Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.

To assess whether Health Risk Appraisal (HRA), a computer-scored lifestyle analysis questionnaire, can result in significant changes in health behavior, a controlled clinical trial with one-year follow-up was conducted among entering freshmen at an urban state university. Three hundred fifty entering freshmen were each assigned to one of four groups: HRA with feedback, HRA without feedback, initial control, and final control. Twenty-two per cent of the nonsmokers in the no-feedback group, as compared with 5% in the feedback group, acquired the habit of cigarette smoking (p less than 0.001). Furthermore, 26% of the smokers in the feedback group, as compared with 6% in the no-feedback group, were able to quit smoking (p less than 0.05). Among those unable to quit smoking, 59% in the feedback group, as compared with 19% in the no-feedback group, were able to reduce their cigarette consumption by more than six cigarettes per day (p less than 0.01). Health Risk Appraisal, when accompanied by feedback counseling, was an effective health promotion tool to help prevent nonsmokers from acquiring the habit and to modify cigarette smoking behavior among college freshmen.

Lectures on moral philosophy. By the Rev. John Witherspoon ... Carefully revised, and freed from the errors of former editions. To which is added, by the same author, an Address to the students of the senior class, and Letters on education and marriage.

An unusual clinical presentation of moderate hypercalcemia as a result of primary hyperparathyroidism is described. The patient complained of fatigue, depression, thirst, polyuria, and focal neurologic symptoms including amaurosis fugax, anomia, right upper-extremity dysesthesias, and a left cerebral transient ischemic attack. No structural central nervous system abnormality could be documented. Signs and symptoms disappeared when serum calcium levels were reduced from 13.2 to 9.8 mg/100 ml. They have not recurred in 30 months of follow-up. The association of focal neurologic disease and hypercalcemia is uncommon. Although the precise pathophysiologic mechanism is unclear, this patient's symptoms suggest a vascular etiology.

No abstract