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PubMed2006

Clinical and electrophysiological predictors of respiratory failure in Guillain-Barré syndrome: a prospective study.

BACKGROUND: Respiratory failure is the most serious short-term complication of Guillain-Barré syndrome and can require invasive mechanical ventilation in 20-30% of patients. We sought to identify clinical and electrophysiological predictors of respiratory failure in the disease. METHODS: We prospectively assessed electrophysiological data and clinical factors, including identified predictors of delay between disease onset and admission, inability to lift head, and vital capacity, in patients admitted with Guillain-Barré syndrome. We related these factors to subsequent need for ventilatory support. Neurophysiological findings were classified as demyelinating, axonal, equivocal, unexcitable, or normal. Predictive values of clinical and electrophysiological data were tested using classification trees to build up a predictive model. This model was initially built up in a two-third (fitting set) then validated in a one-third (validation set) of the total sample. The fitting and validation sets were randomly selected. We also assessed the predictive value of this model for disability at 6 months. FINDINGS: From 1998, to 2006, 154 patients with Guillain-Barré syndrome were included in the study and 34 (22%) were subsequently ventilated. Demyelinating Guillain-Barré syndrome was more common in patients who went on to be ventilated than in those who were not (85%vs 51%, p=0.0003). Vital capacity and the proximal/distal compound muscular amplitude potential (p/dCMAP) ratio of the common peroneal nerve were retained in the tree model, with a probability of needing ventilation of less than 2.5% in patients with a ratio of greater than 55.6% and a vital capacity more than 81% of predicted. A p/dCMAP ratio of the peroneal nerve less than 55.6% and age older than 40 years were retained as independent predictors of disability at 6 months. INTERPRETATION: Neurophysiological testing is helpful for assessing risk of respiratory failure, which is highest in patients with evidence of demyelination and very low in those without both 55.6% conduction block of the common peroneal nerve and a 20% reduction in vital capacity.

Action Potentials↗
PubMed1998

Building-associated pulmonary disease from exposure to Stachybotrys chartarum and Aspergillus versicolor.

The authors present an outbreak of disease associated with exposure to Stachybotrys chartarum and Aspergillus species. A courthouse and two associated office buildings had generated discomfort among employees for two years since initial occupancy. Multiple interventions had been unsuccessful An initial evaluation of 14 individuals identified three with potential asthma and three with symptoms consistent with interstitial lung disease. A clinical screening protocol to identify individuals who should be removed from work identified three likely and seven possible cases of building-related asthma. Detailed environmental and engineering assessments of the building identified major problems in mechanical system design, building construction, and operational strategies leading to excess moisture and elevated relative humidities. Moisture-damaged interior surfaces in both buildings were contaminated with S. chartarum, A. versicolor, and Penicillium species. Aspergillus species, especially A. versicolor, at concentrations of 10(1) to 10(4)/m3 dominated the indoor air under normal operating conditions. Bulk samples also revealed large quantities of Stachybotrys. A questionnaire survey of the three case and two control buildings documented between three- and 15-fold increases in symptoms. A nested case-control study suggested emphysematous-like disease in individuals meeting questionnaire definitions for cases. Replication of analysis strategies used in similar previous investigations suggested an association between worsening symptoms and decreased diffusing capacity of the lung. Performance on neuropsychological measures was similar for both cases and controls, although workers with symptoms reported increased levels of current but not past psychiatric symptomatology. Chemical analyses demonstrated the presence of satratoxins G and H. Cytotoxic laboratory analyses demonstrated the presence of agents with biological effectiveness in bulk materials. No association was seen between IgE or IgG antibodies and the presence of disease. This outbreak represents a likely human response to inhaled fungal toxins in indoor environments. Moisture indoors represents a public health issue currently inadequately addressed by building, health, or housing codes.

Adult↗
PubMed1989

The chick's marginal zone and primitive streak formation. I. Coordinative effect of induction and inhibition.

A variety of transplantation experiments of posterior and lateral marginal zone fragments at stages X, XI, and XII have been carried out in order to test their relevance to the development of a primitive streak (PS). At the stages studied the marginal zone (MZ) was shown to behave as a ring-like gradient field, the maximal value of which was at the posterior end (PM). The PM was found to be capable at the same time of promoting the development of a PS and of suppressing the inductive potential of other regions of the MZ. By systematically evaluating inductive and suppressive capacities of PMs, at different developmental stages, it was found that both features are maximal at stage X. During stages XI and XII, both properties gradually decrease in the MZ and build up in the forming hypoblast.

Animals↗
PubMed2005

Jarosite characteristics and its utilisation potentials.

During metallic zinc extraction from zinc sulphide or sulphide ore, huge quantity of jarosite is being released universally as solid residues. The jarosite mainly contains iron, sulphur, zinc, calcium, lead, cadmium and aluminium. Jarosite released from such industrial process is complex and its quality and quantity make the task more complex for safe disposal. Apart from water contamination, jarosite already accumulated and its increasing annual production is a major source of pollution for surrounding environment including soil, vegetation and aquatic life and hence its disposal leads to major concern because of the stringent environmental protection regulations. An attempt was made to evaluate the characteristics of Indian jarosite with an objectives to understand its potentials for recycling and utilising as raw materials for developing value added products. Sand and Coal Combustion Residues (CCRs) was used as an admixture to attain good workability and detoxify the toxic substance in the jarosite. Result revealed that jarosite is silty clay loam in texture having 63.48% silt sized and 32.35% clay sized particles. The particle size of jarosite (D90=16.21+/-0.20 microm) is finer than the CCRs (D90=19.72+/-0.18 microm). The jarosite is nonuniform in structure and shape as compared to the CCRs having spherical, hollow shaped and some of them are cenosphere in nature. The major mineral phase of jarosite is Potassium Iron Sulphate Hydroxide {KFe3(SO4)2(OH)6}and Iron Sulphate Hydrate {2 Fe2O3SO3 x 5 H2O}. In CCRs the dominant phases are quartz {SiO2}, mullite {3 Al2O3 x 2 SiO2} and hematite {Fe2O3}. The high electrical conductivity of jarosite (13.26+/-0.437 dS/m) indicates that the presence of cations and anions are predominant over CCRs (0.498+/-0.007 dS/m). The major portion of jarosite consists of iron (23.66+/-0.18%), sulphur (12.23+/-0.2%) and zinc (8.243+/-0.075%). But CCRs main constituents are silicon (27.41+/-0.74%), aluminium (15.167+/-0.376%) and iron (4.447+/-0.69%). The other constituents such as calcium, aluminium, silicon, lead, and manganese are also present in the range of 0.5 to 5%. Heavy metals such as copper, chromium, and cadmium are found higher in jarosite as compared to the CCRs. The statistically designed experimental trials revealed that the density, water absorption capacity and compressive strength of fired jarosite bricks are 1.51 gm/cm3, 17.46% and 43.4 kg/cm2 respectively with jarosite sand mixture in the ratio of 3:1 indicating the potentials in developing building materials.

Coal↗
PubMed1996

The modulatory role of estrogens on corticotropin-releasing factor gene expression in the hypothalamic paraventricular nucleus of ovariectomized rats: role of the adrenal gland.

In vitro, estrogens stimulate corticotropin-releasing factor (CRF) gene transcription. In ovariectomized (OVX) rats, estrogens have a negative effect on CRF mRNA levels in the hypothalamic paraventricular nucleus. This suggests that the stimulatory influence of estrogens found in vitro may be masked in vivo by an inhibitory effect mediated through neural and/or humoral factors. Glucocorticoids may be involved in this phenomenon since estrogens increase circulating corticosterone levels in OVX rats. We studied the effect of 7-day 17 beta-estradiol (E2) treatment on CRF gene expression in the paraventricular nucleus of 2-week OVX mature rats after sham operation or adrenalectomy (ADX) with or without corticosterone replacement. In sham ADX animals, E2 administration increased plasma corticosterone concentrations, did not change the binding capacity or the affinity of circulating corticosteroid binding globulin, and decreased hypothalamic CRF gene expression. Following ADX, CRF mRNA levels increased and were normalized by corticosterone treatment. Estrogens induced a significant build up in CRF mRNA concentrations in both ADX or ADX corticosterone-replaced animals. Our data demonstrate that the positive effect of estrogens on CRF gene expression found in vitro or in vivo after ADX is antagonized, in vivo when the adrenal glands are intact, by a negative influence. They strongly suggest that the increased circulating corticosterone levels induced by E2 administration mediate the inhibitory effect of estrogens on CRF mRNA levels. These observations may explain the gender related differences in the basal and stress-induced hypothalamo-pituitary-adrenal activity.

Adrenal Glands↗
PubMed2003

Transgenic tobacco plants expressing antisense ferredoxin-NADP(H) reductase transcripts display increased susceptibility to photo-oxidative damage.

Ferredoxin-NADP(H) reductase (FNR) catalyses the final step of the photosynthetic electron transport in chloroplasts. Using an antisense RNA strategy to reduce expression of this flavoenzyme in transgenic tobacco plants, it has been demonstrated that FNR mediates a rate-limiting step of photosynthesis under both limiting and saturating light conditions. Here, we show that these FNR-deficient plants are abnormally prone to photo-oxidative injury. When grown under autotrophic conditions for 3 weeks, specimens with 20-40% extant reductase undergo leaf bleaching, lipid peroxidation and membrane damage. The magnitude of the effect was proportional to the light intensity and to the extent of FNR depletion, and was accompanied by morphological changes involving accumulation of aberrant plastids with defective thylakoid stacking. Damage was initially confined to chloroplast membranes, whereas Rubisco and other stromal proteins began to decline only after several weeks of autotrophic growth, paralleled by partial recovery of NADPH levels. Exposure of the transgenic plants to moderately high irradiation resulted in rapid loss of photosynthetic capacity and accumulation of singlet oxygen in leaves. The collected results suggest that the extensive photo-oxidative damage sustained by plants impaired in FNR expression was caused by singlet oxygen building up to toxic levels in these tissues, as a direct consequence of the over-reduction of the electron transport chain in FNR-deficient chloroplasts.

Chloroplasts↗
PubMed2006

The role of safety and quality councils in improving the quality of healthcare: an Australian perspective.

The Australian Council for Safety and Quality in Health Care (the Council) has made considerable advances in gaining acceptance of and commitment to the healthcare safety improvement agenda by all involved in healthcare in Australia. It has provided a focus for national efforts in safety and quality improvement, by raising awareness, building consensus and clarifying areas for priority action. While the Council has set the agenda for change and provides advice in relation to problems, initiatives and actions, it has limited operational capacity and lacks the statutory authority to embed a culture of safety at all levels of the healthcare system. Statutory and regulatory responsibility and accountability for implementation lies with the Australian, State and Territory Governments and organizations in the private sector. Progress depends on coordinating the activities of Departments of Health and Human Services of nine sovereign governments. The "levers for change" available to the Council were leadership, persuasion, advice and example, with the ability to develop strategies, frameworks, standards, tools and guidelines. With the end of the Council's term approaching, a recent review recommended the establishment of an Australian Commission on Safety & Quality in Health Care (the Commission).

Australia↗
PubMedDate not supplied

[Ophthalmologic evaluation of VDT/PC operators: approach to the diagnosis with neural networks].

The present study was performed to build a neural network as a diagnostic tool to aid ophthalmologic examination of VDT/PC operators. The network was built on anamnesic and ophthalmologic data (visual acuity and mesopic vision, contrast sensitivity) from 278 VDT/pC operators and is able to predict 88% of total cases who need specialist attention, when ocular pathologies are also present, and 91% when only refraction defects are present. The tests chosen for this study are not useful to build a very sensitive discriminant model. This study confirm the absence for useful ophthalmologic tests in screening of VDT/PC operators, particularly when ocular pathologies are present without refractive errors. For their capacity to translate on a clinical-pratic plane knowledge obtained through studies conducted on large populations, the neural networks seem to be a good diagnostic tool.

Computer Terminals↗
PubMed1999

Three-dimensional quantitative structure activity relationship analyses of substrates for CYP2B6.

To begin to build an understanding of the interactions of CYP2B6 with substrates, two different 3-dimensional quantitative structure activity relationship (3D-QSAR) models were constructed using 16 substrates of B-lymphoblastoid expressed CYP2B6. A pharmacophore model was built using the program Catalyst, which was compared with a partial least-squares (PLS) model using molecular surface-weighted holistic invariant molecular (MS-WHIM) descriptors. The Catalyst model yielded a 3-dimensional model of the common structural features of CYP2B6 substrates, whereas PLS MS-WHIM generated a model based on statistical analyses of molecular descriptors for size and shape of the substrate. The pharmacophore model obtained with Catalyst consisted of three hydrophobes and one hydrogen bond acceptor region. The cross-validated PLS MS-WHIM model gave a good q2 value of 0.607. Size, positive electrostatic potential, hydrogen bonding acceptor capacity, and hydrophobicity were found to be the most relevant descriptors for the model. These models were then used to predict the Km (apparent) values of a test set of structurally diverse substrates for CYP2B6 not included in the model building, specifically lidocaine, amitriptyline, bupropion, arteether, and verapamil. Overall, both 3D-QSAR methods yielded satisfactory Km (apparent) value predictions for the majority of the molecules in the test set. However, PLS MS-WHIM was unable to reliably predict the Km (apparent) value for verapamil, whereas Catalyst did not predict the Km (apparent) value for lidocaine. In both of these cases the residual of the Km (apparent) value was greater than one log unit. The strengths and limitations of both of these 3D-QSAR approaches are discussed.

Aryl Hydrocarbon Hydroxylases↗
PubMed1994

A team approach to OR environmental issues.

At Munroe Regional Medical Center in Ocala, FL, an effective partnership between Materials Management and the Operating Room was begun by building consensus around a shared concern--minimizing the Operating Room's impact on the environment. To accurately evaluate cost-in-use issues, Materials Management and the OR needed a better understanding of each other's processes, procedures and decision-making criteria. Materials Management observed surgical procedures to understand product requirements, and OR personnel were given financial information on such matters as group purchasing and disposal costs. After considering all the data, the MM/OR team decided to continue using single-use polypropylene gowns rather than switch to reusable gowns. Success in this endeavor led the team to institute a disposable wrap recycling program. Lasting benefits of the collaboration include higher cost consciousness among clinicians, open communications, greater supplier accountability for cradle-to-grave cost estimates and team building.

Clothing↗
PubMed1997

Designing today's hospital for the future.

About 8,000 visitors each day are treated to the serene beauty of a four-story, sky-lit atrium, decorated with maple and cherrywood walls, flowering plants, towering evergreens, two fountains, and river-patterned porcelain tile that flows along the entryway. This is the entrance to Genesys Regional Medical Center-Health Park in Grand Blanc, Mich., often mistaken for a hotel. When designing the new 379-bed inpatient hospital, Genesys envisioned a facility that reflected a peaceful, comforting, homelike setting for patients and visitors. This vision, inspired by the spiritual values of the Sisters of St. Joseph, the Genesys sponsors, is now a reality. Having a vision and making it happen, however, was no small undertaking, says author Mark Harris of Genesys Health System. The labor-intensive, evolutionary process took several years and thousands of people. In this article, Harris describes many of the building project considerations involved in designing a hospital of the future.

Architectural Accessibility↗
PubMed1989

Turnarounds require team building and rebuilding. Interview by Donald E. L. Johnson.

James K. Knoble, president of the 369-bed JFK Medical Center, Atlantis, Fla., and former president of Methodist Medical Center of Illinois, Peoria, is in the midst of his third turnaround situation since he became a hospital CEO in 1965. Knoble is known as a CEO who keeps close track of the business environment, works closely with his board and medical staff and is effective at building a staff and delegating significant operating responsibilities. At JFK, whose previous administrator stole large sums of money and left it with serious financial and operating problems, Knoble is back in the operating mode. He is again a hands-on hospital operator, working closely with department heads as well as with the board and medical staff. In this interview with Health Care Strategic Management's editor and publisher, Donald E.L. Johnson, Knoble discusses his team building and turnaround strategy and JFK's progress during the last 18 months.

Florida↗
PubMed2000

[The build-up of human reserve potential by exposure to intermittent normobaric hypoxia].

Effects of intermittent hypoxia at normal pressure (NPH) on physical and mental performance were studied in 32 essentially healthy human subjects. The 24-d NPH cycle was found to increase the maximal aerobic capacity as well as physical and mental performance. Growth of reserve and efficiency of the main physiological systems stipulated this gain in physical and mental performance. The authors make a presumption that NPH can be a part of preflight training, a measure to maintain an adequate level of human performance during orbital mission, and a method of rehabilitation post flight.

Adaptation, Physiological↗
PubMed2001

Synthesis of lipidated eNOS peptides by combining enzymatic, noble metal- and acid-mediated protecting group techniques with solid phase peptide synthesis and fragment condensation in solution.

Lipid-modified proteins play decisive roles in important biological processes such as signal transduction, organization of the cytoskeleton, and vesicular transport. Lipidated peptides embodying the characteristic partial structures of their parent lipidated proteins and semisynthetic proteins synthesized from such peptides are valuable tools for the study of these biological phenomena. We have developed an efficient synthesis strategy that allows for the synthesis of long multiply lipidated peptides embodying various side chain functional groups. The strategy was successfully applied in the synthesis of the N-terminal undetrigintapeptide of endothelial NO-synthase and related lipopeptides. Key elements of the synthesis strategy are the combined use of the enzyme-labile para-phenylacetoxybenzyloxycarbonyl (PhAcOZ) urethane as N-terminal blocking group, the Pd0-sensitive allyl ester as C-terminal protecting function and acid-labile side chain protecting groups for solution-phase synthesis of labile S-palmitoylated building blocks under the mildest conditions with solid-phase techniques and solution-phase fragment condensations. The successful synthesis of the triply lipidated 29-mer eNOS peptide convincingly demonstrates the full capacity of the protecting group methods.

Lipids↗
PubMed2001

Crop residue addition effects on myriad forms and sorption of phosphorus in a Vertisol.

Crop residues are a vital organic resource and their extensive use in soil management for sustainable agriculture is widely advocated. The effects of soybean residue (SR) and wheat residue (WR) applied alone or in combination with fertilizer P (FP) on dynamics of labile P, distribution of P fractions and P sorption in a Vertisol (Typic Haplustert) were assessed in a 16 week long incubation study. The amount of P added through crop residues, FP or their combination was kept constant at 10 mg P kg(-1) soil. Addition of SR or WR resulted in net increase of labile inorganic (Pi) and organic (Po) P, and microbial P throughout the incubation period, except that the WR decreased labile Pi during the first two weeks due to Pi immobilization. Integration of FP with SR had no added benefit compared to SR alone, while use of FP + WR proved better in ensuring short-term P availability by offsetting initial P immobilization associated with WR alone. Sequential fractionation of soil P at the end of 16 weeks showed that addition of SR and WR alone or in combination with FP favoured a build-up in labile Pi and Po (NaHCO3-Pi and Po), and moderately labile Po (NaOH-Po) fractions at the expense of recalcitrant P (HCl-P). The P sorption capacity of soil and P required to maintain optimum solution P concentration of 0.2 mg P 1(-1) also decreased with addition of these crop residues. The implication of the results of this study is that soybean and wheat residues can potentially improve soil P fertility by increasing labile Pi and Po, and moderately labile Po fractions, decreasing P sorption and concomitantly causing dissolution of recalcitrant P in soil.

Crops, Agricultural↗
PubMed2001

Knowledge transfer, policymaking and community empowerment: a consensus model approach for providing public mental health and substance abuse services.

An important problem in creating new programs and policies is how to encourage the transfer of knowledge in non-hierarchical ways so that new, relevant and specific knowledge is co-created by all interested parties. In this paper, we suggest that a consensus model of policymaking is one response and identify four key structural elements thought necessary for creating such a consensus infrastructure. These are a) a leadership and facilitating capacity for initiating and promoting such an endeavor, b) a network or consortium of key researchers, practitioners, consumers, and policymakers to empower community ownership of the endeavor, c) a process for consensus building and strategic problem-solving for such a consortium, and d) the continued creation of a multi-directional dialogue through information dissemination. We examine these elements in action by describing a particular problem solving and consensus building model for developing and implementing a program, resolving group differences, and evaluating the group's process and products.

Community Mental Health Services↗