Quantification of polyhydroxyalkanoates in mixed and pure cultures biomass by Fourier transform infrared spectroscopy: comparison of different approaches.

UNLABELLED: Fourier transform infrared (FTIR) spectroscopy was used in this study for the rapid quantification of polyhydroxyalkanoates (PHA) in mixed and pure culture bacterial biomass. Three different statistical analysis methods (regression, partial least squares (PLS) and nonlinear) were applied to the FTIR data and the results were plotted against the PHA values measured with the reference gas chromatography technique. All methods predicted PHA content in mixed culture biomass with comparable efficiency, indicated by similar residuals values. The PHA in these cultures ranged from low to medium concentration (0-44 wt% of dried biomass content). However, for the analysis of the combined mixed and pure culture biomass with PHA concentration ranging from low to high (0-93% of dried biomass content), the PLS method was most efficient. This paper reports, for the first time, the use of a single calibration model constructed with a combination of mixed and pure cultures covering a wide PHA range, for predicting PHA content in biomass. SIGNIFICANCE AND IMPACT OF THE STUDY: Currently no one universal method exists for processing FTIR data for polyhydroxyalkanoates (PHA) quantification. This study compares three different methods of analysing FTIR data for quantification of PHAs in biomass. A new data-processing approach was proposed and the results were compared against existing literature methods. Most publications report PHA quantification of medium range in pure culture. However, in our study we encompassed both mixed and pure culture biomass containing a broader range of PHA in the calibration curve. The resulting prediction model is useful for rapid quantification of a wider range of PHA content in biomass.

Nottingham Hip Fracture Score: longitudinal and multi-assessment.

BACKGROUND: The Nottingham Hip Fracture Score (NHFS) was developed and validated in a single centre in 2007 as a predictor of 30 day mortality. It has subsequently been shown to predict longer term and functional outcomes. We wished to assess the ability of NHFS to predict outcomes in other centres and to investigate the change in outcome after hip fracture over time. METHODS: The NHFS was calculated for all patients with data from three UK hip fracture units: Peterborough (1992-2009), Brighton (2008-9), and Nottingham (2000-9) including 4804, 585, and 1901 patients, respectively. The logistic regression was used to recalibrate the NHFS to 30 day mortality across the three units using a random selection of 50% of the data set. Calibration was assessed using the Hosmer-Lemeshow goodness of fit. RESULTS: The median (inter-quartile range) NHFS values were Peterborough [4.0 (1-6)], Brighton [5.0 (3-7)], and Nottingham [5.0 (3-7)]. There was no correlation between 30 day mortality and time (R(2)=0.05, P=0.115). The proportion of patients with NHFS ≥ 4 showed a weak correlation with time (R(2)=0.2, P=0.003). The original NHFS equation overestimates mortality in the higher-risk groups. A modified equation shows good calibration for all three centres {30 day mortality (%)=100/1+e([(5.012 × (NHFS × 0.481)])}. The hospital was not a predictor of 30 day mortality. CONCLUSIONS: The NHFS, with an updated equation, is a robust predictor of 30 day mortality after hip fracture repair in geographically distinct UK centres.

Sliding hip screw versus the Targon PF nail in the treatment of trochanteric fractures of the hip: a randomised trial of 600 fractures.

In a randomised trial involving 598 patients with 600 trochanteric fractures of the hip, the fractures were treated with either a sliding hip screw (n = 300) or a Targon PF intramedullary nail (n = 300). The mean age of the patients was 82 years (26 to 104). All surviving patients were reviewed at one year with functional outcome assessed by a research nurse blinded to the treatment used. The intramedullary nail was found to have a slightly increased mean operative time (46 minutes (sd 12.3) versus 49 minutes (sd 12.7), p < 0.001) and an increased mean radiological screening time (0.3 minutes (sd 0.2) versus 0.5 minutes (sd 0.3), p < 0.001). Operative difficulties were more common with the intramedullary nail. There was no statistically significant difference between implants for wound healing complications (p = 1), or need for post-operative blood transfusion (p = 1), and medical complications were similarly distributed in both groups. There was a tendency to fewer revisions of fixation or conversion to an arthroplasty in the nail group, although the difference was not statistically significant (nine versus three cases, p = 0.14). The extent of shortening, loss of hip flexion, mortality and degree of residual pain were similar in both groups. The recovery of mobility was superior for those treated with the intramedullary nails (p = 0.01 at one year from injury). In summary, both implants produced comparable results but there was a tendency to better return of mobility for those treated with the intramedullary nail.

Composition of nifH in a wastewater treatment system reliant on N(2) fixation.

High levels of nitrogen fixation have been observed in the wastewaters of pulp and paper mills. In this study, we show that nitrogen fixation in a model pulp and paper wastewater treatment system is supported by a high density of nifH sequences that are of low diversity. Quantitative PCR revealed a ratio of nifH to 16S rDNA of 1.14 +/- 0.76 which shows that very high levels of the nifH gene were enriched to support the high rates of nitrogen fixation that occur in this wastewater. Changes in wastewater composition and dissolved oxygen levels did not affect the nifH levels and allowed stable wastewater treatment. The nifH sequences identified display a similar profile to those seen in forest soil environments where nifH sequences derived from alpha-proteobacteria and beta-proteobacteria are also prevalent.

The development of a stochastic physiologically-based pharmacokinetic model for lead.

This presentation describes the development of a prototype Monte Carlo module for the physiologically-based pharmacokinetic (PBPK) model for lead, created by Dr Ellen O'Flaherty. The module uses distributions for the following: exposure parameters (soil and dust concentrations, daily soil and ingestion rate, water lead concentration, water ingestion rate, air lead concentration, inhalation rate and dietary lead intake); absoption parameters; and key pharmacokinetic parameters (red blood binding capacity and half saturation concentration). Distributions can be specified as time-invariant or can change with age. Monte Carlo model predicted blood levels were calibrated to empirically measured blood lead levels for children living in Midvale, Utah (a milling/smelting community). The calibrated model was then evaluated using blood lead data from Palmerton, Pennsylvania (a town with a former smelter) and Sandy, Utah, (a town with a former smelter and slag piles). Our initial evaluation using distributions for exposure parameters showed that the model accurately predicted geometric (GM) blood lead levels of Palmerton and Sandy and slightly over predicted the GSD. Consideration of uncertainty in red blood cell parameters substantially inflated the GM. Future model development needs to address the correlation among parameters and the use of parameters for long-term exposure derived from short-term studies.

Recent trends in childhood blood lead levels.

Blood lead levels in children in the United States have declined through 1994, the date of the most recent National Health and Nutrition Examination Survey. In this investigation, the authors analyzed whether blood lead levels have changed since 1994 and quantified the magnitude of any change. The authors evaluated blood lead levels from 12 longitudinal data sets from 11 states and 1 city. Geometric mean blood lead levels declined between 4%/year and 14%/year in 8 of the data sets. No differences in decline rates were observed between data sets from states that had universal screening as a goal or that included repeat measures for an individual child and those data sets that did not. The authors' best estimate for these populations was a decline rate of 4-7%/year, which was comparable to the decline rate prior to 1994.

Rotational atherectomy or balloon angioplasty in the treatment of intra-stent restenosis: BARASTER multicenter registry.

The BARASTER registry was formed to evaluate the initial success and long-term results of rotational atherectomy in the management of in-stent restenosis. Rotational atherectomy was used in 197 cases of in-stent restenosis: 46 with stand-alone rotational atherectomy or at most 1 atmosphere of balloon inflation (Rota strategy), and 151 with rotational atherectomy and adjunctive balloon angioplasty <1 atmosphere (Combination strategy). These were compared with 107 episodes of in-stent restenosis treated with balloon angioplasty alone. In this observational study, the use of Combination therapy was associated with a slightly higher initial success rate (95% vs. 87% with the Rota strategy and 89% with Balloons, P = 0.08). There was a reduction in one year clinical outcomes (death, myocardial infarction or target lesion revascularization) in the combination group (38% vs. 60% with Rota and 52% with balloons, P = 0.02). These data support a benefit of the strategy of debulking with rotational atherectomy followed by adjunctive balloon angioplasty, in the management of in-stent restenosis.

Blood lead slope factor models for adults: comparisons of observations and predictions.

Here we explore the appropriateness of various parameter values for the Bowers et al. model [Risk Anal 14:183-189, 1994] in the context of predicting the influence of site-related exposure to lead in soil on the blood lead (PbB) levels of women of childbearing age. We outline the parameters prescribed by Bowers et al. as well as those prescribed by the U.S. Environmental Protection Agency (U.S. EPA). Comparison of the PbB levels predicted by the Bowers et al. model to those predicted by the validated O'Flaherty pharmacokinetic model indicates that the Bowers et al. model performs favorably when parameter values prescribed here are used. Use of the U.S. EPA-prescribed parameters yields predicted PbB levels that substantially exceed the validated O'Flaherty model predictions. Finally, both the U.S. EPA-prescribed parameter values and the parameter values recommended herein are used to predict PbB levels among adults living in four Superfund communities. Comparison of predicted PbB levels for these communities indicates that the U.S. EPA parameters overstate the incremental influence of lead in soil on PbB levels. Differences between the parameter values prescribed here and the U.S. EPA-prescribed parameters yield substantially different cleanup criteria for lead in soil, although conservative parameter values may still be appropriate for screening purposes.

Droperidol in the interim management of severe mania: case reports and literature review.

There is little information in the literature concerning the use of droperidol in psychiatry. This article presents three cases in which extremely agitated and treatment-refractory persons with mixed mania derived benefit from droperidol administered orally. Symptomatic improvement, including decreased agitation and intrusiveness, improved sleep, and decreased rates of sleep, was observed with the use of oral droperidol at doses ranging from 10-80 mg daily. The only adverse reaction was a dystonia in one patient. This article also reviews the limited available literature on the use of droperidol in psychiatry. Only eight English language articles describing the use of droperidol for psychosis or agitation were found. Future controlled studies to examine the usefulness of oral dosing of droperidol in mania are suggested.

Shipley institute for living scale and the Kaufman Brief Intelligence Test as screening instruments for intelligence.

This study assessed the comparability and acceptability of two tests used to screen for overall intelligence levels in adults. At issue is whether either of these two tests is preferable for a definable subject population. Participants drawn from college (n = 30) and forensic (n = 50) settings completed the Shipley Institute for Living Scale (SILS), the Kaufman Brief Intelligence Test (K-BIT), and the reading section of the Wide Range Achievement Test-Revised (WRAT-R). The correlation between the SILS IQ and the K-BIT IQ scores was .77 for the college sample and .83 for the forensic group, with no significant differences between SILS and K-BIT mean IQ scores within each sample. Reading level also was significantly correlated with SILS and K-BIT IQ scores for both groups. A preference for the SILS over the K-BIT was expressed by two overlapping groups: college students and above average readers, while a majority of the forensic sample and poorer readers chose the K-BIT. Although the SILS and K-BIT yield comparable IQ scores within a sample, clinicians may want to consider the subject's reading ability, educational history, and feelings and attitudes about the assessment situation in deciding which of these two IQ screening tests to utilize.

Effect of reperfusion on biventricular function and survival after right ventricular infarction.

BACKGROUND: Although the salutary effects of reperfusion in patients with left ventricular infarction are well documented, the benefits in patients with acute right ventricular infarction are less clear. METHODS: To determine whether primary angioplasty improves right ventricular function and the clinical outcome in patients with right ventricular infarction, we performed echocardiographic studies before and after angioplasty in 53 patients with acute right ventricular infarction. RESULTS: Complete reperfusion, defined as normal flow in the right main coronary artery and its major right ventricular branches, was achieved in 41 patients (77 percent), leading to prompt and striking recovery of right ventricular function (mean [+/-SE] score for free-wall motion, 3.0+/-0.1 at base line and 1.4+/-0.1 at three days; P<0.001). Twelve patients (23 percent) had unsuccessful reperfusion, defined as the failure to restore right ventricular branch flow, with or without patency of the right main coronary artery. Unsuccessful reperfusion was associated with lack of recovery of right ventricular function (score for free-wall motion, 3.2+/-0.2 at base line and 3.0+/-0.9 at three days; P= 0.55), as well as persistent hypotension and low cardiac output (in 83 percent of the patients, vs. 12 percent of those with successful reperfusion; P=0.002) and a high mortality rate (58 percent, vs. 2 percent for those with successful reperfusion; P=0.001). CONCLUSIONS: In patients with right ventricular infarction, complete reperfusion of the right coronary artery by angioplasty results in the dramatic recovery of right ventricular performance and an excellent clinical outcome. In contrast, unsuccessful reperfusion is associated with impaired recovery of right ventricular function, persistent hemodynamic compromise, and a high mortality rate.

Isolation, sequencing and expression of the gene encoding a major protein from the backteriophage associated with Bartonella henselae.

The gene encoding a 31-kDa major protein (Pap31) associated with the bacteriophage harbored in Bartonella henselae was cloned and sequenced. Analysis of the resulting sequence revealed an open reading frame of 837 nucleotides coding for a protein of 279 amino acids. pap31 was then subcloned downstream of the lacZ promoter in pUC19. pap31 was amplified by polymerase chain reaction, and the linear amplicon was used as template for in-vitro transcription and translation. A protein with an apparent molecular mass of approximately 31 kDa was synthesized from this reaction. Upon analysis of the deduced aa sequence, a potential signal sequence and a consensus signal peptidase cleavage site were identified, indicative that Pap31 is modified posttranslationally, and the mature protein may be targeted to the host membrane.

Tracheobronchial Wallstents for degenerated saphenous vein bypass grafts.

The tracheobronchial Wallstent was employed as an endoluminal prosthesis in degenerated saphenous vein bypass grafts in three patients. This Wallstent has unique characteristics that make it potentially useful in patients with vein graft disease.

Incidence and angiographic predictors of side branch occlusion following high-pressure intracoronary stenting.

We evaluated the incidence, angiographic predictors, and clinical outcome of side branch occlusion (SBO) following high-pressure intracoronary stenting in 175 patients. All stent implants during a 7-month period were reviewed for the incidence of major (>1 mm) SBO. Side branches were further characterized based on side branch and index lesion morphology. Clinical events (death, myocardial infarction, and target vessel revascularization rates) were determined at 9 months. A total of 175 patients (182 lesions) had 224 major side branches covered by intracoronary stents. Of these, 43 (19%) occluded. Most SBOs (29 of 43 [67%]) occurred after poststent dilation using high-pressure inflations (15.3 +/- 3.3 atmospheres). No clinical characteristics correlated with SBO. By multivariate analysis, those side branches with >50% ostial narrowing that arose from within or just beyond the diseased portion of the parent vessel (threatened side branch morphologies) were a powerful angiographic predictor of SBO (odds ratio 40, 95% confidence interval, 14 to 130, p <0.0001). At 9-month follow-up there was no difference in combined clinical events between those patients with and without SBO. These data demonstrate that side branches with ostial stenoses in continuity with diseased parent lesions were at risk of occlusion following stenting. SBO, however, was not associated with adverse clinical outcome. These findings lend support to plaque shift ("snow plow effect") as the mechanism behind SBO following stent placement.

Issues in setting health-based cleanup levels for arsenic in soil.

Health risk assessments often do not take into account the unique aspects of evaluating exposures to arsenic in soil. For example, risks from ingestion of arsenic in soil are often based on toxicity factors derived from studies of arsenic (soluble arsenate or arsenite) in drinking water. However, the toxicity of arsenic in drinking water cannot be directly extrapolated to toxicity of soil arsenic because of differences in chemical form, bioavailability, and excretion kinetics. Because of the differences between soil arsenic and water arsenic, we conclude that risks from arsenic in soil are lower than what would be calculated using default toxicity values for arsenic in drinking water. Site-specific risk assessments for arsenic in soil can be improved by characterizing the form of arsenic in soil, by conducting animal feeding or in vitro bioavailability studies using site soils, and by conducting studies to evaluate the relationship between urinary arsenic and soil arsenic levels. Such data could be used to more accurately measure the contribution that soil arsenic makes to total intake of arsenic. Available data suggest that arsenic usually makes a small contribution to this total.

PET perfusion and vasodilator function after angioplasty for acute myocardial infarction.

UNLABELLED: The aims of this study were to validate invasive coronary Doppler flows against noninvasive PET assessments of myocardial perfusion and to examine the timing and degree of regional coronary vasodilator reserve recovery in patients who are successfully reperfused with primary angioplasty (PTCA) for acute myocardial infarction. METHODS: PTCA was performed in 21 consecutive patients with acute myocardial infarction; the final diameter stenosis was 25% +/- 7%. After restoration of TIMI Grade 3 flow, all patients underwent quantitative coronary angiography and distal Doppler coronary blood flow studies (basal and after adenosine-induced hyperemia) in the infarct and noninfarct vessels. Regional myocardial perfusion and vasodilator function were quantitated after intravenous adenosine infusion PET in all patients at 26 +/- 9 hr after acute PTCA. These were repeated in 17 patients 9 +/- 3 days later. RESULTS: Post-PTCA resting coronary flow was 35 +/- 15 ml/min in the infarct-related vessels and 50 +/- 24 ml/min during peak hyperemia (p < 0.05). Coronary flow reserve (CFR) was 1.48 +/- 0.34 and 2.08 +/- 0.62 in the infarct and noninfarct vessels, respectively (p < 0.001). Early (< 36 hr) PET myocardial perfusion reserves (MPR) in the infarct and noninfarct regions were 1.59 +/- 0.33 and 2.03 +/- 0.62 (p < 0.01). Doppler CFR and PET MPR were correlated in the infarct (r = 0.61, p < 0.01) and noninfarct (r = 0.77, p < 0.0001) regions. Follow-up PET studies demonstrated improved MPR in both infarct and noninfarct regions (1.93 +/- 0.52 versus 2.54 +/- 0.97, p < 0.01). The improvement in coronary vasodilator function from the time of acute PTCA to follow-up PET in the infarct region was significant (p = 0.005). CONCLUSION: After successful mechanical revascularization by PTCA after acute myocardial infarction, intracoronary Doppler blood flows and noninvasive PET regional myocardial perfusion are correlated within the wide range of reperfusion blood flows observed in patients with contrast angiographic TIMI Grade 3 flow. Serial PET studies demonstrated a trend towards continued improvement in the vasodilator response in infarct-related myocardial regions after the restoration of blood flow by PTCA. PET offers the potential for accurate noninvasive serial assessment of reperfusion blood flow after primary angioplasty for acute myocardial infarction.

Supporting special needs in the mainstream classroom: children's perceptions of the adult role.

Inclusion of children with significant special educational needs within the ordinary classroom frequently involves additional human resources. In the UK, specialist teachers and classroom assistants (teachers' aides) are now a regular feature of many classrooms. Their purpose is to provide advice and support to the teacher and/or specifically to assist the child with special educational needs in accessing the mainstream curriculum. There has been little research into the impact of these additional adults on children not designated as having special educational needs, although their attitudes and responses are likely to prove critical to the success of any policy of inclusive education. This study examines the responses of 713 children (ages 7-14+) attending 27 schools in London to questions relating to the role of adults supporting special educational needs (SEN) children in their classrooms and to the social desirability of being singled out for support. The findings suggest that the majority of those responding saw the support being directed towards the teacher's needs. The recognition of pupils' needs was less frequently expressed. The desirability of support became challenged by some children in the upper age range of the sample. Reasons for this and the implications for inclusive education are considered.

Effect of Rotablator atherectomy and adjunctive balloon angioplasty on coronary blood flow.

BACKGROUND: The purpose of this study was to assess serial changes in coronary blood flow velocity before and after Rotablator atherectomy and after adjunctive percutaneous transluminal coronary angioplasty (PTCA). Since Rotablator atherectomy results in luminal enlargement by plaque pulverization and distal embolization, improvement in coronary blood flow could be attenuated despite luminal enlargement. METHODS AND RESULTS: Intracoronary Doppler blood flow velocity measurements were obtained with a Doppler Flowire. Basal average peak velocity (bAPV), hyperemic APV (hAPV), diastolic/systolic velocity ratio (DSVR), and coronary flow reserve (CFR) were assessed before intervention, after Rotablator, and after adjunctive PTCA. Complete clinical, angiographic, and Doppler data were obtained in 22 patients. There was a small but significant difference (P = .02) in resting heart rate and mean arterial pressure before and after Rotablator and after adjunctive PTCA. Minimum lumen diameter increased from 0.8 +/- 0.1 to 1.5 +/- 0.2 to 2.0 +/- 0.1 mm (P < .001), corresponding to decreases in diameter stenosis from 72 +/- 3% to 41 +/- 4% to 36 +/- 3% (P < .001). Although bAPV, hAPV, and DSVR increased significantly (P < .001), CFR remained abnormally low in 19 of 22 patients (despite an increase from baseline to post-PTCA). hAPV > 30 cm/s was the best Doppler correlate of angiographic success. CONCLUSIONS: Rotablator atherectomy and adjunctive PTCA significantly improve distal coronary blood flow velocity and DSVR but not CFR. Failure to normalize CFR could be secondary to parallel increases in bAPV and hAPV, "acquired" microvascular disease due to distal microembolization or spasm, and/or angiographically inapparent dissection or residual stenosis. Adjunctive PTCA contributes significantly to the overall physiological benefit of a combined procedure.