Pasteurella multocida septicemia not associated with primary liver disease

Although systemic infections with Pasteurella multocida rarely occur in humans, liver cirrhosis associated with septicemia due to this organism has been frequently reported. Two cases of elderly women with Pasteurella multocida septicemia are described who had diabetes mellitus and breast cancer, respectively. Underlying diseases other than liver cirrhosis as well as factors hitherto unknown in otherwise healthy persons also enhance the risk of Pasteurella multocida septicemia.

[Determination of alpha-gliadin content in gluten-containing and gluten-free heated food]

The amount of alpha-gliadin and whole gliadin in bread dough after heating at temperatures of 50-100 degrees C was determined by ELISA. At temperatures above 80 degrees C the amount which could be found was greatly reduced. In pasta foods containing wheat (with a max. drying temperature of 75 degrees C) alpha-gliadin could be determined totally but in wheat bread (crust and crumb) only 0.5-40% of the content in the original flour was found. The results of an analysis of "gluten-free" pasta foods on the market and the amounts of alpha-gliadin found are discussed in relation to the recommendations of the Codex alimentarius (WHO).

Evaluation of a Discharge Planning Tool for Use with Families of High-risk Infants

The effectiveness of using a discharge planning tool for families with high-risk infants in a special care nursery is evaluated. Consistent use of the discharge planning tool resulted in parents' increased feeling of preparedness for discharge of their high-risk infants. Implications that resulted from the evaluation are presented.

Four-day, Forty-hour Workweek for Neonatal Intensive Care Nurses

The four-day, 40-hour alternative work schedule was presented to professional nurses in the special care nursery at a hospital and medical center in Chicago, Illinois. Within a few months, every nurse in the unit, in addition to those newly recruited, elected to work the alternative schedule. The project was evaluated at 12 and 18 months, with encouraging results. The nurses perceived the 10-hour day as a major structural support enabling them to provide optimal patient care while coping with work-related stress.

Staging of breast cancer and survival rates. An assessment based on 50 years of experience with radical mastectomy

The correlation of staging criteria for mammary carcinoma with the curability of primary and recurrent local and regional lesions was assessed by follow-up after 1,259 consecutive radical mastectomies performed in women under age 70 between 1927 and 1978. Using a staging scheme revised in the light of our experience, the incidence of recurrence by 20 years was 34% +/- 2.7% for pathological stage I, 65% +/- 2.6% for stage II, and 83% +/- 2.5% for stage III. Recurrence after 20 years was observed in one of 178 patients. After treatment of local recurrence, three of 51 patients survived 20 years. By restriction of entry into clinical or pathological stages I and II, currently employed revisions of staging criteria appear to increase survival in all stages, while placing patients with possibly curable lesions in stages III and IV.

A statistical analysis of the loss of muscle strength in Duchenne's muscular dystrophy

We have confirmed that the loss of muscle strength in 12 boys with Duchenne's muscular dystrophy, as measured by manual muscle testing, approximates a linear decay model, but we have also found that it fits as well a first order decay model. The strength in the same eight muscles was measured over time. Results of an analysis of 111 examinations are reported here. An arbitrary numerical scale for grading muscle strength was used, such that normal was 13 units, and no movement was zero. The maximal sum, if all 8 muscles were normal, would be 104 units. Pooling all measurements, the linear decay rate in this sum was -0.189 +/- 0.023 (estimate +/- standard error) arbitrary muscle strength units . month-1. The corresponding first order fractional decay rate was -0.0034 +/- 0.0004 month-1. However, a more detailed statistical analysis indicated that decay rates in muscle strength were not homogeneous, i.e. muscle strength decayed faster in some patients than others. The decay constants in 11 of the 12 subjects spanned a 10-fold range, and in one subject increased the spread to 40-fold. The distribution frequency of decay rates appears to be bimodal. In these assessments, the muscle strength at time zero was not known. Therefore, an estimate of muscle strength at 10 years was made. This varied from 34 to 71 units. The group mean was 53.0 units using the exponential model, i.e. on average, only 51% (= 53.0/104 X 100) of the normal muscle strength remained in the 8 muscle groups assessed at age 10 years. In conclusion, a quantitative characterization of muscle strength deterioration is reported, which emphasizes the heterogeneity in this disease. This approach may eventually allow quantitative distinctions between Duchenne's and Becker's varieties of muscular dystrophy.

Current research in statistical methodology for clinical trials

Statistical Methodology for Clinical Trials has advanced primarily in those domains opened up by the advent of high speed computation. Data acquisition, data management, and data monitoring have been revolutionized, and statistical analysis in clinical trials has advanced from simple cross tabulation and lists of averages to the use of special regression and other methods for estimation and for covariance adjustment. Research on sequential designs has had little effect on practice, largely because the usual sequential methods fail to address the key problems posed by ethical constraints, but a related development of research on "stopping rules" seems promising. Although considerable attention has been given to the problems of multiplicity--analysis of subgroups, choice of endpoints, post-randomization exclusions--little progress in this area has been made as yet. The paper explores these issues in some detail with the aid of illustrative examples.

Structure and dynamics of phospholipid membranes: an electron spin resonance study employing biradical probes

The large zero-field splitting of rigid biradicals makes them important candidates for spin probes of phospholipid membranes. Here we develop an electron spin resonance line-shape model for such probes on the basis of the stochastic Liouville equation. Particular emphasis is given to the slow-diffusional regime, characteristic of bilayers in the gel phase. The theory is employed to study the line shapes of bis(verdazyl) biradicals, incorporated into oriented multibilayers of dimyristoylphosphatidylcholine. Computer simulations of the angular-dependent spectra provide the orientational distribution functions and rotational correlation times of the spin probes. They occupy two different sites in bilayer membrane. The orientational distribution of the spin probes is related to the structure of the phospholipid phases. In the L beta' phase the hydrocarbon chains are uniformly tilted by delta = 23 degrees with respect to the bilayer normal. For the P beta' phase we observe a random distribution of tilt angles from delta = 0 degree to delta = 19 degrees, indicating that the chains orient perpendicular to the local (rippled) bilayer surfaces. This structure has not been established previously. In agreement with other studies we find no tilt for the L alpha phase. The order parameters of the hydrocarbon chains increase with decreasing temperature, jumping from S less than or equal to 0.6 to S greater than or equal to 0.8 at the main transition. From the rotational correlation times of the spin probes, intrinsic bilayer viscosities of 0.08 P less than or equal to eta less than or equal to 20 P (50 degrees C greater than or equal to T greater than or equal to 1 degree C) are determined. An Arrhenius plot provides activation energies of the viscous flow. The values increase from Evisc approximately 10 kcal/mol in the L alpha phase to Evisc approximately 18 kcal/mol in the L beta' phase.

Competitive effects of verapamil and calcium ion as regulators of myocardial enzyme leakage

Verapamil (Vp) has been found to augment the creatine kinase (CK) and lactate dehydrogenase (LDH) leakage from isolated mouse heart incubated in vitro at 25 degrees C. This leakage was concentration-dependent, and in the second hour followed the Henri-Michaelis-Menten kinetics model. Least-squares estimates obtained with this model for the Km values of verapamil were 0.38 +/- 0.16 mM (CK leakage) and 0.51 +/- 0.21 mM (LDH leakage). Calcium ion inhibited this effect of verapamil, completely abolishing it when the [Ca2+]:[Vp] greater than or equal to 2. At lower [Ca2+], the effect of verapamil also followed hyperbolic kinetics; the Km of verapamil was increased, but the asymptomatic leakage rate at high [Vp] was not changed significantly. These features indicate that the calcium ion is a competitive inhibitor of verapamil-augmented enzyme leakage. These observations suggest that there may exist a common calcium ion and verapamil binding site, or two allosterically related binding sites, which represent a prime determinant of myocardial leakage. The concept of a vulnerable site that binds calcium ions and verapamil competitively and initiates or vitiates processes that influence myocardial enzyme leakage is attractive because it suggests new approaches to the problem of myocardial preservation. As verapamil is thought not to enter the cell, the site of the competitive inhibition may be the sarcolemmal coat.

Relationship between amino acid intake and accretion in a marsupial, Macropus eugenii. I. Total amino acid composition of the milk throughout pouch life

The total amino acid composition of 57 samples of milk was analyzed by ion exchange resin chromatography after acid hydrolysis of proteins. The concentrations of most of the amino acids in the milk increased in proportion to the increase in milk protein. Sharp increases in the sulfur-containing amino acids, cystine (and/or cysteine) and methionine occurred at around 140-160 days which is about the time of hair follicle development. The remaining amino acids reached a peak concentration by 220 days, by which stage of development the pouch young has fully developed homeothermy. These higher amino acids levels were sustained to day 260, the time of highest milk protein concentration. The amino acids provided in the milk to the suckling pouch young thus show changes in relative amounts which correlate with some of the developmental events occurring during this phase of active growth and maturation.

A discharge planning tool for use with families of high-risk infants

The transition from hospital care to home care for high risk infants can be facilitated by the process of discharge planning. A tool designed specifically to coordinate discharge counseling and instruction for parents of high-risk infants has been developed and implemented in a perinatal center. Preliminary results indicate that the tool enables the health team to make an objective, rather than subjective, decision in respect to discharge of infants. Use of the tool also standardizes and documents the nurse's role in discharge planning.

Terminating a trial -- the ethical problem

A comparative clinical trial will often lead to the conclusion that one regimen is clearly better than another. Should the estimated difference in the regimens be large and precisely determined, continuation of the trial would constitute abuse of the participants. Some earlier proposals for ethical decision making on continuing a trial are shown to be unsatisfactory, and a more general framework for dealing with the problem is proposed.

Psychological development of children who received intrauterine transfusions

The intellectual, visual-motor, and social development of 15 children, 3 to 10 years of age, who received IUT for eythroblastosis fetalis was compared with that of 15 children of similar age who had required only exchange transfusions for the treatment of the same disorder. No over-all differences were found between the two groups or between the groups and the normal population. In comparison with normal population, recipients of IUT have above average IQ's and normal development in visual-motor integration and adaptive behavior.