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Aspergillus oryzae in solid-state and submerged fermentations. Progress report on a multi-disciplinary project.

We report the progress of a multi-disciplinary research project on solid-state fermentation (SSF) of the filamentous fungus Aspergillus oryzae. The molecular and physiological aspects of the fungus in submerged fermentation (SmF) and SSF are compared and we observe a number of differences correlated with the different growth conditions. First, the aerial hyphae which occur only in SSFs are mainly responsible for oxygen uptake. Second, SSF is characterised by gradients in temperature, water activity and nutrient concentration, and inside the hyphae different polyols are accumulating. Third, pelleted growth in SmF and mycelial growth in SSF show different gene expression and protein secretion patterns. With this approach we aim to expand our knowledge of mechanisms of fungal growth on solid substrates and to exploit the biotechnological applications.

Aspergillus oryzae↗

Effects of intraoperative progress reports on anxiety of elective surgical patients' family members.

The purpose of this experimental study was to examine the effects of intraoperative progress reports on family members' state anxiety level (STAI S-Anxiety), mean arterial pressure (MAP), and heart rate during elective surgical procedures. Family members of randomly selected surgical patients were eligible to participate. Control group family members (n = 50) received usual care. Family members in the experimental group (n = 50) received a 5- to 10-minute progress report protocol about halfway through a surgical procedure. Families' STAI S-Anxiety scores, MAP, and heart rates were compared between the control and experimental groups using multivariate analysis of variance (MANOVA). Family members in the experimental group reported lower STAI S-Anxiety scores (p < .001), and had significantly lower MAP and heart rates than did the control group (p < .001). Progress reports appear to be a beneficial nursing intervention for reducing anxiety in family members during the intraoperative period.

Adolescent↗

Running a randomised controlled trial in a service setting: a progress report.

This paper will give a progress report on a randomised controlled trial which is currently underway in the Bristol area. Some of the key influencing literature will be summarised, followed by an overview of the study design. The paper will also highlight some of the methodological and practical advantages and disadvantages afforded by the service setting of the study.

Child, Preschool↗

Effects of intraoperative progress reports on anxiety levels of surgical patients' family members.

A three-group quasi-experimental posttest-only design was used to examine the effectiveness of intraoperative progress reports by comparing family members' state-anxiety score, mean arterial pressure level (MAP), and heart rate during elective surgical procedures. Control-group family members (n = 50) received usual care. Family members in the experimental group (n = 50) received a 5- to 10-minute progress report protocol about halfway through a surgical procedure. An additional group of family members (n = 50) received an attention protocol. Family members in the experimental group reported lower state-anxiety scores (p < .001) and had significantly lower MAP levels (p < .001) and heart rates (p < .01) compared with the control and attention groups. Progress reports appear to be a beneficial independent nursing intervention for reducing anxiety in family members during the intraoperative waiting period.

Adult↗

The Framework for Mental Health Services in Scotland--a progress report one year on.

Progress in implementing the Framework for Mental Health Services in Scotland since its launch in September 1997 is described. Reasons for action being behind the expected timetable are discussed. The success of the joint strategies, due for completion by the end of December 1998, hinges on overcoming the deep systemic factors which mitigate against change. The Framework as a template has the potential to be a powerful change agent to counter these. The development of better services requires a balance of "top down" and "bottom up" approaches, and front line staff must be actively engaged in the process.

Health Care Rationing↗

Predictors of adherence to glatiramer acetate therapy in individuals with self-reported progressive forms of multiple sclerosis.

The purpose of this study was to evaluate psychological, biophysical, and sociodemographic variables as predictors of adherence to glatiramer acetate (Copaxone) therapy in individuals with self-reported progressive forms of multiple sclerosis (MS). The literature lends support for self-efficacy, self-esteem, hope, and disability to be predictors of adherence. Therefore the hypotheses for this study were (a) higher self-efficacy will be a significant predictor of adherence, (b) higher self-esteem will be a significant predictor of adherence, (c) higher hope will be a significant predictor of adherence, and (d) a lower level of disability will be a significant predictor of adherence. The MS Self-Efficacy Scale (MSSE), Rosenberg Self-Esteem Scale, Herth Hope Index, and Performance Scales; a sociodemographic questionnaire; and an information sheet regarding consent to participate in the study were mailed to 1,200 potential participants. A total of 594 individuals responded, and for the evaluation of predictors of adherence in individuals with self-reported progressive forms of MS, 199 met the criteria. Logistic regression analysis revealed four significant predictors of adherence: the MSSE Control subscale, MSSE Function subscale, perceived support of the physician, and perceived support of the spouse. The higher the score on the MSSE Control subscale, the more likely the individual will adhere to glatiramer acetate therapy. The higher the score on the MSSE Function subscale, the more likely the individual will adhere to glatiramer acetate therapy. The MSSE Control and Function subscales show promise of being useful to predict adherence.

Activities of Daily Living↗

Intraoperative progress reports to families of surgical clients: a missed opportunity.

The wait while a family member or loved one is undergoing surgery is stressful and anxiety-producing. Perioperative nursing contact during this period can result in positive outcomes of decreased anxiety, increased receptivity to postoperative information, and increased awareness of the professional practice. Perioperative nurses have the skills and the opportunity to provide progress reports to the client's family, at least once during surgery. Characteristics important to this role include motivation and commitment to be informative; caring; sensitivity and perceptivity; sense of humour; and education. Possible barriers to intraoperative communications include various lacks--of time; attention (related to monitoring requirements in the operating room); support from management, peers, and doctors; and therapeutic communication skills to alleviate anxiety. Progress reports to the family can decrease their physical stress and add to their satisfaction with the hospital.

Communication↗

Progress report on the anorectic effects of dexfenfluramine, fluoxetine and sertraline.

This progress report on the anorectic effect of serotoninergic indirect antagonists compares the action of D-fenfluramine, fluoxetine and sertraline and their N-dealkylated metabolites. Brain levels of drugs and their metabolites were measured after equi-active anorectic doses. Fluoxetine and sertraline inhibit 5-HT uptake in vitro with a potency which is at least one order of magnitude higher than for D-fenfluramine while all three drugs release 5-HT from synaptosomes and the active concentrations are closer to the brain concentrations reached after anorectic doses. However, a number of differences have been observed between D-fenfluramine and fluoxetine regarding the mechanisms of 5-HT release. Furthermore fluoxetine affected storage of 5-HT in vesicles much more than D-fenfluramine did. The anorectic effect induced by fluoxetine was not antagonized by antiserotoninergic drugs. No evidence of an involvement of CCK in the anorectic effect of D-fenfluramine was found when food intake was determined in rats previously submitted to food deprivation.

1-Naphthylamine↗

The Swedish Trial in old patients with hypertension-2 (STOP-hypertension-2): a progress report.

OBJECTIVE: The Swedish Trial in Old Patients with Hypertension-2 (STOP-Hypertension-2) was designed by a project group of the Swedish Hypertension Society to test whether the "newer" treatment alternatives (ACE inhibitors and calcium antagonists) are as good as, better or less good than, the "older" ones (beta-blockers and diuretics) in terms of preventing cardiovascular morbidity and mortality in elderly hypertensives. The aim of the present paper is to report on the progress of the study. DESIGN: Prospective, open trial with blinded end-point committee and centralized randomization (PROBE design). STOP-Hypertension-2 may be regarded as a scientific follow-up of the previously published Swedish Trial in Old Patients with Hypertension (STOP-Hypertensioon-1) (6) using the same study organization. SUBJECTS: By the end of 1994 when recruitment was stopped, 6628 hypertensive men (34%) and women (66%) aged 70-84 (mean age 76) had been included at 312 Swedish health centres (out of approximately 850). In the whole cohort 11% are diabetics and 9% smokers. The mean total cholesterol value is 6.5 mmol/L. RESULTS: In the whole study cohort, blood pressure was lowered from 194/98 mmHg to 167/85 mmHg after one year. At the end of 1995, 319 fatal events (all-cause mortality) had been reported, corresponding to a mortality rate of 21.3 per 1000 person-years. CONCLUSION: In STOP-Hypertension-2, 6628 elderly hypertensive have been randomized to three different treatment regimes: beta-blocker+diuretics (the active treatment arm in STOP-Hypertension-1), ACE inhibitors, or calcium antagonists. Their average lowering of blood pressure was 27/13 mmHg and end-points have occurred at the expected rate. Thus, it should be possible to terminate STOP-Hypertension-2 within two to three years.

Aged↗

Potential approaches to the assessment of amino acid adequacy in rats: a progress report.

We report on research progress on two approaches that may be useful in determining the upper adequacy range for macronutrients such as amino acids. One approach was to attempt to identify "toxic metabolites" that were responsible for toxicity or biomarkers for the toxicity of excessive intake of an amino acid in rats. We found that there was hepatic toxicity that was specifically associated with L-cystine excess, but not with L-cysteine excess. We analyzed urine samples from rats fed basal diets or L-cystine or L-cysteine excess diets and identified 25 peaks from gas chromatography mass spectrometry analysis that were specific for L-cystine excess and also correlated with toxicity markers. Another approach was to try to identify "metabolic limits" by measuring CO(2) arising from amino acid excess. Uniformly (13)C labeled L-leucine was used as tracer, in diets with added L-leucine fed to rats, and (13)CO(2) arising from its metabolism was collected over 24 h and the fraction of the ingested L-leucine that was exhaled as CO(2) was calculated. The fractional exhalation of (13)CO(2) increased with increasing L-leucine dose, but showed an inflexion point at approximately 8.9 g/kg body weight, after which it reached a plateau. This suggested that >8.9 g/kg BW, the catabolism of L-leucine changed and this approximately coincided with the dose above which a statistically significant decrease in body weight was seen.

Amino Acids↗

A progress report on accelerated residency programs in family practice.

BACKGROUND: In 1991 the American Board of Family Practice (ABFP) approved 12 programs to participate in an experiment in medical education. Selected students in 12 medical schools are able to complete their first year of family practice residency while completing their fourth year of school. This paper reports on the progress of the programs and residents participating in this project. METHOD: Data from the ABFP in-training examination and certification examination were compiled for all trainees and graduates through 1994. Performances were compared with national norms and the performances of traditional residents in the same programs. The program directors were surveyed to assess their experiences, program effectiveness, benefits, liabilities, and implementation problems. RESULTS: Accelerated residents performed better than their peers and national norms on the ABFP in-training and certification examinations. The directors rated the clinical performance of accelerated residents as equal to or better than the clinical performance of traditional residents by the end of the program. Advantages of accelerated residency included improvements in recruiting, image, and morale. Problems occurred in order and prescription writing and acceptance of the accelerated residents by nurses, other residents, and physicians in other disciplines. CONCLUSION: Early entry into residency training of bright, highly motivated, and mature students appears to offer benefits for trainees and programs alike.

Educational Measurement↗

The Siblings With Ischemic Stroke Study (SWISS): a progress report.

There is increasing evidence that genetic factors are associated with ischemic stroke, including multiple recent reports of association with the gene PDE4D, encoding phosphodiesterase 4D, on chromosome 5q12. Genetic studies of stroke are important but can be logistically difficult to perform. This article reviews the design of the Siblings With Ischemic Stroke Study (SWISS) and discusses problems in performing a sibling-based pedigree study where proband-initiated consent is used to enroll pedigree members. Proband-initiated enrollment optimizes privacy protections for family members, but it is associated with a substantial pedigree non-completion rate such that 3 to 4 probands must be identified to obtain one completed sibling pedigree. This report updates the progress of enrollment in the SWISS protocol, discusses barriers to pedigree completion and describes innovative approaches used by the SWISS investigators to enhance enrollment.

3',5'-Cyclic-AMP Phosphodiesterases↗

Second annual progress report on introduction and use of investigational anticancer agents in Australia, 1984-1985. Anticancer Subcommittee of the Australian Drug Evaluation Committee.

Since the publication of its first report, the Anticancer Subcommittee of the Australian Drug Evaluation Committee (ADEC) has provided advice to ADEC and to the Commonwealth Department of Health on investigational anticancer agents in all stages of development. This second report outlines the progress in 1984-1985.

Antineoplastic Agents↗