Antimicrobial therapy for otitis media with effusion ( secretory otitis media)

Objective. —To determine the effectiveness of antimicrobial treatment for otitis media with effusion ( secretory otitis media) in children. Data Source. —We report the reexamination of a previously published study by Mandel et al that evaluated the efficacy of a 2-week course of antimicrobials (amoxicillin trihydrate) with and without a 4-week course of an oral decongestant-antihistamine combination in a double-blind, placebo-controlled, randomized trial involving 518 infants and children with otitis media with effusion. Data Synthesis. —At 4 weeks, amoxicillin efficacy as determined by a tympanometric criterion (P=.121) or by a measure of improvement in hearing (P=.311) was insignificant. Only by otoscopic judgment, which is shown to contain a systematic bias as used in this clinical trial, could an argument be made for a marginal efficacy of amoxicillin at the 4-week end point. Logistic regression analyses of the combined effects of treatment and prognostic factors showed no significant differences between placebo- and antibiotic-treated groups for unilateral effusions and for bilateral effusions. When subjects with unilateral and bilateral effusions were combined, the estimated efficacy of antibiotic treatment was 12.3% by otoscopy (P =.014) and 4.8% by tympanometry (P =.171). We also demonstrate the sensitivity of outcome to diagnostic measures used and provide statistical evidence questioning the validity of otoscopic observations in this study. Six weeks after the termination of amoxicillin therapy, the recurrence of effusion was two to six times higher in the amoxicillin-treated children than in those treated with placebo (P=.001), and resolution of effusion was not significantly different among antibiotic and placebo groups (13.6% and 11.3%, respectively; P=.477). Conclusions. —Amoxicillin with and without decongestant-antihistamine combination is not effective for the treatment of persistent asymptomatic middle-ear effusions in infants and children

Evaluation of small area crop estimation techniques using LANDSAT- and ground-derived data

Studies completed in fiscal year 1981 in support of the clustering/classification and preprocessing activities of the Domestic Crops and Land Cover project. The theme throughout the study was the improvement of subanalysis district (usually county level) crop hectarage estimates, as reflected in the following three objectives: (1) to evaluate the current U.S. Department of Agriculture Statistical Reporting Service regression approach to crop area estimation as applied to the problem of obtaining subanalysis district estimates; (2) to develop and test alternative approaches to subanalysis district estimation; and (3) to develop and test preprocessing techniques for use in improving subanalysis district estimates

Time Ordering in Kicked Qubits

We examine time ordering effects in strongly, suddenly perturbed two-state quantum systems (kicked qubits) by comparing results with time ordering to results without time ordering. Simple analytic expressions are given for state occupation amplitudes and probabilities for singly and multiply kicked qubits. We investigate the limit of no time ordering, which can differ in different representations.Comment: 26 pages, 5 figure

Candida parapsilosis infection in very low birthweight infants

In a UK national surveillance study, we found that Candida parapsilosis accounted for one quarter of all cases of invasive fungal infection in very low birthweight infants. C parapsilosis was associated with fewer deep-seated infections than C albicans, but mortality was similar. Ongoing surveillance is needed to monitor the epidemiology of invasive fungal infection in very low birthweight infants.This study was partly supported by an educational grant provided by Pfizer UK

Evaluation of large area crop estimation techniques using LANDSAT and ground-derived data

The results of the Domestic Crops and Land Cover Classification and Clustering study on large area crop estimation using LANDSAT and ground truth data are reported. The current crop area estimation approach of the Economics and Statistics Service of the U.S. Department of Agriculture was evaluated in terms of the factors that are likely to influence the bias and variance of the estimator. Also, alternative procedures involving replacements for the clustering algorithm, the classifier, or the regression model used in the original U.S. Department of Agriculture procedures were investigated

Interactions between carbon and nitrogen dynamics in estimating net primary productivity for potential vegetation in North America

We use the terrestrial ecosystem model (TEM), a process-based model, to investigate how interactions between carbon (C) and nitrogen (N) dynamics affect predictions of net primary productivity (NPP) for potential vegetation in North America. Data on pool sizes and fluxes of C and N from intensively studied field sites are used to calibrate the model for each of 17 non-wetland vegetation types. We use information on climate, soils, and vegetation to make estimates for each of 11,299 non-wetland, 0.5° latitude × 0.5° longitude, grid cells in North America. The potential annual NPP and net N mineralization (NETNMIN) of North America are estimated to be 7.032 × 1015 g C yr−1 and 104.6 × 1012 g N yr−1, respectively. Both NPP and NETNMIN increase along gradients of increasing temperature and moisture in northern and temperate regions of the continent, respectively. Nitrogen limitation of productivity is weak in tropical forests, increasingly stronger in temperate and boreal forests, and very strong in tundra ecosystems. The degree to which productivity is limited by the availability of N also varies within ecosystems. Thus spatial resolution in estimating exchanges of C between the atmosphere and the terrestrial biosphere is improved by modeling the linkage between C and N dynamics. We also perform a factorial experiment with TEM on temperate mixed forest in North America to evaluate the importance of considering interactions between C and N dynamics in the response of NPP to an elevated temperature of 2°C. With the C cycle uncoupled from the N cycle, NPP decreases primarily because of higher plant respiration. However, with the C and N cycles coupled, NPP increases because productivity that is due to increased N availability more than offsets the higher costs of plant respiration. Thus, to investigate how global change will affect biosphere-atmosphere interactions, process-based models need to consider linkages between the C and N cycles

Neurocognitive Correlates of Treatment Response in Children with Tourette\u27s Disorder

This paper examined neurocognitive functioning and its relationship to behavior treatment response among youth with Tourette\u27s Disorder (TD) in a large randomized controlled trial. Participants diagnosed with TD completed a brief neurocognitive battery assessing inhibitory functions, working memory, and habit learning pre- and post-treatment with behavior therapy (CBIT, Comprehensive Behavioral Intervention for Tics) or psychoeducation plus supportive therapy (PST). At baseline, youth with tics and Attention Deficit Hyperactivity Disorder (ADHD) exhibited some evidence of impaired working memory and simple motor inhibition relative to youth with tics without ADHD. Additionally, a small negative association was found between antipsychotic medications and youth\u27s performance speed. Across treatment groups, greater baseline working memory and aspects of inhibitory functioning were associated with a positive treatment response; no between-group differences in neurocognitive functioning at post-treatment were identified. Within the behavior therapy group, pre-treatment neurocognitive status did not predict outcome, nor was behavior therapy associated significant change in neurocognitive functioning post-treatment. Findings suggest that co-occurring ADHD is associated with some impairments in neurocognitive functioning in youth with Tourette\u27s Disorder. While neurocognitive predictors of behavior therapy were not found, participants who received behavior therapy exhibited significantly reduced tic severity without diminished cognitive functioning

An Empirical Examination of Symptom Substitution Associated with Behavior Therapy for Tourette\u27s Disorder

Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette’s disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette’s disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette’s disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette\u27s disorder