An assessment of the validity of SOFA score based triage in H1N1 critically ill patients during an influenza pandemic

Sequential Organ Failure Assessment (SOFA) score based triage of influenza A H1N1 critically ill patients has been proposed for surge capacity management as a guide for clinical decision making. We conducted a retrospective records review and SOFA scoring of critically ill patients with influenza A H1N1 in a mixed medical-surgical intensive care unit in an urban hospital. Eight critically ill patients with influenza A H1N1 were admitted to the intensive care unit. Their mean (range) age was 39 (26-52) years with a length of stay of 11 (3-17) days. All patients met SOFA score based triage admission criteria with a modal SOFA score of five. Five patients required invasive ventilation for a mean (range) of 5 (4-11) days. Five patients would have been considered for withdrawal of treatment using SOFA scoring guidelines at 48 h. All patients survived. We conclude that SOFA score based triage could lead to withdrawal of life support in critically ill patients who could survive with an acceptably low length of stay in the intensive care unit.

Residues of spinosad in the tissues of sheep after aerosol treatment of blowfly myiasis

OBJECTIVE

To measure the residues of spinosad and chlorhexidine in the tissues of sheep after treatment of blowfly strike.

PROCEDURE

Fourteen sheep with natural myiasis and 12 with artificial infestations of Lucilia cuprina larvae had the wool removed over their infestations and were treated with an aerosol wound dressing containing spinosad and chlorhexidine. Sheep were killed up to 14 days after treatment and residues of the chemicals measured in tissues.

RESULTS

Chlorhexidine was not detected in any tissue. Residues of spinosad were highest in fat, lowest in muscle and intermediate in liver and kidney. The highest residue detected was 0.2 mg/kg spinosad in perirenal fat 7 days after generous treatment of a sheep with a large fly strike. Residues of spinosad in fat peaked 3 to 7 days after treatment and 1 to 3 days after treatment in liver and kidney.

CONCLUSION

These studies present a realistic worst-case in struck sheep and at the highest dose studied, equivalent to 5.8 mg spinosad per kg body weight, the maximum residue detected of 0.2 mg/kg in peri-renal fat was 20% of the Australian maximum residue limit. Muscle, liver and kidney residues of spinosad were also below the Australian maximum residue limits at all times.

Severe lactic acidosis following alcohol related generalised seizures

A 45-year-old alcoholic man presented following several short grand-mal seizures. He was not known to be epileptic. Initial investigations demonstrated a severe lactic acidosis. The rise in lactate was one of the highest levels reported in similar patients. The patient recovered within 4 h of management with oxygen, fluids and sodium bicarbonate. Lactic acidosis following convulsions is often associated with spontaneous resolution and a favourable outcome.

Flow-by induced hypoventilation in high spinal cord lesions--report of two cases

Flow triggering in ventilators is an alternative to pressure triggering. Differences between these two trigger mechanisms may not be clinically significant in most patients. We report two patients with high spinal cord lesions in whom the use of flow triggering was unsuccessful. Severe muscle weakness in these patients made them sensitive to small changes in ventilator trigger characteristics.

Termination of supraventricular tachycardia by propofol

It is known that propofol can have effects on atrioventricular node conduction. We report a case where administration of propofol was associated with termination of supraventricular tachycardia. Although a similar phenomenon has been reported in children, this is the first such case in an adult.

Modulation of secretory immunoglobulin A in saliva; response to manipulation of mood

Secretory immunoglobulin A (sIgA) measured in saliva, an index of mucosal immunity, has repeatedly been shown to be sensitive to psychological variables. Chronic stress is downregulatory whereas an acute psychological challenge induces mobilisation. We examined whether an acute manipulation of mood to induce negative hedonic tone would be downregulatory, as in the chronic stress paradigm and further, whether induction of positive mood might have opposite effects. Two separate experiments were conducted. In the first, mood manipulation was by mental recall and in the second by music. For both sIgA concentration and sIgA secretion rate there was a significant elevation in response to the mood manipulation by recall regardless of hedonic tone. There was some evidence that for sIgA secretion rate the response was more pronounced for positive mood. Mood induction by music also resulted in significant elevations in sIgA concentration and secretion rate and responses were not distinguished by mood valence. None of the mood induction procedures was associated with changes in free cortisol. In these studies, we found no evidence that transient lowering of mood was downregulatory for salivary sIgA. The predominant finding was of sIgA mobilisation.

Selective effects of nicotine on attentional processes

RATIONALE

It is now well established from electrophysiological and behavioural evidence that nicotine has effects on information processing. The results are usually explained either by a primary effect of nicotine or by a reversal effect of a nicotine-induced, abstinence deficit. In addition, there is dispute about the cognitive processes underlying the changes in performance.

METHODS

This study has approached the first question by using the nicotine patch, in order to administer nicotine chronically. In addition, we examined the effects of nicotine on attention with a selection of tests which assessed the intensity and selectivity features of attention, using the Random Letter Generation test, the Flexibility of Attention test and the Stroop test.

RESULTS

Nicotine enhanced the speed of number generation and the speed of processing in both the control and interference conditions of the Stroop test. There were no effects on attentional switching of the Flexibility of Attention test.

CONCLUSION

The results are consistent with the hypothesis that nicotine mainly improves the intensity feature of attention, rather than the selectivity feature.

Variation of pesticide concentration in sheep dips operated according to traditional and revised methods

OBJECTIVE

To quantify stripping in traditional dipping operations and to revise dipping methods, based on prediction of stripping so that a more stable concentration of pesticide in the dipwash is achieved.

DESIGN AND METHODS

Plunge and shower dips were operated sequentially according to traditional and revised dipping instructions. Dips were operated by continuous and intermittent replenishment. Samples of mixed dipwash were collected periodically and assayed for pesticide (diazinon) concentration.

RESULTS

Diagrammatic representations of pesticide concentration versus number of sheep dipped indicated traditional dipping leads to wide variations in the concentration of pesticide in dipwash during dipping. Intermittent replenishment led to a 'saw-tooth' pattern in the pesticide concentration. Traditional continuous replenishment (using the starting concentration of pesticide) indicated both the rate and extent of stripping was higher in shower dipping. If sufficient sheep were dipped, equilibrium was reached between the rate of pesticide replenishment and removal. An alternative method of dip operation by continuous replenishment, using a low starting concentration of pesticide and a replenishment concentration high enough to offset the pesticide loss through stripping resulted in a more stable concentration of pesticide in the dip.

CONCLUSION

Revision of dipping instructions can lead to exposure of sheep to stable concentrations of stripping pesticide during dipping.

Diet and physical activity patterns of urban American Indian women

A cross sectional survey was conducted of American Indian women ages 18 years and older and residing in Minneapolis to assess dietary and physical activity practices. Results indicate a high amount of fat foods and low amount of fruits or vegetables consumed, and little regular physical activity. For adequate dietary intake, barriers included expense, and for physical activity barriers included lack of child care, health problems and safety concerns.

Dieting status and its relationship to eating and physical activity behaviors in a representative sample of US adolescents

OBJECTIVE

To determine whether adolescents engaging in extreme weight loss methods (i.e., vomiting and diet pills) and those using more moderate methods differ from each other in dietary intake (fruits, vegetables, and higher-fat foods) and physical activity, and to compare these variables in dieting and nondieting adolescents.

DESIGN

Data were obtained from the 1993 Youth Risk Behavior Survey.

SUBJECTS/SETTINGS

The survey was administered to a nationally representative sample of 16,296 adolescents in grades 9 through 12 in a school setting.

STATISTICAL ANALYSES

Data were analyzed for 16,125 adolescents. Associations between weight control behaviors and dietary intake and physical activity were examined using mixed-model logistic regressions, controlling for grade in school, race, parental education, region of the country, and urban vs nonurban residence.

RESULTS

Differences in dietary and physical activity were found among adolescents who use extreme weight loss methods and moderate methods, and between dieters and nondieters. Adolescents using moderate methods of weight control engaged in more health-promoting eating and exercise behaviors than did extreme dieters or nondieters. Girls categorized as extreme dieters were less likely to eat fruits and vegetables than were moderate dieters (odds ratio [OR] = .56) or nondieters (OR = .75), and were more likely than more moderate dieters (OR = .76) to have consumed 2 or more servings of high-fat foods during the previous day.

APPLICATIONS/CONCLUSIONS

Our findings suggest the importance of distinguishing between different types of dieting behaviors in clinical settings and research studies. Adolescents engaging in extreme weight control behaviors may be at particular risk for inadequate nutritional intake. In contrast, adolescents using more moderate methods may be consuming a more healthful diet than are nondieters. For all adolescents, nutrition guidance on healthful and safe weight control strategies is needed.

Immunoreactive gonadotropin-releasing hormone (GnRHir) is associated with vestibular structures in the green anole (Anolis carolinensis)

The distribution of immunoreactive gonadotropin-releasing hormone (GnRHir) in relation to endocrine and behavioral pathways is not well established for lizards. To more completely understand the GnRHir distribution and its possible function in a lizard, we investigated the brain of Anolis carolinensis, a species whose visual courtship displays, mating postures and gonadal cycles are well known. Using antisera that recognize multiple GnRH forms, we observed no GnRHir cells or fibers in the forebrain. In the midbrain, however, GnRHir cells occurred along the medial border of the medial longitudinal fasciculus. These cells appeared to project GnRHir fibers to nuclei of cranial nerve III and IV. In the hindbrain, positive fibers were observed in the area of the vestibular nuclei and dorsal funiculus. These hindbrain fibers were followed to their terminals in the cerebellum. The GnRHir midbrain distribution suggests an association of GnRH with eye movements, whereas the hindbrain distribution suggests a GnRH-vestibular association. The lack of GnRHir in the forebrain of Anolis could reflect the minimal role of the vomeronasal system in mediating reproduction in this species. Thus, our study cannot verify hypothalamic GnRH control of the pituitary in A. carolinensis, but it does indicate GnRH control of oculomotor and vestibular nuclei, which might play a role in Anolis reproductive behaviors.

Comparative behavioural toxicity of the selective serotonin reuptake inhibitors

The psychopharmacological profiles of several selective serotonin reuptake inhibitors (SSRIs) were compared and their behavioural toxicity contrasted both to placebo and the tricyclic antidepressants dothiepin and amitriptyline. On measures of central nervous system arousal (critical flicker fusion), psychomotor speed (choice reaction time), skilled performance (compensatory tracking) and subjective ratings of sedation (line analogue rating scales), the tricyclic compounds clearly impaired performance and led to higher ratings of sedation. While the SSRIs were generally clear of these gross effects, there were quantifiable differences between the compounds, seen mainly as an increase in central nervous system arousal. It remains to be established whether these minor differences have any clinical relevance.

Effects of cigarette smoking on performance in a simulated driving task

A double-blind study was conducted to investigate the psychomotor effects of cigarette smoking on a 1-hour computer-based simulation of driving comprising continuous tracking and brake reaction time tasks. Twelve minimally abstinent smoker subjects were asked to operate the simulator on four occasions while smoking single cigarettes yielding varying levels of nicotine (< 0.1, 0.6, 1.0 or 2.1 mg) but similar levels (8-10 mg) of tar. Data were transformed with regard to baseline scores to counter day-to-day differences in performance and showed brake reaction times to be improved after all active treatments (p < 0.01) but tracking accuracy to be enhanced after the two cigarettes of middle strength alone (p < 0.05). These results suggest that, among smokers cigarette smoking may improve driving performance and that there may exist an optimal nicotine dose for the enhancement of cognitive and psychomotor function.

Amnestic effects of triazolam and other hypnotics

1. The effects of a number of hypnotics were compared to a range of results collected for triazolam on objective measures of CNS sedation (critical flicker fusion) and short-term memory function (memory scanning). 2. Assessments taken after the drugs had been administered but prior to the onset of sleep showed that in comparison to placebo most of the compounds were effective sedatives and this correlated highly (r = 0.734, p < 0.04) with amnestic effects found at the same time, suggesting that general CNS sedation is a major component of anterograde amnesia. 3. Residual effects assessed the morning after the hypnotics had been used showed a similar relationship (r = 0.896, p < 0.005). 4. The distribution of results indicates that 0.25 mg triazolam has an acute amnestic profile which is similar to other hypnotics, but possesses a distinct lack of residual effects.

Ciliated cell remnants in peritoneal dialysis fluid

Ciliocytophthoria are anucleate remnants of ciliated epithelial cells derived from the lower respiratory tract and female reproductive tract. We report a case of ciliocytophthoria found in the effluent dialysis fluid of a young woman undergoing long-term ambulatory peritoneal dialysis. Inability to identify these "organisms" initially led to an extensive search for parasitic contamination or infection of the peritoneum. After identifying these "organisms" as ciliocytophthoria, a prospective study showed that ciliated cell remnants occur frequently in the effluent dialysate of young women, but not in older women or men. With increasing use of peritoneal dialysis, laboratory personnel can expect to see ciliocytophthoria in peritoneal dialysate effluent and should recognize them as benign, normal findings in young women.

Correlation between doses of oxazepam and their effects on performance of a standardised test battery

Ten different doses of oxazepam (ranging from 7.5 to 50 mg) or placebo were administered to a total of 28 female subjects in three separate studies. Subjects completed a battery of psychometric tests at 1 and 2 h postdose. The tests included critical flicker fusion, choice reaction time and a tracking task. Following separate analyses of variance, effect sizes (Cohen's d) were calculated for each dose at each dependent variable. These effect sizes were then correlated with the dose of drug administered, using regression analyses. It was found that the doses correlated highly with most of the psychometric variables determined, implying that the test battery is sensitive to drug effects.

Psychomotor performance in smokers following single and repeated doses of nicotine gum

The psychomotor effects of single and repeated doses of 2 mg nicotine gum were investigated in 13 regular smokers who had abstained from tobacco overnight. In comparison to baseline, a first dose of nicotine led to significantly raised critical flicker fusion thresholds, faster motor reaction times, improved compensatory tracking performance, and faster short-term memory reaction times. Performance after a second and third dose of nicotine remained significantly improved on all measures in comparison to baseline, and absolutely improved when comparing first and third nicotine doses on measures of sensorimotor performance. Throughout, comparisons with a placebo gum condition confirmed that these effects were genuine and not subject to the development of acute nicotine tolerance, suggesting that the enhancement of psychomotor performance experienced by smokers after a first cigarette may be maintained by repeated smoking.

Separate and combined effects of the social drugs on psychomotor performance

Ten female subjects (five smokers and five non-smokers) performed a choice reaction time task (CRT), a compensatory tracking task (CTT), a short-term memory task (STM) and were tested for their critical flicker fusion threshold (CFF) at set points over 4 h after the administration of each possible combination of nicotine (2 mg gum or placebo), caffeine (250 mg capsule or placebo) and alcohol (30 g or placebo). Memory and motor function were shown to be facilitated by nicotine or caffeine, and the debilitating effects of alcohol were frequently antagonised by either drug. In spite of the differences in their neuropharmacological actions, combinations of nicotine, caffeine and alcohol may be compared through their effects on common information processing mechanisms involved in psychomotor performance.

Effects of whole-body vibration on short-term memory

An experiment has been conducted to investigate the effects of whole-body vibration on cognitive performance independent of the direct mechanical action of vibration on vision and manual control. Sixteen subjects completed a short-term memory task (memory scanning) during exposure to 16 Hz sinusoidal whole-body vibration at four magnitudes: 0, 1.0, 1.6, and 2.5 ms-2 r.m.s. The results show a detrimental effect of vibration on performance when measured by mean reaction time (p less than 0.001) and number of attentional lapses (p less than 0.01). Response errors rose significantly during the 1.0 ms-2 r.m.s. condition alone. The data suggest that vibration disrupts central cognitive mechanisms utilized during the processing of information in short-term memory, although compensatory cognitive procedures may exist to minimise these effects.

Effects of nicotine gum on psychomotor performance in smokers and non-smokers

Two experiments were conducted to investigate the effects of nicotine on human performance. In the first study six smokers, who had been allowed to smoke normally prior to testing, completed a battery of psychometric tests (choice reaction time, memory scanning, tracking and flicker fusion threshold) at set points over 4 h after chewing 0, 2, or 4 mg nicotine polacrilex gum. A second study followed a similar design, but used five non-smoker volunteers who were required to chew only the 0 or 2 mg nicotine gum. Blood nicotine levels following the gum were measured in all subjects. The results indicate that additional nicotine improved both the speed and accuracy of motor activity among the smokers, but did not enhance central cognitive processes. No drug effects were found in the non-smoker study.

Comparison of five anxiolytic benzodiazepines on measures of psychomotor performance and sleep

The behavioural toxicity of five anxiolytic benzodiazepines was examined in 28 volunteers who were studied in two groups of 14 subjects each. Each drug was taken nocte for 7 days, with a 4-week washout period between drugs. Assessments of psychomotor performance and sleep were made the morning following the first administration and the morning following the last administration. Comparisons of drug effect magnitudes using Cohen's d scores suggest that effects on psychological function should be considered as central to the selection and use of such compounds.

Characterization of a teleost gonadotropin-releasing hormone

A peptide that is recognized by certain antibodies raised against mammalian gonadotropin-releasing hormone has been purified from extracts of salmon brains by gel filtration and high-performance liquid chromatography. The primary structure of this 10-residue peptide is less than Glu-His-Trp-Ser-Tyr-Gly-Trp-Leu-Pro-Gly-NH2. This represents a difference of two amino acids between salmon and mammalian gonadotropin-releasing hormone and demonstrates that most of the molecule has been conserved during evolution. The synthetic form of salmon gonadotropin-releasing hormone is less potent than is mammalian gonadotropin-releasing hormone on mammalian cells and is biologically active in salmon.

Two chemically and immunologically distinct forms of luteinizing hormone-releasing hormone are differentially expressed in frog neural tissues

Immunoreactive luteinizing hormone-releasing hormone (IR-LRF) has been measured in several neural tissues of the frog Rana catesbeiana and characterized by bioassay, chromatography and immunological analysis. Frog brain contains the mammalian form of LRF (mLRF), whereas, sympathetic ganglia and adrenal glands contain a form of LRF (pLRF) chromatographically and immunologically similar to the IR-LRF found in the central nervous systems of several piscine species. Frog retina contains both mLRF and pLRF, in a ratio of about 1:2. The two forms of LRF are apparently equipotent in their ability to release LH from rat gonadotrophs in vitro. Immunological analysis of the pLRF found in the frog nervous system suggests that it is a decapeptide, like mLRF, with one or more amino acid substitutions in the mLRF molecule.