (χ2 = 4.7, p = 0.03), where smaller hearts were associated with a significantly greater number of false positives.ConclusionsThis study suggests a possible explanation for the poor diagnostic accuracy of exercise stress testing, especially in women, as the overwhelming majority of patients with small heart size were women.

Does Studentsʼ Gender, Citizenship, or Verbal Ability Affect Fairness of Portfolio-Based Promotion Decisions? Results From One Medical School

Measurement experts use four criteria to examine the fairness of tests: (1) equitable treatment for examinees, (2) equal outcomes for subgroups, (3) absence of bias, and (4) equal opportunity to learn. These criteria apply to portfolios just as they do to other assessments. This report examines the fairness of portfolio-based promotion decisions for medical students at the Cleveland Clinic Lerner College of Medicine. Participants were 182 first-year medical students (97 men, 85 women) from six class cohorts (2004-2009). Chi-square statistics with Yates continuity correction were used to compare overall promotion decisions to students' gender, self-reports of language fluency, and MCAT Writing Sample score. The Cramér V statistic served as an effect size index. Post hoc power analyses identified the minimum sample size to obtain acceptable power. Approximately 85% of students were promoted to Year 2 of the program. Gender, U.S. citizenship, language fluency, and MCAT Writing Sample score were not significantly related to overall promotion decisions. Effect sizes were small (≤0.15) for all contingency tables, suggesting weak associations between overall promotion decisions and students' group characteristics. Examining fairness, although challenging, is essential to maintain professional standards and avoid potential liability. Preliminary evidence in this study suggests that students' background characteristics and verbal abilities were not strongly related to portfolio-based promotion decisions. Schools should monitor processes that may affect fairness. This study reports on just one aspect of fairness. More research is needed to evaluate other dimensions of fairness.

An Analysis of Outcomes in twin Pregnancies With Active Fetal Surveillance and Intervention: A Four Year Survey

The present study aims to highlight the prospects of improving fetal and perinatal outcomes in twin pregnancies with active fetal surveillance and effective fetal therapeutic interventions. 88 twin pregnancies booked for care at this centre were included in this study. The maternal demographic variables, course of pregnancy, fetal problems and specialised fetal therapeutic and diagnostic interventions were noted. The above parameters were also compared in dichorionic and monochorionic twin pregnancies and related to the perinatal outcome. Statistical analysis was done using the student's t test and two-tailed chi sqaure tests with Yate's continuity correction. A p value <0.05 was considered as significant. Mean maternal age was 30.34 ± 4.81 years (Range 19–48). 81% of the twins were DCDA and 19% were MCDA. The mean gestaional age at delivery was 34.4±3.5 weeks and this was not significantly different in MCDA and DCDA groups. Serious fetal problems warranting intervention at thetime of initial referral were significantly higher in MCDA twins although overall perinatal outcome in both groups were not different. Active fetal surveillanve and therapeutic intervention improves the perinatal outcome to over 90% of at least one take home baby rate but with an increase in late prematurity.

Thumb Injuries in Intercollegiate Men's Lacrosse

Background Men's intercollegiate lacrosse is played at a fast pace and with significant force. Glove protection is required. However, the thumb is at risk because of contact with opponents’ sticks, the ball, other players, and the ground or artificial surface. Purpose To characterize patterns of hand injuries in men's intercollegiate lacrosse and to compare them with those in similar intercollegiate stick-handling sports that require gloves. Study Design Descriptive epidemiology study. Methods The National Collegiate Athletic Association (NCAA) Injury Surveillance System was utilized to evaluate thumb injuries in intercollegiate stick-handling sports (men's lacrosse, women's lacrosse, and men's ice hockey) during 16 intercollegiate seasons. Injuries were defined as events requiring an athlete to seek medical treatment and miss competition. Data were collected for injuries to the thumb, phalanges, and hand. Descriptive statistics were performed to calculate rates of injury per 1000 athlete-exposures and the relative exposure of the thumb with respect to total hand injuries. χ2 testing with the Yates correction for continuity was performed to determine differences in proportions of injury among the 3 sports studied. Results During 16 intercollegiate seasons, there were 692 thumb, finger, and hand injuries in 3 038 255 athlete-exposures. Total thumb injuries were significantly higher in men's lacrosse, accounting for 59.4% of total hand injuries, when compared with women's lacrosse (42%) and men's ice hockey (35.8%) (P < .001). Thumb fractures and contusions were each also found to be significantly more prevalent (P < .001) when compared with women's lacrosse and men's ice hockey. Conclusion Men's intercollegiate lacrosse requires the use of gloves; nonetheless, injury rates of the thumb are significantly elevated in this sport compared with other gloved, stick-handling sports. Recommendations include the development of gloves with improved thumb protection.

Active Surveillance Screening of MRSA and Eradication of the Carrier State Decreases Surgical-Site Infections Caused by MRSA

Surgical-site infections (SSI), because of MRSA, are a challenge for acute care hospitals. The current study examines the impact of best practices and active surveillance screening for MRSA on reduction of MRSA SSIs. Beginning February 2007, all admissions to a 761-bed tertiary care hospital were screened for MRSA by nasal swab using polymerase chain reaction-based testing. Positive nasal carriers of MRSA were treated before operation. The subset of patients undergoing procedures that are part of the Surgical Infection Prevention Project were followed for MRSA SSIs. SSI rates (per 100 procedures) were determined using the National Nosocomial Infection Surveillance definitions. MRSA SSI rates were compared before and after the MRSA screening intervention. Differences were analyzed using Fisher's exact test and chi-square with Yate's continuity correction. Where specimens were available, genotyping of MRSA was performed using a commercially available assay. After universal MRSA surveillance, 5,094 patients underwent Surgical Infection Prevention Project procedures. The rate of MRSA SSI decreased from 0.23% to 0.09%. The reduction was most pronounced in joint-replacement procedures (0.30% to 0%; p = 0.04). No other differences were statistically significant. Of the seven patients in whom MRSA SSI developed after universal screening, four had positive MRSA screens; none had received preoperative eradication of MRSA. In two of these patients, the genotype of MRSA detected on screening and in SSI was genetically indistinguishable. Surveillance for MRSA and eradication of the carrier state reduces the rate of MRSA SSI.