Functional MRI of the supplementary motor area: comparison of motor and sensory tasks

PURPOSE

The purpose of this work was to assess the activation of the supplementary motor area (SMA) during simple motor, complex motor, hot sensory, and touch sensory tasks.

METHOD

Functional MRI (fMRI) was performed in eight right-handed healthy volunteers. There were four tasks: simple motor, complex motor, hot sensory, and touch sensory. The number of pixels and the average percentage change of signal intensity in the activated SMA were obtained during the four tasks and then compared.

RESULTS

The SMA was consistently activated on fMRI during both motor and sensory tasks. The average number of activated pixels during the complex motor task was more than the number during the hot sensory task, but the difference was not statistically significant. The average number of activated pixels during the complex motor task was greater than during the simple motor task. The average number of activated pixels during the hot sensory task was greater than during the touch sensory task. The average percentage change of signal intensity was statistically significant between the simple motor and the complex motor task. The average percentage change of signal intensity was not statistically significant between the complex motor and the hot sensory task.

CONCLUSION

The SMA is activated in both motor and sensory tasks. The degree of activation of the SMA differs according to the type of task.

Comparison of computer simulations of total lung deposition to human subject data in healthy test subjects

A mathematical model was used to predict the deposition fractions (DF) of PM within human lungs. Simulations using this computer model were previously validated with human subject data and were used as a control case. Human intersubject variation was accounted for by scaling the base lung morphology dimensions based on measured functional residual capacity (FRC) values. Simulations were performed for both controlled breathing (tidal volumes [VT] of 500 and 1000 mL, respiratory times [T] from 2 to 8 sec) and spontaneous breathing conditions. Particle sizes ranged from 1 to 5 microns. The deposition predicted from the computer model compared favorably with the experimental data. For example, when VT = 1000 mL and T = 2 sec, the error was 1.5%. The errors were slightly higher for smaller tidal volumes. Because the computer model is deterministic (i.e., derived from first principles of physics), the model can be used to predict deposition fractions for a range of situations (i.e., for different ventilatory parameters and particle sizes) for which data are not available. Now that the model has been validated, it may be applied to risk assessment efforts to estimate the inhalation hazards of airborne pollutants.

Vasoconstrictive eicosanoid responses to extracorporeal circulation with or without an oxygenator in fetal lambs

INTRODUCTION

This study measured levels of vasoconstrictive eicosanoids during ovine fetal cardiac bypass and compared the measurements between two groups: (1) a group in which the placenta functioned as the only source of oxygen supply during the bypass (the placenta group), and (2) a group in which an artificial oxygenator, instead of the placenta, was included in the bypass circuit (the oxygenator group).

MATERIALS AND METHODS

A total of 16 fetal lambs were randomly assigned into either the oxygenator group or the placenta group. Following anesthesia, the fetal cardiac bypass procedure was performed. The placenta group used a centrifugal pump as the pumping device without an oxygenator during the bypass. The bypass circuit in the oxygenator group consisted of a roller pump and a membrane oxygenator. The fetal cardiac bypass procedure was performed for 30 minutes at normothermia in both groups. For the measurements of thromboxane B2(TXB2) and prostaglandin E2 (PGE2), blood samples were taken before the bypass, at 5 minutes, 15 minutes, and 30 minutes after the start of cardiac bypass, and at 15 minutes after weaning from the bypass. TXB2 and PGE2 levels were determined by radioimmunoassay with PGE2(125I) and TXB2(125I) assay systems. Hemodynamic observations and arterial blood gas analyses were done every 10 minutes.

RESULTS

The mean arterial pressure and heart rate ranged from 69.8 to 82.6 mmHg and 169 to 182/min during the bypass in the oxygenator group, and from 14.4 to 44.7 mmHg and 64.3 to 75/min in the placenta group. Arterial blood gas analysis showed severe hypercapnia and hypoxemia with acidosis during and after the bypass in the placenta group. Bypass flow rates were maintained at 140.3-164.0 ml/kg/min in the oxygenator group, while flow rates were suboptimal (74.3-97.0 ml/kg/min) in the placenta group. There were no statistically significant differences in PGE2 concentrations before, during, or after bypass, although the placenta group displayed a tendency to higher measurements during bypass, compared to the oxygenator group. The placenta group also showed higher TXB2 measurements than the oxygenator group during the bypass (p = 0.0457).

CONCLUSIONS

We have demonstrated increase measurements of PGE2 and TXB2 in the placenta group when compared with the oxygenator group in an ovine fetal cardiac bypass model, although the PGE2 difference failed to reach statistical significance.

Immobilization on the day 14th does not disrupts the basic diurnal rhythm of bone resorption

Weight bearing and physical activity are important mechanical stimuli to bone growth and metabolism, and microgravity, such a space flight and/or bed rest, induces bone resorption and bone loss. An increased excretion of urinary Ca, an increased bone resorption and a decreased bone mineral density (BMD) have been observed in bed rest experiment of healthy subjects. Bone resorption markers show the specific circadian rhythms in human. Cross-linked carboxyl-terminal telopeptide of type I collagen (ICTP) and the urinary excretion of deoxypyridinoline (Dpy) are the highest in the early morning and the lowest late at night. Bed rest immobilization might influence these rhythms, due to no mechanical loading with loss of daily life activity. Bone resorption markers in healthy subjects had been compared between before and during bed rest to determine disruption of diurnal rhythms of bone resorption.

Erythropoietic activity and soluble transferrin receptor level in neonates and maternal blood

Serum transferrin receptor (sTfR) concentration reflects functional iron status and erythropoietic activity. The aims of this study were to examine gender differences of erythropoiesis in newborns and to evaluate the influences of maternal anaemia or iron deficiency on foetal cord blood parameters for iron status and sTfR. In total, 527 newborns and their mothers were examined. Reticulocytes were analysed by flow cytometry and sTfR was measured by an immunoenzymometric method. There were no sex differences in haematological or iron parameters. However, the reticulocyte maturity index (RMI) of male neonates was 37.45%, significantly higher than the 26.81% in female neonates (p <0.01). The high fluorescence reticulocytes (HFR) and middle fluorescence reticulocytes (MFR) of male neonates were 4.91% and 22.36%, respectively, while those of female neonates were 3.31% and 17.83%, respectively (p < 0.01 for each gender). The sTfR concentrations of male and female neonates were 6.27 mg/l and 5.09 mg/l, respectively (p < 0.01). Values for serum iron, ferritin and reticulocyte subpopulations were significantly lower in the newborns of anaemic mothers. However, newborns of iron-deficient mothers showed no differences in iron parameters from those of non-iron-deficient mothers.

CONCLUSIONS

The higher values of RMI and sTfR observed in male neonates indicate that erythropoietic activity is higher in this group. Iron transport to the foetus appears to be independent of maternal iron deficiency. However, iron transport and erythropoiesis in newborns seems to decline from the time that the mothers acquire frank iron deficiency anaemia.

Effects of temperature and calcium availability on ventricular myocardium from rainbow trout

We studied the mechanical and electrophysiological properties of ventricular myocardium from rainbow trout (Oncorhynchus mykiss) in vitro at 4, 10, and 18 degrees C from fish acclimated at 10 degrees C. Temperature alone did not significantly alter the contractile force of the myocardium, but the time to peak tension and time to 80% relaxation were prolonged at 4 degrees C and shortened at 18 degrees C. The duration of the action potential was also prolonged at 4 degrees C and progressively shortened at higher temperatures. An alteration of the stimulation frequency did not affect contraction amplitude at any temperature. Calcium influx via L-type calcium channels was increased by raising extracellular calcium concentration (¿Ca(2+)(o)) or including Bay K 8644 (Bay K) and isoproterenol in the bathing medium. These treatments significantly enhanced the contractile force at all temperatures. Calcium channel blockers had a reverse-negative inotropic effect. Unexpectedly, the duration of the action potential at 10 degrees C was shortened as ¿Ca(2+)(o) increased. However, Bay K prolonged the plateau phase at 4 degrees C. Caffeine, which promotes the release of sarcoplasmic reticulum (SR) calcium, increased contractile force eightfold at all three temperatures, but the SR blocker ryanodine was only inhibitory at 4 degrees C. Our results suggest that contractile force in ventricular myocardium from Oncorhynchus mykiss is primarily regulated by sarcolemmal calcium influx and that ventricular contractility is maintained during exposure to a wide range of temperatures.

Psychometric study of the Child and Adolescent Functional Assessment Scale: prediction of contact with the law and poor school attendance

The predictive validity of the Child and Adolescent Functional Assessment Scale (CAFAS) is investigated using the data set generated by the national evaluation of the demonstration service grants funded by the Center for Mental Health Services. Logistic regressions were performed separately for contact with the law and poor school attendance, which were both assessed at 6 months postintake. Other variables included in the model besides the CAFAS total score at intake were age, gender, and family risk factors. The results show that the CAFAS total score at intake was a positive predictor of the likelihood of contact with the law and poor school attendance, even after controlling for age, gender, and risk factors. Furthermore, the CAFAS total score was predictive even after excluding scores on CAFAS subscales, which may have been influenced by absenteeism or delinquency. These findings are consistent with recent research indicating that the CAFAS predicts recidivism in juvenile delinquents.

Intracellular calcium and the relationship to contractility in an avian model of heart failure

Global contractile heart failure was induced in turkey poults by furazolidone feeding (700 ppm). Abnormal calcium regulation appears to be a key factor in the pathophysiology of heart failure, but the cellular mechanisms contributing to changes in calcium fluxes have not been clearly defined. Isolated ventricular myocytes from non-failing and failing hearts were therefore used to determine whether the whole heart and ventricular muscle contractile dysfunctions were realized at the single cell level. Whole cell current- and voltage-clamp techniques were used to evaluate action potential configurations and L-type calcium currents, respectively. Intracellular calcium transients were evaluated in isolated myocytes with fura-2 and in isolated left ventricular muscles using aequorin. Action potential durations were prolonged in failing myocytes, which correspond to slowed cytosolic calcium clearing. Calcium current-voltage relationships were normal in failing myocytes; preliminary evidence suggests that depressed transient outward potassium currents contribute to prolonged action potential durations. The number of calcium channels (as measured by radioligand binding) were also similar in non-failing and failing hearts. Isolated ventricular muscles from failing hearts had enhanced inotropic responses, in a dose-dependent fashion, to a calcium channel agonist (Bay K 8644). These data suggest that changes in intracellular calcium mobilization kinetics and longer calcium-myofilament interaction may be able to compensate for contractile failure. We conclude that the relationship between calcium current density and sarcoplasmic reticulum calcium release is a dynamic process that may be altered in the setting of heart failure at higher contraction rates.

Methods of calculating lung delivery and deposition of aerosol particles

Lung deposition of aerosol is measured by a variety of methods. Total lung deposition can be measured by monitoring inhaled and exhaled aerosols in situ by laser photometry or by collecting the aerosols on filters. The measurements can be performed accurately for stable monodisperse aerosols. However, for polydisperse and/or unstable hygroscopic aerosols, measurement methods are limited and often unreliable. Regional deposition is assessed primarily by gamma scintigraphy. The scintigraphic method is useful for a general description of deposition patterns, but may not be adequate for quantitative regional dose estimation. New emerging three-dimensional lung imaging methods such as SPECT and PET, and innovative bolus aerosol delivery methods, have great potential for measuring detailed regional deposition. An accurate assessment of regional lung dose is difficult to achieve by the current methods. A multi-prong approach may be needed, with various methods and techniques, both in theory and experiment, to measure site-specific deposition dose.

Voltage-dependent calcium channels in ventricular cells of rainbow trout: effect of temperature changes in vitro

Voltage-dependent calcium channels (VDCC) in ventricular myocytes from rainbow trout (Oncorhynchus mykiss) were investigated in vitro using the perforated patch-clamp technique, which maintains the integrity of the intracellular milieu. First, we characterized the current using barium as the charge carrier and established the doses of various pharmacological agents to use these agents in additional studies. Second, we examined the current at several physiological temperatures to determine temperature dependency. The calcium currents at 10 degrees C (acclimation temperature) were identified as L-type calcium currents based on their kinetic behavior and response to various calcium channel agonists and antagonists. Myocytes were chilled (4 degrees C) and warmed (18 and 22 degrees C), and the response of VDCC to varying temperatures was observed. There was no significant dependency of the current amplitude and kinetics on temperature. Amplitude decreased 25-36% at 4 degrees C (Q(10) approximately 1.89) and increased 18% at 18 degrees C (Q(10) approximately 1.23) in control, Bay K8644 (Bay K)-, and forskolin-enhanced currents. The inactivation rates (tau(i)) did not demonstrate a temperature sensitivity for the VDCC (Q(10) 1.23-1. 92); Bay K treatment, however, increased temperature sensitivity of tau(i) between 10 and 18 degrees C (Q(10) 3.98). The low Q(10) values for VDCC are consistent with a minimal temperature sensitivity of trout myocytes between 4 and 22 degrees C. This low-temperature dependency may provide an important role for sarcolemmal calcium channels in adaptation to varying environmental temperatures in trout.

Tautomer-dependent Bergman cyclization of novel uracil-enediyne chimeras

Uracil-enediyne chimeras 4, 7, and 8 were prepared and examined for their propensity to undergo Bergman cyclization. Kinetic experiments showed lactam tautomers 7 and 8 reacted up to 25 times faster than lactim ether 4. Determination of the activation energy for each cycloaromatization reaction, along with radical trapping agent dependent studies, indicate the rate differences result from different ground state energies of the starting enediynes.

Aerosol transport and deposition in sequentially bifurcating airways

Deposition patterns and efficiencies of a dilute suspension of inhaled particles in three-dimensional double bifurcating airway models for both in-plane and 90 deg out-of-plane configurations have been numerically simulated assuming steady, laminar, constant-property air flow with symmetry about the first bifurcation. Particle diameters of 3, 5, and 7 microns were used in the simulation, while the inlet Stokes and Reynolds numbers varied from 0.037 to 0.23 and 500 to 2000, respectively. Comparisons between these results and experimental data based on the same geometric configuration showed good agreement. The overall trend of the particle deposition efficiency, i.e., an exponential increase with Stokes number, was somewhat similar for all bifurcations. However, the deposition efficiency of the first bifurcation was always larger than that of the second bifurcation, while in general the particle efficiency of the out-of-plane configuration was larger than that of the in-plane configuration. The local deposition patterns consistently showed that the majority of the deposition occurred in the carinal region. The distribution pattern in the first bifurcation for both configurations were symmetric about the carina, which was a direct result of the uniaxial flow at the inlet. The deposition patterns about the second carina showed increased asymmetry due to highly nonuniform flow generated by the first bifurcation and were extremely sensitive to bifurcation orientation. Based on the deposition variations between bifurcation levels and orientations, the use of single bifurcation models was determined to be inadequate to resolve the complex fluid-particle interactions that occur in multigenerational airways.

The Arabidopsis thaliana SOS2 gene encodes a protein kinase that is required for salt tolerance

In Arabidopsis thaliana, the Salt Overly Sensitive 2 (SOS2) gene is required for intracellular Na(+) and K(+) homeostasis. Mutations in SOS2 cause Na(+) and K(+) imbalance and render plants more sensitive toward growth inhibition by high Na(+) and low K(+) environments. We isolated the SOS2 gene through positional cloning. SOS2 is predicted to encode a serine/threonine type protein kinase with an N-terminal catalytic domain similar to that of the yeast SNF1 kinase. Sequence analyses of sos2 mutant alleles reveal that both the N-terminal catalytic domain and the C-terminal regulatory domain of SOS2 are functionally essential. The steady-state level of SOS2 transcript is up-regulated by salt stress in the root. Autophosphorylation assays show that SOS2 is an active protein kinase. In the recessive sos2-5 allele, a conserved glycine residue in the kinase catalytic domain is changed to glutamate. This mutation abolishes SOS2 autophosphorylation, indicating that SOS2 protein kinase activity is required for salt tolerance.

Expression of heat shock protein 72 in rat cochlea with cisplatin-induced acute ototoxicity

Cisplatin ototoxicity is known to involve mainly the organ of Corti. Outer hair cells (OHCs). especially in the basal turn, are preferentially involved. One possible mechanism of ototoxicity might be alteration of the antioxidant system causing an increase in free radicals. It has been demonstrated that heat shock proteins (HSPs), which are believed to protect cells by dissolving and refolding misfolded or denatured protein are induced by various form of stress. HSP is also demonstrated to be induced by free radicals. The purpose of this study was to evaluate HSP 72 induction in cochlea following cisplatin injection in the animal model. Sprague-Dawley (SD) rats were injected intraperitoneally with normal saline as control or cisplatin at a dose of 5, 10 or 20 mg/kg. Cochleae were harvested 1, 3, 6 and 12 h after injection and compared with those of controls. Immunocytochemical study with surface preparation and Western blotting were performed to investigate the expression of HSP 72. Auditory brainstem response (ABR) was also recorded to assess functional change according to the dosage of cisplatin and duration after injection. In the 5 and 10 mg/kg groups, immunostaining for HSP 72 in the OHCs reached a plateau level at 3 h, which was maintained until 12 h after injection. The amount of immunoreactive OHCs in the 20 mg/kg group was smaller than those in 5 and 10 mg/kg groups and declined after 6 h. The bands for HSP 72 became less intense as the cisplatin dosage increased from 5 to 10 and 20 mg/kg in Western blotting. The change in ABR threshold was small in the 5 and 10 mg/kg groups and a marked change in threshold was observed in the 20 mg/kg group. Detection of HSP 72 after cisplatin injection could confirm the OHCs as one of the major injured cells in the cochlea. With a lethal dosage of cisplatin (20 mg/kg), HSP 72 expression was less prominent and declined after 6 h.

Predicting service utilization with the Child and Adolescent Functional Assessment Scale in a sample of youths with serious emotional disturbance served by center for mental health services-funded demonstrations

This study investigated level of restrictiveness of living arrangements and number of days in out-of-family care at six months postintake, based on the Child and Adolescent Functional Assessment Scale (CAFAS), the Child Behavior Checklist (CBCL), gender, age, and level of family income at intake. It was composed of youths who met the criteria for serious emotional disturbance (SED) and were for the most part living in families that are described as socioeconomically disadvantaged. A multinomial logit model was used in the analysis of level of restrictiveness of living arrangements, and an ordinary least squares (OLS) regression model was conducted on number of days in out-of-family care. The CAFAS score at intake was found to be a significant predictor of service utilization between intake and six months and was a more consistent predictor than the CBCL. Results suggest that the CAFAS can be used to match service needs with resource allocation and to monitor performance-based outcome indicators.

Isolation and identification of the probing stimulants in the rice plant for the white-back planthopper, Sogatella furcifera (homoptera: delphacidae)

Adult females of the white-back planthopper, Sogatella furcifera, showed characteristic behavior of stylet sheath deposit on a parafilm membrane when fed on a 2% aqueous crude rice leaf and stem extract containing 15% sucrose. Subsequent bioassays revealed that the butanol-soluble fraction of the extract was highly active against the insects. When the butanol fraction was chromatographed on an ODS open column and eluted in sequence with a mixture of an increasing concentration of methanol in water, the 40 % methanol fraction was separated as the most active. A further bioassay of the HPLC components in the active fraction revealed that two major components (1 and 3) stimulated the high probing activity of the white-back planthopper only when they were combined. Of the active components, one component (3) was identified to be tricin 5-O-glucoside by spectroscopic analyses.

Can peer-comparison feedback improve patient functional status?

OBJECTIVE

To determine whether providing physicians with peer-comparison feedback can improve patient functional status.

STUDY DESIGN

Randomized, controlled, comparative study.

METHODS

Forty-eight primary care physicians at Kaiser Permanente Woodland Hills, a group-model health maintenance organization in southern California, were randomly assigned to an intervention group or a control group. All physicians were informed that their elderly patients (randomly selected patients aged 65 to 75) would be monitored. Physicians in the intervention group received aggregated peer-comparison feedback data (physician "report cards") on the functional status of their elderly patients. Physicians in the control group received only general information that their patients' functional status would be monitored. The effect of the intervention on patients' functional status was determined by comparing responses to surveys completed by the patients at baseline and after the intervention.

RESULTS

Patients in both the control and intervention groups had a statistically significant decrease in functional status, including decreases in their ability to complete daily activities and increases in pain. In addition, patients in the control group reported a significant decrease in social activities, physical fitness, and feelings. In the intervention group, patients also experienced a significant decrease in social support.

CONCLUSIONS

Educational interventions, including peer-comparison feedback, did not result in improvements in patient functional status. Research is desperately needed to identify interventions that can lead to improved health for elderly patients.

False positive head-up tilt: hemodynamic and neurohumoral profile

OBJECTIVES

This study examined differences in mechanisms of head-up tilt (HUT)-induced syncope between normal controls and patients with neurocardiogenic syncope.

BACKGROUND

A variable proportion of normal individuals experience syncope during HUT. Differences in the mechanisms of HUT-mediated syncope between this group and patients with neurocardiogenic syncope have not been elucidated.

METHODS

A 30-min 80 degrees HUT was performed in eight HUT-negative volunteers (Group I), eight HUT-positive volunteers (Group II) and 15 patients with neurocardiogenic syncope. Heart rate and blood pressure (BP) were monitored continuously. Epinephrine and norepinephrine plasma levels, as well as left ventricular dimensions and contractility determined by echocardiography, were measured at baseline and at regular intervals during the test.

RESULTS

The main findings of this study were the following: 1) All parameters were similar at baseline in the three groups; and 2) During tilt: a) the time to syncope was shorter in Group III than in group II (9.5 +/- 3 vs. 17 +/- 3 min p < 0.05); b) there was an immediate, persisting drop in mean BP in Group III; c) the decrease rate of left ventricular end-diastolic dimensions was greater in Group III than in Group II or Group I (-1.76 +/- 0.42 vs. -0.87 +/- 0.35 and -0.67 +/- 0.29 mm/min, respectively, p < 0.05); d) the leftventricular shortening fraction was greater in Group III than in the other two groups (39 +/- 1 vs. 34 +/- 1 and 32 +/- 1%, respectively, p < 0.05); and e) although the norepinephrine level remained comparable among the groups, there was a significantly higher peak epinephrine level in Group III than in Group II and Group I (112.3 +/- 34 vs. 77.6 +/- 10 and 65 +/- 12 pg/ml, p < 0.05).

CONCLUSIONS

Mechanisms of syncope during HUT appeared to be different in normal volunteers and patients with neurocardiogenic syncope. In the latter, there was evidence of an impaired vascular resistance response from the beginning of the orthostatic challenge. Furthermore, in the patients there was more rapid peripheral blood pooling, as indicated by the echocardiographic measurements of left ventricular end-diastolic changes, leading to more precocious symptoms. In syncopal patients, the higher level of plasma epinephrine probably mediated the increased cardiac contractility and possibly contributed to the impaired vasoconstrictive response.

Cytochrome b6/f complex as an indigenous photodynamic generator of singlet oxygen in thylakoid membranes

Possible association of photodynamic sensitization by cytochrome b6/f complex (cyt b6/f) via singlet oxygen (1O2) mechanism with photoinhibition damage to photosystem II (PS II) was studied using such subthylakoid preparations as photosystem I (PS I) particles, PS II core complex and cyt b6/f from spinach leaves. Upon exposure to bright light, PS II core complex lost photosynthetic electron transport activity to a certain extent, whose-spectral dependence implied that pheophytin a is likely involved in photoinactivation of PS II core complex in itself. The presence of PS I particles exerted virtually no effect on PS II core photoinactivation. However, the inclusion of cyt b6/f in samples resulted in a marked exacerbation of the photoinactivation, particularly in UV-A and blue light. Such effect of cyt b6/f was suppressed by azide and enhanced by the medium deuteration. Photogeneration of 1O2 from cyt b6/f was confirmed by ESR and spectrophotometry, chemically trapping 1O2. Action spectra for both 1O2 photoproduction and PS II core photoinactivation by cyt b6/f bore a close resemblance to each other, seemingly carrying the absorption characteristics of the Rieske Fe-S protein. A complex deficient in the Rieske protein prepared from intact cyt b6/f showed virtually no generation of 1O2 in light, whereas an efficient photoformation of 1O2 was seen in the Rieske protein preparation. The results suggest that cyt b6/f, rather specifically the Rieske center, may play a prominent role in photoinhibition processes through type II photosensitization in thylakoids.

An error detection and recovery algorithm for compressed video signal using source level redundancy

The motion compensation-discrete cosine transform (MC-DCT) coding is an efficient compression technique for a digital video sequence. However, the compressed video signal is vulnerable to transmission errors over noisy channels. In this paper, we propose a robust video transmission algorithm, which protects the compressed video signal by inserting redundant information at the source level. The proposed algorithm encodes every lth frame in the semi-intra frame (S-frame) mode, in which the redundant parity-check DC coefficients (PDCs) are systematically inserted into the compressed bitstream. Then, the decoder is capable of recovering very severe transmission errors, such as loss of an entire frame, in addition to detecting the errors effectively without requesting any information from external devices. The proposed algorithm is implemented based on the H.263 coder, and tested intensively in realistic error prone environment. It is shown that the proposed algorithm provides much better objective and subjective performances than the conventional H.263 coder in the error prone environment.

Synthesis and in vitro antibacterial activity of quaternary ammonium cephalosporin derivatives bearing oxazolidinone moiety

Several oxazolidinones having amine moiety were prepared to form a quaternary ammonium salt with cephalosporin nucleus, and antibacterial activity of the quaternary ammonium cephalosporin derivatives bearing oxazolidinone moiety were examined particularly with expectation of dual activity. However, the cephalosporin-oxazolidinone compounds revealed rather weaker antibacterial activity in vitro than their parent oxazolidinone and cephalosporin without showing any characteristic activity as expected.

Physician education and report cards: do they make the grade? results from a randomized controlled trial

PURPOSE

We sought to determine whether tailored educational interventions call improve the quality of care, as measured by the provision of preventive care services recommended by the US Preventive Services Task Force, as well as lead to better patient satisfaction.

SUBJECT AND METHODS

We performed a randomized controlled study among 41 primary care physicians who cared for 1,810 randomly selected patients aged 65 to 75 years old at Kaiser Permanente Woodland Hills, a group-model health maintenance organization in southern California. All physicians received ongoing education. Physicians randomly assigned to the comprehensive intervention group also received peer-comparison feedback and academic detailing. Baseline and postintervention (2 to 2.5 years later) surveys examining the provision of preventive care and patient satisfaction were performed and medical records were reviewed.

RESULTS

Based on the results of patient surveys, there were significant improvements over time in the provision of preventive care in both the education and the comprehensive intervention groups for influenza immunization (79% versus 89%, P <0.01, and 80% versus 91%, P <0.01), pneumococcal immunization (42% versus 73%, P < 0.01 and 34% versus 73%, P < 0.01), and tetanus immunization (64% versus 72%, P <0.01, and 59% versus 79%, P <0.01). Mammography (90% versus 80%, P <0.01) and clinical breast examination (85% versus 79%, P <0.05) scores worsened in the education only group but not in the comprehensive intervention group. However, there were few differences in rates of preventive services between the groups at the end of the study, and the improvements in preventive care were not confirmed by medical record review. Patient satisfaction scores improved significantly in the comprehensive intervention group (by 0.06 points on a 1 to 5 scale, P = 0.02) but not in the education only group (by 0.02 points, P = 0.42); however, the improvement was not significantly greater in the comprehensive intervention group (P = 0.20).

CONCLUSION

A physician-targeted approach of education, peer-comparison feedback, and academic detailing has modest effects on patient satisfaction and possibly on the offering of selected preventive care services. The lack of agreement between patient reports and medical records review raises concerns about current methods of ascertaining compliance with guidelines for preventive care.