Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study).

BACKGROUND: Acute coronary, cerebrovascular, and peripheral vascular events have common underlying arterial pathology, risk factors, and preventive treatments, but they are rarely studied concurrently. In the Oxford Vascular Study, we determined the comparative epidemiology of different acute vascular syndromes, their current burdens, and the potential effect of the ageing population on future rates. METHODS: We prospectively assessed all individuals presenting with an acute vascular event of any type in any arterial territory irrespective of age in a population of 91 106 in Oxfordshire, UK, in 2002-05. FINDINGS: 2024 acute vascular events occurred in 1657 individuals: 918 (45%) cerebrovascular (618 stroke, 300 transient ischaemic attacks [TIA]); 856 (42%) coronary vascular (159 ST-elevation myocardial infarction, 316 non-ST-elevation myocardial infarction, 218 unstable angina, 163 sudden cardiac death); 188 (9%) peripheral vascular (43 aortic, 53 embolic visceral or limb ischaemia, 92 critical limb ischaemia); and 62 unclassifiable deaths. Relative incidence of cerebrovascular events compared with coronary events was 1.19 (95% CI 1.06-1.33) overall; 1.40 (1.23-1.59) for non-fatal events; and 1.21 (1.04-1.41) if TIA and unstable angina were further excluded. Event and incidence rates rose steeply with age in all arterial territories, with 735 (80%) cerebrovascular, 623 (73%) coronary, and 147 (78%) peripheral vascular events in 12 886 (14%) individuals aged 65 years or older; and 503 (54%), 402 (47%), and 105 (56%), respectively, in the 5919 (6%) aged 75 years or older. Although case-fatality rates increased with age, 736 (47%) of 1561 non-fatal events occurred at age 75 years or older. INTERPRETATION: The high rates of acute vascular events outside the coronary arterial territory and the steep rise in event rates with age in all territories have implications for prevention strategies, clinical trial design, and the targeting of funds for service provision and research.

Isolation of isoproturon-degrading bacteria from treated soil via three different routes.

Three different isolation routes (flask enrichment/flask degradation assay, flask enrichment/microplate degradation assay, MPN assay/microplate degradation assay) were used to obtain pure cultures of bacteria which degraded isoproturon (3-(4-isopropylphenyl)-1,1-dimethylurea) as sole carbon and nitrogen source in a mineral salts medium from a field soil treated with isoproturon in the laboratory. All three isolation routes were successful, but the microplate assay of degradation was more successful than the flask assay. Characterization of 36 isolates indicated that they formed 16 distinct phenotypes (10 Gram-positive phenotypes, six Gram-negative phenotypes) which are likely to represent distinct species. Low concentrations of the degradation product 3-(4- isopropylphenyl)-1-methylurea (IPPMU) were occasionally found in the culture solutions. When provided as the sole source of carbon and nitrogen, the monomethyl degradation product was itself rapidly degraded by several of the isolates. Some isolates were also able to use the demethylated degradation product 3-(4-isopropylphenyl)-urea (IPPU) as sole source of carbon and nitrogen, although there was occasionally an extended lag-phase before rapid degradation commenced. One isolate was particularly active and degraded isoproturon, the monomethyl and demethylated degradation products of isoproturon, and demethylated the related phenylureas diuron and linuron.

Demonstration of a bilateral projection from the rostral nucleus of the solitary tract to the medial parabrachial nucleus in rat.

This study examined the projection from the rostral nucleus of the solitary tract (rNST) to the medial parabrachial nucleus (mPBN) in male Wistar rats using DiI as a retrograde tracer and biotinylated dextran as an anterograde tracer. Following successful unilateral injection of DiI into the mPBN (n = 8), retrogradely labeled neurons were always found in the rNST both ipsilateral and contralateral to the pontine injection site. Significantly, approximately 25% of the total number of DiI-labeled neurons were located in the contralateral rNST. The labeled neurons were located throughout the rostral-caudal extent of the rNST with the most cells being located in the central portion of the nucleus, and the fewest located ventromedially and dorsolaterally. Supporting the findings of the retrograde labeling study, axons and terminals, anterogradely labeled by injecting biotinylated dextran unilaterally into the rNST (n = 4), were always found in both the ipsilateral and contralateral mPBN. Although the intensity of anterograde labeling was higher ipsilaterally, a mirror-image staining pattern consistently was present contralaterally. These results indicate that there is a substantial contralateral component of the projection from the rNST to the mPBN. This suggests that convergence of gustatory information from the two sides of the oral cavity may occur within the pons before processing in higher brain centers. These findings may have important implications as to where and how bilateral gustatory information is processed and integrated.

Development of a policy on sexuality for hospitalized chronic psychiatric patients.

OBJECTIVE: This paper describes the need for and development of a policy on patient sexuality implemented at a provincial psychiatric hospital. METHOD: The need for a policy was assessed by reviewing the literature and interviewing a sample of chronic psychiatric patients. Development of the policy involved surveying 38 Canadian psychiatric hospitals in search of an existing policy to use as a model, as well as soliciting input from a variety of stakeholders and 2 lawyers. RESULTS: Both the literature review and patient interviews indicated that a substantial number of hospitalized chronic psychiatric patients are sexuality active. Neither the literature nor the survey of Canadian psychiatric hospitals revealed an existing policy to use as a model. Consequently, a policy was drafted by a task force composed of stakeholders and 2 lawyers. Characteristics of the policy, possibly the first in Canada, are described. The legal basis for the sexual rights of patients is discussed, and the mechanisms for protecting patients from harm are also described. CONCLUSION: Fundamentally, a policy must balance the patient's right to sexual intimacy in a dignified setting with the hospital administration's duty to take reasonable steps to protect patients from harm.

Rapid degradation of the triazinone herbicide metamitron by a Rhodococcus sp. isolated from treated soil.

Seven bacterial isolates which degraded the herbicide metamitron (3-methyl-4-amino-6-phenyl-1,2,4-triazin-5-one) were obtained from field-enhanced soil by liquid enrichment culture. All isolates appeared to be identical and a representative, 0246b, was identified as a Rhodococcus sp. by cell wall and fatty acid analyses. This isolate degraded metamitron as the sole source of carbon within 24 h at 25 degrees C and this is the first report of a bacterium capable of growing with metamitron as the sole source of carbon. Metamitron was degraded less rapidly when it was the sole source of both carbon and nitrogen. The rate and extent of degradation was affected by the presence and type of additional sources of carbon and nitrogen in the culture medium. In studies with [14C]-phenyl-labelled metamitron Rhodococcus sp. 0246b partly mineralized the phenyl ring.

Contingency contracting with delinquents: effects of a brief training manual on staff contract negotiation and writing skills.

A brief training manual was developed for the purpose of teaching child-care workers to contingency contract with delinquent youths living in residential care facilities. The manual was designed to require minimal supplementary training by a professional. In Experiment 1 a multiple baseline design was used to assess the effect of the manual on 4 child-care workers' contract negotiation and writing behaviors. Experiment 2 consisted of four A-B systematic replications. Behaviors were assessed within the context of analogue training simulations and generalization tests with delinquent youths. Results from the analogue simulations indicated that the manual was successful in increasing both types of behaviors to a level of proficiency that equaled or surpassed that of behaviorally trained graduate students, and results from the generalization tests indicated that the child-care workers were able to apply their newly acquired contracting skills with delinquent youths. Procedural reliability varied across child-care workers, but was usually high.

Tight-fitting garments as counterpressure devices.

A case of traumatic splenic rupture in a hemodynamically stable elderly woman is presented. The patient decompensated almost immediately following the removal of a tight-fitting girdle. The implications of recognizing garments as potential counterpressure devices in emergency management are discussed. Emergency physicians are cautioned to carefully explore and reevaluate patients after the removal of tight-fitting garments.

Generalization of naming responses to objects in the natural environment as a function of training stimulus modality with retarded children.

Picture-cards, photographs, and real objects were compared as training stimuli in order to determine which best facilitated the generalization of naming responses learned in a special training room to real objects in the natural environments of four retarded children. The amount of transfer of naming behavior between the three stimulus modes and the average amount of training time required per stimulus mode were also assessed. Three of the four children displayed considerably more generalization to the real objects in the natural environment when they were trained with real objects. The fourth child displayed substantial generalization regardless of the training stimulus mode. No particular training stimulus mode clearly facilitated the transfer of naming responses to other modes or greatly reduced training time. The results of two supplementary procedures conducted with one child showed that: (1) training in several environments facilitated generalization to real objects in the natural environment when real objects were used as training stimuli but not when picture-cards were used, and (2) transfer from picture-cards to real objects was facilitated by training other picture-cards and the real objects portrayed by them at the same time.