The population-based prevalence of achondroplasia and thanatophoric dysplasia in selected regions of the US

There have been no large population-based studies of the prevalence of achondroplasia and thanatophroic dysplasia in the United States. This study compared data from seven population-based birth defects monitoring programs in the United States. We also present data on the association between older paternal age and these birth defects, which has been described in earlier studies. The prevalence of achondroplasia ranged from 0.36 to 0.60 per 10,000 livebirths (1/27,780-1/16,670 livebirths). The prevalence of thanatophoric dysplasia ranged from 0.21 to 0.30 per 10,000 livebirths (1/33,330-1/47,620 livebirths). In Texas, fathers that were 25-29, 30-34, 35-39, and > or =40 years of age had significantly increased rates of de novo achondroplasia among their offspring compared with younger fathers. The adjusted prevalence odds ratios were 2.8 (95% CI; 1.2, 6.7), 2.8 (95% CI; 1.0, 7.6), 4.9 (95% CI; 1.7, 14.3), and 5.0 (95% CI; 1.5, 16.1), respectively. Using the same age categories, the crude prevalence odds ratios for de novo cases of thanatophoric dysplasia in Texas were 5.8 (95% CI; 1.7, 9.8), 3.9 (95% CI; 1.1, 6.7), 6.1 (95% CI; 1.6, 10.6), and 10.2 (95% CI; 2.6, 17.8), respectively. These data suggest that thanatophoric dysplasia is one-third to one-half as frequent as achondroplasia. The differences in the prevalence of these conditions across monitoring programs were consistent with random fluctuation. Birth defects monitoring programs may be a good source of ascertainment for population-based studies of achondroplasia and thanatophoric dysplasia, provided that diagnoses are confirmed by review of medical records.

Updated CCPS Investigation Guidelines book

Incident investigation standards and performance criteria continue to improve. In recognition, the Center for Chemical Process Safety (CCPS) undertook a major project to upgrade and update the Incident Investigation Guidelines originally published in 1992. These significantly expanded guidelines provide a practical resource for effective investigation of process-related incidents, and reflect changes in good practices and expectations of regulators. This paper highlights the content of the new guidelines with special emphasis on what is new and improved. Entirely new chapters address the topics of legal considerations, the near-miss event, and continuous improvement of the investigation system. The objective of the guidelines is to allow chemical process organizations to develop and implement an incident investigation management system that is effective in identifying underlying causes.

Motor systems

The field of motor control has broadened considerably over the past decade. Increasingly detailed information has accrued about the cellular and molecular processes involved in motor pattern generation and motor learning while, at the other extreme, the comparison of studies in humans and monkeys has begun to bridge the gap between cognitive and motor functions. The most striking feature of recent research has been the intense use of electrophysiological procedures in behaving monkeys and non-invasive imaging procedures in humans to elucidate details of sensory-motor transformations and the functional roles of different brain regions in the learning, planning and execution of movements.

Chimpanzee (Pan troglodytes) handedness: variability across multiple measures of hand use

This study examined intertask consistency in handedness across multiple measures of hand use in a sample of 187 chimpanzees (Pan troglodytes). Hand preferences for 2 to 6 measures were collected from the sample, and hand preference scores were derived on the basis of the individual hand preferences for each measure. Seven of 15 possible intratask correlations were significant, with some degree of clustering depending on the motor demands of the tasks. Two overall measures of handedness revealed population-level right-handedness in the chimpanzees, although the degree of bias was reduced for chimpanzees tested on more than 3 measures of hand use. The results are interpreted in the context of several recent studies that proposed theoretical models of handedness in nonhuman primates.

Surgical ICU underutilization does not significantly discourage discharge

An SICU must have sufficient capacity to handle peak weekly demand to prevent re-admission and/or poor quality of care. Excess capacity may, however, encourage unnecessary SICU utilization. The goal of this study was to assess the influence of availability of SICU beds on patient discharge and re-admission rates. The case series included 1,492 days, 36,816 patient days, 8,821 discharges, and 186 re-admissions within 3 days from a 24-bed multidisciplinary SICU at a tertiary care center. Census was defined to equal the total number of patients in the SICU each day. We found low census levels were not associated with significantly lower discharge rates. Decreasing the census from 19-24 to 13-18 patients per day decreased discharge rates from 31% to 30%. Odds ratio that a decrease in census by five from 24 decreased discharge rate equaled 1.01 (95% confidence interval 0.96 to 1.06). We conclude that when hospital managers choose an appropriate SICU capacity they need not be concerned that intermittent excess capacity will prompt physicians to significantly decrease their discharge rates.

A clinical intervention for children exposed to alcohol in utero

This study describes a statewide system of delivering special services to children affected by prenatal alcohol exposure and investigates the usefulness of this system as part of a statewide fetal alcohol syndrome surveillance system. The Alaska Department of Health and Social Services administered seven clinics in four of the five largest cities in Alaska during 1992-1995. Among the 74 children selected to be evaluated for fetal alcohol syndrome, 70 had one or more central nervous system abnormalities. Four children were assigned the diagnosis of fetal alcohol syndrome. Recommendations made to parents of the evaluated children included parent support group follow-up (38%), referral to a psychologist (35%), and further school testing and planning (27%). Clinics for alcohol-exposed children provide health officials an opportunity to deliver appropriate services to children exposed to alcohol in utero and to their families. Further studies are necessary to improve the delivery of services to birth mothers of alcohol-exposed children who attend the clinic. State-wide fetal alcohol syndrome surveillance can be accomplished by linking these clinics with other state data sources.

Waiting times: the search for equitable solutions. Case study: Mater Misericordiae Adult Public Hospital Continuum of Care Model

For the survival of any health care organisation, evidence-based practice is fundamental, particularly in today's economic climate. The Mater Misericordiae Adult Public Hospital in Brisbane is committed to providing a flexible health care system that is responsive and accountable to the needs of the customers. As part of the Mater's continuous quality improvement program, a Continuum of Care Service Delivery Model was developed. This model comprises many innovative clinical management systems which have evolved over recent years. Clinical pathways, care management, pre-admission clinics, variance management and evidence-based practice are core components of the model.

Ondansetron prevents postoperative nausea and vomiting in women outpatients

Three doses of intravenous (i.v.) ondansetron, 1 mg, 4 mg, and 8 mg, were compared to placebo for their antiemetic effect and safety. The drugs or placebo were administered in a double-blind manner, prophylactically to 589 women undergoing elective outpatient surgical procedures under nitrous oxide opioid-based general endotracheal anesthesia. In the postanesthesia care unit, the number of emetic episodes, periodic assessments of nausea severity using an 11-point scale (0 = no nausea; 10 = worst nausea), vital signs, and adverse events were collected by an independent observer for 2 h. Upon discharge, identical information, with the exception of vital signs, was collected from the patients' diary and via phone call. One pre- and two poststudy blood specimens for hematology and chemistries were evaluated. During the initial 2 h, patients receiving any dose of ondansetron had significantly better complete response rates (no emesis) than those receiving placebo. Over the 24-h study period, patients who received either 4 mg or 8 mg ondansetron continued to have significantly greater complete response rates. Adverse events were minor, and ondansetron-treated patients had profiles similar to those of the placebo. Heart rate, blood pressure, respiratory rate, and laboratory safety variables were not different among the groups. Ondansetron did not prolong awakening time. This study indicates that ondansetron is a safe and effective prophylactic antiemetic for women who have outpatient surgery under nitrous oxide opioid-based general anesthesia.

Torsional testing of Canal Master U hand instruments

Ten each of size 25, 30, 35, 40, and 45 Canal Master U hand instruments were tested for torsional failure and revolutions to failure. In addition, the point at which separation occurred was measured on the instrument shaft. An Instron 1125 machine was used for all torsion testing. The mean torque failure value for size 25 and 35 Canal Master U instruments exceeded the ADA specification No. 28 minimum values while sizes 30, 40, and 45 were below the ADA minimum average values. All Canal Master U averages for revolutions to failure exceeded the ADA minimums. Although size 25 was above the minimum average, due to a wide range of values, 5 of the 10 were below the ADA specification No. 28 values. The point of instrument separation was 0.325 to 1.575 mm behind the cutting head. Due to the structural design differences of endodontic files versus Canal Master U, it is suggested that an additional category of ADA specification be introduced for Canal Master endodontic instruments.

Validation of a self-administered questionnaire for assessing occupational and environmental exposures of pregnant women

The present investigation sought to determine whether a self-administered questionnaire could be used to obtain occupational information from pregnant women attending the obstetrical clinics at the University of California, San Francisco from July to November 1986. The authors compared the accuracy of responses of 57 women on the self-administered questionnaire with those obtained on a detailed clinical interview by an occupational health professional. The self-administered questionnaire and the clinical interview included information on the woman's job title, the type of company she worked for, the level of physical activity, her exposures on the job and at home, and her partner's occupation. The authors also examined whether the "validity" of the self-administered questionnaire could be improved on review by an industrial hygienist. The questionnaire took less than 20 minutes to complete, with over 90% of the women answering three-quarters of it. It was "substantially" accurate in obtaining information on number of hours worked during pregnancy, type of shift worked, and stress level in the workplace; exposure to radiation, video display terminals, fumes, gases, and cigarette smoke in the workplace; and exposure to pesticides, paint, and cigarette smoke at home. On those variables for which the responses on the self-administered questionnaire were less accurate, review by the industrial hygienist improved the level of accuracy considerably. These findings suggest that a self-administered questionnaire can be used to obtain valid information from pregnant women attending a prenatal clinic.

Toxic shock syndrome and the vaginal contraceptive sponge

Thirteen confirmed cases of toxic shock syndrome temporally related to use of the vaginal contraceptive sponge have been reported. The observed risk of toxic shock syndrome in sponge users may be elevated above estimated background rates, but this risk remains very low. Traumatic manipulation of the sponge, use during menstruation or the puerperium, and prolonged retention of the sponge may additionally increase toxic shock syndrome risk. As with all contraceptives, risks must be balanced against benefits.

Nucleotide sequence of the 5' noncoding region and part of the gag gene of mouse mammary tumor virus; identification of the 5' splicing site for subgenomic mRNAs

We have determined the sequence of the first 1371 nucleotides at the 5' end of the genome of mouse mammary tumor virus using molecularly cloned proviral DNA of the GR virus strain. The most likely initiation codon used for the gag gene of mouse mammary tumor virus is the first one, located 312 nucleotides from the 5' end of the viral RNA. The 5' splicing site for the subgenomic mRNA's is located approximately 288 nucleotides downstream from the 5' end of the viral RNA. From the DNA sequence the amino acid sequence of the N-terminal half of the gag precursor protein, including p10 and p21, was deduced (353 amino acids).

The pharmacist and adverse drug reaction reporting

During premarketing trials, the number of patients exposed to a drug and the length of exposure to a drug are both limited. After marketing, many thousands, frequently millions, of patients are exposed to the drug over considerably longer periods of time, and adverse drug reactions not previously recognized appear. Because of these factors, postmarketing surveillance is extremely important. Pharmacists can contribute to drug safety and improved patient care by understanding and actively participating in the Food and Drug Administration's Spontaneous Reporting Program.

The region of mouse mammary tumor virus DNA containing the long terminal repeat includes a long coding sequence and signals for hormonally regulated transcription

Starting from a biologically active recombinant DNA clone of exogenous unintegrated GR mouse mammary tumor virus, we have generated three subclones of PstI fragments of 1.45, 1.1, and 2.0 kb in the plasmid vector PBR322. The nucleotide sequence has been determined for the clone of 1.45 kb which includes almost the complete region of the long terminal repeat (LTR) plus an adjacent stretch of unique sequence DNA. A short region of the 2.0 kb clone, containing the beginning of the LTR, has also been sequenced. Starting with the A of an initiation codon outside the LTR, we detected an open reading frame of 960 nucleotides, potentially coding for a protein of 320 amino acids (36K). Two hundred nucleotides downstream from the termination codon, and approximately 25 nucleotides upstream from the presumptive initiation site of viral RNA synthesis, we found a promoter-like sequence. The sequence AGTAAA was detected approximately 15-20 nucleotides upstream from the 3' end of virion RNA and probably serves as a polyadenylation signal. The 1.45 kb PstI fragment has been transfected into Ltk- cells together with a plasmid containing the thymidine kinase gene of herpes simplex virus. The virus-specific RNA synthesis detected in a Tk+ cell clone was strongly stimulated by the addition of dexamethasone.