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Behavioural responses of dairy cattle to the stable fly, Stomoxys calcitrans, in an open field environment.

Individual cows (25 in each of four herds) were monitored 8-10 times weekly for 12 weeks (stable fly season) on a southern California dairy, with 100 observations per cow. The numbers of biting stable flies, Stomoxys calcitrans (L.) (Diptera: Muscidae) on the front legs and the frequencies of four fly-repelling behaviours per 2-min observation period [head throws, front leg stamps, skin twitches (panniculus reflex) and tail flicks] were recorded. Fly numbers varied, peaking at 3.0-3.5 flies per leg in week 9 (late May). Weekly herd mean frequencies of fly-repelling behaviours were highly dependent on fly numbers, with a linear regression r(2) > 0.8. Head throws and stamps were less frequent than skin twitches and tail flicks. Individual cows differed in numbers of stable flies and behaviours. Behaviours were correlated with flies for individual cows, but at a lower level than were herd means (r = 0.3-0.7). Cows that stamped more within a herd tended to have lower fly counts; other fly-repelling behaviours were less effective. Cows maintained ranks within a herd with regard to fly numbers (r = 0.47), head throws (0.48), leg stamps (0.64), skin twitches (0.69) and tail flicks (0.64). Older cows tended to harbour higher fly numbers and to stamp less relative to younger adult cows. Ratios of leg stamps and head throws to fly numbers dropped significantly through time, suggesting habituation to pain associated with fly biting. Tail flicks were not effective for repelling Stomoxys, but were easiest to quantify and may help in monitoring pest intensity. At this low-moderate fly pressure, no consistent impacts on milk yield were detected, but methods incorporating cow behaviour are recommended for future studies of economic impact.

Analysis of Variance↗

Direct microcontact printing of oligonucleotides for biochip applications.

BACKGROUND: A critical step in the fabrication of biochips is the controlled placement of probes molecules on solid surfaces. This is currently performed by sequential deposition of probes on a target surface with split or solid pins. In this article, we present a cost-effective procedure namely microcontact printing using stamps, for a parallel deposition of probes applicable for manufacturing biochips. RESULTS: Contrary to a previous work, we showed that the stamps tailored with an elastomeric poly(dimethylsiloxane) material did not require any surface modification to be able to adsorb oligonucleotides or PCR products. The adsorbed DNA molecules are subsequently printed efficiently on a target surface with high sub-micron resolution. Secondly, we showed that successive stamping is characterized by an exponential decay of the amount of transferred DNA molecules to the surface up the 4th print, then followed by a second regime of transfer that was dependent on the contact time and which resulted in reduced quality of the features. Thus, while consecutive stamping was possible, this procedure turned out to be less reproducible and more time consuming than simply re-inking the stamps between each print. Thirdly, we showed that the hybridization signals on arrays made by microcontact printing were 5 to 10-times higher than those made by conventional spotting methods. Finally, we demonstrated the validity of this microcontact printing method in manufacturing oligonucleotides arrays for mutations recognition in a yeast gene. CONCLUSION: The microcontact printing can be considered as a new potential technology platform to pattern DNA microarrays that may have significant advantages over the conventional spotting technologies as it is easy to implement, it uses low cost material to make the stamp, and the arrays made by this technology are 10-times more sensitive in term of hybridization signals than those manufactured by conventional spotting technology.

Journal Article↗

[Philately in the service of rehabilitation (author's transl)].

The first stamps to draw attention to physical impairment were surcharge stamps issued during and after World War 1. A 1931 charity issue offered by the Netherlands post office was made up of postage stamps indicating to the public some of the problems involved in the care of handicapped children. Depiction of the concept of rehabilitation on stamps have been substantiated after 1945 by special cancels and first-day covers, and will be amply complemented in 1981, the International Year of Disabled Persons. Stamp and postmark collection is a hobby. If done with a view to specific design themes, it is a systematic hobby. The author describes the principal lines along which topical collection of disability-related stamps can be organised.

Persons with Disabilities↗

Hunger in an adult patient population.

CONTEXT: Although clinical observations suggest that some patients experience hunger and food insecurity, there are limited data on the prevalence of hunger in adult patients. OBJECTIVE: To determine the prevalence of hunger and food insecurity in adult patients at an urban county hospital. DESIGN: Cross-sectional survey conducted in 1997. PATIENTS: The primary survey included all patients aged 18 years or older who were admitted to the medicine, surgery, and neurology services during a 2-week period, and all patients who attended the hospital's general medicine clinic during 1 week. A second survey included primary care patients who received insulin from the hospital pharmacy during a 1-month period. MAIN OUTCOME MEASURES: Rates of hunger and food insecurity. RESULTS: Of 709 eligible patients, 567 (participation rate, 80%) were interviewed in either the clinic (n=281) or hospital (n=286). An additional 170 patients who received insulin were interviewed by telephone (response rate, 75%). Of the primary sample, 68 (12%) respondents reported not having enough food, 75 (13%) reported not eating for an entire day, and 77 (14%) reported going hungry but not eating because they could not afford food. A total of 222 (40%) had received food stamps in the previous year and of those, 113 (50%) had their food stamps reduced or eliminated. Recipients whose food stamps had been eliminated or reduced were more likely to report not having enough food (18% vs 13%, P=.006), not eating for a whole day (20% vs 16%, P=.01), going hungry but not eating (20% vs 16%, P=.08), and cutting down on the size of meals or skipping meals (33% vs 27%, P=.01). In multivariate analysis, independent predictors of hunger included an annual income of less than $10000 (odds ratio [OR], 7.55; 95% CI, 3.01-18.92), drug use (OR, 3.56; 95% CI, 1.46-8.66), and a reduction in food stamp benefits (OR, 1.73; 95% CI, 1.01-2.96). Predictors of food insecurity included an annual income of less than $10000 (OR, 4.12; 95% confidence interval [CI], 1.98-8.58), drug use (OR, 2.11; 95% CI, 1.66-5.08), and a reduction in food stamps (OR, 2.02; 95% CI, 1.23-3.32). In addition, 103 (61%) patients in the sample of diabetics reported hypoglycemic reactions; 32 (31%) of these were attributed to inability to afford food. CONCLUSION: Hunger and food insecurity are common among patients seeking care at an urban county hospital.

Adult↗

Soft lithographic printing of patterns of stretched DNA and DNA/electronic polymer wires by surface-energy modification and transfer.

Aligned and stretched lambda DNA is directed to specific locations on solid substrates. Surface-energy modification of glass substrates by using patterned polydimethylsiloxane (PDMS) stamps is used to direct DNA onto the surface-energy-modified micrometer-scale pattern through molecular combing. As an alternative, patterned and nonpatterned PDMS stamps modified with polymethylmethacrylate (PMMA) are utilized to direct the stretched DNA to the desired location and the results are compared. The DNA is elongated through molecular combing on the stamp and transfer printed onto the surfaces. PMMA-modified stamps show a more defined length of the stretched DNA, as compared to bare PDMS stamps. A combination of these two methods is also demonstrated. As an application example, transfer printing of DNA decorated with a semiconducting conjugated polyelectrolyte is shown. The resulting patterned localization of stretched DNA can be utilized for functional nanodevice structures, as well as for biological applications.

DNA↗

Public versus private food assistance: barriers to participation differ by age and ethnicity.

OBJECTIVE: To examine participation in the Food Stamp Program, food pantries, and soup kitchens and to identify reasons food-insecure households choose not to participate. DESIGN: Cross-sectional retrospective cohort study. SETTING: In respondents' homes. PARTICIPANTS: 330 randomly selected low-income households (below 185% of poverty). MAIN OUTCOME MEASURES: Participation in any of 3 public or private food assistance programs and barriers to participation in each program. ANALYSIS: Chi-square tests of association between program participation and sociodemographic characteristics. Logistic regression tested for associations between program participation and ethnicity and between food security status and household composition while controlling for potential confounding factors. RESULTS: Controlling for socioeconomic status, Black households are less than half as likely to receive food stamps (odds ratio [OR] = 0.49; P <.02) as Hispanic households. Hispanic households are more likely than non-Hispanic households to say that they feel uncomfortable using food pantries (P <.01). Elderly households are less than half as likely to receive food stamps (OR = 0.44; P =.04) as nonelderly households and are more likely to say that they feel uncomfortable receiving food stamps (P =.05). CONCLUSIONS AND IMPLICATIONS: Low-income households' perceptions of which programs are socially acceptable differ by race and age. Outreach for food stamps and private food assistance should accommodate these differences so that food-insecure households can benefit from all available food assistance.

Adolescent↗

Growth kinetics and morphology of self-assembled monolayers formed by contact printing 7-octenyltrichlorosilane and octadecyltrichlorosilane on Si(100) wafers.

The growth kinetics and morphologies of self-assembled monolayers deposited by contact printing 7-octenyltrichlorosilane (OCT) and octadecyltrichlorosilane (OTS) on Si(100) were studied by ellipsometry and atomic force microscopy. We found that, for both OCT and OTS, full monolayers could be obtained at room temperature after printing times of 120-180 s; the printing-based monolayer assembly processes follow apparent Langmuir adsorption kinetics, with the measured film growth rates increasing both with the ambient humidity and with concentration of the ink used to load the stamp. At a dew point of 10 degrees C and an ink concentration (in toluene) of 50 mM, the observed film growth rate constant is 0.05 s(-)(1). When the printing was carried out at a lower ambient humidity (dew points of 1-3 degrees C), the measured rates of assembly were approximately a factor of 2 slower. Increasing the deposition temperature from 25 to 45 degrees C under these conditions increased the film growth rate only slightly. The morphology of the films depends on the identity of the ink. Uniform, high-coverage films could be obtained readily from the eight-carbon chain length adsorbate OCT, provided that the stamp was not overloaded with the ink; for high concentrations outside of the optimal range, the surface presented significant numbers of adsorbed particles ascribed, in part, to siloxane polymers formed by hydrolysis of the ink on the stamp before printing. In marked contrast, for the 18-carbon adsorbate OTS, the printed films always consisted of a mixture of a uniform monolayer plus adsorbed polysiloxane particles. The different film morphologies seen for OCT and OTS are proposed to result from the different transfer efficiencies of the organotrichlorosilane relative to polysiloxane hydrolysis products formed during the printing process. These transfer efficiencies exhibit sensitivities related to the permeation of the poly(dimethylsiloxane) (PDMS) stamp by the silane reagents. Short-chain inks such as OCT evidently permeate the PDMS stamp more deeply than longer-chain inks such as OTS. This difference, and the different diffusion rates of ink vs oligomeric silane hydrolysis products, determines the film morphology obtained by contact printing. The mass transfer dynamics of the process thus yield surface layers derived from varying quantities of siloxane oligomers, which subsequently transfer to the substrate along with unhydrolyzed silane adsorbate during the printing step. The structural evolution of the contact-printed films so obtained is strikingly different from that of SAMs prepared by immersion.

Adsorption↗

Numerical and experimental study of critical roof collapse conditions in soft lithography.

One of the major issues during soft lithographic processes is that, if the pressing force on the stamp becomes too high, the stamp may erroneously come into contact with the substrate in zones where contact is not intended. This decreases the patterning accuracy and may lead to badly or nonperforming electronic devices and is therefore undesired. Design rules, available at an early stage in the design phase, are desired to speed-up the development of this technique. Ultimately, these rules should give an indication of the critical pressure that can safely be applied on the stamp thereby avoiding unwanted contact between the stamp and the substrate. To obtain these critical pressures, numerical analyses of the deformation behavior of two characteristic configurations in the microstructured surface pattern of the rubber stamp are performed. The deformation behavior of the rubber is modeled according to a Gaussian and a non-Gaussian approach, leading to a neo-Hookean and Arruda-Boyce constitutive model, respectively. Besides these material nonlinearities, geometrical nonlinearities are taken into account as well. The calculated pressure at which undesired contact takes place (the roof collapse pressure) is compared to experimentally obtained values for two particular types of structures, and the results are in agreement within the error margins of the experiments and those ensuing from the assumptions of the numerical simulations.

Journal Article↗

Use of social services by pregnant Medicaid eligible women in Baltimore.

OBJECTIVES: To use linked health and social service databases to determine differences in the use of social services by pregnant women in different managed care systems. METHODS: Comparison of service use by women enrolled in a fee-for-service primary care case management program (Maryland Access to Care or MAC), in a capitated health maintenance organization (HMO), or not assigned to managed care using six state databases. Participants included 5181 women receiving Medical Assistance (MA) and delivering in Baltimore City in 1993. Outcome measures were receipt of WIC, AFDC, and Food Stamps. RESULTS: The overall proportions of women receiving WIC, AFDC, and Food Stamps at delivery were 52.7%, 89.2%, and 62.7%, respectively. Women enrolled in an HMO at delivery were less likely to be receiving WIC (adjusted odds ratios, 0.8, 95% CI, 0.69 to 0.93), AFDC (OR, 0.20; CI, 0.03 to 0.43 for women with prior children and OR 0.13; CI, 0.09 to 0.20 for women without prior children), and Food Stamps (OR 0.77; CI, 0.59 to 0.95 for women with prior children and OR, 0.49; CI, 0.35 to 0.67 for women without prior children) than their MAC counterparts. Women not assigned to managed care also generally were less likely than their MAC counterparts to receive WIC (OR 0.55; CI, 0.46, 0.66), AFDC (OR 1.07; CI 0.83, 1.30 for women with prior children and OR 0.24; CI 0.18, 0.34 for women without prior children), and Food Stamps (OR 0.31; CI 0.08, 0.55 for women with prior children and OR 0.31; CI 0.23, 0.41 for women without prior children). CONCLUSIONS: Although many low-income pregnant women qualify for select social services, receipt of WIC and Food Stamps was low. Increasing efforts are needed by managed care systems and public health agencies to ensure delivery of appropriate services for women.

Adolescent↗

In vitro activity of stampidine against primary clinical human immunodeficiency virus isolates.

The in vitro activity profile of stampidine (CAS 217178-62-6, STAMP) was examined against clinical isolates of HIV-1. In a side-by-side comparison against 10 zidovudine-sensitive clinical HIV-1 isolates, STAMP was 100-fold more potent than stavudine (CAS 3056-17-5) and twice as effective as zidovudine (CAS 30516-87-1). STAMP was also active against phenotypically and/or genotypically NRTI (nucleoside analog inhibitors of reverse transcriptase) -resistant HIV and inhibited the replication of 20 zidovudine-resistant clinical HIV-1 isolates with low nanomolar to subnanomolar IC50 values. Similarly, STAMP inhibited the replication of 9 genotypically NNRTI (non-nucleoside analog inhibitors of reverse transcriptase)-resistant clinical HIV-1 isolates (n = 9) with an average IC50 value of 11.2 +/- 6.5 nmol/L. The remarkable potency of STAMP against clinical HIV-1 isolates with NRTI- or NNRTI-resistance warrants the further development of this promising new antiviral agent.

Cells, Cultured↗

Method for patterning stretched DNA molecules on mica surfaces by soft lithography.

Lambda DNA was stretched and patterned on mica surface using soft lithography. A highly diluted solution of amino propyl trimethoxy silane in hexane was deposited on a line patterned polydimethylsiloxane (PDMS) stamp. The functionalized stamp was then used to pick up DNA by molecular combing while the line patterns are parallel to the liquid surface. The stamp was then microcontact printed on freshly cleaved mica. We successfully obtained stretched DNA pattern on mica surface. DNA was found to be stretched in patterns perpendicular to those carved on the stamp. The stretched DNA population was large enough to be used for molecular biology mapping studies. Furthermore, the possibility of locating stretched DNA molecules in the desired position by stamping makes this method a good candidate for assembling non-semiconductor molecular devices.

Aluminum Silicates↗

Danegeld remembered: taxing further the coin head illusion.

Two experiments studied memory for the appearance of a Danish 20 kroner coin. The coin bears the portrait of Queen Margrethe II in profile, facing to the right. Previous studies have examined memory for British coins, which similarly bear a right-facing portrait of Queen Elizabeth II. They have revealed the occurrence of a mnemonic illusion, in that British people tend to believe the portrait faces left. This finding has been attributed to the occurrence of a joint coin-stamp schema. British stamps bear a left-facing profile of the Queen, and it is possible that information from the stamp predominates in the formation of the schema. In the case of Denmark, however, stamps bear a full-face portrait of the Queen. Nevertheless, the present experiments showed that the Coin Head Illusion is also found in Denmark. That is, the number of participants recalling the Queen's head as facing to the right was significantly below even the chance level of 50%. Further, this result occurred both for residents of Denmark and for visitors to Denmark. These findings suggest that the bias underlying the Coin Head Illusion may be a more general one than that envisaged by the joint coin-stamp schema hypothesis.

Adult↗

Reducing financial barriers enhances the return rate of stool Hemoccult packets.

Patient compliance in returning fecal-hemoccult card packets has been studied in recent years but no specific interventions have been shown consistently to improve the return rate. It was wondered whether removing a small financial barrier for indigent patients would positively affect compliance. Therefore, the effect of prepaid postage on the rate of return was studied. Pre-prepared packets containing hemoccult cards with return envelopes were distributed in a randomized fashion to indigent and private insurance patients in outpatient clinics. On half of the return envelopes return postage was applied. The main outcome measure was the rate of return of stamped and unstamped packets stratified between indigent and private insurance patients. The overall rates of return were 117 of 159 (74%) for the stamped packets and 102 of 166 (61%) for unstamped packets (p < 0.02). After stratification, in the indigent patients (n = 177), 73 of 95 (77%) stamped packets were returned compared to 46 of 82 (56%) unstamped packets (p < 0.006). In the private insurance patients (N = 148), 44 of 64 stamped packets (69%) and 52 of 84 unstamped packets (62%) were returned (p > 0.10). Removing even small financial barriers (eg, providing a postage stamp) can enhance compliance for indigent patients.

Aged↗

Acute barrier disruption by adhesive tapes is influenced by pressure, time and anatomical location: integrity and cohesion assessed by sequential tape stripping. A randomized, controlled study.

BACKGROUND: Tape stripping is an established procedure in stratum corneum (SC) physiology research. Adhesive films are pressed to the surface of the skin and then removed. The superficial layers of the SC adhere to the film and are accessible for further investigations. Although this method is widely used, only scant information about standardization is known. Various protocols are used but are difficult to compare. OBJECTIVES: The aim of the present study was to investigate the effects of the type of tape, pressure, time, anatomical site and type of applied pressure. METHODS: Twelve healthy volunteers (age range 20-31 years) were entered in a randomized, controlled study with sequential tape stripping at the volar forearm, upper arm, cheek and back. Different methods (roller, stamp, thumb, stretched skin), total duration of applied pressure (2 s, 10 s), degrees of pressure (2 N stamp, 7 N stamp) and different tapes (D-Squame, Corneofix, Blenderm) were investigated and the impact on barrier function assessed by transepidermal water loss measurements. Furthermore, measurements of SC hydration, skin colour and skin surface pH were performed. Spectroscopic measurements and a Bradford protein assay to determine the mass of removed SC were carried out in parallel. RESULTS: The degree of barrier disruption, irritation and SC cohesion is influenced by the character of adhesive tapes, total duration of applied pressure (2 s, 10 s; 2 N, 7 N), the kind of method for pressure application (roller, stamp, thumb, stretched skin), anatomical site and condition before stripping (occlusion vs. nonocclusion). The spectroscopic assessment and Bradford protein assay determination showed a significant correlation (P < 0.0001; r = 0.7041). CONCLUSIONS: The present study showed significant differences between different factors on controlled barrier disruption. The results indicate the importance of defining these factors when a study is initiated and when results of different studies should be compared. Based on our data we propose using a 2 N stamp for a duration of 2 s on 15 sequential D-Squame tape strips on the volar forearm and then discarding the first and second strips. This approach allows the performance of a standardized study with a reasonable amount of resources.

Adult↗

Welfare reform consequences for children: the Wisconsin experience.

BACKGROUND: The Temporary Assistance to Needy Families, enacted under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, is a reality for many working families. As public policies are enacted, unintended consequences for infants/children must be minimized. Child advocates in Wisconsin, leading this nation in reforming Aid to Families with Dependent Children (AFDC), are concerned about supporting eligible infants/children as safety-net programs are unlinked. OBJECTIVE: This study reviews the enrollment status of 4 linked programs over time in Wisconsin, from January 1995 to August 1998. Eligible infants/children in programs, such as Medicaid/AFDC, Medicaid/Healthy Start, and Food Stamps, were analyzed and compared with enrollment in Special Supplemental Nutrition Program for Women, Infants/children (WIC), a nonlinked program. DESIGN: A cross-sectional analysis of monthly enrollment for infants/children was subdivided into 3 periods: prewelfare reform or AFDC (January 1, 1995 to December 31, 1995), the welfare reform pilot or Pay For Performance (January 1, 1996 to August 31, 1997), and welfare reform better known as Wisconsin Works (W-2), (September 1, 1998 to August 31, 1998), periods 1, 2, and 3, respectively. PARTICIPANTS: Infants/children in Wisconsin from birth to 18 years of age enrolled in W-2 and/or other safety-net programs were monitored: AFDC or W-2, WIC, Food Stamps, Medicaid/AFDC, and Medicaid/Healthy Start. RESULTS: The average number of infants/children removed from AFDC and Medicaid/AFDC during periods l and 2 were -1210 increasing to -3128 per month, respectively, almost tripling the rates of decline during the pilot period (see ). By the end of this study, >100 000 (111 198) infants/children were removed from AFDC/W-2 enrollment and 51 559 fewer infants/children benefited from Medicaid. This rate of decline slowed during period 3, averaging -687 per month, while W-2 enrollment continued to decline significantly at a rate of -2692 per month. In contrast, Medicaid/Healthy Start enrollment, targeted to infants/children <6 years of age, increased significantly over all periods by +332, +1327, and +266, respectively. Food Stamps enrollment also declined throughout all 3 consecutive periods, -603, -2462, and -1450, respectively. However, enrollment in the WIC program did not decline significantly to the same degree as other certification-linked programs with AFDC or W-2, as indicated by the consecutive slopes of -60, -111, and -183, respectively. CONCLUSION: Wisconsin infants/children were rapidly removed from welfare rolls in unprecedented numbers during the periods January 1995 and August 1998. Comparisons of periods before W-2 implementation and 1 year after implementation support the fact that certification-linked programs, such as Medicaid and Food Stamps, were sufficiently aligned to AFDC/W-2 to significantly impact infants/children enrollment. Historically, WIC certification in Wisconsin has not been linked to AFDC, and infants/children traditionally eligible for Medicaid and Food Stamps are also eligible for WIC. Yet, contrary to the AFDC-linked safety-net programs, declines in WIC enrollment were not statistically significant during all study periods. Statewide and local interventions within Wisconsin, such as outreach activities, targeted to Medicaid/Healthy Start and more recently Title XXI (State Children Health Insurance Program), slowed the reductions of Medicaid enrollment for Wisconsin infants/children. These findings support that altering safety-net programs can result in unintended consequences if not carefully transitioned as demonstrated in Wisconsin welfare reform.

Adolescent↗

Impact of the Oregon Health Plan on access and satisfaction of adults with low income.

OBJECTIVE: To evaluate the effects of the Oregon Health Plan (OHP) on beneficiary access and satisfaction. DATA SOURCES: Telephone survey of nondisabled adults in 1998. STUDY DESIGN: Two groups of adults were surveyed: OHP enrollees and Food Stamp recipients not enrolled in OHP. The Food Stamp sample included both privately insured and uninsured recipients. This allowed us to disentangle the insurance effects of OHP from other effects such as its reliance on managed care and the priority list. OHP and Food Stamp adults were compared along the following measures: usual source of care, utilization of health care services, unmet need, and satisfaction with care. DATA COLLECTION: The survey was conducted by telephone, using computer-assisted telephone interviewing techniques. PRINCIPAL FINDINGS: Much of OHP's impact has been realized by its extension of health insurance coverage to Oregon's low-income residents. The availability of health insurance significantly increased the utilization of many health care services and reduced unmet need for care. OHP was associated within a higher percentage of enrollees having a usual source of care and higher rates of Pap test screening among women compared with Food Stamp recipients. OHP enrollees also reported significantly higher use of dental care and prescription drugs; use we attribute to the expanded benefit package under the priority list. At the same time, OHP enrollees reported a greater unmet need for prescription drugs. Drug treatment for below-the-line conditions was one reason for this unmet need, but often the specific drug simply was not in the plan's formulary. OHP enrollees were as satisfied with their health care as those Food Stamp recipients with private health insurance. CONCLUSIONS: Despite the negative publicity prior to its implementation, there is no evidence that "rationing" under OHP's priority list has substantially restricted access to needed services. OHP adults appear to enjoy access equal to or better than that of low-income persons with private health insurance and have far greater access than the uninsured.

Adult↗

Raising our HEADSS: adolescent psychosocial documentation in the emergency department.

OBJECTIVES: To determine the effectiveness of a chart stamp featuring the acronym "HEADSS" (Home, Education, Alcohol, Drugs, Smoking, Sex) at improving adolescent psychosocial documentation in the emergency department (ED) chart. METHODS: The study sample consisted of ten emergency physicians. The ED charts of 306 adolescent patients (aged 13-18 years) completed by these physicians were surveyed. An analysis of ED chart psychosocial documentation was conducted that compared a six-week control phase (with no chart stamp) with a four-week intervention phase (with a chart stamp featuring the HEADSS acronym). Presenting complaints in the ED, psychosocial documentation in the ED, and information from past medical records were compared between the two groups. RESULTS: The ED charts surveyed consisted of 153 charts from each phase. HEADSS documentation ranged from 8% to 12% in the intervention phase and 0% to 7% in the control phase. Emergency physicians were more likely to document the topics of education (p = 0.029), alcohol (p = 0.045), and smoking (p = 0.009) as well as whether the patient was interviewed alone (p = 0.0001) in the intervention phase charts. Documentation of a detailed psychosocial assessment (>4/6 HEADSS topics addressed; p = 0.003) was more likely during the intervention phase. CONCLUSIONS: The HEADSS stamp is useful in prompting psychosocial documentation in the ED chart. Further study is needed to determine whether routine use of the HEADSS stamp technique can improve the detection and management of adolescent psychosocial problems.

Adolescent↗

A comparison of response rate and time according to the survey methods used: a randomized controlled trial.

The purpose of this study was to evaluate the effects of recorded and standard deliveries, and stamped and franked return envelops in a postal survey of Korean-Vietnam veterans. Nine hundred veterans were randomly divided into four subgroups. A randomized controlled trial was conducted for two mailing strategies. The 52 study subjects to whom mail was undeliverable and 36 additional study subjects found not to be residing at the listed addresses were excluded from the study. The 699 (86%) surveys were returned within 39 business days after the first mailing. The response rate for the recorded delivery (88%) was significantly higher than that of the standard delivery (82%)(p = 0.03), and the response rate of the stamped return envelops (88%) was higher than that of the franked return envelops (85%)(p = 0.27). The replies for the recorded and standard deliveries arrived an average of 10.2 and 9.9 business days, respectively, after the first mailing (p = 0.60). The average times of the responses for the stamped and franked return envelops were 9.8 and 10.4 business days, respectively (p = 0.25). Recorded deliveries significantly increased the response rate compared to standard deliveries, and stamped return envelops slightly increased the response rate a little compared to franked return envelops. The timing of response of recorded deliveries was similar to that of standard deliveries but the volume of response of recorded deliveries was higher than that of standard deliveries.

Data Collection↗