Mobile Stroke Unit Reduces Time to Image Acquisition and Reporting

Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency medical service activation overall improves the timeliness of acute stroke treatment, the time from emergency medical service dispatch to hospital arrival unavoidably decreases the timeliness of thrombolytic administration. Our mobile stroke unit, a new-generation ambulance with on-board CT scanning capability, reduces key imaging time metrics and facilitates in-the-field delivery of IV thrombolytic therapy.

Populations of methane-producing bacteria and in vitro methanogenesis in salt marsh and estuarine sediments

Most probable numbers (MPNs) of methanogens in various salt marsh and estuarine sediments were determined with an anaerobic, habitat-simulating culture medium with 80% H(2) plus 20% CO(2) as substrate. Average MPNs for the short Spartina (SS) marsh sediments of Sapelo Island, Ga., were maximal at the 5- to 7-cm depth (1.2 x 10/g of dry sediment). Populations decreased to approximately 880/g of dry sediment at the 34- to 36-cm depth. There was no significant difference between summer and winter populations. In tall Spartina (TS) marsh sediments, average populations were maximal (1.2 x 10/g of dry sediment) in the upper 0- to 2-cm zone; populations from the 5- to 36-cm zones were similar (average of 9 x 10/g of dry sediment). Methanogenic populations for TS sediments of James Island Creek marsh, Charleston, S.C., were similar (average of 3 x 10/g of dry sediment) for all depths tested (0 to 22 cm), which was comparable to the trend observed for TS sediments at Sapelo Island, Ga. Sediment grab samples collected along a transect of James Island Creek and its adjacent Spartina marsh had MPNs that were approximately 20 times greater for the region of Spartina growth (average of 10/g of dry sediment) compared with the channel (approximately 5 x 10 methanogens per g of dry sediment). A similar trend was found at Pawley's Island marsh, S.C., but populations were approximately one order of magnitude lower. In vitro rates of methanogenesis with SS sediments incubated under 80% H(2)-20% CO(2) showed that the 5- to 7-cm region exhibited maximal activity (51 nmol of CH(4) g h), which was greater than rates for sediments above and below this depth. SS sediment samples (5 to 7 cm) incubated under 100% N(2) and supplemented with formate exhibited rates of methanogenesis similar to those generated by samples under 80% H(2)-20% CO(2). Replacing the N(2) atmosphere with H(2) resulted in an eightfold decrease in the rate of methanogenesis. In vitro methanogenic activity by TS salt marsh sediments, incubated under 80% H(2)-20% CO(2), was similar for all depths tested (0 to 22 cm). TS sediment samples (0 to 7 cm) supplemented with formate and incubated under 100% N(2) had greater rates of methanogenesis compared with unsupplemented samples.

Methanogenesis from sucrose by defined immobilized consortia

A bacterial consortium capable of sucrose degradation primarily to CH(4) and CO(2) was constructed, with acetate as the key methanogenic precursor. In addition, the effect of agar immobilization on the activity of the consortium was determined. The primary fermentative organism, Escherichia coli, produced acetate, formate, H(2), and CO(2) (known substrates for methanogens), as well as ethanol and lactate, compounds that are not substrates for methanogens. Oxidation of the nonmethanogenic substrates, lactate and ethanol, to acetate was mediated by the addition of Acetobacterium woodii and Desulfovibrio vulgaris. The methanogenic stage was accomplished by the addition of the acetophilic methanogen Methanosarcina barkeri and the hydrogenophilic methanogen Methanobacterium formicicum. Results of studies with low substrate concentrations (0.05 to 0.2% [wt/vol]), a growth-limiting medium, and the five-component consortium indicated efficient conversion (40%) of sucrose carbon to CH(4). Significant decreases in yields of CH(4) and rates of CH(4) production were observed if any component of the consortium was omitted. Approximately 70% of the CH(4) generated occurred via acetate. Agar-immobilized cells of the consortium exhibited yields of CH(4) and rates of CH(4) production from sucrose similar to those of nonimmobilized cells. The rate of CH(4) production decreased by 25% when cysteine was omitted from reaction conditions and by 40% when the immobilized consortium was stored for 1 week at 4 degrees C.

Acquisition of dwarf male "harems" by recently settled females of Osedax roseus n. sp. (Siboglinidae; Annelida)

After the deployment of several whale carcasses in Monterey Bay, California, a time-series analysis revealed the presence of a new species of Osedax, a genus of bone-eating siboglinid annelids. That species is described here as Osedax roseus n. sp. It is the fifth species described since the erection of this genus and, like its congeners, uses a ramifying network of "roots" to house symbiotic bacteria. In less than 2 months, Osedax roseus n. sp. colonized the exposed bones of a whale carcass deposited at 1018-m depth, and many of the females were fecund in about 3 months post-deployment. As with other Osedax spp., the females have dwarf males in their tube lumens. The males accrue over time until the sex ratio is markedly male-biased. This pattern of initial female settlement followed by gradual male accumulation is consistent with the hypothesis that male sex may be environmentally determined in Osedax. Of the previously described species in this genus, Osedax roseus n. sp. is most similar to O. rubiplumus, but it has several anatomical differences, as well as much smaller females, dwarf males, and eggs. Osedax roseus n. sp. is markedly divergent (minimally 16.6%) for mitochondrial cytochrome oxidase subunit I (mtCOI) sequences from any other Osedax species.

N-GLUCURONIDATION OF THE PLATELET-DERIVED GROWTH FACTOR RECEPTOR TYROSINE KINASE INHIBITOR 6,7-(DIMETHOXY-2,4-DIHYDROINDENO[1,2-C]PYRAZOL-3-YL)-(3-FLUORO-PHENYL)-AMINE BY HUMAN UDP-GLUCURONOSYLTRANSFERASES

The potential cancer therapeutic agent, 6,7-(dimethoxy-2, 4-dihydroindeno[1,2-c]pyrazol-3-yl)-(3-fluoro-phenyl)-amine (JNJ-10198409), formed three N-glucuronides that were positively identified by liquid chromatography-tandem mass spectrometry and NMR as N-amine-glucuronide (Glu-A), 1-N-pyrazole-glucuronide (Glu-B), and 2-N-pyrazole-glucuronide (Glu-C). All three N-glucuronides were detected in rat liver microsomes, whereas only Glu-A and -B were found in monkey and human liver microsomes. In contrast to common glucuronides, Glu-B was completely resistant to beta-glucuronidase. Kinetic analyses revealed that glucuronidation of JNJ-10198409 in human liver microsomes exhibited atypical kinetics that may be described by a two-site binding model. For the high affinity binding, K(m) values were 1.2 and 5.0 microM, and V(max) values were 2002 and 2,403 nmol min(-1) mg(-1) for Glu-A and Glu-B, respectively. Kinetic constants of low affinity binding were not determined due to low solubility of the drug. Among the human UDP-glucuronosyltransferases (UGTs) tested, UGT1A9, 1A8, 1A7, and 1A4 were the most active isozymes to produce Glu-A; for the formation of Glu-B, UGT1A9 was the most active enzyme, followed by UGT1A3, 1A7, and 1A4. Glucuronidation of JNJ-10198409 by those UGT1A enzymes followed classic Michaelis-Menten kinetics. In contrast, no glucuronides were formed by all UGT2B isozymes tested, including UGT2B4, 2B7, 2B15, and 2B17. Collectively, these results suggested that glucuronidation of JNJ-10198409 in human liver microsomes is catalyzed by multiple UGT1A enzymes. Since UGT1A enzymes are widely expressed in various tissues, it is anticipated that both hepatic and extrahepatic glucuronidation will likely contribute to the elimination of the drug in humans. Additionally, conjugation at the nitrogens of the pyrazole ring represents a new structural moiety for UGT1A-mediated reactions.

Metabolism and excretion of the antiepileptic/antimigraine drug, topiramate in animals and humans

The metabolism and excretion of 2,3:4,5-bis-O-(1-methylethylidene)-beta-D-fructopyranose sulfamate (TOPAMAX, topiramate, TPM) have been investigated in animals and humans. Radiolabeled [14C] TPM was orally administered to mice, rats, rabbits, dogs and humans. Plasma, urine and fecal samples were collected and analyzed. TPM and a total of 12 metabolites were isolated and identified in these samples. Metabolites were formed by hydroxylation at the 7- or 8-methyl of an isopropylidene of TPM followed by rearrangement, hydroxylation at the 10-methyl of the other isopropylidene, hydrolysis at the 2,3-O-isopropylidene, hydrolysis at the 4,5-O-isopropylidene, cleavage at the sulfamate group, glucuronide conjugation and sulfate conjugation. A large percentage of unchanged TPM was recovered in animal and human urine. The most dominant metabolite of TPM in mice, male rats, rabbits and dogs appeared to be formed by the hydrolysis of the 2,3-O-isopropylidene group.

Outcomes of newly referred neurology outpatients with depression and pain

BACKGROUND

Although depression and pain are common in neurology outpatients, patient factors influencing chronicity are poorly understood. The authors sought to determine the predictors of persistent depression and pain symptoms at 3 and 12 months after an initial outpatient neurology clinic visit.

METHODS

Consecutive new patients (n = 483) at three clinics completed the Patient Health Questionnaire nine-item depression scale and the Brief Pain Inventory at baseline and at 3- and 12-month follow-up. Multivariate analysis was used to model 3- and 12-month depression and pain severity.

RESULTS

The prevalence of depression and pain at baseline/3/12 months was depression 33%/28%/27% and pain 66%/61%/62%. Independent predictors of depression severity at follow-up were more severe depression and pain at baseline and less improvement in pain (model r(2) = 0.53 to 0.56). Independent predictors of pain intensity at follow-up were more severe pain and depression at baseline and less improvement in depression (model r(2) = 0.44 to 0.46). Health care utilization and impairments in health status were greatest in patients with coexisting depression and pain and least in those with neither depression nor pain.

CONCLUSIONS

Depression and pain symptoms in neurology outpatients often persist for at least 12 months and have long-term negative effects on patients' health status. Pain is more likely to persist in patients with depression, and depression is more likely to persist in those with coexistent pain.

Prevalence and impact of depression and pain in neurology outpatients

BACKGROUND

We examined the prevalence and health related quality of life (HRQoL) of depression and/or pain in neurology outpatients.

METHODS

Patients at outpatient clinics completed depression, pain, and HRQoL scales. Group comparisons between those with pain alone, depression alone, both conditions, and neither condition were done.

RESULTS

Overall, pain was present in 2/3 and depression in 1/3 of patients. Pain with depression was present in 25%; 75% of depressed patients had pain. These conditions had significant negative impact on mental and physical health status scores. The odds ratio (OR) for having pain was significantly increased in women (OR 2.0), those with depression (OR 2.4), and those with neuropathy/neuromuscular (OR 3.8) or pain syndromes (OR 4.8). The odds of having depression were increased in those with pain (OR 2.4) and with cognitive (OR 4.8) or cerebrovascular (OR 3.3) diagnoses. Neurologists were more likely to recognise and treat pain than depression.

CONCLUSIONS

Depression and pain are common in newly referred neurology outpatients and have substantial negative effects on patients' physical and mental health. Pain is more likely than depression to be recognised and treated by neurologists.

Analyses of nuclear ldhA gene and mtDNA control region sequences of Atlantic northern bluefin tuna populations

There has been considerable debate about whether the Atlantic northern bluefin tuna exist as a single panmictic unit. We have addressed this issue by examining both mitochondrial DNA control region nucleotide sequences and nuclear gene ldhA allele frequencies in replicate size or year class samples of northern bluefin tuna from the Mediterranean Sea and the northwestern Atlantic Ocean. Pairwise comparisons of multiple year class samples from the 2 regions provided no evidence for population subdivision. Similarly, analyses of molecular variance of both mitochondrial and ldhA data revealed no significant differences among or between samples from the 2 regions. These results demonstrate the importance of analyzing multiple year classes and large sample sizes to obtain accurate estimates when using allele frequencies to characterize a population. It is important to note that the absence of genetic evidence for population substructure does not unilaterally constitute evidence of a single panmictic population, as genetic differentiation can be prevented by large population sizes and by migration.

Host plant effects on activity of the mitosporic fungi Beauveria bassiana and Paecilomyces fumosoroseus against two populations of Bemisia whiteflies (Homoptera: Aleyrodidae)

Laboratory bioassays were conducted to determine the effect of host plant on mycosis in two geographically distinct populations of early 2nd-instar nymphs of Bemisia argentifolii Bellows & Perring from the entomopathogenic fungi Beauveria bassiana (Balsamo) Vuillemin and Paecilomyces fumosoroseus (Wize) Brown & Smith. Mycosis in B. argentifolii nymphs varied according to the host plant on which the nymphs were reared but not according to the population. Both populations of whiteflies reared on cotton were consistently significantly less susceptible to infection by either fungus than when reared on melon. We hypothesized that the cotton plant produced a fungal inhibitor that may confer protection on whiteflies feeding (and possibly sequestering) upon it. Germination of conidia of both fungi was strongly inhibited (below 12% germination) on the cuticle of nymphs reared on cotton but was over 95% on the cuticle of nymphs reared on melon. We further hypothesized that the terpenoid gossypol, produced by many cultivars of cotton, might have been involved in antibiosis. Gossypol mixed with Noble agar at five concentrations was tested for its effects on germination of conidia of both fungi. P. fumosoroseus was highly tolerant of gossypol, even at the relatively high concentration of 1000 ppm, while B. bassiana tolerated gossypol at concentrations up to 500 ppm and strong inhibition only occurred in presence of gossypol at 1000 ppm. Our in vivo findings on cotton and on the insect's cuticle pointed at a potential host plant-mediated antibiosis. The in vitro tolerance of P. fumosoroseus and partial tolerance of B. bassiana to gossypol disagreed with our in vivo data. Gossypol concentrations higher than 1000 ppm might have increased the sensitivity of the fungi in our in vitro tests. Sequestered gossypol (and/or other cotton plant allelochemicals) by B. argentifolii nymphs would explain, at least partially, the insect's defense against the pathogens.

Hydrogen concentrations in sulfate-reducing estuarine sediments during PCE dehalogenation

Despite recent progress made evaluating the role of hydrogen (H2) as a key electron donor in the anaerobic remediation of chloroethenes, few studies have focused on the evaluation of hydrogen thresholds relative to reductive dehalogenation in sulfidogenic environments. Competition for hydrogen exists among microbial populations in anaerobic sediments, and direct evidence indicates that lower hydrogen thresholds are observed with more energetically favorable electron-accepting processes. This study examined aqueous hydrogen concentrations associated with sulfate reduction and perchloroethylene (PCE) dehalogenation in anoxic estuarine sediment slurry microcosms and evaluated the competition for H2-reducing equivalents within these systems. After an initial lag period of 13 days, PCE was reductively transformed to trichloroethylene (TCE). During the time of continuous PCE dehalogenation, a significantly (P < 0.05) lower hydrogen concentration (0.5 nM) was observed in the sediment slurries amended with PCE as compared to slurries without PCE (0.8 nM). Sulfate reduction to sulfide was observed in all sediment slurries, but in microcosms actively dechlorinating PCE, the amount of reducing equivalents directed to sulfate reduction was approximately half the amount in sediment slurries without PCE. These findings provide evidence that a lower hydrogen threshold exists in anoxic estuarine sediment slurries with PCE as a terminal electron acceptor as compared to sediment slurries in which sulfate reduction was the predominant electron-accepting process. Furthermore, our results utilizing the inhibitor molybdate indicated that H2-utilizing methanogens may have the potential to effectively compete with dechlorinators for hydrogen when sulfate reduction is initially inhibited.

Genetics: year zero

Ignorance, denial, and physician centric health care have prevented health systems from adopting new genetics technology into their practices.

Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by neurological history and examination

BACKGROUND AND PURPOSE

The Questionnaire for Verifying Stroke-Free Status (QVSFS) is an 8-item structured interview designed to identify stroke-free individuals. Previously, the QVSFS was validated with medical record review in a cohort with a low prevalence (7.1%) of stroke or transient ischemic attack (TIA). The objective of this study was to evaluate the validity of the QVSFS by comparing it with stroke status as determined by neurological history and examination in a population with a higher prevalence of stroke.

METHODS

A research assistant administered the QVSFS to outpatients from Veterans Administration stroke and general medicine clinics. Subjects were defined as QVSFS negative if responses to all 8 questions were negative. Questions requiring rephrasing or clarification were noted. Neurologists, blinded to QVSFS scores, interviewed and examined all subjects to determine stroke-free status, defined as no history or examination findings of previous stroke and/or TIA.

RESULTS

One hundred fifty-five subjects were examined; mean age was 70 years; 98.1% were male. Seventy-eight subjects were determined to be stroke free by the neurologist. The negative predictive value of the QVSFS was 0.96, with positive predictive value of 0.71. No question required rephrasing or clarification >5 times. Twenty-two subjects (14.2%) required rephrasing or clarification of at least 1 question.

CONCLUSIONS

The QVSFS can effectively identify stroke-free individuals with a high degree of accuracy, even in a population with a large proportion of patients with prior stroke or TIA. Accuracy for identifying subjects with stroke and/or TIA is lower, but the QVSFS may still be useful as a screening tool in that regard.

Metabolism of the analgesic drug, tramadol hydrochloride, in rat and dog

1. Metabolism of the analgesic agent, tramadol hydrochloride, was investigated after a single oral administration of 14C-tramadol to four rats (50)mgkg(-1) and two dogs (20)mg kg(-1). 2. Recovery of total radioactivity in rat and dog urine samples over 24 h was 73 and 65% of the radioactive dose, respectively. 3. Unchanged tramadol and a total of 24 metabolites, consisting of 16 Phase I metabolites and eight conjugates (seven glucuromides, one sulphate), were isolated and tentatively identified, which accounted for > 52% of the dose in urine of both species. 4. Of the metabolites, five (M1-5) were previously identified. 5. The metabolites were formed via the following six metabolic pathways: O-demethylation, N-demethylation, cyclohexyl oxidation, oxidative N-dealkylation, dehydration and conjugation. 6. Pathways 1-3 appear to be major steps, forming seven O-desmethyl/N-desmethyl and hydroxy-cyclohexyl metabolites in major quantities. 7. Pathways 1-3 in conjunction with pathway 6 produced four glucuronides along with four minor conjugates. 8. In addition, the in vitro metabolism of tramadol was conducted using rat hepatic S9 fraction in the presence of an NADPH-generating system. Unchanged tramadol (30% of the sample) plus nine metabolites, M1-7, tramadol-N-oxide (M31) and OH-cyclohexyl-M1 (M32), were profiled and tentatively identified based on MS and MS/MS data.

Gene-gene concordance and the phylogenetic relationships among rare and widespread pygmy sunfishes (genus Elassoma)

Pygmy sunfishes (Elassoma) are primarily lowland species with an interesting biogeographic dichotomy: three species have broad geographic distributions, and three are narrowly distributed (and have been recommended for threatened or endangered status). To test phylogenetic predictions derived from the geographic distributions of pygmy sunfishes and possible historical factors contributing to the threatened/endangered status of the rare species, we reconstructed trees for two mitochondrial genes and introns of three nuclear genes. The pattern and rate of nuclear and mitochondrial sequence evolution were heterogeneous within Elassoma, but relationships were generally concordant across gene trees. Elassoma is monophyletic and, as predicted by geographic distributions, E. evergladei, E. okefenokee, and E. zonatum consistently branch from deeper nodes. Phylogeographic structure in mitochondrial and nuclear genes also supports an early origin of E. zonatum. Phylogenetic analyses of the five loci support widely divergent positions for the rare species E. alabamae. Two rare species, E. boehlkei and E. okatie, are sister taxa and are related to a widespread species, E. evergladei.

Softgels: consumer perceptions and market impact relative to other oral dosage forms

Softgels, which contain a liquid formulation of a drug, often provide clinical benefit over other solid oral dosage forms and may represent an attractive alternative to them. A consumer preference survey of softgels versus other solid forms investigated four areas: (1) identification of various dosage forms; (2) perception of therapeutic benefit (easiest to swallow, faster-acting, work longer); (3) impact of individual product characteristics on overall product selection; and (4) market impact in terms of premiums consumers would pay on the basis of dosage form. The 300 survey participants strongly preferred clear softgels over other dosage forms in virtually every area. Softgels were perceived as easy to swallow and fast-acting, with a duration of action second only to that of a two-piece capsule. Overall preference was driven by ease of swallowing, and softgels were rated first by the majority of respondents. Consumers would be interested in various products if these were available as softgels rather than in their current oral dosage forms and may be willing to pay a premium for softgel products. This survey confirms consumer preferences for particular dosage forms and for softgels over other solid forms. Pharmaceutical scientists and marketers should consider softgels as alternative dosage forms when developing new compounds or considering life-cycle management of existing products.

Public and private perspectives on hospital conversions: proposed MUSC-Columbia/HCA "partnership"

Conversion has been defined as "any type of transaction that results in the shift of all or a substantial portion of the assets of nonprofit health care organizations to for-profit use" (Claxton and Colleagues, 1997:10-11). Not surprisingly, efforts at such conversion create political conflict and opposition within communities with some groups supporting and others opposing the intended conversion. This study looks at a particular effort at conversion: the proposed "partnership" between three hospitals of the Medical University of South Carolina (MUSC) and Columbia/HCA, the largest for-profit health services network in the U.S. Beginning in 1995, the three-year effort (now at an impasse) has drawn local and state policy-markers into increasing controversy and acrimony. Beyond the details, the episode also raises fundamental issues about the nature of public health care and the extent to which we can convert public health facilities to private control while preserving their essential public missions.

Mass spectrometric determination of a novel modification of the N-terminus of histidine-tagged proteins expressed in bacteria

Two proteins, FKBP, and Spo0F, were expressed in bacteria as histidine-tagged fusion proteins and isolated under native conditions. MALDI-TOF-MS analysis revealed that each protein preparation contained two components, neither of which corresponded to the molecular weights predicted from DNA sequences. The difference in molecular weight between the two FKBP components and two Spo0F components was approximately 178 +/- 14 Da. Site-specific proteolytic cleavage resulted in the release of histidine-tagged peptide from the recombinant proteins. MALDI mass spectra of the cleaved proteins showed a single molecular ion peak for each species with the predicted molecular weights. The histidine-tagged peptide released from both fusion proteins displayed two distinct peaks by MALDI-FT-MS corresponding to monoisotopic molecular weights of 2269. 027 Da and 2447.087 Da, respectively, which were both inconsistent with the predicted peptide sequence M-G-H-H-H-H-H-H-H-H-H-H-S-S-G-H-I-E-G-R of 2400.055 Da. The peptide at 2269.027 Da was sequenced by ESI-MS-MS and found to be a truncated histidine tag resulting from an initiator methionine deletion. ESI-MS-MS analysis of the peptide at 2447.087 Da indicated a moiety of 178.0 Da attached to the second residue glycine of the histidine tag. This alteration of the N-terminus does not fit any known modifications. A synthetic peptide with the identical sequence of the isolated his-tag M-G-H-H-H-H-H-H-H-H-H-H remained unmodified during the protein purification process, suggesting that modification of the initiator methionine was carried out in vivo, rather than the result of a chemical reaction from the isolation procedure.

Oxygen starvation induces cell death in Candida shehatae fermentations of D-xylose, but not D-glucose

Candida shehatae cells, cultivated on D-glucose and D-xylose, were subjected to a shift from fully aerobic to anaerobic fermentative conditions. After anaerobic conditions were imposed, growth was limited to approximately one doubling or less as C. shehatae rapidly entered a stationary phase of growth. Following the shift to anoxia, cell viability rapidly declined and the total cell volume declined in the D-xylose fermentations. Moreover, the cell volume distribution shifted to smaller volumes. Cell viability, measured by plate counts, declined nine times faster for D-xylose fermentations than for D-glucose fermentations. Anaerobic growth did not occur on either D-glucose or D-xylose. Selected vitamins and amino acids did not stimulate anaerobic growth in C. shehatae, but did enhance anaerobic growth on D-glucose in S. cerevisiae. The decline in cell viability and lack of anaerobic growth by C. shehatae were attributed to oxygen deficiency and not to ethanol inhibition. The results shed light on why C. shehatae anaerobic fermentations are not currently practical and suggest that research directed towards a biochemical understanding of why C. shehatae can not grow anaerobically will yield significant improvements in ethanol fermentations from D-xylose.

Biotransformation of the antipsychotic agent, mazapertine, in dog--mass spectral characterization and identification of metabolites

1. Biotransformation of the antipsychotic agent, mazapertine, was studied after a single oral administration of 14C-mazapertine succinate (10 mg/kg, free base) to six beagle dogs (three male, three female). 2. Following oral administration of 14C-mazapertine, plasma (0-48 h), urine (0-7 days), and faeces (0-7 days) were collected. Recoveries of total radioactivity in urine and faeces were 26.9 and 62.0% of the dose, respectively. 3. Unchanged mazapertine plus 14 metabolites were isolated and identified, which accounted for > 60% of the sample radioactivity in the plasma, 17% of the dose in urine and 28% of the dose in faecal extract. 4. Unchanged mazapertine accounted for < 4% of the radioactive dose in excreta samples and < 21% of the sample radioactivity present in plasma samples. 5. Seven metabolic pathways for the formation of metabolites were identified including: (1) phenyl hydroxylation, (2) piperidyl oxidation, (3) O-dealkylation, (4) N-dephenylation, (5) oxidative N-debenzylation, (6) depiperidylation and (7) conjugation. 6. Pathways 1, 2, 5 and 6 produced 4-OH-piperidyl, OH-phenyl-OH-piperidyl, carboxybenzoyl piperidine and depiperidyl analogues of mazapertine as major metabolites.

Preventing falls in hospitals. The roles of patient age and diagnostic status in predicting falls

Patient falls are some of the most frequent accidents in hospitals, and they can lead to significant personal and financial costs for both patients and facilities. This study examines the relationship between two patients characteristics and patient falls at a large general hospital and a small psychiatric facility in Tennessee; its findings should be useful for hospital risk management.

Administrative complement and managerial efficiency in South Carolina hospitals

This article examines the infrastructure and efficiency of administrative personnel employed by hospitals in South Carolina. The analysis suggests that variation in the administrative complement and the efficiency of hospital administrators is related to the scale of operations and related organizational complexity, the occupancy rate, ownership, and affiliation with multihospital systems. The results of the study also indicate that the administrative complement should be regarded as a resource that results in a discretionary rather than a committed cost and might be altered to increase productivity and improve profitability.

Clinical integration in a population-based planning framework

Population-based planning provides context and scope to the goal of clinical integration. It also is a transforming process for organizations and programs devoted to a hospital-centric care system, as well as source of language that can support collaboration among buyers, payers, providers, and community groups. At the clinical care level, population-based planning recognizes the differences in how people perceive health and use health care services, as an important corollary to understanding specific diseases and clinical service needs.

Succeeding beyond the Year 2000: how to rise to the challenges of the new millennium. Interview by Jill L. Sherer

Are you ready to take your organization into the 21st century? Do you fully grasp the implications of current and emerging trends in the field? Healthcare Executive talked with six healthcare experts and asked them what they saw as the greatest challenge for both executives and their organizations in the new millennium. Although the experts' opinions vary, their responses emphasize the importance of repairing old relationships and building new partnerships between those working in healthcare organizations, as well as bringing a consumer focus back to healthcare delivery.

Thermococcus guaymasensis sp. nov. and Thermococcus aggregans sp. nov., two novel thermophilic archaea isolated from the Guaymas Basin hydrothermal vent site

Thermococcus strains TYST and TYT isolated from the Guaymas Basin hydrothermal vent site and previously described were compared by DNA-DNA hybridization analysis with the closest Thermococcus species in terms of physiology and nutritional aspects. On the basis of the new data and taking into consideration the molecular, physiological and morphological traits published previously, it is proposed that strains TYT and TYST should be classified as new species named Thermococcus aggregans sp. nov. and Thermococcus guaymasensis sp. nov., respectively. The type strain of T. aggregans is strain TYT (= DSM 10597T) and the type strain of T. guaymasensis is strain TYST (= DSM 11113T).

In vivo microdialysis and liquid chromatography/thermospray mass spectrometry of the novel anticonvulsant 2,3:4,5-bis-O-(1-methylethylidene)-beta-D-fructopyranose sulfamate (topiramate) in rat brain fluid

The concentration of a novel anticonvulsant, 2,3:4,5-bis-O-(1-methylethylidene)-beta-D-fructopyranose sulfamate (topiramate), was determined in the extracellular fluid of rat brain by in vivo microdialysis combined off-line with liquid chromatography/thermospray mass spectrometry. A microdialysis probe was stereotaxically implanted in the nucleus accumbens region of the rat brain. The maximum concentration of topiramate in the brain dialysate for a dose of 50 mg kg-1 i.v. was approximately 10 microM and occurred 45 min post-injection. The detection limit of topiramate in the extracellular fluid of rat brain was in the 0.1 microM range using selected ion monitoring techniques. The base peak, which was the ammonium adduct ion [M + NH4]+, was used for detection. An internal standard of d12-labeled topiramate was utilized for quantitation by isotope dilution analysis.

A cost-effectiveness analysis of anemia screening before erythropoietin in patients with end-stage renal disease

The treatment efficacy of erythropoietin (EPO) in end-stage renal disease (ESRD) can be limited by deficiencies of iron, folate, or vitamin B12, by hyperparathyroidism, or by aluminum intoxication. Since EPO costs are significant, this study attempted to determine the cost-effectiveness of performing a panel of screening tests for anemia before starting EPO. Anemia screening was performed prospectively in 48 new-onset ESRD patients at the Ralph H. Johnson Veterans Affairs Medical Center before EPO treatment was started. Serum iron, transferrin, folate, vitamin B12, parathyroid hormone, and aluminum levels were determined, and transferrin saturation (Tfsat) was calculated at the first dialysis session. At presentation for dialysis, the mean hematocrit was 0.264 +/- 0.036 and the mean blood urea nitrogen was 32 +/- 2 mmol/L. Eighteen patients (37.5%) had a serum iron level lower than 7 micromol/L, suggesting iron deficiency. Twenty-five patients (52%) had Tfsat less than 0.20, consistent with overt iron deficiency. No patient was found to be vitamin B12 deficient, to be aluminum intoxicated, or to have significant hyperparathyroidism. One patient had folate deficiency. A cost-effectiveness analysis was performed assuming that (1) EPO would be given at an average starting dose of 6,000 U/wk at a cost of $14/2,000 U of EPO; (2) that without screening 1 month would elapse before a poor response was identified; and (3) that the failure to treat aluminum intoxication and hyperparathyroidism or to replete iron, vitamin B12, or folate deficiency would significantly impair the response to EPO. The Tfsat screen had a cost-effectiveness ratio of 0.2019, saving approximately $5.00 in EPO use for each dollar of test administration. All other screens had cost-effectiveness ratios greater than 1.0, indicating that their testing costs exceeded dollar savings in EPO use. In conclusion, iron deficiency is common in anemic patients starting dialysis, but other causes of anemia are not. It is imperative that current clinical practices be influenced by cost-effectiveness considerations. Given the cost of laboratory screens, and the relative ineffectiveness of the other screens examined here to identify factors known to impair the response to EPO, anemia screening before initiating EPO therapy should be limited to tests to identify iron deficiency.

Biochemical and phylogenetic characterization of two novel deep-sea Thermococcus isolates with potentially biotechnological applications

The partial 16S rDNA gene sequences of two thermophilic archaeal strains, TY and TYS, previously isolated from the Guaymas Basin hydrothermal vent site were determined. Lipid analyses and a comparative analysis performed with 16S rDNA sequences of similar thermophilic species showed that the strains isolated from deep-sea vents were not identical to the other species belonging to the genus Thermococcus. On the basis of the results of the phylogenetic analyses, lipid analyses, and previously reported physiological data, we believe that strains TY and TYS are significantly different from the previously described Thermococcus species. According to specific physiological and molecular features, we propose the use of these isolates as potential tools for the development of biotechnological applications in the field of starch processing and DNA technology.

Genomic organization of the mouse double minute 2 gene

Transfection of the mouse double minute 2 (Mdm2) oncogene has been found to induce immortalization of primary cells and to transform cultured cells. Amplification and/or overexpression of human MDM2 has been documented in a large percentage of human cancers. Mouse and human Mdm2 cDNA have been cloned from transformed cells and the cDNA sequence of both genes have been reported previously. In this report, we present the gene structure of mouse Mdm2. Comparison of the coding sequences of the Mdm2 gene with the previously reported cDNA sequence and with Mdm2 sequences obtained from an Mdm2-bearing cosmid clone capable of inducing transformation revealed that the reported cDNA sequence was in error, and that Mdm2-induced transformation of cells does not require an activating mutation in Mdm2. Ligation-anchor PCR analysis of transcripts produced from the P1 and P2 promoters indicates that transcription initiates at sites upstream of those reported previously for both promoters.

Capitating physician group practices

To prepare for capitated payment, physician group practices must gather essential data on service utilization and cost of services, must develop appropriate compensation and incentive plans for physicians, and must analyze and, if necessary, modify their practices's clinical and business operations. Those group practices that take these steps will be positioned to profit from capitated payment.

Trauma management therapy: a preliminary evaluation of a multicomponent behavioral treatment for chronic combat-related PTSD

The development and initial evaluation of a new, comprehensive and multicomponent behavioral treatment (Trauma Management Therapy, or TMT) for chronic combat-related Post-Traumatic Stress Disorder (PTSD) is described. The program utilizes elements of intensive exposure therapy, programmed practice, and structured social and emotional skills training to target the multiple aspects of chronic combat-related PTSD. The treatment was found to be effective in alleviating a broad spectrum of difficulties in combat veterans with chronic PTSD, most of whom had co-occurring Axis I and/or Axis II disorders. The results are discussed with respect to the implementation of the new treatment and the general need for a comprehensive approach to treating combat-related PTSD. Implications for the potential cost-effectiveness of the treatment program also are discussed.

Norplant prescribing in family practice

BACKGROUND

This study describes the Norplant prescribing experience, training, and attitudes of South Carolina family practice and general practice (FP/GP) physicians.

METHODS

A survey was mailed to all FP/GP physicians licensed in South Carolina, with two follow-up mailings to nonrespondents.

RESULTS

Responses were received from 520 physicians, representing 43% of all licensed FP/GP physicians and 73% of all board-certified FP physicians. Norplant had been inserted by 39% of the respondents, and fewer than 10% reported encountering complications during the insertion process. Norplant removal was reported by 135 physicians, averaging 4.4 removals per year. Complications during removal were reported by 52% of physicians, with the most common problem being difficulty finding the capsules. Some degree of training in Norplant insertion was reported by 82% of physicians; 69% reported having had some training, formal or informal, in removal; but only 57% reported having received formal training either during residency or at a workshop. Training reduced insertion time but did not affect removal time or the number of complications encountered. Formal training was more likely to prepare physicians to successfully manage procedural complications.

CONCLUSIONS

FP/GP physicians are important providers of Norplant. Improved training is needed to ensure that insertion is performed properly and to disseminate effective removal techniques.

Regulation of RAD53 by the ATM-like kinases MEC1 and TEL1 in yeast cell cycle checkpoint pathways

Mutants of the Saccharomyces cerevisiae ataxia telangiectasia mutated (ATM) homolog MEC1/SAD3/ESR1 were identified that could live only if the RAD53/SAD1 checkpoint kinase was overproduced. MEC1 and a structurally related gene, TEL1, have overlapping functions in response to DNA damage and replication blocks that in mutants can be provided by overproduction of RAD53. Both MEC1 and TEL1 were found to control phosphorylation of Rad53p in response to DNA damage. These results indicate that RAD53 is a signal transducer in the DNA damage and replication checkpoint pathways and functions downstream of two members of the ATM lipid kinase family. Because several members of this pathway are conserved among eukaryotes, it is likely that a RAD53-related kinase will function downstream of the human ATM gene product and play an important role in the mammalian response to DNA damage.

A priority queuing model to reduce waiting times in emergency care

Investigates the increased waiting time costs imposed on society due to inappropriate use of the emergency department by patients, seeking non-emergency or primary care. Proposes a simple economic model to illustrate the effect of this misuse at a public or not-for-profit hospital. Provides evidence that non-emergency patients contribute to lengthy delays in the ER for all classes of patients. Proposes a priority queuing model to reduce average waiting times.

Biotransformation of dichloroaromatic compounds in nonadapted and adapted freshwater sediment slurries

Nonadapted freshwater sediment slurries and sediment slurries adapted to dechlorinate 2,3-dichloropyridine (2,3-Cl2Pyd), 2,3-dichloroaniline (2,3-Cl2Anl), 2,3-dichlorophenol (2,3-Cl2PhOH), 3,5-dichloropyridine (3,5-Cl2Pyd), 3,5-dichloroaniline (3,5-Cl2Anl) and 3,5-dichlorophenol (3,5-Cl2PhOH) were studied to determine the rate, range and extent of biotransformation of structurally related compounds under anaerobic conditions. 2,3-dichloroanisole (2,3-Cl2Ans) and 3,5-dichloroanisole (3,5-Cl2Ans) were initially demethylated, producing 2,3-Cl2PhOH and 3,5-Cl2PhOH as intermediate transformation products. All other dichloroaromatic compounds examined were initially dechlorinated. The rates of dechlorination of 2,3-Cl2PhOH, 2,3-Cl2Anl, and 2,3-Cl2Pyd were significantly lower (5-15 times) in nonadapted sediment slurries compared to sediment slurries adapted to 2,3-Cl2Anl or 2,3-Cl2Pyd. In 2,3-Cl2PhOH adapted sediment, the rate of dechlorination of 2,3-Cl2PhOH was 15 times greater than in nonadapted sediment; however, the rates of dechlorination of 2,3-Cl2Anl and 2,3-Cl2Pyd were similar for 2,3-Cl2PhOH-adapted and nonadapted sediment slurries. In adapted and nonadapted sediment slurries, 2,3-Cl2PhOH, 2,3-Cl2Anl, and 2,3-Cl2Pyd were preferentially dechlorinated at the ortho, meta, and meta positions, respectively. Additionally, 2,3-Cl2Pyd adapted sediment slurries dechlorinated 2,3-Cl2PhOH and 2,3-Cl2Pyd at both ortho and meta positions. Rates of dechlorination of 3,5-Cl2PhOH, 3,5-Cl2Anl, and 3,5-Cl2Pyd were lower (2-4 times) in nonadapted sediment slurries compared to sediment slurries adapted to 3,5-Cl2Anl or 3,5-Cl2Pyd. In 3,5-Cl2PhOH adapted sediment, the rate of dechlorination of 3,5-Cl2PhOH was approximately 10 times greater than in nonadapted sediment.(ABSTRACT TRUNCATED AT 250 WORDS)