A typology of care episodes experienced by people with schizophrenia in an English town

The paper presents an analysis of the psychiatric care histories of people diagnosed with schizophrenia which is set within the policy context of the deinstitutionalisation debate. The durations of successive terms of in-patient and community care were drawn from the records of the Salford Psychiatric Case Register and related to the age, gender and social isolation of each patient. Strong age-sex interactions are revealed by the tendencies for young male patients to exhibit rapid hospital readmission and discharge rates and elderly female patients to experience long terms of in-patient care. The role of social isolation in relation to these care durations turns out to be more restricted.

A logical (discrete) formulation for the storage and recall of environmental signals in plants

When subjected to an appropriate asymmetric stimulus, seedlings of Bidens pilosa L. "store" a symmetry-breaking instruction that will finally take effect (in the form of a differential growth of the cotyledonary buds) only if the plants are in a state in which they can "recall" this information. The ability of the plants to recall the stored symmetry-breaking instruction may be switched "on" or "off" by the application of a variety of stimuli. Although its detailed phenomenology is rather complicated, the overall behaviour of the plant storage/recall system can be modelled by use of an asynchronous, logical (discrete) description involving positive and negative feedback circuits, which are required for the existence of multi-stationarity and stability, respectively. The state tables, as used in this formalism, give a concise and easy-to-handle description of the evolution of the system and make it particularly easy to determine its stable states. This modelling approach may be extended to the formulation of many other experimental systems.

Evaluating the QuikRead® C-reactive protein test as a point-of-care test

BACKGROUND

Available tests to diagnose infection in neonates often provide results after 12-24 hours. A bedside test that is reliable will facilitate earlier exclusion or diagnosis of infection.

OBJECTIVE

To validate a bedside C-reactive protein (CRP) test against the currently available laboratory CRP test in neonates with suspected sepsis.

METHODS

This was a prospective observational study where a bedside CRP was done concurrently with and validated against a laboratory CRP in neonates with suspected sepsis. The sensitivities, specificities and predictive values for the bedside CRP tests were calculated using the laboratory CRPs as the reference test.

RESULTS

There were 209 measured CRP-sample pairs. Seventy per cent of these had suspected early-onset neonatal sepsis and 30% had suspected late-onset neonatal sepsis. Twelve per cent had culture-proven sepsis. At the recommended cut-off of 8.0 mg/L for the bedside CRP test, the sensitivity, specificity, positive and negative predictive values were 84%, 80%, 30% and 97%, respectively. Adjusting the cut-off value from 8.0 to 15.0 mg/L improved the specificity to 88%. The sensitivity, specificity and positive and negative predictive values were not different between early-onset and late-onset sepsis. The receiver operating characteristic curve had an area below the curve of 0.84 for the cut-off at 16.2 mg/L on the beside CRP test.

CONCLUSIONS

The bedside CRP test may be used as a screening test to aid decisions to either commence or discontinue antibiotics in circumstances where the clinical diagnosis of sepsis is in doubt. By using a cut-off of 16.0 mg/L for the bedside CRP test, the possibility of a false negative result is minimised.

Criterion validity and sensitivity to change of the Early Rehabilitation Index (ERI): results from a German multi-center study

BACKGROUND

Evaluation of functional status is difficult in neurological and neurosurgical early rehabilitation patients. The Early Rehabilitation Index (ERI) was introduced in Germany over 20 years ago, but since then validation studies are lacking. The ERI (range -325 to 0 points) includes highly relevant items including the necessity of intermittent mechanical ventilation or tracheostomy.

METHODS

The present paper analyzed data from a German multi-center study, enrolling 754 neurological early rehabilitation patients. Together with ERI, Barthel Index (BI), Glasgow Coma Scale (GCS), Glasgow Outcome Score Extended, Coma Remission Scale (CRS), Functional Ambulation Categories and length of stay were obtained.

RESULTS

ERI showed significant improvements from admission to discharge (p < 0.001). In addition, there were significant correlations of the ERI upon admission and at discharge with BI, CRS and GCS.

CONCLUSIONS

Evaluation of our study data suggest that the ERI may be used as a valid assessment instrument for neurological and neurosurgical early rehabilitation patients.

Foot ulceration in a secondary care diabetic clinic population: a 4-year prospective study

Diabetes guidelines recommend that feet are stratified into low-risk, increased-risk and high-risk. We examined prospective foot ulceration in our secondary care diabetes clinic. At 4-year follow-up, foot ulceration was present in 1/586 (0.17%) in the low-risk, 10/305 (3.3%) in those at increased-risk and 28/236 (11.9%) in the high-risk group.

1998 American Urological Association Gallup Survey: changes in physician practice patterns, treatment of ureteral stones and impact of managed care

PURPOSE

The American Urological Association first commissioned the Gallup Organization to conduct a study to assess urologist practice patterns in 1992. We present the results of the seventh consecutive Gallup Survey performed for the Association.

MATERIALS AND METHODS

A random sample of 537 American urologists who completed urological residency and practiced at least 20 hours weekly in 1997 were interviewed by telephone in March 1998. Major topic areas included general demographics, practice patterns, treatment of ureteral stones and experience with managed care.

RESULTS

Demographic trends indicated a significant decrease in average urologist age from 49.4 years in 1992 to 46.8 in 1998. Of the urologists 99% reported that they treat ureteral stones. Managed care had an increasingly larger role in most practices, particularly in the western United States, where 73% of urologists reported that they contract with a Medicare health maintenance organization.

CONCLUSIONS

The average age of practicing urologists significantly decreased, which may be due to an increasing number of urologists retiring at an earlier age, although this finding is not clear. Nearly all urologists treated ureteral stones with considerable consistency. Finally, managed care appeared to have a major impact on most urologists throughout the United States.

Fludarabine induced intestinal pseudo-obstruction: case report and literature review

Intestinal pseudo-obstruction is a recognized but rare complication of chemotherapy. Vinca alkaloids and cytarabine have been reported to be associated with intestinal pseudo-obstruction. We report a case of fludarabine induced severe intestinal pseudo-obstruction in a 66-year-old man suffering from non-Hodgkin's lymphoma, and describe our successful management of this with a combination of parasympathomimetic and mechanical decompression, after failure of conservative management.

The place of trabeculectomy in the management of primary open-angle glaucoma and factors favouring success

Medical treatment has always been the mainstay in the management of primary open-angle glaucoma (POAG). Surgical intervention has been reserved for cases with intraocular pressures uncontrolled on medical therapy and/or progression of visual field loss. Following the introduction of trabeculectomy, there was a move toward earlier surgery in POAG with some advocating it as a primary procedure. However, others have emphasised the complications and unpredictability of trabeculectomy and use it only as a last resort. In this article the literature is reviewed and the factors that prevent complications and help ensure a successful result in trabeculectomy are considered. While the role of trabeculectomy as a primary procedure in POAG is debatable, the authors favour earlier surgical intervention rather than using surgery as a last resort.

Pulmonary effects of expiratory-assisted small-lumen ventilation during upper airway obstruction in pigs

Novel devices for small-lumen ventilation may enable effective inspiration and expiratory ventilation assistance despite airway obstruction. In this study, we investigated a porcine model of complete upper airway obstruction. After ethical approval, we randomly assigned 13 anaesthetised pigs either to small-lumen ventilation following airway obstruction (n = 8) for 30 min, or to volume-controlled ventilation (sham setting, n = 5). Small-lumen ventilation enabled adequate gas exchange over 30 min. One animal died as a result of a tension pneumothorax in this setting. Redistribution of ventilation from dorsal to central compartments and significant impairment of the distribution of ventilation/perfusion occurred. Histopathology demonstrated considerable lung injury, predominantly through differences in the dorsal dependent lung regions. Small-lumen ventilation maintained adequate gas exchange in a porcine airway obstruction model. The use of this technique for 30 min by inexperienced clinicians was associated with considerable end-expiratory collapse leading to lung injury, and may also carry the risk of severe injury.

A novel canine kidney cell line model for the evaluation of neoplastic development: karyotype evolution associated with spontaneous immortalization and tumorigenicity

The molecular mechanisms underlying spontaneous neoplastic transformation in cultured mammalian cells remain poorly understood, confounding recognition of parallels with the biology of naturally occurring cancer. The broad use of tumorigenic canine cell lines as research tools, coupled with the accumulation of cytogenomic data from naturally occurring canine cancers, makes the domestic dog an ideal system in which to investigate these relationships. We developed a canine kidney cell line, CKB1-3T7, which allows prospective examination of the onset of spontaneous immortalization and tumorigenicity. We documented the accumulation of cytogenomic aberrations in CKB1-3T7 over 24 months in continuous culture. The majority of aberrations emerged in parallel with key phenotypic changes in cell morphology, growth kinetics, and tumor incidence and latency. Focal deletion of CDKN2A/B emerged first, preceding the onset and progression of tumorigenic potential, and progressed to a homozygous deletion across the cell population during extended culture. Interestingly, CKB1-3T7 demonstrated a tumorigenic phenotype in vivo prior to exhibiting loss of contact inhibition in vitro. We also performed the first genome-wide characterization of the canine tumorigenic cell line MDCK, which also exhibited CDKN2A/B deletion. MDCK and CKB1-3T7 cells shared several additional aberrations that we have reported previously as being highly recurrent in spontaneous canine cancers, many of which, as with CDKN2A/B deletion, are evolutionarily conserved in their human counterparts. The conservation of these molecular events across multiple species, in vitro and in vivo, despite their contrasting karyotypic architecture, is a powerful indicator of a common mechanism underlying emerging neoplastic activity. Through integrated cytogenomic and phenotypic characterization of serial passages of CKB1-3T7 from initiation to development of a tumorigenic phenotype, we present a robust and readily accessible model (to be made available through the American Type Culture Collection) of spontaneous neoplastic transformation that overcomes many of the limitations of earlier studies.

Association of lifestyle and demographic factors with estrogenic and glucocorticogenic activity in Mexican American women

Breast cancer risk is higher in US-born than in foreign-born Hispanics/Latinas and also increases with greater length of US residency. It is only partially known what factors contribute to these patterns of risk. To gain new insights, we tested the association between lifestyle and demographic variables and breast cancer status, with measures of estrogenic (E) and glucocorticogenic (G) activity in Mexican American women. We used Chemical-Activated LUciferase gene eXpression assays to measure E and G activity in total plasma from 90 Mexican American women, without a history of breast cancer at the time of recruitment, from the San Francisco Bay Area Breast Cancer Study. We tested associations of nativity, lifestyle and sociodemographic factors with E and G activity using linear regression models. We did not find a statistically significant difference in E or G activity by nativity. However, in multivariable models, E activity was associated with Indigenous American ancestry (19% decrease in E activity per 10% increase in ancestry, P = 0.014) and with length of US residency (28% increase in E activity for every 10 years, P = 0.035). G activity was associated with breast cancer status (women who have developed breast cancer since recruitment into the study had 21% lower G activity than those who have not, P = 0.054) and alcohol intake (drinkers had 25% higher G activity than non-drinkers, P = 0.015). These associations suggest that previously reported breast cancer risk factors such as genetic ancestry and alcohol intake might in part be associated with breast cancer risk through mechanisms linked to the endocrine system.

Development and evaluation of an in vivo mouse model for studying myocutaneous flap microcirculation and viability before and after suturing or stapling

A model was developed in albino hairless mice to study microcirculation and viability of dorsal distally based myocutaneous flaps. The efficacy of this model was tested in 120 mice by evaluating the effects of excessive crimping and tension attributed to Proximate or Signet staples or to simple or mattress nylon sutures. Microhemodynamics were assessed using computer-assisted intravital videomicroscopic and electro-optical methods. Volumetric rates of blood flow were calculated within terminal arterioles from measurements of internal diameter and mean centerline cellular velocity. The viability was determined on day 5 by measuring the areas of necrosis (mm2) along the cut edges of these flaps. In 80 mice, flaps were elevated and examined at 0 h and then again at 24 or 48 h. There were 40 mice in each of these disturbed groups. In a third group of 40 mice, flaps were raised at 0 h without videomicroscopic examination at 0, 24, or 48 h (undisturbed group). All flaps were stapled or sutured to the original donor site with one of the four methods of closure. The results of this study indicate that sutures produce the highest incidence of necrosis at 5 days when compared to staples in the undisturbed groups of mice. However, no significant differences in necrosis were observed when flaps were disturbed at 48 h despite videomicroscopic evidence of depressed blood flow along their cut edges. In contrast, results at 24 h were equivocal and statistically not significant. These data suggest that the phenomenon of delay and/or flap recirculation following removal and reapproximation of sutures or staples drastically improves perfusion and viability of disturbed flaps.(ABSTRACT TRUNCATED AT 250 WORDS)

Microbiological quality of Queensland stockfeeds with special reference to salmonella

One hundred Queensland stockfeeds were examined for their counts of total aerobic bacteria, coliforms, fungi and salmonellas. The total aerobic bacteria, coliform and fungal counts were significantly higher (P < 0.005) for mashes than for crumbles and pellets and salmonellas were isolated from significantly more (P < 0.005) mashes (64%) than pellets and crumbles (8%). Counts of less than 1 salmonella per 100 g were found in 36.4% of the 44 positive feeds. The remainder of the counts ranged from 1.2 per 100 g to greater than 147 salmonellas per 100 g feed.

Multiregion contact systems for modelling STD epidemics

This paper elicits properties of some multiregional contact systems for STD infections that are intended to assist the understanding of disease control strategies. To this end, a space-time SIS model is described that maintains the symmetry of contact that is inherent in the formation of sexual partnerships. It is demonstrated how the characteristic stability conditions of this model provide a framework for understanding the potential for sustained transmission after the introduction of the agent into a given region. Then, more complex SI specifications are derived that are particularly relevant to the transmission of HIV. These extensions include the introduction of alternative modes of travel and behavioural adaptations made in response to the circulation of HIV and the incidence of AIDS. The discussion suggests some additions to the systems that might enhance their applicability in practice.

An integrated cytogenetic, radiation-hybrid, and comparative map of dog chromosome 5

The development of a detailed genome map for the domestic dog (Canis familiaris, CFA) is a prerequisite for the continued use of this species as a model system for the study of inherited traits. We present an integrated cytogenetic, radiation-hybrid, and comparative map of dog Chromosome (Chr) 5 (CFA 5). The map comprises 14 gene markers, selected from loci previously mapped within the corresponding evolutionarily conserved chromosome segments (ECCS) of the human genome. Large-insert clones representing each marker were first isolated and mapped by fluorescence in situ hybridization (FISH) analysis to determine their subchromosomal localization on CFA 5. Thirteen gene markers were subsequently mapped by using a commercially available whole genome radiation hybrid (WG-RH) panel for the dog. Nine anonymous markers were also assigned to CFA 5 by both FISH and WG-RH analysis. The 22 markers formed six RH-linkage groups, spanning each of the four ECCS comprising this 99 megabase chromosome. All cytogenetic, WG-RH, and comparative mapping data were in agreement and were combined to determine both the most likely locus order within each linkage group, and also the gross relative orientation of the corresponding ECCS. This study provides a resource for the transfer of information from the human transcript map to that of the dog, and extends existing data regarding the structural relationships between CFA 5 and its evolutionary counterparts within the human genome.

A comparative study of co-trimoxazole and amoxycillin in the treatment of acute bronchitis in general practice: a multicentre study

One hundred and five patients with acute bronchitis were treated with co-trimoxazole, and amoxycillin, in a single-blind trial. The present study confirms that co-trimoxazole and amoxycillin are effective, and well tolerated agents, both suitable for the management of acute bronchitis.