Antimicrobial Resistance Incidence and Risk Factors among Helicobacter pylori–Infected Persons, United States

Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a prospective, multicenter U.S. network that tracks national prevalence rates of H. pylori antimicrobial resistance. Of 347 clinical H. pylori isolates collected from December 1998 through 2002, 101 (29.1%) were resistant to one antimicrobial agent, and 17 (4.8%) were resistant to two or more antimicrobial agents. Eighty-seven (25.1%) isolates were resistant to metronidazole, 45 (12.9%) to clarithromycin, and 3 (0.9%) to amoxicillin. On multivariate analysis, black race was the only significant risk factor (p < 0.01, hazard ratio 2.04) for infection with a resistant H. pylori strain. Formulating pretreatment screening strategies or providing alternative therapeutic regimens for high-risk populations may be important for future clinical practice

A Cluster-Based Framework for Interface Analysis in Large-Scale Aerospace Systems

This paper proposes a framework using a community maturity level metric to determine the integration readiness of interface elements in a particular network cluster. As a proof of concept this methodology is applied to an aircraft seating system to assess the readiness of complex interfaces before proceeding to full-scale production and systems integration. A multi-objective genetic algorithm, MOGA-Net, is coupled with the Newman-Girvan modularity metric as a clustering algorithm. This algorithm identifies system elements grouped by common interfaces, referred to as community clusters. The TRL and IRL values for these elements is then used to calculate an overall community maturity level. The achieved performance in these clusters is then compared to the target performance to determine overall maturity of the interfaces. This is compared to other system readiness metrics and interface readiness metrics as applied to the aircraft seating system and was found to be more consistent with subject matter expert evaluations during the critical design review. This gives a better representation of the true readiness of system interfaces before entering design reviews to reduce overall integration risks

SoS Explorer Application with Fuzzy-Genetic Algorithms to Assess an Enterprise Architecture -- A Healthcare Case Study

Kevin Dooley (1997), defined Complex Adaptive System (CAS) as a group of semi-autonomous agents who interact in interdependent ways to produce system-wide patterns, such that those patterns then influence behavior of the agents. A healthcare system is considered as a Complex Adaptive System of system (SoS) with agents composed of strategies, people, process, and technology. Healthcare systems are fragmented with independent systems and information. The enterprise architecture (EA) aims to address these fragmentations by creating boundaries around the business strategy and key performance attributes that drive integration across multiple systems of processes, people, and technology. This paper uses a SoS Explorer to select an optimal architecture that provide the necessary capabilities to meet key performance attributes (KPAs) in a dynamic, complex healthcare business environment. The SoS Explorer produced an optimal meta-architecture where all but two systems (disease and facility processes) participated with many of the systems having at least four interfaces. The healthcare meta-architecture produced in this study is not a solution to address the challenges of the healthcare enterprise architecture but provides insight on the areas - systems, capabilities, characteristics, and interfaces - to pay attention to where agility is an important attribute and not to be severely compromised

Difluoromethylornithine plus sulindac for the prevention of sporadic colorectal adenomas: a randomized placebo-controlled, double-blind trial.

Preclinical studies of chemoprevention drugs given in combination at low doses show remarkable efficacy in preventing adenomas with little additional toxicities, suggesting a strategy to improve risk to benefit ratios for preventing recurrent adenomas. Three hundred seventy-five patients with history of resected (&gt; or =3 mm) adenomas were randomly assigned to receive oral difluoromethylornithine (DFMO) 500 mg and sulindac 150 mg once daily or matched placebos for 36 months, stratified by use of low-dose aspirin (81 mg) at baseline and clinical site. Follow-up colonoscopy was done 3 years after randomization or off-study. Colorectal adenoma recurrence was compared among the groups with log-binomial regression. Comparing the outcome in patients receiving placebos to those receiving active intervention, (a) the recurrence of one or more adenomas was 41.1% and 12.3% (risk ratio, 0.30; 95% confidence interval, 0.18-0.49; P &lt; 0.001); (b) 8.5% had one or more advanced adenomas, compared with 0.7% of patients (risk ratio, 0.085; 95% confidence interval, 0.011-0.65; P &lt; 0.001); and (c) 17 (13.2%) patients had multiple adenomas (&gt;1) at the final colonoscopy, compared with 1 (0.7%; risk ratio, 0.055; 0.0074-0.41; P &lt; 0.001). Serious adverse events (grade &gt; or =3) occurred in 8.2% of patients in the placebo group, compared with 11% in the active intervention group (P = 0.35). There was no significant difference in the proportion of patients reporting hearing changes from baseline. Recurrent adenomatous polyps can be markedly reduced by a combination of low oral doses of DFMO and sulindac and with few side effects

Difluoromethylornithine plus sulindac for the prevention of sporadic colorectal adenomas: a randomized placebo-controlled, double-blind trial.

Preclinical studies of chemoprevention drugs given in combination at low doses show remarkable efficacy in preventing adenomas with little additional toxicities, suggesting a strategy to improve risk to benefit ratios for preventing recurrent adenomas. Three hundred seventy-five patients with history of resected (&gt; or =3 mm) adenomas were randomly assigned to receive oral difluoromethylornithine (DFMO) 500 mg and sulindac 150 mg once daily or matched placebos for 36 months, stratified by use of low-dose aspirin (81 mg) at baseline and clinical site. Follow-up colonoscopy was done 3 years after randomization or off-study. Colorectal adenoma recurrence was compared among the groups with log-binomial regression. Comparing the outcome in patients receiving placebos to those receiving active intervention, (a) the recurrence of one or more adenomas was 41.1% and 12.3% (risk ratio, 0.30; 95% confidence interval, 0.18-0.49; P &lt; 0.001); (b) 8.5% had one or more advanced adenomas, compared with 0.7% of patients (risk ratio, 0.085; 95% confidence interval, 0.011-0.65; P &lt; 0.001); and (c) 17 (13.2%) patients had multiple adenomas (&gt;1) at the final colonoscopy, compared with 1 (0.7%; risk ratio, 0.055; 0.0074-0.41; P &lt; 0.001). Serious adverse events (grade &gt; or =3) occurred in 8.2% of patients in the placebo group, compared with 11% in the active intervention group (P = 0.35). There was no significant difference in the proportion of patients reporting hearing changes from baseline. Recurrent adenomatous polyps can be markedly reduced by a combination of low oral doses of DFMO and sulindac and with few side effects