The effects of biostimulation and bioaugmentation on crude oil biodegradation in two adjacent terrestrial oil spills of different age, in a hyper-arid region.

This study deals with two adjacent terrestrial oil spills, with similar properties, located in a hyper-arid region in Israel, one from 1975 and the other from 2014. It tests the effect of biostimulation on crude oil degradation in both spills and whether biostimulated sediments from the 1975 spill can bioaugment crude oil degradation in the 2014 spill. Soil hydrophobicity, expressed as Water Drop Penetration Time (WDPT), and Gasoline Range Organics (GRO) and Diesel Range Organics (DRO) content in sediments were measured in one-month ex-situ experiments. No significant reduction in hydrophobicity and GRO + DRO content was observed in non-biostimulated controls. A combined treatment of mineral fertilization at t0 and maintaining 50% water saturation, significantly accelerated the decrease in hydrophobicity and GRO + DRO content in sediments of both spills. The addition of biostimulated sediments from the 1975 spill failed to accelerate the reduction of GRO + DRO content and hydrophobicity in the 2014 spill. Surprisingly, the GRO + DRO degradation rate in biostimulated sediments from the 2014 spill was 36% higher than in biostimulated sediments from the 1975 spill. Crude oil composition in both spills changes during its degradation and is characterized by an increase in the GRO fraction. To a certain range, WDPT was found to serve as a reliable indicator for oil content in the soil. We conclude that even in a hyper-arid region, oil bio-degradation capabilities develop in a relatively short time. Moreover, while biostimulation was effective in accelerating biodegradation, bioaugmentation with biostimulated sediments from a nearby older spill was found ineffective.

[The epidemiological features of visceral leishmaniasis, revealed on examination of children by polymerase chain reaction, in the Papsky District, Namangan Region, Uzbekistan].

Patients with visceral leishmaniasis (VL) have been registered in the Papsky District, Namangan Region, Uzbekistan, over the past 23 years. A total of 95 patients were notified in 1987 to 2009. In 2007-2008, a mass survey using the polymerase chain reaction (PCR) within the international INTAS project 05-100006-8043 was conducted in 5 population aggregates of the Papsky District, Namangan Region, Uzbekistan, where VL cases had been regularly registered in the last years. Bone marrow and venous and peripheral blood smears were used as a test material. A total of 234 samples, including 3 bone marrow biopsy specimens, 9 venous blood samples and 222 peripheral blood ones, were tested. All the samples were on the glass slides. Three groups were identified among the examinees. Group 1 consisted of 13 subjects who had been ill at different times. Group 2 comprised 27 children treated at hospital for various diagnoses. Group 3 (the largest one, n=190) included apparently healthy children. All the children of this group felt well and had no symptoms of any illnesses at the examination. In this group, 85 (44.7%) subjects were PCR-positive. Twenty-four (55.8%) of 43 children in the age group of 0-3 years were PCR-positive; the 4-7-year age group comprised 66 subjects and 33 (50%) of them were PCR-positive. Group over 7 years of age included 81 subjects; 45 (55.5%) were PCR-positive. The results of the mass survey with PCR, which covered the 5 population aggregates in the Papsky District, Namangan Region, Uzbekistan, suggest the epidemic activity of a synathropic focus of VL and make us look at many fixed notions of its epidemiology in new contexts.

[Human and canine visceral leishmaniasis in the Papsky District, Namangan Region, Uzbekistan: seroepidemiological and seroepizootological surveys].

In 2007 - 2008, four (Chodak, Oltinkan, Gulistan, and Chorkesar) of 9 population aggregates in the Papsky District, Namangan Region, Uzbekistan, where visceral leishmaniasis (VL) cases had been registered in the last years were selected to make seroepidemiological and seroepizootological surveys within the international project funded by INTAS grant 05-100006-8043. The surveys of the populations were conducted visiting their homesteads. These additionally included children's and health care facilities where all children aged less than 14 years were examined. On examining the children, their peripheral blood (approximately 0.1 ml) was taken on filter paper for serological assays. Canine blood was sampled from the vein. Enzyme-linked immunosorbent assay (ELISA) was carried out to detect antibodies to VL pathogens. A total of 521 children were examined for two years, by applying ELISA. Five hundred and fourteen blood samples from children younger than 14 years, 162 dogs, 4 foxes, and 1 cat were tested. Testing 514 children's blood samples for VL pathogen antigen ascertained that in the 4 population aggregates there was an average of 10% VL-seropositive children, including those who were ill with VL at the moment of the examination and had been ill. The highest number of VL-seropositive samples (14.9%) was found in the settlement of Chodak. VL pathogen antibodies were detected in 26 (61.9%) of 42 dogs with the clinical signs of VL. VL-positive tests were found in 26 (21.6%) of 120 apparently healthy dogs. The samples from 4 foxes and 1 cat were negative. Immunological findings indicated that 0-3-year-old children were a group that is most susceptible to VL in the study focus of this disease. The high proportion of dogs with VL may account for the rise in infant morbidity and suggests the epizootic strain in the focus of VL in the Papsky District.

Establishing and running an effective telephone-based anticoagulation service.

Observational studies and randomized controlled trials have revealed improvement in international normalized ratio (INR) control and reduced thrombotic and hemorrhagic events in patients taking warfarin who are managed by an anticoagulation service (ACS) compared with traditional physician care. In this article, we describe how to establish a multidisciplinary telephone-based ACS to monitor INRs, dose warfarin, and heparin therapy, and to educate patients by telephone. We address how to improve ACS efficiency by using an electronic medical record, charting by exception, holding group-based education, communicating by telephone, and conducting quality assurance. We also make recommendations for improving the quality of care of patients taking anticoagulants that can be implemented in any setting and we discuss how to apply these guidelines to other remote disease-state management programs (eg, diabetes).

Patient and physician satisfaction with a telephone-based anticoagulation service.

OBJECTIVES: To compare the satisfaction and knowledge of patients who have their warfarin managed by their physician or by a multidisciplinary, telephone-based anticoagulation service (ACS) and to assess referring physicians' satisfaction with the ACS. DESIGN AND PARTICIPANTS: We surveyed 300 patients taking warfarin (mean age 73 years): 150 at health centers randomized to have access to an ACS, and 150 at control health centers without ACS access. We also surveyed 17 physicians who refer patients to the ACS. SETTING: Eight outpatient health centers in Missouri and Southern Illinois. MEASUREMENTS: We asked patients about the timeliness of international normalized ratio (INR) monitoring, perceived safety of warfarin, overall satisfaction with their warfarin management, and knowledge of what a high INR meant. We asked physicians at ACS-available health centers how many minutes they saved per INR by referring patients to the ACS, their satisfaction with the ACS, and their willingness to recommend the ACS to a colleague. MAIN RESULTS: As compared with patients at control health centers, patients at ACS-available health centers were more satisfied with the timeliness of getting blood test results (mean 4.31 vs 4.03, P =.02), were more likely to know what a safe INR value was (45% vs 15%, P =.001), and felt safer taking warfarin (mean 5.7 vs 5.2, P =.04). Physicians reported that using the ACS saved, on average, four minutes of their time and 13 minutes of their staff's time, per INR. All physicians recommended use of the ACS to a colleague and were highly satisfied with the ACS. CONCLUSIONS: A telephone-based ACS can be endorsed by primary-care physicians and improve patients' satisfaction with and knowledge about their antithrombotic therapy.

Development and implementation of a decision support system for carotid artery stenosis: the Carotid Ultrasound Report Enhancement (CURE).

The management of carotid artery stenosis is an art evolving into a science, increasingly informed by clinical trials of medical management versus carotid endarterectomy (CEA). Ideas about optimal management depend on the confluence of patient-specific variables, surgical expertise, and the state of medical knowledge. In this complex and progressing setting, an up-to-date decision support system could help physicians apply the latest evidence to patient care. Carotid ultrasonography (US) studies provide an excellent opportunity to aid in the therapy of carotid stenosis. We developed a Carotid US Report Enhancement (CURE) to augment carotid US reports with treatment-specific prognostic information and patient-specific portions of the American Heart Association's 1998 guideline for the management of carotid artery stenosis. In the process of designing and implementing the CURE software, we encountered and eventually solved a variety of problems. The first problem was that US test was not always precise enough to distinguish between a moderate and mild carotid stenosis. Likewise, the standard US reports did not elucidate several technical problems that decreased the reliability of the US result. Third, although 17 of 18 physicians agreed to receive the CURE reports, they requested non-incriminating wording. Fourth, vascular surgeons supervising the US laboratories were reluctant to support the CURE report if they thought it would be construed as prompting self-referral. Finally, information about some comorbid conditions (e.g. a history of atrial fibrillation) could not be obtained reliably from the patients. The result of responding to these problems is a decision support program that is increasingly robust, able to detect many of its own limitations, and capable of integrating data from multiple sources. A randomized controlled trial now in progress will evaluate the clinical impact of the CURE program.

Light-harvesting complex II pigments and proteins in association with Cbr, a homolog of higher-plant early light-inducible proteins in the unicellular green alga Dunaliella.

Like higher plants, unicellular green algae of the genus Dunaliella respond to light stress by enhanced de-epoxidation of violaxanthin and accumulation of Cbr, a protein homologous to early light-inducible proteins (Elips) in plants. Earlier studies indicated that Cbr was associated with the light-harvesting complex of photosystem II (LHCII) and suggested it acted as a zeaxanthin-binding protein and fulfilled a photo-protective function (Levy et al. 1993, J. Biol. Chem. 268: 20892-20896). To characterize the protein-pigment subcomplexes containing Cbr in greater detail than attained so far, thylakoid membranes from Dunaliella salina grown in high light or normal light were solubilized with dodecyl maltoside and fractionated by isoelectric-focusing. Analysis of the resolved LHCII subcomplexes indicated preferred associations among the four LHCIIb polypeptides and between them and Cbr: subcomplexes including Cbr contained one or two of the more acidic of the four LHCIIb polypeptides as well as large amounts of lutein and zeaxanthin relative to chlorophyll a/b. After sucrose gradient centrifugation, Cbr free of LHCIIb polypeptides was detected together with released pigments; this Cbr possibly originated in subcomplexes dissociated in the course of the analysis. These results agree with the conclusion that Cbr is part of the network of LHCIIb protein-pigment complexes and suggest that the role played by Cbr involves the organization and/or stabilization of assemblies highly enriched in zeaxanthin and lutein. Such assemblies may function to protect PSII from photodamage due to overexcitation.

Characterization of human and mouse H19 regulatory sequences.

H19 is expressed in a large percentage of bladder tumors, but not expressed in healthy bladder tissue. The aim of this study is to define H19 optimal transcriptional regulatory sequences in tumor cells, which can potentially be used to control expression of a toxin gene in constructs to be used in bladder cancer gene therapy trials in mice and human. Transient expression assays revealed that elements responsible for promoter activity are contained within the 85 bp upstream region. The transcriptional activity of this region was strongly inhibited by the methylation of the Hpa II sites. A modest cell specificity is conferred by the upstream sequences. The human and murine promoter activities were significantly increased by the human H19 4.1 kb enhancer sequence. The 85 bp H19 upstream region contains all the elements to interact with the enhancer. We showed that the human H19 promoter is highly active in a murine bladder carcinoma cell line, justifying its use to drive the expression of a cytotoxin gene in gene therapy trials in mice.

Differential responses to different light spectral ranges of violaxanthin de-epoxidation and accumulation of Cbr, an algal homologue of plant early light inducible proteins, in two strains of Dunaliella.

Unicellular green algae of the genus Dunaliella, similar to higher plants, respond to light stress by enhanced de-epoxidation of violaxanthin and accumulation of Cbr, a protein homologous to early light inducible proteins (Elips) in plants. These proteins belong to the superfamily of chlorophyll a/b binding proteins. Two Dunaliella strains, D. bardawil and D. salina, were compared for these two responses under light in the UVA, blue, green and red spectral ranges. In D. bardawil, the two stress responses were similarly induced under UVA, blue or red light and to a lesser extent under green light. In D. salina, a similar spectral range dependence was exhibited for violaxanthin de-epoxidation. However, Cbr accumulated only under UVA or blue light but not under green or red light. A strong synergistic effect of a low dose of blue light superimposed on red light resulted in Cbr accumulation. These results reveal strain-specific differences in spectral range requirements of the two light-stress responses. In the two strains, violaxanthin de-epoxidation is triggered under photosynthetically-active spectral ranges but at least in D. salina, Cbr accumulation appears to require a specific light signal additionally to a signal(s) generated by light stress.

The potential utility of a shared medical record in a "first-time" stroke population.

This preliminary investigation explored the utilization of a shared medical record for improving treatment compliance and outcome measures for "first-time" stroke victims. It was hypothesized that individuals who had access to information regarding the diagnosis and treatment of their stroke and general stroke-related educational materials would have improved compliance and outcomes when compared with persons with only educational materials. Inpatient teaching was reinforced during outpatient visits. Data were collected at two points in time, comparing the two groups. Chi-square tests showed no differences between the shared-record and control groups regarding baseline demographic characteristics. Subjects reported their intentions to modify health-related behaviors by completing the diet, smoking and medication subscales of Miller's Health Intention Scale. They reported their compliance with treatment on the diet, medication, and smoking subscales of Miller's Health behavior Scale. The Glasgow Outcome Scale and the Global Outcome provided treatment outcome measures. Analysis of outcome measures was performed by means of analysis of variance. At the 6-month follow-up, no differences were seen in health practices. A trend toward better perceived outcome was suggested in the shared medical record group when poorest perceived outcomes were compared. For the most part, subjects in the shared-record group were satisfied with having a copy of their records, took them on visits to physicians, and reported learning more about their strokes. Suggestions for future research include specific treatment information as a variable to be assessed against better measures of health practices. In particular, studies might investigate whether access to personal health and treatment information interacts with the amount of responsibility patients take for their own health and whether this leads to the development of a collaborative relationship with primary health care professionals.

Possible Role of Cbr, an Algal Early-Light-Induced Protein, in Nonphotochemical Quenching of Chlorophyll Fluorescence.

The unicellular green alga Dunaliella bardawil exhibits typical responses to excessive light when starved for sulfate under normal light (60 [mu]E m-2 s-1) but not under low light (14 [mu]E m-2 s-1). Algae were analyzed during several days of sulfate starvation for nonphotochemical quenching of chlorophyll fluorescence in the absence or presence of the uncouplers SF-6847 (SF) or carbonyl cyanide p- trifluoromethoxyphenyl hydrazone. Parallel analyses followed two light-stress responses: (a) violaxanthin conversion to zeaxanthin and (b) accumulation of Cbr, a protein analogous to plant early-light-induced proteins and implicated in zeaxanthin binding. In cells starved under normal light SF inhibited nonphotochemical quenching during the first 24 h, but not from 40 h onward. In cells starved under low light SF inhibited nonphotochemical quenching throughout the starvation period. Under normal light accumulation of zeaxanthin was nearly maximal by 24 h, but Cbr was fully induced only by 40h. Under low light zeaxanthin accumulated slowly but no Cbr was evident. These results suggest that during exposure to excessive light, the initial pH gradient-dependent, Cbr-independent mode of nonphotochemical quenching is modified to become less dependent on pH gradient and requires Cbr.

Stroke in young adults: a retrospective analysis.

Recent data suggest that stroke in young adults is more frequent than previously reported. To explore clinical and discharge characteristics of young adults with stroke, a retrospective chart review was completed for all young adults (ranging from 18 to 45 years of age, inclusively) admitted to this institution in 1992 with a diagnosis of stroke. The group consisted of 37 patients (mean age 36 years). The 16 men and 21 women represented 8.4% of the 441 patients with stroke treated in 1992. A total of 25 (67.6%) had ischemic strokes (37.8% cerebral infarction and 29.8% transient ischemic attacks), and 12 (32.5%) had hemorrhagic strokes (18.9% subarachnoid and 13.4% intracerebral hemorrhage). The distribution of cerebral infarction/transient ischemic attack subtypes included 16% atherothromboembolic, 32% cardiogenic, 4% lacunar, 16% other causes (such as migraine or vasculitis), and 32% of undetermined cause. Hemorrhagic stroke subtypes included 25% hypertensive, 41.6% aneurysmal, 16.7% other vascular anomalies (such as arteriovenous malformations), and 16.7% of undetermined cause. Among those who survived, 88% were discharged directly home, and 12% required rehabilitation. During the acute phase, 11% of the population died. These data suggest that strokes in young adults (1) are more frequent than previously recognized, (2) have multiple etiologic and pathologic factors, and (3) in many cases, are treatable. In general, these patients have a good prognosis.

Code stroke. An attempt to shorten inhospital therapeutic delays.

BACKGROUND AND PURPOSE: Significant delays often occur during the treatment of patients with acute stroke. Some of those delays occur in the hospital. We attempted to shorten inhospital treatment intervals by creating a rapid-response system, similar to that available for cardiac arrest, that would allow the stroke team to be available within a few minutes to care for stroke victims. METHODS: We connected all beepers (pocket pagers) of stroke team members to a common access number and instructed the emergency staff to activate that number immediately upon arrival of a stroke victim. We monitored the response time and treatment interval for patients who were treated after this system was activated (Code Stroke patients) during the first 3 months of its availability and compared the results to those of patients seen for similar reasons during the study period but without the use of Code Stroke (control patients). RESULTS: A total of 12 Code Stroke patients were available for analysis, representing 12% of all patients (n = 98) seen in the emergency department for ischemic stroke during the study period. The remaining 86 patients constituted the control group. The mean time to evaluation of a Code Stroke patient by a stroke team member was 4.8 minutes (range, 2 to 7 minutes), and the mean time to treatment institution was 30 minutes (range, 10 to 120 minutes). There were significant differences between the consultation intervals in the two groups (P < .05). There was only a trend of a difference between treatment institution intervals (P = .06). CONCLUSIONS: It is possible to shorten inhospital treatment delays by instituting rapid-response systems within individual institutions.

Delay between emergency room arrival and stroke consultation.

We reviewed retrospectively the charts of all stroke patients admitted through our emergency room (ER) during the first halves of 1986 (Group A) and 1992 (Group B). Specifically, the time elapsed between ER arrival and the request for consultation by neurology or neurosurgery was subjected to comparison by analysis of variance. In Group A, the time elapsed from arrival to consultation request varied between 1 and 100 min (mean, 32.5). In Group B, the same period ranged from 2 to 285 min (mean, 84). The difference in mean elapsed time between the two groups was statistically significant (<0.0001). In Group A, patients with hemorrhagic events had significantly shorter delay between arrival and consultation (p = 0.026). This was not the case in Group B. Stroke type did not influence the time to consultation in Group A (p = 0.18) orGroupB (p = 0.60). The results show that neurologic and neurosurgical consultations of stroke patients in the ER are delayed more now than in the past. This finding may have a significant impact on acute stroke intervention trials and underscores the need for active collaboration between stroke specialists and emergency physicians.

Arteriovenous malformation of the hand: a case study.

Arteriovenous malformations (AVMs) are complex congenital vascular anomalies resulting from faulty embryonic development of arterial and venous structures. The present discussion will specifically address AVMs of the extremities. Complications of these lesions can include tissue damage, functional impairment and amputation. The article reviews current diagnostic procedures and treatment options. A case study is presented with a discussion of nursing care focusing on pain, anxiety, and alteration in peripheral tissue perfusion.