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PubMed2004

Ventricular assist devices as destination therapy.

The prospects for long-term mechanical circulatory support are improving. Axial flow pumps are a promising competitor to pulsatile first-generation LVADs, although the two may serve different patient populations. Centrifugal pumps are in the development phase and seem to require less anticoagulation. Clinical experience has established the safety of diminished pulse pressure circulation, and mechanical unloading appears to promote recovery of the native left ventricle. Under these circumstances, true left ventricular assist is preferable to ventricular replacement and detailed medical management improves patient outcomes. Further clinical trials of destination therapy are indicated and must use more reliable blood pumps implanted before terminal decline into multiorgan failure.

Cardiac Output, Low↗

PubMed2003

Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study.

OBJECTIVE: To examine the association between initial hematocrit level at the time of ischemic stroke, discharge destination, and resource utilization. DESIGN: Case series. SETTING: University hospital. PARTICIPANTS: A total of 1012 consecutive patients with ischemic stroke admitted to a university health system between August 3, 1995, and June 24, 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of stay, hospital cost, and discharge disposition. RESULTS: Of 1012 patients presenting with ischemic stroke, 58% were discharged home, 10% were discharged home with home care services, 15% were discharged to a rehabilitation hospital, 11% were discharged to a skilled or intermediate care facility, and 6% died. After adjusting for age, sex, race, and comorbidities, a significant association (P=.009) existed between discharge outcome and initial hematocrit level. The probability of achieving an equivalent or less favorable outcome increased at both high and low hematocrit levels, with a minimum probability at a hematocrit level of approximately 45%. CONCLUSIONS: An association exists between hematocrit level at the time of ischemic stroke and discharge outcome. Midrange hematocrit levels appear to be associated with discharge to home rather than to an inpatient rehabilitation unit or to a nursing facility. Further study is indicated to examine the relationship among hematocrit level, stroke severity, and outcome.

Aged↗

PubMed2001

Protein kinase D regulates the fission of cell surface destined transport carriers from the trans-Golgi network.

When a kinase inactive form of Protein Kinase D (PKD-K618N) was expressed in HeLa cells, it localized to the trans-Golgi network (TGN) and caused extensive tubulation. Cargo that was destined for the plasma membrane was found in PKD-K618N-containing tubes but the tubes did not detach from the TGN. As a result, the transfer of cargo from TGN to the plasma membrane was inhibited. We have also demonstrated the formation and subsequent detachment of cargo-containing tubes from the TGN in cells stably expressing low levels of PKD-K618N. Our results suggest that PKD regulates the fission from the TGN of transport carriers that are en route to the cell surface.

Biological Transport↗

PubMed2000

Risk and aetiology of diarrhoea at various tourist destinations.

Almost two of three tourists developed traveller's diarrhoea during 2-week stays at high-risk destinations. Large differences in infection rates between hotels were seen. Patients with milder forms of diarrhoea show a similar chronology to those more severely affected. Although enterotoxigenic Escherichia coil was the most frequent cause, viral pathogens were detected more often than in other studies.

Brazil↗

PubMed1986

Membrane biogenesis in embryonal carcinomas: glycoproteins destined for the cell surface are delayed in a pre-Golgi compartment.

Embryonal carcinoma and early embryonic cells assemble a family of unusually large and complex carbohydrates. These glycans are highly branched, repeating copolymers of the sugars galactose and N-acetylglucosamine, referred to as polylactosamines, and are frequently decorated with fucose, sulfate, and sialic acid. We have previously shown that in teratocarcinoma cells these glycans are part of a large spectrum of glycans assembled on mannose cores derived from a common precursor glycan. Metabolic studies revealed a large excess of high-mannose glycans at a time when complex-type glycans cease to accumulate. The present studies demonstrate that these high-Man glycans are not degraded internally or secreted directly but are on glycoproteins destined for the cell surface. These unprocessed glycoproteins replace material lost during the extensive membrane turnover that occurs in these cells. Their export to the cell surface is delayed in a pre-Golgi compartment.

Animals↗

PubMed2001

Titanium powder sintering for preparation of a porous functionally graded material destined for orthopaedic implants.

This work focuses on basic research into a P/M processed, porous-surfaced and functionally graded material (FGM) destined for a permanent skeletal replacement implant with improved structural compatibility. Based on a perpendicular gradient in porosity the Young's modulus of the material is adapted to the elastic properties of bone in order to prevent stress shielding effects and to provide better long-term performance of the implant-bone system. Using coarse Ti particle fractions the sintering process was accelerated by silicon-assisted liquid-phase sintering (LPS) resulting in a substantial improvement of the neck geometry. A novel evaluation for the strength of the sinter contacts was proposed. The Young's modulus of uniform non-graded stacks ranged from 5 to 80 GPa as determined by ultrasound velocity measurements. Thus, the typical range for cortical bone (10-29 GPa) was covered. The magnitude of the Poisson's ratio proved to be distinctly dependent on the porosity. Specimens with porosity gradients were successfully fabricated and characterized using quantitative description of the microstructural geometry and acoustic microscopy.

Journal Article↗

PubMed1988

S-R compatibility between response position and destination of apparent motion: evidence of the detection of affordances.

In choice reaction time, stimuli and responses in some combinations (e.g., based on spatial arrangement) are faster than in other combinations. To test whether motion toward a position yields faster responses at that position, a computer-generated square in front of one hand appeared to move either toward that hand or toward the other hand. Compatible responses (e.g., motion toward left hand/left response) were faster than incompatible responses, even when that opposed traditional positional compatibility. In Experiment 2, subjects responded to the same stimuli but with both hands left, right, or on the body midline. Medial responses were the fastest, showing that destination, rather than mere relative position, was a critical variable. It was suggested that spatial compatibility effects are not unique to position but apply to a variety of task situations, describable by J.J. Gibson's theory of affordances, in which he claims that one perceives the actions (e.g., catching) permitted in a situation.

Adult↗

PubMed1998

Cerebellar complex spikes encode both destinations and errors in arm movements.

Purkinje cells of the cerebellum discharge complex spikes, named after the complexity of their waveforms, with a frequency of approximately 1 Hz during arm movements. Despite the low frequency of firing, complex spikes have been proposed to contribute to the initiation of arm movements or to the gradual improvement of motor skills. Here we recorded the activity of Purkinje cells from the hemisphere of cerebellar lobules IV-VI while trained monkeys made short-lasting reaching movements (of approximately 200 milliseconds in duration) to touch a visual target that appeared at a random location on a tangent screen. We examined the relationship between complex-spike discharges and the absolute touch position, and between complex-spike discharges and relative errors in touching the screen. We used information theory to show that the complex spikes occurring at the beginning of the reach movement encode the absolute destination of the reach, and the complex spikes occurring at the end of the short-lasting movements encode the relative errors. Thus, complex spikes convey multiple types of information, consistent with the idea that they contribute both to the generation of movements and to the gradual, long-term improvement of these movements.

Action Potentials↗

PubMed1998

Sugar feeding and fluid destination control in the phlebotomine sandfly Lutzomyia longipalpis (Diptera: Psychodidae).

Sandfly feeding behaviour and destination of coloured sugar meals in the gut of Lutzomyia longipalpis were investigated with particular attention to the role of the crop. Sandflies were able to ingest sugar from liquid drops, microcapillaries, a slice of pear and even sugar powder. In most cases the flies adopted a 'sugar feeding mode' with raised palps. As the fruit dried, flies of both sexes fed by piercing the tissue with the proboscis. All sugar-fed flies had a full crop plus a small amount of sugary fluid in the thoracic mid-gut, i.e. past the stomodaeal valve. Dissections of flies interrupted during feeding showed that the very first trace of sugar passed through the stomodaeal valve, but that the rest of the meal was diverted into the crop. This suggests that closure of the stomodaeal valve is initiated only after a small volume of sugar solution has passed through it.

Animals↗

PubMed2002

Career destinations and views in 1998 of the doctors who qualified in the United Kingdom in 1993.

OBJECTIVE: To report career destinations and views in 1998 of doctors who qualified in the United Kingdom (UK) in 1993. DESIGN: Postal questionnaire survey. SETTING: This study took place in the United Kingdom. SUBJECTS: All doctors who qualified in the UK in 1993. MAIN OUTCOME MEASURES: The percentage of doctors in each branch of medicine five years after qualification, and their views on their training and career opportunities. RESULTS: The NHS and universities in the UK employed 88% of respondents (men 90%, women 86%). UK general practice employed 24% of respondents (men 19%, women 28%). There were significant differences (P < 0.01) between the percentages of men and women working in the surgical specialties (men 28%, women 10%), paediatrics (men 8%, women 15%) and obstetrics and gynaecology (men 5%, women 10%). Respondents not in paid employment comprised 1.4% of men and 6.6% of women. 45% of respondents agreed that their postgraduate training was of a high standard, with 26% disagreeing and 29% unsure. 47% of specialist registrars felt their training was too short and 78% were concerned about the availability of consultant posts on completion. CONCLUSIONS: Although loss of doctors from the British workforce through emigration or unemployment is not increasing, our findings confirm a substantial shift away from careers in general practice. The number of home-trained GPs from this generation of doctors will be inadequate to meet service needs. GPs and hospital specialist doctors expressed concerns about quality of training, lack of careers advice, the shortness of specialist registrar training and availability of consultant posts on completion of training.

Career Choice↗

PubMed1998

Chaos in a dynamic model of traffic flows in an origin-destination network.

In this paper we investigate the dynamic behavior of road traffic flows in an area represented by an origin-destination (O-D) network. Probably the most widely used model for estimating the distribution of O-D flows is the gravity model, [J. de D. Ortuzar and L. G. Willumsen, Modelling Transport (Wiley, New York, 1990)] which originated from an analogy with Newton's gravitational law. The conventional gravity model, however, is static. The investigation in this paper is based on a dynamic version of the gravity model proposed by Dendrinos and Sonis by modifying the conventional gravity model [D. S. Dendrinos and M. Sonis, Chaos and Social-Spatial Dynamics (Springer-Verlag, Berlin, 1990)]. The dynamic model describes the variations of O-D flows over discrete-time periods, such as each day, each week, and so on. It is shown that when the dimension of the system is one or two, the O-D flow pattern either approaches an equilibrium or oscillates. When the dimension is higher, the behavior found in the model includes equilibria, oscillations, periodic doubling, and chaos. Chaotic attractors are characterized by (positive) Liapunov exponents and fractal dimensions.(c) 1998 American Institute of Physics.

Journal Article↗

PubMed2002

The effect of decreasing length of stay on discharge destination and readmission after coronary bypass operation.

BACKGROUND: Over the decade of the 1990s, hospital stay after operation declined in response to prospective payment and managed care. As a result, complications previously detected and treated in the hospital may have begun to occur after discharge. In addition, discharge to nursing homes and rehabilitation hospitals may have increased. To address these questions, we used a statewide database to look at the use of postacute care and the 30-day readmission and mortality after coronary bypass operation. METHODS: A modification of the Commonwealth of Massachusetts Division of Health Care Finance and Policy discharge data to include a unique patient identifier allowed us to retrospectively track patient destination at discharge and study 30-day readmission to all hospitals in the state. RESULTS: Over the 3-year period after the institution of the unique patient identifier (1993 to 1996), postoperative length of stay after coronary bypass operation decreased from 7.4 to 6 days (19%, P <.0005), but the 30-day readmission rate (17.7%) did not increase. Discharge to rehabilitation hospitals and skilled nursing facilities rose significantly (11.7% to 23.8%), especially in the Medicare population (17.2% to 38.5%). Mortality in the 30 days after discharge remained constant at 0.3%. CONCLUSIONS: A shorter postoperative length of stay did not appear to disadvantage coronary artery bypass patients by increasing their likelihood of readmission or death. Cost savings from reduced length of stay were offset by increased use of postacute services.

Aged↗

PubMed1988

Patterns of mRNA expression during early cell growth differ in kidney epithelial cells destined to undergo compensatory hypertrophy versus regenerative hyperplasia.

An increase in cell size and protein content is characteristic of cells undergoing hypertrophy and of replicating cells prior to DNA synthesis. Cell enlargement in the two situations could be regulated by similar early events with an interruption of the cell cycle occurring in hypertrophy, or the two processes could be uncoupled. In vivo models were used to compare hypertrophy induced by unilateral nephrectomy and hyperplasia induced by folic acid injection in rabbit renal cortical cells. Within 48 hr, cell volume increased in both groups but the number of cells in the cell cycle and DNA synthesis was increased only after folic acid. Patterns of mRNA expression of the following three groups of cell cycle-dependent genes were analyzed: (i) protooncogenes (c-fos, c-myc, and c-Ha-ras), (ii) structural protein genes (vimentin and beta-actin), and (iii) transport protein genes (Na+, K+-ATPase, ADP-ATP translocase, and calcyclin). mRNAs for all genes, except calcyclin and c-Ha-ras, were detected in controls. Folic acid generally induced rapid, transient increases in mRNA levels, but after unilateral nephrectomy, expression of most mRNAs showed a gradual, progressive increase. These data indicate that gene expression in the early stages of cell enlargement differs in cells destined to undergo proliferation vs. hypertrophy. The term "sustained message amplification" is proposed to describe the hypertrophied cell.

Animals↗

PubMed1994

Generation of a fusion partner to sample the repertoire of splenic B cells destined for apoptosis.

B cells proliferate and diversify in germinal centers in response to antigen. Only a small percentage of these B cells will emerge to form the serum antibody response. Other B cells making lower affinity antibodies, acquiring nonsense mutations, or expressing autoreactivity as a result of somatic mutation undergo an apoptotic cell death and are not efficiently sampled in current analyses of B-cell hybridomas. We have demonstrated that expression of bcl-2 in the NSO myeloma fusion partner leads to a higher yield of viable hybridomas, with a selective increase in hybridomas from B cells that produce autoantibodies and are seldom recovered when spleen cells from non-autoimmune mice are fused to the conventional NSO cell line. Using this fusion partner, we have generated hybridomas from anti-DNA antibody-producing transgenic B cells that are anergic in vivo and destined for apoptosis. These studies provide a strategy to sample the repertoire of B cells that arise in vivo but are not selected to contribute to the expressed antibody response. Furthermore, they demonstrate that restricted expression of bcl-2 in B cells contributes to the maintenance of self-tolerance in secondary lymphoid organs.

Animals↗

PubMed2006

Elevated amniotic fluid leptin levels in pregnant women who are destined to develop preeclampsia.

OBJECTIVE: To analyze whether leptin levels of the amniotic fluid elevate during early pregnancy in women destined to develop preeclampsia and to evaluate the relationship between amniotic fluid leptin levels and gestational age, maternal body mass index, and fetal sex. STUDY DESIGN: Leptin levels of the amniotic fluid were compared in two groups of women, preeclamptic (n = 20) and normotensive pregnant (n = 40), matched for fetal sex, maternal body mass index at sampling, gravidity and fetal gestational age at sampling. Furthermore, amniotic leptin levels in 400 normotensive pregnant women were analyzed for their correlation with gestational age, maternal body mass index, and fetal sex. RESULTS: Median leptin concentrations were significantly higher (p < 0.001) in the women with preeclampsia (7.3+/-0.7 ng/ml) than in the normotensive pregnant women (4.1 +/- 0.3 ng/ml), independent of fetal sex. The leptin levels in the amniotic fluid decreased with advanced gestational age (r = 0.24, p < 0.001). Amniotic fluid leptin levels in the pregnant women carrying a female fetus (5.6+/-0.3ng/ml) were significantly higher than those carrying a male fetus (4.7+/-0.2 ng/ml) (p = 0.004). CONCLUSION: Higher amniotic fluid leptin levels were observed in the preeclamptic pregnant women, and they decreased as gestational age advanced. Furthermore, the women with a female fetus were noted to have higher amniotic fluid leptin levels.

Amniotic Fluid↗

PubMed1995

Investigating discharge destinations for schizophrenic patients.

An audit of hospital records of 542 patients diagnosed as having schizophrenia discharged in the years 1986-88 from the Princess Alexandra Hospital, Brisbane, showed that 46% of patients left hospital to live with other family members, usually parents or spouses. Analysis of destination suggested that the extent of patient-family connectedness increases when the patient is younger, has had fewer admissions, or has had the illness for a shorter period of time.

Activities of Daily Living↗

PubMed2006

Screening of antibiotic residues in ewes' milk destined to cheese by a commercial microbiological inhibition assay.

Bulk ewes' milk from Spanish dairy farms in the Castilla-La Mancha region and destined for production of protected denomination of origin (PDO) Manchego cheese were analysed each month for antimicrobial residues during the course of 1 year. A microbiological assay specific for ewes' milk (Eclipse '100ov') was used. The number of positive samples by the Eclipse '100ov' test was 2.6%. A second examination of positives following heat treatment at 82 degrees C for 10 min showed a reduction of up to 0.9% (i.e. 63% of the samples detected corresponded to 'false-positives'). Of the confirmed positives, 25% were identified as beta-lactams by a penicillinase solution; the remainder corresponded to antimicrobial compounds that could not be identified. The month of collection was related to the probability of positive results, but to no other factors such as somatic cell counts, bacteriology or composition (fat and protein). The highest rates of positives were observed in September and October. Finally, the results were compared with those obtained by the Delvotest SP method, which showed the detection of a higher number of positive samples compared with the Eclipse '100ov' method.

Animals↗

PubMed2001

Rehabilitation outcomes for brain injured patients in Australia: functional status, length of stay and discharge destination.

This study describes the rehabilitation length of stay (LOS), discharge destination and discharge functional status of 149 patients admitted with traumatic brain injury (TBI) to an Australian hospital over a 5-year period. Hospital charts of patients admitted between 1993-1998 were reviewed. Average LOS over the 5-year time period was 61.8 days and only decreased nominally over this time. Longer LOS was predicted by lower admission motor FIM scores and presence of comorbidities. Mean admission and discharge motor FIM scores were 58 and 79, which represented a gain of 21 points. Higher discharge motor FIM scores were predicted by higher admission motor FIM scores and younger age. FIM gain was predicted by cognitive status and age. Most patients, 88%, were discharged back to the community, with 30% changing their living setting or situation. Changing living status was predicted by living alone and having poorer functional status on admission.

Activities of Daily Living↗