Boston jobfocus. Nursing in Boston: a learning experience.
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Rates of drug-induced gastrointestinal bleeding were estimated from data on 16 646 consecutively monitored medical inpatients who had no known predisposing illness. Heparin, warfarin, ethacrynic acid, steroids, and aspirin-containing drugs were associated with gastrointestinal bleeding and were estimated to account for about two-thirds of such bleeds. Major gastrointestinal bleeding, defined as bleeding severe enough to require transfusion, occurred in only 57 patients (0.3%).
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BACKGROUND: In 1999, the Centers for Disease Control and Prevention (CDC) funded Play Across Boston to address disparities in access to physical activity facilities and programs for Boston, Mass, inner-city youths. CONTEXT: Local stakeholders worked with the Harvard School of Public Health Prevention Research Center and Northeastern University's Center for the Study of Sport in Society to improve opportunities for youth physical activity through censuses of facilities and programs and dissemination of results. METHODS: Play Across Boston staff conducted a facility census among 230 public recreational complexes and a program census of 86% of 274 physical activity programs for Boston inner-city youths aged 5 to 18 years during nonschool hours for the 1999 to 2000 school year and summer of 2000. Comparison data were collected from three suburban communities: one low income, one medium income, and one high income. CONSEQUENCES: Although Boston has a substantial sports and recreational infrastructure, the ratio of youths to facilities in inner-city Boston was twice the ratio found in the medium- and high-income suburban comparison communities. The low-income suburban comparison community had the highest number of youths per recreational facility with 137 youths per facility, followed by Boston with 117 youths per facility. The ratio of youths to facilities differed among Boston neighborhoods. Boston youths participated less in school-year physical activities than youths in medium- and high-income communities, and less advantaged Boston neighborhoods had lower levels of participation than more advantaged Boston neighborhoods. Girls participated less than boys. INTERPRETATION: Play Across Boston successfully developed and implemented a rigorous needs assessment with local relevance and important implications for public health research on physical activity and the environment. Boston Mayor Thomas M. Menino called the Play Across Boston report a "playbook" for future sports and recreation planning by the city of Boston and its community partners.
A study was made of 30 patients presenting with lumbar and thoracolumbar scoliosis; 15 patients had been treated with a 3-valve orthosis and 15 with a Boston brace. The mean age at the commencement of treatment was 14 years for the 3-valve orthosis and 14 years 4 months for the Boston brace. The total duration of treatment was 11.1 months for the 3-valve orthosis and 11.8 months for the Boston brace. The patients with the 3-valve orthoses presented with an initial mean curve of 30 degrees and with the Boston braces a curve of 24 degrees. The mean follow-up after removal of the brace was 17 months for the 3-valve orthosis and 12 months for the Boston braces. The efficacy of the two orthoses was studied in the frontal and horizontal planes, taking into account the overall rotation of the curve and the segmental rotation of each vertebra in the curve. The Boston brace and the 3-valve orthosis were identical in the correction of the curve. The overall derotation was better with the 3-valve orthosis. Segmentally, the 3-valve orthosis was more effective at the apex of the curve whilst the Boston brace was more effective at the extremities of the curve. The ilio-lumbar angle and the trunk instability were corrected better by the Boston brace. The specific indication for the 3-valve orthosis seems, therefore, to be scolioses in which there is a predominance of rotation at the apex of the curve. The Boston brace has its main indication in cases where rotation is considerably close to or at the ends of the curve.
Resonance Raman spectra have been obtained for Hb M Boston [His-E7(58) alpha leads to Tyr], Hb M Iwate [His-F8-(87) alpha leads to Tyr], and Hb M Milwaukee [Val-E11(67) beta leads to Glu]. The abnormal alpha subunits of Hb M Boston and Hb M Iwate exhibited the porphyrin nu10 band at 1628 and 1627 cm-1, respectively, which indicates that the ferric alpha hemes are five-coordinated in both Hb M Boston and Hb M Iwate. In addition to the porphyrin bands, four extra polarized lines were observed at 1607, 1506, 1278, and 603 cm-1 for the alpha abnormal subunit of Hb M Boston and at 1605, 1506, 1310, and 589 cm-1 for that of Hb M Iwate. By comparison with the vibrational spectra of Fe-tyrosine proteins and Fe-phenolate complexes, the 1605-1607- and 1506-cm-1 lines are assigned to the phenolate ring vibrations of the heme-coordinated tyrosine, and the 1278-cm-1 line of Hb M Boston and the 1310-cm-1 line of Hb M Iwate are assigned to the phenolate CO stretching mode. We propose that the 603-cm-1 line of Hb M Boston and the 589-cm-1 line of Hb M Iwate arise from the Fe-O(tyrosine) stretching mode. These four Raman lines are intensity enhanced upon the excitation around 475-520 nm, probably due to the presence of a charge-transfer interaction between Fe and Tyr. The dissimilarity of the Fe-O and phenolate CO stretching frequencies between Hb M Boston and Hb M Iwate, despite the similarity of frequencies of their porphyrin and phenolate ring modes, suggests that the heme-phenolate bonding angles differ between Hb M Boston and Hb M Iwate although both adopt the five-coordinate form with Tyr as the only axial ligand. The resonance Raman spectra of oxy- and deoxy-Hb M Milwaukee showed no anomaly and can be accounted for by those of the equimolar mixtures of aquomet- and oxy- or deoxy-Hb A.
Several functional tests were performed to compare Hb A, Hb A2, and Hb Lepore Boston, which has a delta-beta crossover in the region of residues 87 to 116. Oxygen equilibrium curves determined by an automatic apparatus in 0.1 M potassium phosphate buffer, pH 7.0, at 20 degrees showed that the p50 was 5.8 mm Hg for Hb Lepore Boston, in contrast to 8.1 and 10.3 mm Hg for Hb A2 and Hb A, respectively. The n values (Hill coefficinets) of Hb Lepore Boston and Hb A2 were slightly smaller than that of Hb A. The effect of 2,3-diphosphoglycerate and inositolhexophosphate on the p50 of Hb Lepore Boston and Hb A2 was less than that on the p50 of Hb A. The molecular stability to mechanical shaking of Hb Lepore Boston and Hb A2 showed that the oxy forms of Hb Lepore Boston and Hb A2 denatured at a rate 3 times faster than that of Hb A. MetHb Lepore Boston was more unstable than MetHb A2 to mechanical shaking. These results indicate that, although the molecular stability of Hb Lepore Boston is more similar to that of Hb A2 than that of Hb A, the oxygen-binding properties of Hb Lepore differ from both Hb A and Hb A2.
Two cystic fibrosis (CF) clinic populations of similar size and age distribution were compared with respect to growth, pulmonary function, and survival. Height and weight measurements were made on 499 patients in Boston (mean +/- SD age 15.9 +/- 9.6, range 1 month to 45 years) and on 534 patients in Toronto (mean +/- SD age 15.2 +/- 8.3, range 1 month to 43 years). Males constituted 57% in the Boston group, 58% in Toronto. Pulmonary function test results were recorded for 64% of the Boston patients and 77% of the Toronto patients. Survival curves for the period 1972-1981 generated by the CF Patient Registry were compared. Patients in Boston tended to be shorter than patients in Toronto. This pattern was seen in both sexes in the 10-20 year age groups. Toronto males also weighed more than Boston males. Mean forced expiratory volume in one second (FEV1) was not different in Boston and Toronto CF patients whether expressed as a percent of predicted or in litres by age groups. Median age of survival in Boston was 21 years, in Toronto 30, the two curves showing a marked separation from age 10. Although progressive pulmonary disease is the major cause of mortality in cystic fibrosis, the differences in growth and survival in these two patient groups, with very similar age-specific pulmonary function, suggest further examination of nutritional guidance and intervention in CF, especially regarding the traditional restriction of dietary fat.
STUDY OBJECTIVE: Although safety belt legislation exists for drivers in Massachusetts, there is an exemption for taxicab drivers. According to the most recent data from the Governor's Highway Safety Bureau, the observed safety belt use rate of drivers in Massachusetts is 64%. However, the safety belt use among taxicab drivers in Boston is unknown. METHODS: An observational study was conducted to assess the prevalence of safety belt use among taxicab drivers in Boston. We compared our findings with state-level data obtained from the Governor's Highway Safety Bureau. Research staff made observations of taxicabs arriving at various sites within Boston (Logan Airport, Back Bay subway entrance, Government Center, and a hospital in Boston). The methodology used in this study was adapted from MASS-Safe, the Traffic Safety Research Program of the Governor's Highway Safety Bureau. In brief, research staff assessed the use of shoulder safety belts worn by taxicab drivers in Boston. Researchers observed traffic flow coming from a single direction at each observation site. These observers were instructed to include only taxicabs in motion, approaching in the nearest lane to the sidewalk. RESULTS: Two hundred fifty taxicabs were observed during the study period. Of these, 247 taxicab drivers were men (98.9%), whereas 3 were women (1.2%). Overall, 17 of 250 taxicab drivers (6.8%; 95% confidence interval 3.9% to 9.7%) wore safety belts, whereas 233 (93.2%) did not. CONCLUSION: The safety belt use among taxicab drivers in Boston is 6.8%, markedly lower than the state-level safety belt use of other drivers in Massachusetts. Stronger safety belt use legislation in Massachusetts may help to improve safety belt use among taxi drivers in Boston.