Identifying errors in dust models from data assimilation.

Airborne mineral dust is an important component of the Earth system and is increasingly predicted prognostically in weather and climate models. The recent development of data assimilation for remotely sensed aerosol optical depths (AODs) into models offers a new opportunity to better understand the characteristics and sources of model error. Here we examine assimilation increments from Moderate Resolution Imaging Spectroradiometer AODs over northern Africa in the Met Office global forecast model. The model underpredicts (overpredicts) dust in light (strong) winds, consistent with (submesoscale) mesoscale processes lifting dust in reality but being missed by the model. Dust is overpredicted in the Sahara and underpredicted in the Sahel. Using observations of lighting and rain, we show that haboobs (cold pool outflows from moist convection) are an important dust source in reality but are badly handled by the model's convection scheme. The approach shows promise to serve as a useful framework for future model development.

The professional nurse education program: a work force development model.

Invariably, healthcare institutions respond to repeated voids in professional nurse positions by recruiting persons external to the organization, rather than examining their nonprofessional ranks for high achievers worthy of formal career advancement opportunities. The authors describe why and how their professional work force development operates, the demographics of participants, and outcomes, such as retention rate, gains in college preparatory competencies, changes in self-reported psychosocial aspects of participants, influence of work hours on academic achievement, and financial investment.

Nuclear medicine in oncology.

The role of the nuclear medicine department in the diagnosis and management of malignant disease is constantly evolving. For example, the development of new radiopharmaceuticals, such as indium-111-labelled octreotide (pentetreotide), has enabled more specific imaging for the diagnosis of gastroentero-pancreatic (GEP) endocrine tumours to be carried out. New techniques such as sentinel lymph node localisation and biopsy now allow less invasive tumour staging. Advances in chemotherapy necessitate careful monitoring of the effects of chemotherapeutic drugs on normal organ function during follow-up, and tumour specific radiopharmaceuticals are being used for non-invasive, targeted tumour therapy. Nuclear medicine investigations should always be interpreted in the knowledge of results of other imaging investigations if they are to have greatest impact on patient care.

Aspiration pneumonia following surgically placed feeding tubes.

BACKGROUND: The enteral route is preferred in surgical patients requiring nutritional support; however, controversy surrounds the choice of location of feeding tube placement. Although jejunostomy has been commonly accepted as superior to gastrostomy for long-term nutritional support because of an assumed lower risk of aspiration pneumonia, recent studies suggest that reevaluation of common practices of surgical tube placement is warranted. PATIENTS AND METHODS: We conducted a retrospective chart review of gastrostomy and jejunostomy procedures from 1986 to 1993. Demographic information and complications related to the procedure were reviewed. Aspiration pneumonia was defined as respiratory symptoms, leukocytosis, and infiltrate on chest radiograph. RESULTS: Sixty-nine gastrostomies and 86 jejunostomies were performed during the study period. Six patients were diagnosed with aspiration pneumonia; 2 cases of which occurred with jejunostomy and 4 cases occurred with gastrostomy (P = not significant). CONCLUSIONS: There was no difference in rates of pulmonary aspiration or other complications between gastrostomy and jejunostomy. We suggest that when a surgically placed feeding tube is required, the determination of appropriate procedure be based on clinical factors such as the technical difficulty of the operation or long-term feeding goals.

Carcinoma of the thyroid in black patients.

In the period from January 1, 1976 to December 31, 1988, we reviewed the charts of 33 patients treated for carcinoma of the thyroid at Howard University Hospital. The three non-black patients (two Whites and one Pakistani) were excluded from the study. There were 19 females and 11 males. Of the 30 cases elevated, 10 were papillary, 7 were follicular variant of papillary, 8 were follicular, 3 were undifferentiated (anaplastic), and 2 were medullary. Ten patients had either distant metastasis (Hoffman, South Med J 80:741, 1987) or locally advanced disease in the neck (Woolner et al., Am J Surg 102:354, 1961.) at the time of diagnosis. The treatment of these lesions depended on, among other variables, the cell type, the extent of the lesion, and the personal preference of the attending surgeon. Carcinoma of the thyroid remains an uncommon lesion in Black patients. Because of its rarity, the diagnosis may often be delayed and, as a result, patients may first come to attention with a more advanced stage of this disease. To prevent this occurrence, a high index of suspicion must be maintained for all thyroid nodules, and appropriate diagnostic steps taken. Diagnostic and treatment options are discussed.

Long term follow up of spinal cord injury caused by penetrating missiles.

Eighty-four spinal cord injured patients (SCIP) injured as a result of penetrating missiles were categorised according to: neurological level of injury, age at time of injury, circumstances of injury, missile type, initial treatment, duration of injury, and ethnic background. Evaluations and comparisons were made concerning: life habits, family status, education, employment, and mental well being. A discussion of complicating factors, both physical and psychological, and their relation to the final rehabilitation result is presented.

Controlled study of cimetidine in the treatment of benign prostatic hypertrophy.

A series of 60 patients with benign prostatic hypertrophy (BPH) was randomly divided into 2 groups; 30 received cimetidine 1 g/day for 4 weeks and 30 received vitamin C 1 g/day for the same period. The study was double-blind. No significant difference between the 2 groups was observed in mean urinary flow, subjective obstructive or irritative symptoms, or prostate size. There was a statistically significant difference in the peak urinary flow rate but this was a result of net deterioration in the control group. Cimetidine was found to be no more active than vitamin C in treating benign prostatic hypertrophy.

Arm crank ergometry in chronic spinal cord injured patients.

Cardiovascular response to arm crank ergometry, using a specially adapted Monark bicycle ergometer, was examined in 98 men with long-standing spinal cord injuries (SCI), who were classified into groups by neurologic level of SCI. Exercise response was significantly correlated with lesion levels: the higher the lesion, the lower the levels of physical work capacity and mean exercise systolic and diastolic blood pressure. Also, physical symptoms and abnormal systolic blood pressure exercise response were more frequent. Exercise response of patients with lower thoracic and lumbar SCI did not differ from the control group. The undisputed value of ergometry in the routine evaluation and exercise prescription for health maintenance in SCI and other wheelchair-disabled patients was substantiated by the study findings.

Effect of Longitudinal Versus Transverse Electrode Placement on Torque Production by the Quadriceps Femoris Muscle during Neuromuscular Electrical Stimulation.

The purpose of this study was to evaluate the effect of electrode placement in relation to muscle design for producing muscle torque when using neuromuscular electrical stimulation (NMES). Thirty-five healthy subjects (19 men, 16 women) participated in this study on a voluntary basis. All subjects were tested for maximum voluntary isometric contraction (MVC) of their dominant quadriceps femoris muscle while seated on an isokinetic dynamometer. NMES to subject tolerance was used while determining the effect of electrode placement (longitudinal and transverse) on the torque. Findings show that the longitudinal electrode position produces significantly more torque than the transverse position when the knee extensor muscles are electrically stimulated by the same current amplitude. Physical therapists should be aware of this technique when using NMES clinically to produce muscle torque. J Orthop Sports Phys Ther 1990;11(11):530-534.

Hyperprolactinemia, galactorrhea and amenorrhea in women with a spinal cord injury.

Six women with a traumatic spinal cord injury (SCI) developed hyperprolactinemia, amenorrhea and galactorrhea. Five of them had thoracic level lesions and 1 had a lumbosacral lesion. Two were postpartum and 1 was pregnant at the time of injury. Transient diabetes insipidus developed in 1 patient. Temporary administration of bromocriptine decreased prolactin levels, caused cessation of lactation and restored ovulatory cycles. The syndrome disappeared spontaneously in all 6 patients. Pituitary stalk concussion resulting from the trauma might cause this phenomenon, with the level of the cord injury playing a role. Being pregnant or early postpartum can predispose women to develop this syndrome.

The prevalence of hypertension, ischaemic heart disease and diabetes in traumatic spinal cord injured patients and amputees.

The clinical impression that spinal cord injured and traumatic lower limb amputees are more prone to develop degenerative diseases was investigated by comparing the prevalence of hypertension, ischaemic heart disease, and diabetes mellitus in these two patient groups with the prevalence of these diseases among a group of healthy age-matched controls. Seventy seven spinal cord injured patients and 53 amputees fulfilled the criteria for inclusion in this study. Our results show a significant increased incidence of hypertension and ischaemic heart disease among those with spinal cord injuries compared with their controls; and among the amputees, a significant increased incidence of ischaemic heart disease and of diabetes mellitus.

The rehabilitation of patients with severe Guillain-Barré syndrome.

Twenty four of more than 800 patients admitted to our centre presented with a severe Guillain-Barré Syndrome. The length of hospitalisation, duration of illness, treatment, and the rehabilitation course of these patients are discussed. Suggestions are made concerning the necessity to obtain maximal rehabilitation for these patients.

Massive centrifugal multitrauma resulting in paralysis and limb loss. A report of 4 cases and discussion of the special problems in rehabilitation.

Four cases are described wherein massive centrifugal trauma caused a whirl-whiplash type injury to the spinal cord resulting in paralysis. Two patients became paraplegics and two quadriplegics. In three cases, there was a loss of one or more limbs associated with other concomitant injuries. Attention is focused on the problems facing patients with a combination of plegias and amputation.

Urologic complications after surgery on lumbosacral spine.

Forty-five of 74 patients (60%) postsurgery for disk disease showed findings of neurogenic bladders. Sixty-nine of these patients had no complaints before surgery and presented with complaints only after surgery. We believe this is a high surgical morbidity, and all patients should have a presurgical urodynamic diagnostic evaluation to aid in selection of patients in whom surgery will be most helpful and to establish a presurgical baseline for further postsurgical urodynamic comparison.

Relationship between subjective complaints and urinary flow.

Two hundred six patients were examined with urine flowmetry and residual urine measurements to determine if a relationship exists between pathologic urine flowmetry determinations and specific subjective patient complaints. A statistical correlation exists in men with the complaint of frequency and in women with the complaint of frequency and incontinence. Possible explanation for these findings is discussed.

Systemic humoral factors participating in the course of spinal cord injury.

Systemic humoral factors have been studied in traumatic, chronic and acute spinal cord injured patients. Antibodies specific to nervous system autoantigens were detected in a majority of the sera obtained from these patients, at different periods after injury. Limited in vitro sprouting of dorsal root ganglia in chicken embryos was observed in the presence of serum from these patients. The possible association between growth inhibiting factors and the presence of antibodies against nervous tissue autoantigens is discussed.