First measurement of the double spin asymmetry in (-->)e(-->)p-->e(prime)pi(+)n in the resonance region

The double spin asymmetry in the (-->)e(-->)p --> e(prime)pi(+)n reaction has been measured for the first time in the resonance region for four-momentum transfer Q2 = 0.35-1.5 GeV(2). Data were taken at Jefferson Lab with the CLAS detector using a 2.6 GeV polarized electron beam incident on a polarized solid NH3 target. Comparison with predictions of phenomenological models shows strong sensitivity to resonance contributions. Helicity-1/2 transitions are found to be dominant in the second and third resonance regions. The measured asymmetry is consistent with a faster rise with Q(2) of the helicity asymmetry A1 for the F(15)(1680) resonance than expected from the analysis of the unpolarized data.

Gastrointestinal illness in managed care: healthcare utilization and costs

Identification of inefficiencies is a first step to improving the quality of gastrointestinal (GI) care at the most reasonable cost. This analysis used administrative data to examine the healthcare utilization and associated costs of the management of GI illnesses in a 2.5 million-member private managed care plan containing many benefit designs. An overall incidence of 10% was found for GI conditions, with a preponderance in adults (patients older than 40 years) and women. The most frequently occurring conditions were abdominal pain, nonulcer peptic diseases, lower GI tract diseases, and other GI tract problems. These conditions, along with gallbladder/biliary tract disease, were also the most costly. Claims submitted for care during GI episodes averaged $17 per member per month. Increasing severity of condition was associated with substantial increases in utilization and costs (except for medication use). For most GI conditions, approximately 40% of charges were for professional services (procedures, tests, and visits) and 40% of charges were for facility admissions. The prescription utilization analysis indicated areas where utilization patterns may not match accepted guidelines, such as the low use of anti-Helicobacter pylori therapy, the possible concomitant use of nonsteroidal anti-inflammatory drugs in patients with upper GI diseases, and the use of narcotics in treating patients with lower GI disease and abdominal pain. Also, there was no clear relationship between medication utilization and disease severity. Thus, this analysis indicated that GI disease is a significant economic burden to managed care, and identified usage patterns that potentially could be modified to improve quality of care.

Nosocomial respiratory tract colonization and infection with aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus: epidemiologic characteristics and clinical significance

During the period July 1983 through December 1984, aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus (ACA) were isolated from 98 patients in a university hospital. Eighty-seven percent of patients (85/98) acquired aminoglycoside-resistant ACA in the intensive care unit (ICU) and 92% (90/98) of all initial isolates were from sputum. ICU patients with respiratory colonization/infection with aminoglycoside-resistant ACA were compared with matched ICU controls with other gram-negative rods in sputum. Compared with controls, the duration of ICU stay prior to colonization/infection with aminoglycoside-resistant ACA was significantly longer for cases (14.7 days v 5.9 days, P = 0.002). Although exposures to devices and procedures were not significantly different for the two groups, cases received respiratory therapy significantly longer than did controls (14.7 days v 6.6 days, P = 0.006). Prior to isolation of aminoglycoside-resistant ACA in sputum, cases received more cephalosporins than did controls (1.9 v 1.2, P = 0.018); aminoglycoside usage in the two groups was comparable but cases tended to have received aminoglycoside for longer durations before colonization/infection than had controls (9.0 days v 6.1 days, P = 0.08). Following sputum isolation of ACA, 6 of 22 cases developed ACA bacteremia compared with bacteremia in 2 of 22 controls. We conclude that factors predisposing to colonization/infection with aminoglycoside-resistant ACA were extended ICU care, prolonged respiratory therapy, and prior therapy with cephalosporins and aminoglycoside. In addition, ACA may be a more common cause of secondary bacteremia than previously appreciated.