Implementing a space-time rainfall model for the Sydney region

This paper investigates a Spatial Neyman-Scott Rectangular Pulse (SNSRP) model, which is one of only a few models capable of continuous simulation of rainfall in both space and time. The SNSRP is a spatial extension of the Neyman-Scott Rectangular Pulse model at a single point. The model is highly idealized having six parameters: storm arrival, cell arrival, cell radius, cell lifetime and two cell intensity parameters. A spatial interpolation of the scale parameter is used so that the model can be simulated continuously in space, rather than as a multi-site model. The parameters are calibrated using least-squares fits to statistical moments based on data aggregated to hourly and daily totals. The SNSRP model is calibrated to a very large network of 85 gauges over metropolitan Sydney and shows a good agreement to calibrated statistics. A simulation of 50 replicates over the region compares favourably to several observed temporal statistics, with an example given for one site. A qualitative discussion of the simulated spatial images demonstrates the underlying structure of non-advecting cylindrical cells.

A problem with her lead weight

An autistic patient living in a residential home presented with symptoms of weight loss and abdominal pain. On investigation, she was found to have lead poisoning from an unusual source. Her treatment proved difficult due to failure to cooperate, and a 'best-case' protocol was devised. The positive identification of a source of exposure can be difficult in a single case of exposure, but this was eventually achieved by means of stable lead isotope analysis following painstaking detective work.

Antioxidant levels in the cord blood of term fetus

The aim of this study was to compare the differences in the total antioxidant levels in the cord blood after a normal vaginal delivery and after an elective caesarean section. This was a prospective study approved by the Wirral Hospital ethical research committee. The study was carried out in a district general hospital. We investigated 96 healthy pregnant women who had normal antenatal period with singleton pregnancies between 37 and 42 completed weeks of gestation. Sixty-five women had a spontaneous normal vaginal delivery and 31 underwent elective caesarean section. Umbilical cord blood was obtained immediately after delivery. Antioxidants such as glutathione peroxidase (GPX) and superoxide dismutase (SOD) were measured and compared between the normal vaginal delivery and elective ceasarean sections. The mean values for GPx in umbilical cord arterial blood (95; 86-103, n=74) was found to be significantly higher (P=0.0133) than that found in umbilical cord venous blood (84; 80-88, n=95). The arterial SOD values were found to be significantly higher (P=0.0337) in infants who had been delivered by caesarean section (1188; 1065-1311, n=22) than by vaginal delivery (1021;958-1083, n=39). The differences in the levels of GPX between the arterial and venous systems is not well documented but may be due to differences in the level of selenium, hydroperoxides or glutathione. In addition, why infants delivered by ceasarian section have a higher level of arterial SOD than those delivered by vaginal delivery remains unclear, but it may be a reflection of a relatively low level in infants subjected to the stress of labour.

Mophometric study of the aortic arch and its major branches in rat fetuses on the 21st day of gestation

The anatomy and embryology of the aortic arch and its branching tributaries (brachiocephalic trunk, left common carotid artery and left subclavian artery) in man and animals are well substantiated. However, the anatomical variations and morphometry of the aortic arch and its branching tributaries in rat fetus at the 21st gestation day have not been studied. Pregnant rats were hysterectomized and the arterial systems of 114 fetuses were injected with a polymerisable resin through the umbilical artery. After maceration, the vascular casts were dissected out and prepared for observations under a scanning electron microscope (SEM). The resulting SEM pictures were studied with a picture analyser and different vessel parameters (diameters, lengths and angles) were measured. The success rate of the microvascular cast injection was 46.5%. Out of the 53 observed aortic arch casts, 98.1% showed the classical branching pattern and one (1.9%) had no brachiocephalic trunk. Morphological analysis showed many differences, which were not linked to the litter. The statistical processing of the measurements enabled us to determine that the aorta diameter after the branching of the left subclavian artery was the most replicable parameter. Moreover, the results revealed some strong correlations between different parameters. There are probably no discrete categories among the various observed parameters as diameters and angles. Some parameters show very little variability and can thus be used as reference points for further studies such as the comparison of a control population with a population treated with a relevant xenobiotic.

Role of polyhydroxybutyrate and glycogen as carbon storage compounds in pea and bean bacteroids

Rhizobium leguminosarum synthesizes polyhydroxybutyrate and glycogen as its main carbon storage compounds. To examine the role of these compounds in bacteroid development and in symbiotic efficiency, single and double mutants of R. leguminosarum bv. viciae were made which lack polyhydroxybutyrate synthase (phaC), glycogen synthase (glgA), or both. For comparison, a single phaC mutant also was isolated in a bean-nodulating strain of R. leguminosarum bv. phaseoli. In one large glasshouse trial, the growth of pea plants inoculated with the R. leguminosarum bv. viciae phaC mutant were significantly reduced compared with wild-type-inoculated plants. However, in subsequent glasshouse and growth-room studies, the growth of pea plants inoculated with the mutant were similar to wildtype-inoculated plants. Bean plants were unaffected by the loss of polyhydroxybutyrate biosynthesis in bacteroids. Pea plants nodulated by a glycogen synthase mutant, or the glgA/phaC double mutant, grew as well as the wild type in growth-room experiments. Light and electron micrographs revealed that pea nodules infected with the glgA mutant accumulated large amounts of starch in the II/III interzone. This suggests that glycogen may be the dominant carbon storage compound in pea bacteroids. Polyhydroxybutyrate was present in bacteria in the infection thread of pea plants but was broken down during bacteroid formation. In nodules infected with a phaC mutant of R. leguminosarum bv. viciae, there was a drop in the amount of starch in the II/III interzone, where bacteroids form. Therefore, we propose a carbon burst hypothesis for bacteroid formation, where polyhydroxybutyrate accumulated by bacteria is degraded to fuel bacteroid differentiation.

The human factor: the critical importance of effective teamwork and communication in providing safe care

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

The human factor: the critical importance of effective teamwork and communication in providing safe care

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

Amphiphilic derivatives of dextran: Adsorption at air/water and oil/water interfaces

Ionic amphiphilic dextran derivatives were synthesized by the attachment of sodium sulfopropyl and phenoxy groups on the native polysaccharide. A family of dextran derivatives was thus obtained with varying hydrophobic content and charge density in the polymer chains. The surface-active properties of polymers were studied at the air-water and dodecane-water interfaces using dynamic surface/interfacial tension measurements. The adsorption was shown to begin in a diffusion-limited regime at low polymer concentrations, that is to say, with the diffusion of macromolecules in the bulk solution. In contrast, at long times the interfacial adsorption is limited by interfacial phenomena: adsorption kinetics or transfer into the adsorbed layer. A semiempirical equation developed by Filippov was shown to correctly fit the experimental curves over the whole time range. The presence of ionic groups in the chains strongly lowers the adsorption kinetics. This effect can be interpreted by electrostatic interactions between the free molecules and the already adsorbed ones. The adsorption kinetics at air-water and oil-water interfaces are compared.

Amphiphilic polysaccharides: useful tools for the preparation of nanoparticles with controlled surface characteristics

Polymeric surfactants obtained by hydrophobic modification of dextran are used as stabilizers for oil-in-water emulsions. The kinetics of interfacial tension decrease is studied as a function of polymer structural characteristics (degree of hydrophobic substitution) and at various polymer concentrations. Several hydrocarbon oils, either aliphatic (octane, decane, dodecane, and hexadecane) or aromatic (styrene), are tested. Kinetics exhibits the same general trends no matter which oil or polymer is considered. The emulsifying properties of the polymeric surfactants are illustrated by the preparation of oil-in-water emulsions. The droplet size at the preparation is correlated to the amount of oil and to the polymer concentration in the aqueous phase. For low polymer/oil ratios, it is shown that the droplet size is limited by the initial amount of polymer. On the contrary, for high polymer/oil ratios, the droplet size seems to level down, indicating that other parameters become predominant. Emulsion aging occurs by Ostwald ripening, and it is demonstrated that the theoretical equation of Lifshitz, Slyozov, and Wagner (LSW) correctly describes the experimental results. The nature of the oil has important effects on emulsion aging, as described by the LSW equation. The aging of emulsions containing oil mixtures is quantitatively described on the basis of the results with pure oils. The influence of polymer chemical structure can be conveniently correlated to interfacial tension results through the LSW equation. On the contrary, the influence of oil volume fraction seems to be overestimated by the usual correction factor, k(phi). The effect of temperature on emulsion aging is finally examined. Miniemulsions stabilized with dextran derivatives are used for the radical polymerization of styrene. Following this procedure, polysaccharide-covered polystyrene nanoparticles are prepared and characterized (size and surface coverage). The size of the particles is directly correlated to that of the initial droplets for styrene volume fractions around 10%. On the contrary, for initial styrene volume fractions around 20%, particles exhibit a larger size than the initial droplets, indicating that coalescence processes take place during polymerization. The amount of dextran at the surface of the particles is determined and compared to the adsorbed amounts resulting from emulsion preparation.

Hydrophobically modified alginate hydrogels as protein carriers with specific controlled release properties

Amphiphilic derivatives of sodium alginate, prepared by chemical covalent binding of long alkyl chains onto the polysaccharide backbone via ester functions, form strong hydrogels in aqueous solutions. The shear-thinning and thixotropic behaviors of these hydrogels have been exploited to prepare particles (millimetric beads or microparticles) by dispersion in sodium chloride solutions. This all-aqueous procedure was used for the encapsulation of model proteins, such as bovine serum albumin (BSA) and human hemoglobin (Hb), or of a vaccine protein (Helicobacter pylori (H. pylori) urease). In all cases, the encapsulation yields were very high (70-100%). No release of model proteins was observed in water within several days, in contrast with protein-loaded calcium alginate particles, which exhibit an important release within only a few hours. The controlled release of proteins can, however, be achieved by inducing the dissociation of the physical hydrophobic network. This dissociation has been obtained either by addition of surfactants, acting as disrupting agents of intermolecular hydrophobic junctions, or of esterases such as lipases, which hydrolyze the ester bond between alkyl chains and the polysaccharide backbone. The level of immunization against H. pylori infection in mice, induced by encapsulated urease administrated by either systemic or mucosal routes, was also assessed.

Physical alginate hydrogels based on hydrophobic or dual hydrophobic/ionic interactions: Bead formation, structure, and stability

Hydrophobically associating alginate (AA) derivatives were prepared by covalent fixation of dodecyl or octadecyl chains onto the polysaccharide backbone (AA-C12/AA-C18). In semidilute solution, intermolecular hydrophobic interactions result in the formation of physical hydrogels, the physicochemical properties of which can be controlled through polymer concentration, hydrophobic chain content, and nonchaotropic salts such as sodium chloride. The mechanical properties of these hydrogels can then be reinforced by the addition of calcium chloride. The combination of both calcium bridges and intermolecular hydrophobic interactions leads to a decrease in the swelling ratio accompanied by an increase of elastic and viscous moduli. Beads made of hydrophobically modified alginate were obtained by dropping an aqueous solution of alginate derivative into a NaCl/CaCl2 solution. As compared to unmodified alginate beads, modified alginate particles proved to be stable in the presence of nongelling cations or calcium-sequestering agents. However, evidence is presented for a more heterogeneous structure than that of plain calcium alginate hydrogels with, in particular, an increase in the effective gel mesh size, as determined by partition and diffusion coefficient measurements.

Physicochemical evaluation of PLA nanoparticles stabilized by water-soluble MPEO–PLA block copolymers

Different water-soluble MPEO-PLA diblock copolymers with various alpha-methoxy-omega-hydroxyl polyethylene (MPEO) and poly(lactic acid) (PLA) block lengths have been synthesized. Their surface-active properties were evidenced by surface tension (water/air) measurements. In each case the surface tension leveled down above a critical polymer concentration, which was attributed to the formation of a dense polymer layer at the liquid-air interface. The applicability of copolymers as emulsion stabilizers in the preparation of PLA nanospheres by an o/w emulsion/evaporation technique was then investigated. Four copolymers presenting sufficient water solubility and good surfactive properties were used to prepare PLA nanospheres with MPEO chains firmly anchored at the particle surface. The effect of polymer concentration in emulsion on particle size and surface coverage was examined. Whatever the copolymer characteristics, it was found that the optimal concentration to obtain a large amount of MPEO at the particle surface was similar (around 2 g/l). The effect of the copolymer composition on MPEO layer characteristics and on colloidal stability was also evaluated. The conformation of MPEO blocks at the PLA particle surface is discussed in relation to the layer thickness and the surface area occupied per molecule.

Production of microspheres based on hydrophobically associating alginate derivatives by dispersion/gelation in aqueous sodium chloride solutions

A new "all aqueous" procedure for the preparation of stable polysaccharide microparticles was developed. The method consists of dispersing a water solution of an amphiphilic alginate derivative (in the current work, alginate substituted with low amounts of dodecyl chains) first fluidified under mechanical stress, into an NaCl solution. The procedure exploits the ability of amphiphilic associative derivatives to form strong hydrogels in the presence of nonchaotropic salts and their shear-thinning/thixotropic properties. Depending on the experimental conditions, the size of the microparticles can be varied from 10 microm to several hundred micrometers. Their mechanical properties can eventually be reinforced by addition of low concentrations of calcium chloride. The resulting microparticles exhibit a better stability than that of plain Ca(2+)-alginate particles, as they are not disrupted when nongelling cations or calcium-sequestering agents are added to the solution. In addition, the particles can be easily redispersed after being centrifuged or freeze-dried.

Surface Activity and Emulsification Properties of Hydrophobically Modified Dextrans

Neutral polymeric surfactants were synthesized by covalent attachment of hydrophobic groups (aromatic rings) onto a polysaccharide backbone (dextran). By changing the conditions of the modification reaction, the number of grafted hydrophobic groups per 100 glucopyranose units (substitution ratio) was varied between 7 and 22. In aqueous solution, these polymers behaved like classical associative polymers as demonstrated by viscometric measurements. The associative behavior was more pronounced when the substitution ratio increased. The surface-active properties of the modified dextrans were evidenced by surface tension (air/water) and interfacial tension (dodecane/water) measurements. In each case the surface or interfacial tension leveled down above a critical polymer concentration, which was attributed to the formation of a dense polymer layer at the liquid-air or liquid-liquid interface. Dodecane-in-water emulsions were prepared using the polymeric surfactants as stabilizers, with oil volume fractions ranging between 5 and 20%. The oil droplet size (measured by dynamic light scattering) was correlated to the amount of polymer in the aqueous phase and to the volume of emulsified oil. The thickness of the adsorbed polymer layer was estimated thanks to zeta potential measurements coupled with size measurements. This thickness increased with the amount of polymer available for adsorption at the interface. The dextran-based surfactants were also applied to emulsion polymerization of styrene and stable polystyrene particles were obtained with a permanent adsorbed dextran layer at their surface. The comparison with the use of an unmodified dextran indicated that the polymeric surfactants were densely packed at the surface of the particles. The colloidal stability of the suspensions of polystyrene particles as well as their protection against protein adsorption (bovine serum albumin, BSA, used as a test protein) were also examined.

Role of alendronate and risedronate in preventing and treating osteoporosis

Alendronate and risedronate, the two oral bisphosphonates approved in the United States for preventing and treating osteoporosis, have never been compared in direct head-to-head trials, but they appear to have similar pharmacokinetics, drug interactions, adverse effect profiles, and efficacy. Alendronate, however, can be given as a once-weekly dose, whereas risedronate is not yet available in this dosage form. On the other hand, alendronate is not approved for preventing glucocorticoid-induced osteoporosis, whereas risedronate carries this indication.

Surface modification of polystyrene nanoparticles using dextrans and dextran-POE copolymers: polymer adsorption and colloidal characterization

Hydrophobically-modified dextran (dextran-phenoxy, DexP) and dextran-phenoxy-poly(oxyethylene) (DexP-POE) copolymers have been used to modify the surface properties and the stability of polystyrene nanoparticles. We examined the effect of phenoxy group and POE chain concentrations on their adsorption behaviour. The adsorbed amount was determined by the standard depletion method and the layer thickness of the adsorbed layer by photon correlation spectroscopy and electrokinetic measurements. The results show that the hydrophobic interaction is the driving force during the adsorption while the layer thickness correlates with the interfacial concentration of grafted POE chains. The effects of adsorbed layers on the properties of latex dispersions have been characterized in terms of the stability of the dispersions toward added electrolyte and temperature. The conformation of the adsorbed copolymers is discussed in relation to layer thickness and colloidal stability of suspensions.

The effect of different methods of storage on the results of serum total CO2 assays

Metabolic acidosis frequently complicates end-stage renal failure. In haemodialysis patients its severity is usually monitored by measurement of the total CO(2) (TCO(2)) level. Samples from 'satellite dialysis' patients are often stored prior to analysis. We investigated the affect of storage of 21 samples for 24 h under different conditions prior to analysis. If samples were stored at room temperature the TCO(2) fell from 22.7+/-4.2 mmol/l to 21.6+/-3.7 mmol/l (P=0.001). If the same samples were spun and stored at 4 degrees C the TCO(2) was 22.4+/-3.9 mmol/l (P=not significant). We conclude that the magnitude in the fall of TCO(2) stored at room temperature for 24 h is unlikely to be clinically significant and can be prevented by spinning the sample and refrigerating it.