Excerpt: Dr Meier and colleagues1 present intriguing data that individuals with a first acute myocardial infarction (AMI) were less likely than matched controls to have used tetracycline antibiotics or quinolones in the previous 3 years. The authors raise the possibility that organisms susceptible to these antibiotics may be involved in the pathogenesis of coronary heart disease. However, several methodological limitations lead to other possible explanations for the observed associations.

The purpose of this research project was to compare inpatient mortality rates for rural hospitals with mortality rates of urban hospitals of given sizes and ranges of service. Statistical adjustments for risk were made in the probability of death during hospitalization for 43,000 patients across 166 hospitals by age, gender, principal diagnosis, principal surgical procedure, characteristics of the secondary diagnoses, and whether or not cancer was a secondary diagnosis. Eighty-three small hospitals that had a relatively unspecialized range of services constituted the study group. Patient characteristics of this study group were moderately representative of the national population. A standardized score was calculated for each hospital using a formula based on the actual hospital death rate and the death rate expected for a given hospital with patients of the same demographic and medical characteristics. Patients admitted to hospitals in nonmetropolitan areas had a mortality rate of 0.41 percent compared with a mortality rate of 0.66 percent in peer hospitals in metropolitan areas. After mortality rates were risk-adjusted and converted to z scores, nonmetropolitan areas had an average z of +0.16, and metropolitan areas had an average z of -0.25, where positive z scores reflect a lower-than-average adjusted mortality rate. The metropolitan-nonmetropolitan (urban-rural) difference was not statistically significant, but it is meaningful in that rural hospitals tended to have a lower adjusted mortality rate than urban hospitals of the same size and type, indicating that rural hospitals had the same or lower adjusted mortality rates. The possibility of urban hospitals having riskier patients was minimized but could not be definitively ruled out. Taken together with other studies, the data are consistent with the view that small rural hospitals generally make appropriate transfer decisions for severely ill patients and provide quality care for retained patients.

Book Summary: With contributions from more than 40 renowned experts, Modeling in the Neurosciences: From Ionic Channels to Neural Networks is essential for those interested in neuronal modeling and quantitative neiroscience. Focusing on new mathematical and computer models, techniques and methods, this monograph represents a cohesive and comprehensive treatment of various aspects of the neurosciences from the biophysical, cellular and netwrok levels. Many state-of-the-art examples are presented as to how mathematical and computer modeling can contribute to the understanding of mechanisms and systems in the neurosciences. Each chapter also includes suggestions of possible refinements for future modeling in this rapidly changing and expanding field. This book will benefit and inspire the advanced modeler, and give the beginner sufficient confidence to model a wide selection of neuronal systems at the biophysical, cellular and network levels.

The objectives of the study were to identify which risk factors for heart disease were most prevalent in a poor, underserved, rural Appalachian county. A random sample of medical records was selected (n = 292) of adult men and women who participated in a countywide health care project. Data were obtained from a health risk appraisal questionnaire and other physical and demographic information and were analyzed using univariate and bivariate statistical procedures. The findings indicated that these rural Appalachian subjects had a significant number of heart disease risk factors: excessive smoking, lack of exercise, high fat diets, and abnormal serum lipid levels.

Two single-pass methods for fitting multiexponentials to experimental data are described. These methods rely on the construction of a matrix whose characteristic polynomial is used to determine the rates of decay. In the first method, which we call the multiple-delay method, the matrix is constructed using time delays of the experimental data. This method is fast and highly accurate even if the experimental signal contains exponential components with similar rates of decay. In the second method, which we call the successive-integral method, the matrix is constructed using integrals of the experimental data. This procedure yields good results for noisy signals and is a generalization of the method of Martin et al. ((1993) J. Neurosci. Methods, 51: 135-146). In addition, a particular instability of the multiexponential curve fitting problem is identified and a method for overcoming this instability is given.

The purpose of this study was to investigate whether mandatory universal precautions changed nurses' body fluid exposure and reporting rates, hepatitis B vaccination rates, and human immunodeficiency virus (HIV) testing rates. Random cross-sectional surveys of nurses in Tennessee were conducted in 1991 and 1993 (n = 145 in 1991; n = 143 in 1993). The questionnaire in both surveys included frequency of body fluid exposures and reporting in the past year, and whether or not the respondent had received the hepatitis B vaccine or had been HIV tested. Findings indicated that self reported needlestick injuries decreased by 69%, and other sharps injuries decreased by 81%. Only 4.1% of all exposure incidents reported on this anonymous survey were reported to employee health officials, as required. Body fluid exposure incidents were the most common form of exposure (81%) and the most underreported. Hepatitis B vaccinations significantly increased (61.4% to 82.5%), with a nonsignificant increase in HIV testing (47.2% to 55.6%) from 1991 to 1993. Findings of this study suggest that the universal precautions regulatory mandate has been effective in increasing nurses' compliance to universal precautions. Body fluid contacts were significantly underreported and showed no decrease between 1991 and 1993.

This pilot study sought to describe the patterns of health risk factors and objective physical findings in well rural Appalachian women. A retrospective chart review was conducted of the records of 50 women who received a health history, physical examination, and appropriate laboratory testing as part of a rural community wellness project. The most prevalent risk factors found were past or present smoking, history of lung disease, physical inactivity, obesity, and hypercholesterolemia. Higher numbers of risk factors per person were correlated with lower levels of education. The most prevalent physical findings were systolic blood pressure greater than 140 and diastolic greater than 90, diastolic blood pressure greater than 90 with normal systolic, total cholesterol greater than 240, low-density lipoprotein levels greater than 130, and greater than 20% over ideal weight. This sample reveals a high prevalence of risk factors for the leading causes of mortality in middle-aged women, partially accounted for by low formal education levels, poverty, and limited access to health care.

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