Facility and operations planning for quiet hospital nurseries.

This article discusses architectural design and construction and recommends criteria for achieving quiet nursery environments. Designs for new construction or facility renovation should incorporate vibration and noise control methods appropriate to the occupants and activities of the proposed space. Noise and vibration are environmental factors within a hospital nursery that can affect infant health and development, staff and parent communications, operational efficiencies, and the fatigue/comfort level of all occupants. Facility noise and vibration levels set a threshold that will be increased by operational noise. It is important, therefore, that hospital administrators, clinicians, and facility managers assure that architects, engineers, and builders use appropriate acoustical design criteria, methods, and materials to control noise and vibration.

Fetal rat brain damage caused by maternal seizure activity: prevention by magnesium sulfate.

OBJECTIVE: Our purpose was to determine whether maternal rat seizure activity was associated with fetal histopathologic brain changes and whether magnesium sulfate reduced these changes. STUDY DESIGN: Electrodes were stereotaxically implanted into the hippocampus of nonpregnant rats 1 week before breeding. Pregnant rats were randomly assigned to 1 of 4 groups: (1) sodium chloride solution and no seizure (n = 2), (2) magnesium sulfate and no seizure (n = 2), (3) sodium chloride solution and seizure (n = 5), and (4) magnesium sulfate and seizure (n = 5). On gestational days 9, 11, 13, 15, 17, and 19, subcutaneous doses of sodium chloride solution or magnesium sulfate were administered to all rats every 20 minutes for 4 hours (loading-maintenance-loading), followed by seizure induction. On gestational day 20, the rats were perfused with formalin and fetuses were delivered via cesarean. Fetuses were perfused with formalin, brains were obtained and embedded in paraffin, and the forebrain and hindbrain were sectioned in the coronal plane and stained with hematoxylin and eosin. A neuropathologist masked to the protocol performed histopathologic grading of each section, including extent and nature of cellular damage. Eleven brain regions were examined in each section. Scores were expressed as mean +/- SD. Kruskal-Wallis analysis of variance was used, and P <.05 was considered significant. RESULTS: We evaluated 26 fetal brains in group 1, 9 in group 2, 72 in group 3, and 45 in group 4. Fetuses in the sodium chloride solution-and-seizure group (group 3) presented significantly higher grades of neuronal damage in the hippocampus (group 1, 0.50 +/- 0. 88; group 2, 0.22 +/- 0.66; group 3, 1.01 +/- 1.17; and group 4, 0. 48 +/- 0.72) and in the tegmentum region (group 1, 1.0 +/- 1.0; group 2, 0.8 +/- 1.0; group 3, 1.7 +/- 0.7; and group 4, 1.5 +/- 0. 8) (P <.05, group 3 compared with others). Isolated and patchy neuronal injury with shrinkage of cells, nuclear pyknosis, and karyorrhexis were the main histologic findings. CONCLUSIONS: Maternal rat seizure activity was associated with histologic brain injury in the fetus. Maternal administration of magnesium sulfate before seizure prevented or significantly decreased this effect.

Conditional reasoning with inducements and advice.

In an earlier study of conditional reasoning, Newstead et al. [Newstead, S.E., Ellis, C.E., Evans, J.St.B.T., Dennis, I., (1997). Conditional reasoning with realistic material. Thinking and Reasoning 3, 49-96] found that people drew more inferences from conditionals framed as inducements (threats and promises) than from conditionals phrased as advice (tips and warnings). The present study was designed to test the hypothesis that this difference arose from the fact that the speaker of an inducement is normally seen to have control over the consequent event whereas the giver of advice does not. In the experiment reported here, inducement and advice conditionals were constructed in brief contexts such that in either case the speaker could be seen to have high or low control. Participants drew many more conditional inferences of all kinds for high control than for low control conditionals in either context. A second finding of interest was that participants drew many more forward (antecedent to consequent) inferences than backward inferences with these kinds of realistic conditionals.

The synergy of group and individual psychotherapy training.

Although this paper has focussed on ways in which group-therapy experience differs from the experience of individual therapy for the beginning therapist, all of the differences discussed are only matters of degree and thus are important in both individual and group therapy. Group-therapy experience tends to enhance the visibility of important aspects of all forms of psychotherapy and therefore should be looked at as a useful tool in learning all forms of psychotherapy. Experience in group psychotherapy should ideally precede or occur simultaneously with initial exposure to individual therapy rather than following afterwards as an option, as is usually the case in current psychotherapy training programs. The most important skill to acquire in learning psychotherapy is the sophisticated ability to listen. To do so involves attending to content, affect, the patient's and one's own verbal language, body language, and meta-communications, conscious as well as unconscious. Group psychotherapy experience early in one's development as a psychotherapist can be a powerful tool in developing this ability to listen. Being part of the group process allows a unique level of intimacy that is probably more equal and vulnerable than in other forms of therapy. The use of the self, and the ability to trust in the process without using theory as a barrier between ourselves and our patients, but rather as a bridge to greater understanding, can all flow from the unique experience of leading a psychodynamic group.

A comparison of three pulmonary artery oximetry catheters in intensive care unit patients.

OBJECTIVE: To compare the clinical performance of three pulmonary artery oximetry catheters (Oximetrix 3, SAT-2, and HEMOPRO2) in intensive care unit (ICU) patients. DESIGN: Unblinded comparison of performance over 24 h using an IL-282 CO-oximeter as a criterion standard. SETTING: Multispecialty adult ICU at a university teaching hospital. PATIENTS: Thirty critically ill patients selected from those requiring hemodynamic monitoring for medical management. MEASUREMENTS AND MAIN RESULTS: By all measures, performance of the Oximetrix 3 and SAT-2 systems were comparable; bias +/- precision were -1.98 +/- 3.07 and +1.80 +/- 3.49, respectively, vs -2.28 +/- 5.24 for the HEMOPRO2. The Oximetrix 3 and SAT-2 systems demonstrated consistent performance over the range of saturations tested, though Oximetrix 3 tended to underestimate and SAT-2 tended to overestimate the CO-oximeter value. The HEMOPRO2 underestimated the CO-oximetry-derived saturation, although this was not constant across the range of values tested. The 95 percent confidence limits based on intrasubject variability were similar (+/- 4.59, +/- 5.66, and +/- 6.56 for the Oximetrix 3, SAT-2, and HEMOPRO2, respectively); however, the 95 percent confidence limits based on total variability, while similar for Oximetrix 3 (+/- 6.03) and SAT-2 (+/- 6.86), were larger for the HEMOPRO2 (+/- 10.30). The expected SD was similar for the three systems (2.03, 2.50, and 2.90 for the Oximetrix 3, SAT-2, and HEMOPRO2 systems, respectively). None of the systems equaled or exceeded (p greater than 0.05) the manufacturers' published specifications, which, in all cases, are listed as +/- 2 percent (saturation; 1 SD) when compared with bench oximetry. CONCLUSIONS: Although each system measures mixed venous oxygen saturation, the Oximetrix 3 and SAT-2 systems demonstrate closer agreement with CO-oximetry. However, none of these catheters provided statistically significant evidence that they would perform within +/- 2 percent of CO-oximetry. As a continuous monitor used to detect changes or trends, any of the three may be acceptable.

Enterotoxin production by atypical Staphylococcus aureus from poultry.

Phenotypically typical Staphylococcus aureus was isolated frequently from the necrotic bone and liver of poultry suffering from femoral head necrosis. Occasionally strains were isolated that differed from typical Staph. aureus in one or more of the major diagnostic tests, i.e. coagulase production, anaerobic fermentation of mannitol and production of a heat-stable deoxyribonuclease. Such atypical strains were also isolated from nasal swabs of healthy birds. Tests for enterotoxin production demonstrated that some atypical strains from both sick and healthy birds are capable of producing staphylococcal enterotoxins.

The mitochondrial adenosine triphosphatase of Acanthamoeba castellanii. Oscillatory accumulation of enzyme activity, enzyme protein and F1-inhibitor during the cell cycle.

1. The mitochondrial ATPase of Acanthamoeba castellanii accumulated discontinuously in synchronous cultures prepared by a minimally perturbing size-selection technique. 2. Enzyme activity per ml of culture doubled overall during one cell cycle time of 8 h, but oscillated to give seven maxima during this period. Similar oscillations were observed in the specific activities of ATPase and of the naturally occurring inhibitor protein. 3. These variations in enzyme activity reflected changes in amount of enzyme protein as assayed by an immunological technique. 4. Large variations in I50 values (micrograms of inhibitor/mg of protein necessary for 50% inhibition of inhibitor-sensitive activity) for inhibition of ATPase activity by seven different inhibitors of energy conservation were observed. Activity was more sensitive to inhibition by oligomycin, efrapeptin, citreoviridin and quercetin when values were highest. 5. The results are discussed in relation to the phased organization of biosynthesis and degradation of cellular components known to occur during the cell cycle of this organization.

The mitochondrial adenosine triphosphatase of Acanthamoeba castellanii. Partial characterization and changes in activity during exponential growth.

1. The mitochondrial adenosine triphosphatase (ATPase) of Acanthamoeba castellanii is Mg2+-requiring (optimum cation: ATP ratio of 1.5) and has two pH optima of activity (at pH 6.6 and 8.1). 2. ATPase activity of submitochondrial particles is effectively inhibited by twelve different inhibitors of energy conservation suggesting similarities in inhibitor-binding sites to other previously characterized complexes. 3. Gel filtration by passage through Sephadex G-50 increases ATPase activity of submitochondrial particles between 1.5 and 3.5 fold indicating the presence of a low molecular weight inhibitor protein. 4. After removal of the inhibitor protein, sensitivity to inhibitors of energy conservation decreases by between 1.5 and 14 fold. Crude F1-inhibitor preparations from A. castellanii, Schizosaccharomyces pombe, Tetrahymena pyriformis and bovine heart also inhibit ATPase activity. 5. Large variations in ATPase activity, F1-inhibitor protein activity, and amounts of immunologically-determined ATPase protein were observed during exponential growth, and the correlation between changes in these measurements is discussed. 6. The results are also discussed highlighting the similarities between the mitochondrial ATPase of A. castellanii and other mitochondrial ATPases.

Anaerobic resistance of clinical isolates of Staphylococcus aureus to aminoglycosides.

The anaerobic minimum inhibitory concentration of six aminoglycosides (amikacin, gentamicin, kanamycin, netilmicin, sisomicin, and tobramycin) averaged over 10-fold greater than the aerobic minimum inhibitory concentration for 50 clinical isolates of Staphylococcus aureus. Cultures from osteomyelitis and blood generally showed a somewhat greater increase in minimum inhibitory concentration due to anaerobiosis than did cultures from abscesses and wounds, and amikacin activity was most affected by anaerobiosis.

Agar shake tube technique for simultaneous determination of aerobic and anaerobic susceptibility to antibiotics.

The broth dilution method of determining the minimum inhibitory concentration (MIC) of antibiotics has been adapted to an agar shake tube technique with semisolid media. This permits the simultaneous determination of the aerobic and anaerobic MICs for facultatively anaerobic bacteria such as staphylococci.

Effect of anaerobiosis on antimicrobial susceptibility of staphylococci.

The minimum inhibitory concentration (MIC) of 12 antibiotics was determined for four strains of staphylococci (representing the three major species) under aerobic and anaerobic conditions by using the broth dilution method. Nine of the antibiotics showed no significant difference between aerobic and anaerobic MIC for any of the four cultures. Gentamicin and kanamycin showed a small, but significant, increase in MIC for at least two strains under anaerobic conditions. Trimethoprim was less effective against all strains under anaerobic conditions.

Uracil and pyruvate requirements of anaerobic growth of staphylococci.

Sixty-six strains of staphylococci recently isolated from human skin and identified as members of the three recognized species of staphylococci, and 21 stock strains representing most of the Baird-Parker subgroups of staphylococci and micrococci were studied. All 16 skin strains of Staphylococcus aureus demonstrated weak to moderate anaerobic growth in the basal medium, growth stimulation by either uracil or pyruvate, and best growth when both were added. The 20 skin strains of S. epidermidis responded similarly to S. aureus but with a tendency toward heavier growth. The 28 isolates of S. saprophyticus generally gave little or no growth in the basal medium, no increase due to pyruvate alone, a weak response to uracil alone, and, with three exceptions, gave moderate to good growth when both supplements were present. The Baird-Parker strains from subgroups S-II and S-III responded like S. epidermidis; those from subgroups S-V, S-VI, M-1, M-2, M-3, and M-6 generally responded like S. saprophyticus; and those from subgroups M-4 and M-5 failed to grow anaerobically in all media.

Evaluation of selective media for enumeration of group D streptococci in bovine feces.

Eight commercially available selective media were evaluated by the membrane filter technique. Enterococcosel broth (BBL) consistently gave the best recovery of group D streptococci, particularly of Streptococcus bovis.

Use of shake cultures in a semisolid thioglycolate medium for differentiating staphylococci from micrococci.

The standard diagnostic test for differentiating staphylococci from micrococci is based on the ability of the former to produce acid anaerobically in a glucose-containing growth medium. This test has been modified to provide greater convenience, easier interpretation of results, and better correlation with deoxyribonucleic acid (DNA) base composition. In the modified test, shake cultures in Brewer's fluid thioglycolate medium with 0.3% agar added are observed for growth in the anaerobic zone of the tubes. This test was applied to 125 strains of staphylococci and micrococci, and all except two strains gave results that were consistent with other criteria. Of particular interest were eight strains of Micrococcus saprophyticus and three strains of M. lactis that have a DNA composition of 30 to 37% guanine plus cytosine (GC). All 11 of these cultures produced anaerobic growth and thus would be classified as staphylococci. Strains of M. lactis that have a high GC content in their DNA grew only aerobically. Some cultures of staphylococci produced characteristic band patterns of anaerobic growth and other cultures produced only a few anaerobic colonies from an inoculum of 10(6) to 10(7) cells. These observations suggest some interesting genetic and metabolic capabilities in such cultures.