BackgroundTo develop content validity of a comprehensive patient-reported outcome (PRO) measure following current best scientific methodology to standardize assessment of influenza (flu) symptoms in clinical research.MethodsStage I (Concept Elicitation): 1:1 telephone interviews with influenza-positive adults (≥18 years) in the US and Mexico within 7 days of diagnosis. Participants described symptom type, character, severity, and duration. Content analysis identified themes and developed the draft Flu-PRO instrument. Stage II (Cognitive Interviewing): The Flu-PRO was administered to a unique set of influenza-positive adults within 14 days of diagnosis; telephone interviews addressed completeness, respondent interpretation of items and ease of use.ResultsSamples: Stage I: N = 46 adults (16 US, 30 Mexico); mean (SD) age: 38 (19), 39 (14) years; % female: 56 %, 73 %; race: 69 % White, 97 % Mestizo. Stage II: N = 34 adults (12 US, 22 Mexico); age: 37 (14), 39 (11) years; % female: 50 %, 50 %; race: 58 % White, 100 % Mestizo. Symptoms: Symptoms identified by >50 %: coughing, weak or tired, throat symptoms, congestion, headache, weakness, sweating, chills, general discomfort, runny nose, chest (trouble breathing), difficulty sleeping, and body aches or pains. No new content was uncovered during Stage II; participants easily understood the instrument.ConclusionsResults show the 37-item Flu-PRO is a content valid measure of influenza symptoms in adults with a confirmed diagnosis of influenza. Research is underway to evaluate the suitability of the instrument for children and adolescents. This work can form the basis for future quantitative tests of reliability, validity, and responsiveness to evaluate the measurement properties of Flu-PRO for use in clinical trials and epidemiology studies.

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We have tested the entire Keio collection of close to 4,000 single-gene knockouts in Escherichia coli for increased susceptibility to one of seven different antibiotics (ciprofloxacin, rifampin, vancomycin, ampicillin, sulfamethoxazole, gentamicin, or metronidazole). We used high-throughput screening of several subinhibitory concentrations of each antibiotic and reduced more than 65,000 data points to a set of 140 strains that display significantly increased sensitivities to at least one of the antibiotics, determining the MIC in each case. These data provide targets for the design of "codrugs" that can potentiate existing antibiotics. We have made a number of double mutants with greatly increased sensitivity to ciprofloxacin, and these overcome the resistance generated by certain gyrA mutations. Many of the gene knockouts in E. coli are hypersensitive to more than one antibiotic. Together, all of these data allow us to outline the cell's "intrinsic resistome," which provides innate resistance to antibiotics.Antibiotics have had a major impact over the past 6 decades in the fight against infectious diseases (for a review by Davies, see reference 11). However, the spread of antibiotic-resistant microorganisms has reached an alarming point (1,11,35), prompting renewed efforts to find new antibiotics by detecting new targets through genomics, altering existing antibiotics, screening chemical (e.g., see reference 9) or peptide (21, 31) libraries for specific inhibitors (e.g., see reference 9), or finding new sources of antibiotics via metagenomics (e.g., see reference 53). While these lines of investigation show great promise, additional approaches are constantly being sought to yield a new generation of useful antimicrobial compounds. For instance, focusing on species-specific antibiotics rather than broad-spectrum antibiotics can result in important new agents (38), as could targeting bacterial transcription factors (5) or different processes, such as Holliday junction processing (21, 31) and quorum sensing (24), or even targeting host factors that support pathogen growth (33). Another approach, examined here, involves potentiating existing antibiotics by identifying targets for increasing susceptibility to specific antimicrobials. There are precedents for using such combinational therapy. For example, inhibitors of ␤-lactamase have been used together with ␤-lactam antibiotics (for a review by Buynak, see reference 7) and inhibitors of efflux pumps together with tetracycline in Escherichia coli (46) and with levofloxacin in Pseudomonas aeruginosa (37). In the case of chemotherapeutics, zebularine, a cytosine analog (41) and mutagen (34) that is converted in vivo to an inhibitor of cytosine deaminase (41), is used in combination with certain cytosine deaminase-susceptible cytosine-based drugs (14, 40). With regard to finding new targets for this type of approach, a number of genes that increase the sensitivities of microorganisms to different antibiotics have been identified (e.g., for a review by Drlica and Zhao, ...

The Osteoporosis Health Belief Scale was developed to measure health beliefs related to osteoporosis. It is a 35-item self-report questionnaire based on the Health Belief Model which is specifically designed to assess beliefs related to exercise behaviors and calcium intake of elderly subjects. The instrument consists of seven subscales: Seriousness, Susceptibility, Health Motivation, Calcium Benefits, Calcium Barriers, Exercise Benefits, and Exercise Barriers. The instrument was tested on a sample of 150 elderly individuals. The psychometric properties of the scales are discussed along with recommendations for its use in research and practice.

ES is associated with fewer complications, shorter LOHS, but higher reintervention rates and overall charges.

The incremental increase in diagnostic yield of EUS and fluid analysis over CT and MRI for prediction of a neoplastic cyst is 36% and 54%, respectively. The addition of EUS-FNA to abdominal imaging significantly increases overall accuracy for diagnosis of neoplastic pancreatic cysts.

The Osteoporosis Self-Efficacy Scale was developed as a measure of self-efficacy, or confidence, for behaviors related to physical activity and calcium intake. An item pool of 21 statements, responded to on a visual analog self-report format, was reviewed by a panel of expert judges. The revised item stems were tested with a sample of 201 women, ages 35 to 95. Concurrent data on sport, leisure, and exercise activity and calcium in diet and dietary supplements were collected from the respondents. Factor analysis of responses to the self-efficacy items revealed a logical, theoretically meaningful two-factor structure, one for physical activity and one for calcium intake. Internal consistency estimates for each of the two factors were in the .90s. Convergent and discriminant validity analyses as well as hierarchical regression analyses to explain self-reports of physical activity and calcium intake were supportive. The final version of the brief, psychometrically sound scale contains items reflecting initiation, maintenance, and persistence at osteoporosis preventive behaviors; thus, the Osteoporosis Self-Efficacy Scale is a potentially beneficial research instrument.

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