The legendary Smiths and their Paris hospital.

The Paris Hospital in Paris, Arkansas, provided high quality care during its existence from 1910 to 1971, offering a prepaid health care plan from 1920 to 1971. Three generations of Smith doctors were its nucleus, subsidizing the annual losses of the hospital and providing care to all, regardless of ability to pay. The hospital was a community unto itself for the nurses who lived, trained, and worked there. A unique family in the history of medicine in Arkansas, the Smith physicians were well trained, altruistic, compassionate, and conscientious, exemplifying the traditional values of twentieth century medical practice.

Effect of bubble-induced surface turbulence on gas-liquid mass transfer in diffused aeration systems.

Models that predict volatilization of organic compounds from wastewater treatment basins may underestimate emission rates if the surfaces are considered as quiescent. In reality, the water surface may be agitated by subsurface aeration, increasing mass transfer across the tank surface air-water interface. This study investigated the effect of turbulence, induced by diffused bubble aeration, on mass transfer at the water surface of a pilot aeration basin. The mass transfer of ammonia from an enclosed headspace over the basin to acidified water was measured when different diffuser types and airflow rates were applied. Oxygen-transfer tests were conducted immediately following each ammonia-transfer test. Increasing airflow rates through fine- and coarse-bubble diffusers had a significant effect on the ammonia mass-transfer rate. Experimental mass-transfer parameters (K(L)a's) for surface volatilization derived with aeration present were up to 48% higher than the K(L)a values for quiescent conditions over the range of conditions tested. No effect of diffuser type on ammonia transfer could be determined. The study results infer an effect on oxygen transfer into the water at the surface and potential transfer of volatile organic compounds, if present, from the water. The results of the ammonia mass-transfer experiments suggest that adjustments to the existing mass transfer correlations for surface volatilization from aeration basins may be in order. Such adjustments will have the greatest effect on predictions for the less volatile compounds, under conditions of low airflow rates.

Vitamin C and quinapril abrogate LVH and endothelial dysfunction in aortic-banded guinea pigs.

Left ventricular hypertrophy (LVH) is a cardiovascular risk factor. A possible role for endothelial dysfunction in this condition was investigated in a Dunkin-Hartley guinea pig aortic-banded pressure overload-induced model of LVH. Aortic banding produced significant elevation of fore- and hindlimb blood pressure (BP), heart-to-body weight ratios, plasma angiotensin II (ANG II), endothelin-1 (ET-1), tumor necrosis factor-alpha (TNF-alpha) levels, and coronary microvascular endothelial cell (CMEC) NAD(P)H-dependent superoxide (O) production, and a significant decrease in basal and stimulated CMEC cGMP levels. Treatment of aortic-banded animals with the angiotensin-converting enzyme inhibitor quinapril and the antioxidant vitamin C, either alone or in combination, did not affect BP but caused a significant inhibition of the increases in the heart-to-body weight ratio, ANG II, ET-1, and TNF-alpha levels, and O production and restored cGMP responses to levels comparable with sham-operated animals. These data suggest that quinapril and vitamin C are capable of inhibiting LVH development due to pressure overload via mechanisms that involve the inhibition of oxidative stress, an improvement in coronary endothelial function, and increased nitric oxide bioavailability.

Phenotypic changes in rat and guinea pig coronary microvascular endothelium after culture: loss of nitric oxide synthase activity.

OBJECTIVES: Coronary microvascular endothelial cells (CMVEs) can modulate the contractile performance of the adjacent myocardium by the release of agents such as nitric oxide (NO). Most previous studies using CMVEs have been done in situ, in the intact organ. We set out to study possible differences in NO synthase (NOS) regulation between freshly isolated and cultured rat and guinea pig CMVEs. METHODS: CMVEs were isolated from Wistar rats and Dunkin Hartley guinea pigs and then grown in culture for varying times. Fura-2 fluorescence was used to measure agonist-induced changes in CMVE intracellular calcium levels. Agonist-induced changes in CMVE cGMP levels were measured by commercial radioimmunoassay kit. Western blot analysis was used to measure endothelial, constitutive NOS (ecNOS) and soluble guanylate cyclase (sGC) protein levels. Reverse transcription, polymerase chain reactions and Southern blotting were used to measure ecNOS mRNA transcripts. RESULTS: In both fresh (1 h post-isolation) and cultured (14 days with one passage) CMVEs of the rat and guinea pig, bradykinin (BK) and the calcium ionophore A23187 (both 1 microM) elicited significant (P < 0.01) increases in the fura-2 340/380 fluorescence ratio. In cultured CMVEs, basal cGMP levels were unaffected by exposure to BK or A23187. Exposure to sodium nitroprusside (SNP) or atrial natriuretic peptide (ANP) (both 1 microM) induced significant (P < 0.01) increases in cGMP in guinea pig cells, whereas in rat cells only ANP produced a significant (P < 0.01) response. By contrast, freshly isolated CMVEs of both species had higher basal cGMP levels than cultured cells, and on exposure to BK and A23187, responded with significant (P < 0.01) increases in cGMP. Moreover, exposure of both fresh rat and guinea pig CMVEs to SNP or ANP also resulted in significant (P < 0.01) increases in cGMP. Western blot analysis demonstrated that ecNOS and sGC protein were lost from the rat CMVEs following culture. Furthermore, there was also a significant loss of ecNOS mRNA from the rat cells following culture. CONCLUSIONS: These data demonstrate that freshly isolated rat and guinea pig CMVEs possess ecNOS activity, and that this activity is downregulated following culture. At least for the rat, this effect would seem to lie at both the transcriptional and translational level. Furthermore, rat CMVEs have reduced activity of sGC following culture.

Impact of the New Zealand flatworm (Artioposthia triangulata) on soil structure and hydrology in the UK.

Through north west Europe, concern has been growing in recent years about the predatory nature of Artioposthia triangulata on indigenous earthworm species. In this study, the consequence of earthworm depletion by A. triangulata on soil structure and related hydrological processes is examined. Field measurements compare differences in saturated hydraulic conductivity between sites overrun by A. triangulata and neighbouring unaffected sites. Laboratory experiments were conducted on soil cores containing worms only, worms and A. triangulata, and a control with no worms or A. Triangulata. Differences in the water release characteristic and bulk density between treatments was studied. It is concluded that in the short term, infestation by flatworms and consequent depletion of earthworms will increase infiltration. However, as macropores degenerate or are removed over time, an increased risk of surface run off may result in increased pollution and flood hazards, whilst reduced drainage and subsequent waterlogging may reduce agricultural productivity in certain soils. More research into understanding the processes is required.

Setting standards for cervical screening fail-safe mechanisms: a target based on an audit of cytopathology laboratory records.

OBJECTIVE: To examine the efficacy of cytopathology laboratories in monitoring action following an abnormal cervical smear. SETTING: 11 screening laboratories serving 19 districts in the former North Western region of the United Kingdom. METHOD: 944 validated cases were identified at 11 laboratories. The screening history for each abnormal smear was obtained from the screening laboratory and compared with the records from the relevant family health services authority (FHSA) database. RESULTS: Laboratories held complete follow up records in 740 (78.4%) cases; the FHSA records extended this to 910 (96.4%) cases. Poor communication was the main problem; computerisation was not necessary to improve fail-safe procedures. CONCLUSIONS: Audit of fail-safe procedures is a valuable purchasing tool, identifying weaknesses and strengths, setting and maintaining standards.

The status and tasks of public health medicine in England in 1991 and 1993.

Two national postal surveys of directors of public health, the first in 1991 and the second in 1993, looked at the extent to which HC(88)64 had been implemented. Response rates for both exceeded 80%. In 1991 virtually all health authorities had, as required by the circular, appointed directors of public health and had annual health reports published. It took until 1993 for the requirement for collaborative work to be more firmly established. More work with FHSAs is now needed, together with effective use of extensive provider involvement, if HSG(93)56 is to be achieved.

The continuous recovery of uranium from biologically leached solutions using immobilized biomass.

The potential of uranium recovery from the dilute uranium ore bioleach solutions of the Elliot Lake district of Canada was examined using immobilized microbial biomass. Batch and continuous laboratory scale pilot plant experiments were carried out. The results have shown that the immobilized microbial biomass can successfully recover all of the uranium from dilute (less than 300 mg U/L) solutions. The uranium can subsequently be eluted producing a high uranium concentration eluate perhaps exceeding 5000 mg U/L. The biomass maintained its biosorption capacity of about 50 mg U/g over 12 examined successive adsorption-elution cycles with no apparent indication of failure.

A survey of neural tube defect pregnancies in north-west England.

The preliminary results are reported of the first eighteen months of a three year survey of NTD affected pregnancies in the North Western Region of England. The results are consistent with a general decline in the incidence of NTD. Prenatal screening has been available for 10 years but babies continue to be born with NTD. Supportive services are often lacking for parents having had an affected pregnancy and methods of imparting advice regarding recurrence risks have been shown to be variable and not always efficient.

The use of smart cards in the NHS.

The majority of doctors have experienced the frustration of the loss of a patient's medical records. A new development in technology may help alleviate this problem and indeed facilitate patient care. This development is the smart card. This article describes the types of smart cards and their use within the NHS.

Infantile hypertrophic pyloric stenosis in Greater Manchester.

An "unprecedented" rise in the incidence of infantile hypertrophic pyloric stenosis (IHPS) was reported from the Central Region of Scotland in 1979. Examination of statistics from Greater Manchester showed a similar trend in some district health authorities but not others. Possible explanations are examined but future research is required. Hospital Activity Analysis can provide a useful tool for such research.

Disposition of flunisolide in the rat, mouse, dog, rhesus monkey, and cynomolgus monkey.

Flunisolide (6 alpha-fluoro-11 beta, 16 alpha, 17 alpha, 21-tetrahydroxypregna-1,4-diene-3,20-dione 16,17-acetonide) administered as a single iv or oral dose to rats, mice, dogs, rhesus monkeys, and cynomolgus monkeys had a plasma t 1/2 of 1-3.5 hr and was eliminated mainly via the bile. After iv administration of 14C-labeled flunisolide, radioactivity was widely distributed into tissues and organs. The apparent volume of distribution of flunisolide in these five species was 3.0-8.0 liters/kg. A major metabolite isolated from rhesus monkey urine was shown to be 6 beta, 11 beta, 16 alpha, 17 alpha, 21-pentahydroxypregna-1,4-diene-3,20-dione 16,17-acetonide (6 beta-OH metabolite). Free 6 beta-OH metabolite was a major radioactive entity detected in urine of all species given radiolabeled flunisolide, whereas flunisolide conjugated with glucuronic acid and/or sulfate was a major metabolite detected in the bile of rats, dogs, and cynomolgus monkeys. Following the oral administration of radiolabeled flunisolide, radioactivity was rapidly and efficiently absorbed in all species, but in the rhesus and cynomolgus monkeys most of the plasma radioactivity was due to the 6 beta-OH metabolite and to water-soluble conjugates, suggesting extensive first-pass metabolism of flunisolide.

Delayed open reduction of isolated fractures of the femoral shaft.

Twenty-five isolated fractures of the femoral shaft treated by delayed open reduction and internal fixation are reported. On the average, operation was done 13.4 days after fracture. Several early postfracture complications, including fat embolism in 20% of the cases, were resolved before operation. There were no nonunions, refractures, or deep infections. Delaying operation until revascularization and callus formation are under way ultimately produces less tissue destruction and ischemia and may partially explain the decreased incidence of infection seen in this series.