Chest dynamics asymmetry facilitates earlier detection of pneumothorax.

Pneumothorax is usually diagnosed when signs of life-threatening tension pneumothorax develop. The case report describes novel data derived from miniature superficial sensors that continuously monitored the amplitude and symmetry of the chest wall tidal displacement (TDi) in a premature infant that suffered from pneumothorax. Off-line analysis of the TDi revealed slowly progressing asymmetric ventilation that could be detected 38 min before the diagnosis was made. The TDi provides novel and valuable information that can assist in early detection and decision making.

Monitoring the respiratory rate by miniature motion sensors in premature infants: a comparative study.

OBJECTIVE: Existing respiratory rate (RR) monitors suffer from inaccuracy. The study assesses the accuracy of a novel modality that monitors lung ventilation with miniature motion sensors. STUDY DESIGN: RR was measured by three methods: impedance technology, motion sensors and visual count, in babies (n=9) that breathed spontaneously or with respiratory support and babies (n=12) that received high-frequency oscillatory ventilation (HFOV). RESULTS: A line close to equality (slope=0.96, r(2)=0.83) was obtained between the motion sensor and the visual count of the RR with narrow 95% limits of agreements (<14.0 b.p.m.). The relationship between the impedance and the visual count showed a lower correlation (r(2)=0.65) and wider 95% limits of agreements (21.4 b.p.m.). The motion sensor- and the ventilator-determined RRs demonstrated a good agreement during HFOV, whereas the impedance failed to measure the RR during HFOV. CONCLUSION: Monitoring RR with motion sensors is more accurate compared with the impedance, in infants, in all ventilation modes.

[Rehabilitee-management-categories (RMK)--results of the development phase and of the first clinical implementation in alcohol rehabilitation centres]. / Rehabilitanden-Management-Kategorien (RMK)--Entwicklungsprozess und ausgewählte Ergebnisse am Beispiel der Suchtrehabilitation.

BACKGROUND: Due to the introduction of lump sum reimbursement systems for acute-care settings (DRGs), patient classification systems have been developed in Germany during the last 15 years to adapt a case-based lump sum system to the field of medical rehabilitation. The concept of Rehabilitee-Management-Categories (RMK), developed by the Charité - Universitätsmedizin Berlin, classifies rehabilitees primarily by their relevant impairments of activity and participation, as these factors mainly determine treatment needs and resources required in rehabilitation. It can, inter alia, be used to optimize the demand-related allocation of treatment services in the rehabilitation centres as well as lead to more transparency in the allocation process. RMK results are reported on the example of inpatient rehabilitation of alcohol dependence. METHODS: Utilizing internationally established assessments, an RMK-assessment was developed that allows the assessment of rehab treatment needs of patients undergoing alcohol dependence rehabilitation. The RMK-assessment was completed by n=731 rehabilitees. Latent class analysis was applied to find groups of cases. To facilitate the RMK-patient classification a software-based algorithm was developed and implemented in 12 rehabilitation centres (implementation study). To validate the results of the first study phase, the data collected during implementation (n=1,533) was again analyzed using latent class analysis. Combined standardized and qualitative user surveys were conducted at the end of the implementation study. RESULTS: On the basis of 15 needs-related patient characteristics, 4 comparable case groups (AL-1 to AL-4) each were identified in 2 independent samples, groups that differed significantly in their degree of dependence-related, psychological and social impairment. The user survey confirmed the basic clinical plausibility of the 4 different case groups as well as the feasibility of the instruments applied in a rehabilitation setting. CONCLUSIONS: The RMK-concept offers a new approach for a demand-related patient classification in medical rehabilitation. The RMK-instruments allow a standardized initial assessment of impairment and treatment needs in alcohol rehabilitation and can hence be used for objective comparisons between rehabilitation centres. The results of the RMK-assessment provide relevant information about demand-related treatment requirements, which is a matter of great interest in the context of limited resources. Appropriate treatment requirements for the 4 RMK-case groups will be defined and verified in the next step of the RMK-concept. A financial evaluation of the RMK is possible in principal, will however require more extensive development, not least in order to model and evaluate the health-economic implications involved.

Deep mantle cycling of oceanic crust: evidence from diamonds and their mineral inclusions.

A primary consequence of plate tectonics is that basaltic oceanic crust subducts with lithospheric slabs into the mantle. Seismological studies extend this process to the lower mantle, and geochemical observations indicate return of oceanic crust to the upper mantle in plumes. There has been no direct petrologic evidence, however, of the return of subducted oceanic crustal components from the lower mantle. We analyzed superdeep diamonds from Juina-5 kimberlite, Brazil, which host inclusions with compositions comprising the entire phase assemblage expected to crystallize from basalt under lower-mantle conditions. The inclusion mineralogies require exhumation from the lower to upper mantle. Because the diamond hosts have carbon isotope signatures consistent with surface-derived carbon, we conclude that the deep carbon cycle extends into the lower mantle.

Study on the antimicrobial effect of silver-containing inner liners in refrigerators.

AIMS: To investigate the effect of silver-based antimicrobial material incorporated in the inner liners of refrigerators on food safety and quality. METHODS AND RESULTS: In the first stage, the bactericidal effect was tested in the laboratory. Silver-containing samples and control plates were inoculated with different bacterial suspensions and stored at various temperatures. After defined storage periods the bacterial reduction was calculated by comparing viable cell count on reference plates and on silver-containing plates. The reduction caused by the silver-containing material varied between 1.0 and 5.9 log(10) units, depending on bacterial strain, incubation time and temperature. In the second stage, food storage experiments have been carried out. Thus, perishable foods were stored in coated and untreated refrigerators. After certain time periods the products were analysed for their sensorial and microbiological characteristics. A clear drop in viable counts both on the refrigerator wall and on the food was demonstrated using the silver-based antimicrobial material. CONCLUSIONS: Silver prevents refrigerators from being a hot spot for contaminants that could be transferred upon contact with food. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides original results regarding the antimicrobial activity of silver-containing refrigerator surfaces.

33S solid state NMR of sulphur speciation in silicate glasses.

33S solid-state NMR is reported from some model crystalline sulphides, sulphates, sulphites and thiosulphates. This is the first report of (33)S NMR signals of the latter two species from a solid. Good quality spectra, which have distinct, well separated shift ranges can be identified for all these groupings, except for sulphites and hydrogen sulphites whose resonances are very broad. Nonetheless the presence of sulphites and hydrogen sulphites can be confirmed from their characteristic sharp, intense time domain echoes. (33)S MAS NMR is also applied to a range of dry and hydrous silicate glasses with approximately 1wt% 99at% (33)S-enriched sulphur. It is clear that in all these glasses sulphate is present, and in mixed cation systems there is some evidence of preferential association of sulphate with a specific cation. In a dry potassium silicate glass sample two resolved (33)S resonances are observed, a sulphate, and the second from thiosulphate. Hence solid state (33)S NMR is shown to be a feasible probe that can be applied to this problem that can readily distinguish different sulphur species.

[Birbeck granules in epidermal Langerhans cells of elderly patients with decubital ulcers].

UNLABELLED: Birbeck granules (Bg), known also as Langerhans cell (L) granules are special organelles found in the L cells' cytoplasm, which serve as a marker for their identification. These organelles have been studied in epidermal L cells in elderly patients with pressure sores and were compared to those found in epidermal L cells of healthy volunteers who served as controls. RESULTS: There was an increase of about 47% in the number of B granules in patients' L cells from sacral epidermis near lesion (p < 0.01) and an increase of about 68% of the number of B granules in patients' L cells from normal epidermis (p < 0.005) was found as compared to healthy control L cells. Part of the B granules in patients' L cells were of similar morphology to those of controls. They were found throughout the cytoplasm as simple rods or rackets. In addition, in patients' epidermis some irregularly shaped granules were observed, such as: racket structure common to two or more rod structures; rod shaped granules in direct continuity with mitochondria, and others with lysosomes. Moreover, B granules in continuity with the cell plasma membrane and groups of closely opposed rod shaped granules were observed. These two last shaped structures apparently reflected formative stages of B granules. It is suggested that an increase of the number of B granules indicated an active state of L cells in the epidermis of patients studied. It is not clear whether the morphologic alterations of B granules influence the L cell functions in antigen presentation. It is possible that they may be partly involved in infections which occur frequently in patients with decubital ulcers. It is also possible that the increase in the number of B granules and the altered structures found among them in patients' epidermis express a reaction of L cells to inflammation.

Can questionnaire reports correctly classify relationship distress and partner physical abuse?

Relationship adjustment (e.g., Dyadic Adjustment Scale; DAS) and physical aggression (e.g., Conflict Tactics Scale) measures are used both as screening tools and as the sole criterion for classification. This study created face valid diagnostic interviews for relationship distress and physical abuse, through which one could compare preliminarily the classification properties of questionnaire reports. The DAS (and a global measure of relationship satisfaction) had modest agreement with a structured diagnostic interview; both questionnaires tended to overdiagnose distress compared with the interview. Results for partner abuse reiterated the need to go beyond occurrence of aggression as the sole diagnostic criterion, because men's aggression was more likely than women's to rise to the level of "abuse" when diagnostic criteria (injury or substantial fear) were applied.

Randomized, controlled trial comparing once daily and three times daily gentamicin in children with urinary tract infections.

OBJECTIVE: To undertake population pharmacokinetic modeling and to determine the safety and efficacy of once daily (OD) gentamicin dosing in children with severe urinary tract infections (UTI). METHODS: An open, randomized, controlled trial comparing OD with three times daily (TD) gentamicin dosing in hospitalized children ages 1 month to 12 years with UTI. Daily doses (milligrams per kg per day) of gentamicin in both groups were 7.5 (<5 years old), 6.0 (5 to 10 years old) and 4.5 (>10 years old). RESULTS: There were 179 children enrolled (90 OD, 89 TD). Baseline clinical characteristics and pathogens were similar, except that circulatory compromise and renal cortical scintigraphic defects were more common in the OD group. Median gentamicin treatment durations were 3.0 (OD) and 2.7 (TD) days. Mean peak gentamicin concentrations were 17.3 (OD) vs. 6.4 (TD) mg/l; 99% of peak concentrations were >7 mg/l in the OD group whereas 16% of peak concentrations were <5 mg/l in the TD group. Mean trough concentrations were 0.35 (OD) vs. 0.55 (TD) mg/l. In the OD group 4% of trough concentrations were > or = 2 mg/l, whereas in the TD group only 0.7% were > or = 2 mg/l. Age or prior elevated peak concentrations did not predict high trough concentrations. Population pharmacokinetic modeling of the data fitted a one-compartment model with first order elimination. There were no clinical or bacteriologic failures. The two disease-related complications were confined to the OD group. No nephro- or ototoxicity was identified. CONCLUSIONS: With age-appropriate dosing and measurement of serum trough concentrations before the second dose, OD gentamicin is safe and effective for the treatment of UTI requiring parenteral treatment in children aged 1 month to 12 years.

Rod-shaped bodies resembling birbeck granule-like structures in endothelial cells of dermal capillaries in generalized granuloma annulare.

A previous study demonstrated that, in generalized granuloma annulare in the epidermis, the Langerhans' cell section area and the number of Langerhans' cell granules or Birbeck granules per cell section were increased, suggesting an active state of these Langerhans' cells. Reexamination by transmission electron microscopy of the same tissue, but in samples also containing dermal tissue, from the same subjects revealed endothelial cells with rod-shaped bodies resembling Birbeck granules or Birbeck granule-like structures. This finding has not been previously described in blood vessels of human skin and is described here.

Grammatical encoding in aphasia: evidence from a "processing prosthesis".

Agrammatic aphasia is characterized by severely reduced grammatical structure in spoken and written language, often accompanied by apparent insensitivity to grammatical structure in comprehension. Does agrammatism represent loss of linguistic competence or rather performance factors such as memory or resource limitations? A considerable body of evidence supports the latter hypothesis in the domain of comprehension. Here we present the first strong evidence for the performance hypothesis in the domain of production: an augmentative communication system that markedly increases the grammatical structure of agrammatic speech while providing no linguistic information, functioning merely to reduce on-line processing demands.

The effects of interpersonal and personal agency on perceived control and psychological well-being in adulthood.

A theoretical model that links social support with global beliefs in primary control and provides a developmental perspective on how normative age-related changes alter control beliefs was examined with data from 482 adults aged 18 to 93. Generalized belief in primary control was hypothesized to have a direct positive effect on psychological well-being and to arise from two distinct sources: (a) interpersonal agency (obtaining positive ends through interactions with others) and (b) personal agency (achieving desired outcomes on one's own behalf). Age was believed to affect both types of agency indirectly as a result of age-related changes in physical health and emotional support. Although physical health was presumed to have a direct positive effect on psychological well-being, the effect of emotional support on well-being was mediated by interpersonal agency and perceived primary control. Structural equation modeling analyses with the EQS 5.4 program revealed good model fit (goodness-of-fit index = .98, comparative fit index = .94, root mean square residual [RMR] = .02, standardized RMR = .05, root mean square error of approximation = .06) after a negative direct path from age to generalized beliefs in primary control was added to the a priori model.

Effects of morphological complexity on phonological output deficits in fluent and nonfluent aphasia.

This study examined the effects of morphological complexity on aphasic speakers with lexical-phonological output deficits. Subjects were two fluent and two nonfluent aphasic speakers who repeated morphologically simple words at the same level of accuracy and whose errors were virtually all phonological in nature. They were asked to repeat a variety of morphologically complex (i.e., affixed) words. Results were interpreted within our two-stage model of lexical-phonological production (Kohn & Smith, 1994, 1995), which we expand to include a distinction between derivational and inflectional morphology. When comparing overall performance levels between morphologically simple and complex words, only three subjects exhibited more difficulty repeating the morphologically complex targets. Nevertheless, when comparing repetition accuracy between different types of morphologically complex words (e.g., derived vs. inflected), all four subjects displayed similar patterns. These findings suggested that while morphological complexity has different effects on the two stages within the lexical-phonological output system, the relative effects of different morphological structures are constant. At the level of error analysis, patterns of affix errors distinguished the nonfluent from the fluent subjects in ways that are reminiscent of the affix errors associated with agrammatic and paragrammatic speech. This finding raised questions concerning the relationship between morphosyntactic and morphophonological deficits.

Effect of zinc supplementation on epidermal Langerhans' cells of elderly patients with decubital ulcers.

In the present study, Langerhans' cells (LCs) in the sacral epidermis, 8-10 cm from lesions of patients (mean age 71 years) with decubital ulcers, were compared ultrastructurally and morphometrically with those in the patients' own normal epidermis from the upper leg, before and after supplementation with 50 mg/day elementary zinc (in the form of a 220-mg tablet of Avazinc, administered once daily) for four months. Zinc intake resulted in from 80% to full healing of the decubital ulcers in the patients studied. The percentages of LCs were low in both perilesional sacral epidermis (2.07 +/- 0.71%) and in control leg epidermis (2.71 +/- 1.38%) before zinc supplementation and also afterward (2.12 +/- 0.16% and 2.59 +/- 0.88%, respectively). LCs demonstrated a more dendritic morphology after zinc supplementation: 68.15 +/- 9.28% and 77.0 +/- 3.45% of sacral and of control leg epidermal LCs, respectively, had dendrites before, and 91.52 +/- 3.43% and 84.15 +/- 3.64% of sacral and of control leg epidermal LCs, respectively, had dendrites after zinc supplementation. The LC section area in the sacral epidermis near the lesion as well as in the control leg epidermis and the number of LC granules in LC sections were not affected by zinc supplementation. The higher percentage of LCs having dendrites in the epidermis of patients with decubital ulcers after zinc supplementation may indicate that these LCs are in a more motile state, which might affect the healing process of the lesions.

Gender and ethnic differences in health behaviors and risk factors for coronary disease among urban teenagers: the PATH program.

OBJECTIVE: To assess gender and ethnic differences among teenagers in heart health behaviors, risk factors for coronary heart disease (CHD), and cardiovascular fitness. DESIGN: Observations consist of cross-sectional data collected prior to a school-based health promotion intervention program. PARTICIPANTS: Teenage girls (N = 865) and boys (N = 497) from three New York City high schools. The ethnic composition of this sample was 20% Asian-American, 40% African-American, 25% Hispanic, and 15% white. METHOD: Subjects were compared on the following: height, weight, body mass index, percentage body fat, total cholesterol, blood pressure, heart health knowledge, family history, socioeconomic status, dietary habits, smoking, physical activity, and estimated aerobic capacity. Differences were assessed with independent t tests, analysis of variance, and chi-square statistical techniques. RESULTS: Compared with girls, boys were more active and had higher estimated aerobic capacity, higher systolic blood pressure, and better self-perception of health. Compared with boys, girls had higher cholesterol, percentage body fat, and heart health knowledge scores and ate fewer foods high in saturated fat, cholesterol, salt, and simple sugars. Among girls, African-Americans had the highest blood pressure, cholesterol, body mass index, and intake of foods high in saturated fat, cholesterol, and sugar. Among boys, Hispanics had the highest body mass index and percentage body fat and the lowest heart health knowledge scores. White girls and white boys were the most frequent smokers. CONCLUSIONS: Poor health behaviors and risk factors for CHD occurred frequently among urban teenagers. In general, teenage girls had poorer health behaviors and a greater prevalence of risk factors than teenage boys, even though they scored better in heart health knowledge testing. Ethnic comparisons revealed poorer health behaviors and higher prevalence of risk factors in African-American and Hispanic teens compared with white and Asian-American teens. Results support the need for health promotion intervention among urban teenagers.

Impaired spelling in Alzheimer's disease: a linguistic deficit?

Different kinds of real words and pronounceable pseudowords (PWs) were presented for writing to dictation to patients with the diagnosis of probable Alzheimer's disease (AD) and to age- and education-matched healthy controls. Though spelling less accurately on all tasks, AD patients responded in a manner generally qualitatively similar to controls. Except for a slightly enhanced effect of spelling regularity in real word writing accuracy, AD patients showed the same sensitivity to various lexical, orthographic and phonological variables as controls. Both groups showed no difference in spelling accuracy for words and PWs with regular vs ambiguous spelling patterns, and groups also showed similar orthographic preferences when spelling PWs having several different acceptable pronunciations. Finally, AD patients and controls produced similar types of errors when spelling real words. Dementia severity was related to the overall accuracy, but not to the pattern, of spelling responses. It is suggested that the decline in response accuracy in cognitively demanding writing tasks in patients with more advanced dementia is most likely due to semantic impairment and impairments of nonlinguistic functions of attention, executive control and praxis, rather than to a disturbance within language specific processes.

An encyclopedia of mouse genes.

The laboratory mouse is the premier model system for studies of mammalian development due to the powerful classical genetic analysis possible (see also the Jackson Laboratory web site, http://www.jax.org/) and the ever-expanding collection of molecular tools. To enhance the utility of the mouse system, we initiated a program to generate a large database of expressed sequence tags (ESTs) that can provide rapid access to genes. Of particular significance was the possibility that cDNA libraries could be prepared from very early stages of development, a situation unrealized in human EST projects. We report here the development of a comprehensive database of ESTs for the mouse. The project, initiated in March 1996, has focused on 5' end sequences from directionally cloned, oligo-dT primed cDNA libraries. As of 23 October 1998, 352,040 sequences had been generated, annotated and deposited in dbEST, where they comprised 93% of the total ESTs available for mouse. EST data are versatile and have been applied to gene identification, comparative sequence analysis, comparative gene mapping and candidate disease gene identification, genome sequence annotation, microarray development and the development of gene-based map resources.

Observation of hydroxyl groups by 17O solid-state multiple quantum MAS NMR in sol-gel-produced silica.

17O NMR parameters (CQ, eta, delta(iso) and T1) are reported for both Si-O-Si and Si-OH fragments within a silica gel. The Si-OH units have a wide spread of parameters but are typically characterised by a very short T1 (approximately 0.1 ms) and CQ < 200 kHz. These observations have extremely important implications for the quantification of such units in these gels and related glassy materials by 17O NMR. In light of these observations, the 17O NMR experiments have been optimised and a distinct resonance from the OH group is observed in 1D static and magic angle spinning (MAS) NMR measurements as well in the multiple quantum (MQ) experiment.

Cognitive mechanisms for processing nonwords: evidence from Alzheimer's disease.

Repetition and reading of various types of pronounceable nonwords (pseudowords) was examined in patients with probable Alzheimer's disease (AD) and healthy elderly controls. Overall accuracy of performance was lower in AD patients compared to controls, but the two groups showed qualitatively similar response patterns when reading different kinds of pseudowords aloud and when repeating pseudowords composed of familiar phonological forms, analogous to those in real English words. AD patients diverged in performance from controls, however, when repeating pseudowords composed of phonologically unusual forms. These results support two conclusions: (1) Aspects of phonological processing may become disrupted in AD patients in association with increasing dementia severity, while orthographic processing remains comparatively less impaired. (2) The results are consistent with the view that the processing of pseudowords is achieved through the same system as real words, and further show that the influence of prior language experience on the processing of novel linguistic forms occurs primarily at the level of phonological, rather than orthographic processing.