Trends in weighted vital signs and the clinical course of 44,531 acutely ill medical patients while in hospital.

BACKGROUND: little is known about the changes and trends of individual vital signs during the course of acute illness in hospital. METHODS: the weighted points of the VitalPAC Early Warning Score (ViEWS) were assigned to each vital sign value measured on 44,531 acutely ill medical patients while they were hospitalized in the Thunder Bay Regional Health Sciences Centre, Ontario, Canada. These ViEWS weighted vital signs were averaged for every 24 hour period for five days after admission and five days before death or discharge and then combined to obtain an approximation of the trajectory of each vital sign while in hospital. RESULTS: compared with the other vital signs, the ViEWS weighted points for respiratory rate increase the most in patients who died in hospital and decrease the most in survivors. Combining respiratory rate with the weighted points for any of the other vital signs reduced rather than increased their monitoring performance. CONCLUSION: trends in respiratory rate, measured by observation at the bedside and given a ViEWS weighting is the best predictor of clinical outcome; minor changes predicted clinical outcome several days in advance.

Supplemental patient education for patients taking oral anticoagulants: systematic review and meta-analysis.

OBJECTIVE: Lack of patient knowledge has been associated with poor anticoagulation control, but the effect of patient education on clinical outcomes is unclear. We systematically reviewed the effect of supplemental patient education vs. usual care on hemorrhage, thromboembolic events (TEEs), time in therapeutic range (TTR) and knowledge test scores for all oral anticoagulants. DATA SOURCES: The data sources were electronic databases, including MEDLINE, EMBASE, CENTRAL, CINAHL and IPA, to February 2012 examining any oral anticoagulant. We reviewed references for additional potentially relevant studies. METHODS: Only randomized controlled trials (RCTs) were considered. Data extraction and quality assessment were conducted with GRADE. Pooled relative risks (RRs) were calculated, and heterogeneity was determined by use of χ(2) and I(2) statistics. RESULTS: Seven RCTs (n = 1209) were included in the systematic review, and five RCTs (n = 847) in the meta-analysis. All included studies examined vitamin K antagonists. No significant difference was found for hemorrhage (RR 0.92, 95% confidence interval [CI] 0.04-20.56), TEE (RR 0.66, 95% CI 0.10-4.39), a composite outcome of hemorrhage or TEE (RR 0.48, 95% CI 0.23-1.01), or TTR (mean absolute difference of 2.02%, 95% CI - 2.81 to 6.84). Evidence was conflicting on the impact of supplemental education on test scores. All trials had at least one substantial methodologic limitation. CONCLUSION: Current evidence does not support supplemental patient education as a means to improve patient outcomes, but the quality of this evidence is poor. Larger randomized trials are needed with longer follow-up, recruitment of patients initiating anticoagulation in primary care settings, and clearly defined education interventions.

First Report of Thiabendazole-Resistant Isolates of Fusarium sambucinum Infecting Stored Potatoes in Nova Scotia, Canada.

Fusarium dry rot is a significant postharvest disease of potato (Solanum tuberosum L.) and is often controlled by applying thiabendazole to tubers prior to storage. However, thiabendazole-resistant isolates of Fusarium spp. have been reported from Europe (2), the United States (1), and Canada (1,4). To address concerns, samples of potato tubers showing symptoms of dry rot caused by Fusariumspp. were collected from three storage bays in a commercial storage facility in Nova Scotia, Canada, in February 2001. All tubers had been treated with thiabendazole after harvest and prior to storage. Tubers were cut longitudinally, and small tissue samples (10 × 5 × 3 mm) were taken from the margins of internal necrotic regions with a sterile scalpel, surface-sterilized in 0.6% sodium hypochlorite for 15 s, rinsed twice in sterile distilled water (SDW), and blotted dry on sterile filter paper. Tissue pieces were plated on 0.5-strength potato dextrose agar (PDA) amended with tetracycline (0.05 g/liter) and streptomycin sulfate (0.1 g/liter). Petri dishes were incubated in the dark at 22°C for 4 to 7 days. After incubation, hyphal tips from the margins of actively growing isolates were removed with a sterile probe and plated on 0.5-strength PDA to generate pure cultures. Of 35 potato tubers examined, 10 (29%) yielded Fusarium isolates for further study. All 10 isolates were identified as F. sambucinum Fuckel according to Nelson et al. (3). Agar plugs (5 mm diameter) taken from the margins of 7- to 10-day-old cultures of F. sambucinum isolates were transferred to petri dishes containing 0.5-strength PDA amended with thiabendazole at 0, 1, 5, 10, 20, 50, or 100 mg/liter. Thiabendazole was prepared as a stock solution in SDW and added to molten agar after autoclaving. Cultures were grown in the dark for 7 days at 22°C, after which mycelial growth diameter was measured using digital calipers. Two measurements, along orthogonal diameters, were taken from each of three replicate plates for a total of six measurements per thiabendazole concentration. Means were calculated, and the diameter of the inoculation plug was subtracted from each mean. Calculated EC50 values (thiabendazole concentration inhibiting pathogen growth by 50%) were obtained by regression of the log of the chemical concentration against the corresponding probit of percent fungal inhibition. All isolates of F. sambucinum were resistant to thiabendazole, with EC50 values ranging from 7 to 82 mg/liter. Six isolates had EC50 values between 40 and 82 mg/liter. Control isolates of F. sambucinum, F. avenaceum, F. solani, and F. oxysporum were sensitive to thiabendazole, with EC50 values of <1 mg/liter. Although isolates of F. sambucinum resistant to thiabendazole have been recovered from eastern Canada (1,4), this is the first report of thiabendazole resistance in F. sambucinum isolates from tubers in commercial storage in the Annapolis Valley of Nova Scotia, Canada, a production region that concentrates on growing processing potatoes for the potato chip industry and is several hundred kilometers from other potato-growing regions of Prince Edward Island and New Brunswick. References: (1) A. E. Desjardins. Am. Potato J. 72:145, 1995. (2) G. A. Hide et al. Plant Pathol. 41:745, 1992. (3) P. E. Nelson et al. 1983. Fusarium Species: An Illustrated Manual for Identification . Pennsylvania State University Press, University Park, PA. (4) H. W. Platt. Phytoprotection 78:1, 1997.

Sensitive absorption spectroscopy by use of an asymmetric multiple-quantum-well diode laser in an external cavity.

We have developed a broadly tunable diode laser system by employing custom-designed asymmetric multiple-quantum-well (AMQW) InGaAsP lasers in an external cavity configuration. Feedback is provided by a diffractive optical element with high coupling efficiency and wavelength selectivity, allowing for single-mode tuning of the output wavelength by varying the external cavity length. This tunable laser system was used experimentally to perform absorption spectroscopy on weak CO2 lines over a broad wavelength region in the near infrared. An experimental tuning range of 80 nm has been observed for a laser cavity length of 600 micron, which is double the tuning range found with conventional, uncoated quantum-well lasers. We achieved a detection sensitivity of 5 x 10(-6) at 95% confidence over the wavelength range of 1.54-1.62 micron by employing a second-harmonic detection technique. The theoretical predictions of a broad gain profile from an ambipolar rate equation model are found to correspond to the experimentally observed increased tunability of the uncoated AMQW lasers.

Trouble in the second year: three questions about family interaction.

3 questions regarding family interaction in the second year of life are addressed in this report on 69 families rearing firstborn sons. Question 1 concerns the identification, via cluster analysis, of families having difficulty managing their child, using codings of narrative records of family interaction when children were 15 and 21 months of age. Parents in families identified as "troubled" at each age tried to control their toddlers most often, were least likely to rely upon control-plus-guidance management strategies, had children who defied them most frequently, and experienced the greatest escalation of negative affect in these control encounters. Families identified as "troubled" at both 15 and 21 months had children who received the highest "externalizing" problem scores at 18 months and mothers who experienced the most daily hassles during the second year. Question 2 concerns the antecedents of "trouble in the second year." Discriminant function analyses indicated that membership in the groups of families that appeared troubled at both ages of measurement (n = 15), at only one age (n = 28), or never (n = 26) could be reliably predicted (hit rate = 71%) using a set of 9 measurements of parent personality, child emotionality/temperament, marital quality, work-family relations, and social support, suggested by Belsky's model of the determinants of parenting, and social class. Question 3 concerns the proposition that extensive nonmaternal care in the first year is a risk factor for troubled family functioning in the second year. As hypothesized, prediction analysis showed that families at moderate and high contextual risk (based on 10 antecedent variables pertaining to Question 2), were significantly more likely to experience trouble in the second year when children experienced 20 or more hours per week of nonmaternal care in their first year, and these results could not be attributed to "selection effects."

Personality and parenting: exploring the mediating role of transient mood and daily hassles.

In order to explore the role that transient mood and daily hassles might play in mediating the impact of enduring personality on parenting, naturalistic home observations of mothering and fathering were conducted when firstborn sons were 15 and 21 months of age. Observationally based, behavioral ratings of mothering and fathering were related to three self-report personality scales (Agreeableness, Neuroticism, Extraversion), administered to parents when their children were 10 months of age, and to self-reports of transient mood (positive and negative) and daily hassles obtained prior to each observation of family interaction. Results indicated that (a) mothering was more consistently predicted by personality and mood/hassles than fathering; (b) Extraversion played a larger role in predicting fathering than mothering, with the reverse being true of Agreeableness; (c) Neuroticism was the most consistent predictor of men's and women's parenting; and (d) there was little support for affect-specific linkages between personality, mood/hassles, and parenting. Finally, some evidence of mediation by transient mood and daily hassles emerged, more consistently for mothers than fathers, though more strongly for fathers than mothers. These results are discussed in terms of the primacy of the role of parenting for men and women.

A prospective study on the association between red hair color and endometriosis in infertile patients.

OBJECTIVE: To determine if red-haired infertile women have an increased prevalence of endometriosis. DESIGN: Prospective, nonblinded. SETTING: Large, metropolitan, private hospital, associated with a university. Subspeciality care provided by reproductive endocrinologists. PATIENTS: One hundred forty-three consecutive women undergoing laparoscopy or laparotomy for infertility. INTERVENTIONS: Laser ablation of any endometriosis present. MAIN OUTCOME MEASURE: Presence of endometriosis. RESULTS: Of 143 women entered into the study, 12 had natural red hair. The ages of these women ranged between 23 and 41 years. Ten of 12 (83%) of the red-haired women were found to have endometriosis compared with 55 of 131 (42%) of nonredheads. By statistical analysis, the 95% confidence intervals for the presence of endometriosis in redheads was 55% to 100% versus 34% to 51% for nonredheads. CONCLUSION: The results suggest an association between the occurrence of natural red hair and those factors that lead to the development of endometriosis.

Novel expression of luteinizing hormone/chorionic gonadotropin receptor gene in rat prostates.

The reverse transcription-polymerase chain reaction (RT-PCR) amplified an expected 255 bp luteinizing hormone/chorionic gonadotropin (LH/CG) receptor sequence from rat prostates. Northern blotting demonstrated that prostates contain 4.3, 3.3, 2.6, 1.8, 0.8 and 0.2 kb LH/CG receptor transcripts. Western immunoblotting and ligand blotting demonstrated that prostates also contain an 80 kDa receptor protein which can bind 125I-labeled hCG and this binding was inhibited by excess unlabeled hCG. In situ hybridization and immunocytochemistry revealed that while the receptors are most abundant in epithelial cells, they are scarcely found in the stroma. The ventral lobe contained more receptors than the lateral lobe and the receptors in peripheral acini of the ventral lobe are higher which progressively decreased towards central acini. In summary, prostate glands express LH/CG receptor gene. The cellular, topographical and lobular distribution of receptors suggest that LH may directly regulate prostate functions.

Eicosanoid biosynthetic enzymes in placental and decidual tissues from preeclamptic pregnancies: increased expression of thromboxane-A2 synthase gene.

Preeclampsia is a disease of late pregnancy characterized by hypertension, edema, and proteinuria, in which vasoconstriction, platelet aggregation, and reduced uteroplacental blood flow contribute to preterm delivery, perinatal morbidity, and mortality. Increased thromboxane-A2 (TXA2) and/or decreased prostacyclin (PGI2) have been implicated as causative factors of this disease. The present studies investigated the expression of TXA2 synthase gene along with those of TXA2 receptors, PGI2 synthase, cyclooxygenase-1 (COX-1), and COX-2 in placental and decidual tissue from preeclamptic and normal pregnancies. In situ hybridization and immunocytochemistry showed that primarily trophoblast layer and decidual cells express TXA2 synthase, COX-1, and COX-2 enzymes. Immunocytochemistry for PGI2 synthase and in situ hybridization for TXA2 receptors showed similar results. Trophoblast layer and decidua from preeclamptic pregnancies contained a greater abundance of mRNA and protein of TXA2 synthase than the matched normal pregnancies. In summary, our findings suggest that an increased local expression of TXA2 synthase could be responsible for local and/or peripheral vascular changes in preeclampsia.

Endometriosis after neosalpingostomy.

A patient seen for infertility developed severe endometriosis within 2 years of neosalpingostomy for bilateral fallopian tube obstruction. A retrospective review of infertility surgeries revealed none of 20 patients with obstructed tubes to have endometriosis, compared with 66 of 125 (52.8%) with at least one patent fallopian tube (p < 0.001, 95% confidence interval 0% to 17% vs 44% to 62%.