Impacts of rainfall variability and expected rainfall changes on cost-effective adaptation of water systems to climate change.

Stormwater drainage and other water systems are vulnerable to changes in rainfall and runoff and need to be adapted to climate change. This paper studies impacts of rainfall variability and changing return periods of rainfall extremes on cost-effective adaptation of water systems to climate change given a predefined system performance target, for example a flood risk standard. Rainfall variability causes system performance estimates to be volatile. These estimates may be used to recurrently evaluate system performance. This paper presents a model for this setting, and develops a solution method to identify cost-effective investments in stormwater drainage adaptations. Runoff and water levels are simulated with rainfall from stationary rainfall distributions, and time series of annual rainfall maxima are simulated for a climate scenario. Cost-effective investment strategies are determined by dynamic programming. The method is applied to study the choice of volume for a storage basin in a Dutch polder. We find that 'white noise', i.e. trend-free variability of rainfall, might cause earlier re-investment than expected under projected changes in rainfall. The risk of early re-investment may be reduced by increasing initial investment. This can be cost-effective if the investment involves fixed costs. Increasing initial investments, therefore, not only increases water system robustness to structural changes in rainfall, but could also offer insurance against additional costs that would occur if system performance is underestimated and re-investment becomes inevitable.

Impact of interdisciplinary learning on critical thinking using case study method in allied health care graduate students.

It remains unclear which classroom experiences, if any, foster critical think ability. We measured the effectiveness of interdisciplinary, case-based learning on the critical-thinking ability of graduate students enrolled in allied health care programs. We designed a voluntary classroom experience to examine the effectiveness of case studies used in an interdisciplinary setting to increase critical-thinking ability. Two groups of students were measured for their critical thinking ability using an online assessment both before and after their respective classroom experiences. One group of 14 graduate students from 4 different allied health care programs (interdisciplinary, ID) discussed complex interdisciplinary case studies and answered multiple-choice type questions formed around the cases. The second group was composed of graduate students (n = 28) from a single disciple enrolled in a clinical anatomy course (discipline specific, DS). They discussed complex case studies specific to their discipline and answered multiple-choice questions formed around the cases. There was no overall change in critical-thinking scores from the pre- to post-test in either group (delta scores: ID 1.5 ± 5.3, DS -1.7 ± 5.7). However, ID students scoring below the median on the pretest improved significantly (paired t-test, pre 50.7 ± 3.8, post 54.2 ± 1.7, p = 0.02). The interdisciplinary learning experience improved critical-thinking ability in students with the least proficiency. As case studies have long been used to advance deeper learning, these data provide evidence for a broader impact of cases when used in an interdisciplinary setting, especially for those students coming in with the least ability.

The cost of walking downhill: is the preferred gait energetically optimal?

Humans tend to prefer walking patterns that minimize energetic cost, but must also maintain stability to avoid falling over. The relative importance of these two goals in determining the preferred gait pattern is not currently clear. We investigated the relationship between energetic cost and stability during downhill walking, a context in which gravitational energy will assist propulsion but may also reduce stability. We hypothesized that humans will not minimize energetic cost when walking downhill, but will instead prefer a gait pattern that increases stability. Simulations of a dynamic walking model were used to determine whether stable downhill gaits could be achieved using a simple control strategy. Experimentally, twelve healthy subjects walked downhill at 1.25 m/s (0, 0.05, 0.10, and 0.15 gradients). For each slope, subjects performed normal and relaxed trials, in which they were instructed to reduce muscle activity and allow gravity to maximally assist their gait. We quantified energetic cost, stride timing, and leg muscle activity. In our model simulations, increase in slope reduced the required actuation but also decreased stability. Experimental subjects behaved more like the model when using the relaxed rather than the normal walking strategy; the relaxed strategy decreased energetic cost at the steeper slopes but increased stride period variability, an indicator of instability. These results indicate that subjects do not take optimal advantage of the propulsion provided by gravity to decrease energetic cost, but instead prefer a more stable and more costly gait pattern.

Oviductin (Muc9) is expressed in rabbit endocervix.

While isolating and characterizing cervical mucin glycoproteins, oviductin (Muc9) was identified in the rabbit endocervix. Following tissue homogenization, endocervical proteins were fractionated by exclusion chromatography (Sepharose CL-4B). High molecular weight components of the void volume were resolved by density gradient centrifugation using cesium bromide and dissociative conditions (4 M guanidinium chloride). High density fractions (rho = 1.40 - 1.56 g/ml) were deglycosylated with anhydrous trifluoromethane sulfonic acid and sent to Harvard Microchemistry where in situ digestion and tryptic peptide separation were performed. Out of an HPLC map, microsequence (KLIMGFPTYGR) from peak 51 was 100% identical to mouse oviductin, and microsequence (KSTGHNFPLP) from peak 70 was 90% identical to hamster oviductin. Temporal expression of oviductin transcripts (2.4-kilobase) was negligible during the first three months of postnatal cervical differentiation. Transcripts were minimally detectable in the cervices of 4-month-old juveniles. Strong expression in the endocervices of adults was eliminated by ovariectomy and restored by estrogen treatment. The presence of oviductin in the rabbit endocervix indicates this glycoprotein may have multiple functions, and it can no longer be considered oviduct-specific.

Uteroglobin gene transcription: what's the RUSH?

Prolactin enhances progesterone-dependent transcription of the rabbit uteroglobin gene. RUSH transcription factors are implicated in the signal transduction pathway. The RUSH acronym identifies key features of these nuclear phosphoproteins, that is, RING-finger motif, binds the uteroglobin promoter, structurally related to the SWI/SNF family of transcription factors, and helicase-like. Cloned by recognition site screening, RUSH proteins bind to an 85-bp region (-170/-85) of the uteroglobin promoter that was subsequently identified as a novel prolactin-responsive region by promoter deletion analysis. Gel shift and linker-scanning assays further reduced the RUSH target site to -160/-110. A hexameric core of MCWTDK was identified as the RUSH-specific DNA-binding site (-126/-121) by CASTing. This site overlaps authentic HNF3 beta and OCT-1 binding sites. A unique Type IV P-type ATPase that is embedded in the inner nuclear membrane binds the RING domain of RUSH. The conformationally flexible loop portion of this RING-finger binding protein (RFBP) extends into the nucleoplasm to contact euchromatin. The physical association of RFBP with transcriptionally active chromatin supports the speculation that RFBP targets RUSH transcription factors to the active uteroglobin promoter.

Head-injured patients who are nasal carriers of Staphylococcus aureus are at high risk for Staphylococcus aureus pneumonia.

OBJECTIVE: To determine if head-injured patients with premorbid nasal colonization with Staphylococcus aureus are at increased risk for S. aureus infection. DESIGN: Patients admitted over a 2-yr period were enrolled if they met the following criteria: Injury Severity Score > or = 9, intensive care unit (ICU) admission, hospitalization in another hospital < 24 hrs, no recent use of antibiotics. SETTING: Acute care trauma facility. PATIENTS: Any patient sustaining acute, blunt, or penetrating injury and meeting the enrollement criteria were eligible. INTERVENTIONS: Swab cultures of both internal nares were performed within 72 hrs of readmission and cultured for S. Aureus. Patients were prospectively monitored for S. Aureus infections until discharge. MEASUREMENTS AND MAIN RESULTS: Admission nasal cultures were positive (NC+) for S. aureus in 144 of the 776 patients cultured. Forty of the 144 NC+ patients had isolated head (37) or high cervical spine (3) injury, and 11 of that group (27.5%) developed S. aureus infections. The remaining 104 patients positive for S. aureus on admission had no head injury (74) or head combined with torso and extremity injuries (30). S. aureus infection was diagnosed in 11 of the 104 patients (10.6%). The difference in incidence of infections is significant (p <.01), as is the difference in incidence of pneumonia (20% vs. 3.8%, respectively [p <.01]). Organisms causing pneumonia were often the same organisms isolated from the nares on admission. CONCLUSIONS: Nasal colonization with S. aureus at the time of severe head injury increases the risk of S. aureus pneumonia during hospitalization. Prophylactic measures against S. aureus pneumonia may help reduce the length and cost of hospitalization.

Statewide assessment of school-age children with asthma in Delaware.

In Delaware, asthma affects almost 14,000 children. The American Lung Association of Delaware and the University of Delaware surveyed school nurses to identify the needs of children with asthma and the services and accommodations available for these children. Researchers developed a survey instrument that was mailed to all Delaware schools (N = 324). The response rate was 38.6% (n = 125). According to respondents, a variety of protocols were in place regarding the administration of asthma medications. Respondents also reported that several measures had been taken to modify the school environment to improve air quality and reduce asthma triggers. Most respondents (77%) indicated they did not have asthma education programs in their schools. Findings from this study sparked development of a multidisciplinary Delaware Asthma Committee, an Asthma Education Center, and a statewide system for communicating with the parents of children with asthma.

Phenotypic and genotypic characterization of nosocomial Staphylococcus aureus isolates from trauma patients.

Staphylococcus aureus is a major cause of nosocomial infections. During the period from March 1992 to March 1994, the patients admitted to the intensive care unit of the University of Maryland Shock Trauma Center were monitored for the development of S. aureus infections. Among the 776 patients eligible for the study, 60 (7.7%) patients developed 65 incidents of nosocomial S. aureus infections. Of the clinical isolates, 43.1% possessed a polysaccharide type 5 capsule, 44.6% possessed a type 8 capsule, and the remaining 12.3% had capsules that were not typed by the type 5 or type 8 antibodies. Six antibiogram types were noted among the infection-related isolates, with the majority of the types being resistant only to penicillin and ampicillin. It was noted that the majority of cases of pneumonia were caused by relatively susceptible strains, while resistant strains were isolated from patients with bacteremia and other infections. Only 16 (6.3%) of the isolates were found to be methicillin-resistant S. aureus (MRSA). DNA fingerprinting by pulsed-field gel electrophoresis showed 36 different patterns, with characteristic patterns being found for MRSA strains and the strains with different capsular types. Clonal relationships were established, and the origins of the infection-related isolates in each patient were determined. We conclude that (i) nosocomial infection-related isolates from the shock trauma patients did not belong to a single clone, although the predominance of a methicillin-resistant genotype was noted, (ii) most infection-related S. aureus isolates were relatively susceptible to antibiotics, but a MRSA strain was endemic, and (iii) for practical purposes, the combination of the results of capsular and antibiogram typing can be used as a useful epidemiological marker.

Immunogenicity of a 24-valent Klebsiella capsular polysaccharide vaccine and an eight-valent Pseudomonas O-polysaccharide conjugate vaccine administered to victims of acute trauma.

We measured the antibody response in 10 victims of acute blunt trauma and penetrating trauma who were immunized against Klebsiella pneumoniae and Pseudomonas species within 72 hours of injury. The two vaccines, which were previously shown to be safe and immunogenic in uninjured humans, were a 24-valent K. pneumoniae capsular polysaccharide vaccine and an eight-valent Pseudomonas O-polysaccharide-toxin A conjugate vaccine. The patients were between 18 and 44 years of age, had Injury Severity Scores that ranged between 9 and 34, and did not have chronic infections or malignancies. On days 14 and 28 after immunization, all patients had a response of greater than fourfold to at least six of the nine Pseudomonas vaccine antigens. Half of the patients responded to eight of the nine antigens. Nine patients responded to at least 18 of 24 Klebsiella antigens, and seven patients responded to 22 of the 24 antigens. No important side effects were attributed to the vaccines. The results of this preliminary study indicate that active immunization against potential pathogens is possible in victims of acute trauma.

Seroprevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and rapid plasma reagin in a trauma population.

We evaluated the presence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and rapid plasma reagin (RPR) among patients admitted to our trauma unit from April 15 to June 30, 1993. Of 984 patients tested, we found 255 (26%) had evidence of exposure to one or more of these agents: HIV, 4%; HBV, 20%; HCV, 14%; and RPR, 1%. Thirty-eight percent of patients had more than one positive serology, 75% of the HIV patients, 49% of the HBV patients, and 66% of the HCV patients. There was no difference between penetrating and nonpenetrating trauma with respect to any of the viruses. The risk factors for HIV-positive patients were non-White race, positive drug screen, positive alcohol screen, and city resident. Risk factors for HBV patients were non-White race, positive drug screen, and city resident. Risk factors for HBC patients were male sex, non-White race, positive alcohol screen, positive drug screen, and city resident. The risk of blood-borne infections in this group of patients is substantial.

Steroid hormone regulation of rat myometrial gap junction formation: effects on cx43 levels and trafficking.

The formation of myometrial gap junctions coincides with onset of labor in many mammalian species, including humans. The assembly of gap junction protein into functional gap junction plaques is a final step in a cascade that begins with estrogen-dependent expression of the connexin43 (cx43) gene and continues with synthesis of cx43 in the rough endoplasmic reticulum (RER) and transport to the Golgi, followed by its trafficking to the plasma membrane and its assembly into functional gap junctions. Moreover, in several models of preterm labor in rats, precocious synthesis, trafficking, and assembly of cx43 follow an increase in the estrogen:progesterone ratio. The actions of these steroids on cx43 expression, gap junction formation, and labor led us to consider whether or not the cascade of cx43 expression and gap junction assembly typical of preterm and term labor would be disrupted by manipulations that inhibit labor through experimental reduction of the estrogen:progesterone ratio. Ovariectomized and non-ovariectomized pregnant rats were treated with minimal doses of progesterone or the anti-estrogenic compound ICI 182780 over a time course sufficient to inhibit labor. We found that cx43-positive gap junction formation was prevented in all animals treated with ICI 182780 or progesterone but that the mechanism by which this disruption occurred was different in anti-estrogen- and progesterone-treated animals. We found that ICI 182780 significantly inhibited the typical rise in myometrial cx43 concentrations normally observed just before labor. In contrast, it was surprising to find that significant cx43 was synthesized in myometrium of progesterone-treated intact and ovariectomized animals even though labor was inhibited. However, we found that the trafficking of myometrial cx43 from the Golgi and assembly into gap junctions at the plasma membrane were suppressed in these progesterone-treated animals, providing further support for the hypothesis that it is not synthesis of cx43 per se but trafficking of cx43 to the plasma membrane and its assembly into gap junctions that are required for effective synchronized myometrial contractions typical of labor.

[Preparation of bonded porcelain inlays and onlays using a milling-coping system]. / Réalisation d'inlays et onlays de porcelaine collés à l'aide d'une fraiseuse-copieuse.

The Celay-system offers an interesting alternative to existing systems for esthetic posterior restorations with ceramics. The basic idea of the concept is to prepare, either directly on the patient or indirectly on a plaster model, a pro-inlay using a light-curable precision material. The modelling also covers the occlusal surface. This pro-inlay is then used with the help of a milling center to machine a precise replica out of a ceramic block. The copying process is carried out via three-dimensional mechanical scanning and milling using eight axes of freedom. In this way additional corrections on the ceramic within the mouth can almost completely be avoided. The system is designed to be used as a direct chairside method by the dentist or as an indirect method by the dental technician. It is a promising but unproved restoration, more research and long-term clinical evaluation is recommended.

Myometrial connexin 43 trafficking and gap junction assembly at term and in preterm labor.

Modulation of connexin 43 (cx43) in the myometrium of timed pregnant rats was studied using enzyme-linked immunosorbent assay (ELISA), immunocytochemical localization, and immunoblot. These techniques utilized site-specific antibodies directed against a portion of the carboxyl tail of cx43. We found that cx43 is synthesized several days prior to labor but accumulates within the cytoplasm until parturition, when it is rapidly transported to the plasma membrane and assembled into gap junction plaques at the cell surface. These cx43-positive gap junctions begin to disappear from the plasma membrane within hours of delivery of the last pup and are completely absent within 24 hr following delivery. These structures are apparently internalized and degraded within the cytoplasm. ELISA documents a reduction of total cellular cx43 to baseline levels within 5 days following parturition. While the timing of synthesis, cytoplasmic storage, concentration in apparent Golgi vesicles, and transport to and assembly in the plasma membrane are accelerated in three models of preterm labor, the sequence of these events and the correlation of parturition with the formation of gap junctions are identical to those documented in normal labor. These results support the hypothesis that effective labor requires the synthesis and assembly of cx43 into functional gap junctions at the myometrial cell surface.

Quantitative immunoassay of total cellular GAP junction protein connexin32 during liver regeneration using antibodies specific to the COOH-terminus.

A radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) were used to determine relative concentrations of liver connexin32 (CX32) in rats. The RIA and ELISA utilize synthetic peptides corresponding to regions of the carboxyl-terminus and antibodies raised in rabbits against these peptides. Assuming that affinities of antisera are similar for peptide and native CX32, total cellular CX32 was found to exceed the amount of gap junction protein at the cell surface calculated from morphometric analyses by 1.5-2.0 fold. This finding raises the possibility that some of the protein is present in cytoplasmic compartments or as occult precursors in the plasma membrane. Studies of CX32 content in regenerating rat liver support this conclusion and show a time course of loss and recovery of CX32 that agrees with those reported in studies using other techniques.

Hyaluronic acid synthesis and gap junction endocytosis are necessary for normal expansion of the cumulus mass.

The application of a quantitative videographic technique has provided an opportunity to compare the quantitative volumetric expansion of cultured oocyte complexes (COCs) to quantitative changes in gap junction down-regulation and hyaluronic acid synthesis and to investigate the effects of physiological agents that influence these processes. Results of these experiments support the idea that the down-regulation of cumulus gap junctions is required for the initial phase of cumulus cell disaggregation and confirm earlier reports that hyaluronic acid synthesis plays a major role in additional expansion of the cumulus. These studies also provide evidence that the degree of expansion observed in culture lacking substrates of hyaluronic synthesis is significantly attentuated when compared with expansion occurring in vivo and that the failure of cultured complexes to expand maximally can be overcome by the addition of substrates of hyaluronic acid synthesis to the culture medium.

The effect of topical pharyngeal anesthesia on esophageal motility.

A strong gag reflex may be a limiting factor to perform esophageal motility in some patients. Even though local anesthetics could alleviate such a problem, they are not used for fear of interfering with various manometric parameters. In this study, we evaluated the effect of topical pharyngeal local anesthesia on lower esophageal sphincter pressure, amplitude, duration, and velocity of esophageal contractions. We also studied its effects on the patient's tolerance. Esophageal motility was performed before and after topical anesthesia with 20% benzocaine. The baseline tracing and the tracing obtained after topical anesthesia were number coded and separated. They were evaluated blindly as to the pressure in the lower esophageal sphincter, amplitude, duration, and velocity of esophageal contractions. An average of 10 wet swallows was used to determine the above values. There was no significant change in the lower esophageal sphincter pressure or the amplitude of esophageal contractions after benzocaine. Similarly, there was no change in the duration or velocity of peristaltic activity. The patient's tolerance to the tube was unchanged or improved in 12 of 14 patients. Six patients had some difficulty in swallowing, but were able to compensate by sucking on the syringe. Our results indicate that topical pharyngeal anesthesia does not affect the usually measured manometric parameters; and while it may improve the patient's tolerance to the manometric catheter, it interferes with the ability to swallow.

Comparison of hypertonic glucose to other provocative tests in patients with noncardiac chest pain.

The effect of hypertonic glucose as a provocative test was studied in 51 patients with noncardiac chest pain, 15 patients with esophagitis, and 16 asymptomatic controls. It was compared to esophageal perfusion with 0.1 N HCl and saline and intravenous administration of 10 mg edrophonium. Continuous esophageal manometric recordings were performed at the time of testing. The patients' symptoms were monitored every minute. The effect of these solutions and edrophonium on lower esophageal sphincter (LES) pressure and amplitude of esophageal contractions was also evaluated. Esophageal perfusion with hypertonic glucose, saline, or acid had no significant effect on LES pressure or amplitude of esophageal contractions in most patients. Edrophonium, however, resulted in a significant rise in the amplitude of esophageal contractions and the LES pressure in all groups studied. Hypertonic glucose resulted in chest pain in 13.6% of patients with noncardiac chest pain and 20% of those with esophagitis, whereas edrophonium reproduced the pain in 38.7 and 37%, respectively. Our results indicate that hypertonic glucose is not effective as a provocative test for noncardiac chest pain nor does it contribute to the chest pain in esophagitis. They also had no significant effect on the amplitude of esophageal contractions or LES pressure. Edrophonium continues to be a relatively sensitive test for noncardiac chest pain.