Future on the fringes.

Set against the palm trees, riotous flowers, and golf courses of LaQuinta Resort and Spa in California is something new -- a destination health center. Minutes from seaweed wraps and hot stone massage is the option of comprehensive health evaluations (including 150 diagnostic tests and genetic testing), longevity medicine, sports medicine, health coaches, and an array of personal wellness and corporate health programs.

Study of the conversion of methanol to dimethyl ether on zeolite HZSM-5 using in situ flow MAS NMR.

The conversion of methanol to gasoline (MTG) range hydrocarbons on zeolite catalyst HZSM-5 has been studied extensively using solid-state NMR. We have studied the reaction under batch and flow conditions using an isolated flow variable-temperature (VT) MAS NMR probe. This probe was developed to study heterogeneous catalysis reactions in situ at temperatures greater than 300 degrees C with reactant flow. In the batch studies, when 13C-labeled methanol was adsorbed on zeolite HZSM-5, sealed, and heated to 250 degrees C, dimethyl ether was formed. Two-dimensional exchange NMR shows that dimethyl ether was in equilibrium with methanol at 250 degrees C. When 13C-methanol was flowed over HZSM-5 at temperatures > or = 200 degrees C, only dimethyl ether was observed. Between 160 degrees C and 200 degrees C, both methanol and dimethyl ether were observed. The flow results are significant in that they suggest that there is no equilibrium between methanol and dimethyl ether in the catalyst at high temperatures, and that surface methoxy groups do not exist on the catalyst at high temperatures.

Complementary and alternative medicine: an opportunity for reform.

Healthcare in the United States is in the midst of a grassroots consumer movement as the use of complementary and alternative medicine (CAM) continues to increase. Traditional health providers find themselves in the unenviable and challenging position of being late entrants into a market that in theory could provide some ready cash at a time when reimbursement is scarce. This article first takes a look at the numbers involved in CAM, and from that foundation predicts future trends involving CAM, discusses the challenge presented to providers and insurers, and offers up the opportunities for systems providing CAM to consumers. While the task of incorporating CAM into the traditional healthcare system may seem daunting, systems that bring CAM into their continuum of care can take heart that millions of people and billions of dollars are just waiting for a new approach that adds value to health and quality to life.

Study of cavernosal arterial anatomy using color and power Doppler sonography: impact on hemodynamic parameter measurement.

PURPOSE: We report on color and power Doppler ultrasound to study cavernosal arterial anatomy, and evaluate the impact of vascular anatomy on the measurement of hemodynamic parameters. MATERIALS AND METHODS: Cavernosal arterial anatomy of 42 patients with erectile dysfunction was evaluated using color and power Doppler ultrasound. A computerized waveform analysis was used to measure peak systolic velocity, end diastolic velocity and resistive indexes at various sites, including the penile crura, and proximal mid and distal penile shaft. Hemodynamic parameters were measured in each artery in cases of bifurcated or multiple cavernosal arteries. RESULTS: A total of 80 corpora were adequately evaluated. We observed a single artery without major proximal branches in 37 corpora, a single artery with major proximal branches in 17, bifurcated arteries in 15, 2 cavernosal arteries in 4 and marked arterial tortuosity in 1. In 6 corpora the main cavernosal artery arose from the superficial dorsal artery. The peak systolic velocity was highest at the proximal and decreased progressively at the distal site. The peak systolic velocity plus or minus standard deviation at the mid shaft averaged 69.3+/-30.0% of that at the proximal penile shaft. Of the 15 corpora with bifurcated arteries 67% had a 40% or greater difference in peak systolic velocity between the branches. Complete or partial occlusion of the cavernosal artery was identified in 3 corpora, and a dramatic difference in peak systolic velocity proximal and distal to the stenotic area was demonstrated. CONCLUSIONS: Cavernosal arterial anatomy is variable and hemodynamic parameters differ at various sites of measurement. Parameters should be measured at a consistent proximal site to obtain a reliable assessment. Variations in vascular anatomy and cavernosal artery pathology should be considered when interpreting color Doppler sonography and before penile vascular surgery.

A cluster of fourteen genes from enteropathogenic Escherichia coli is sufficient for the biogenesis of a type IV pilus.

Enteropathogenic Escherichia coli (EPEC) adhere to epithelial cells in microcolonies, a pattern termed localized adherence (LA). LA is dependent upon the presence of 50-70 MDa plasmids, termed EPEC adherence factor (EAF) plasmids. Expression of an EAF plasmid-encoded type IV fimbria, the bundle-forming pilus (BFP), is associated with the LA phenotype. TnphoA insertions in bfpA, the gene encoding the major structural subunit of the BFP, abolish LA. While bfpA::TnphoA mutants cannot be complemented for LA by plasmids carrying the bfpA gene alone in trans, this work shows that they can be complemented by plasmids carrying the bfpA gene, as well as approximately 10 kb of downstream sequence, suggesting that such mutations have polar effects on downstream genes. The identification and characterization of a cluster of 13 genes immediately downstream of bfpA are described. The introduction into a laboratory Escherichia coli strain of a plasmid containing these 14 bfp gene cluster genes, along with pJPN14, a plasmid containing another fragment derived from the EAF plasmid, confers LA ability and BFP biogenesis. However, when a mutation is introduced into the last gene of the bfp cluster, neither LA nor BFP biogenesis is conferred. This work also provides evidence to show that the fragment cloned in pJPN14 encodes a factor(s) which results in increased levels of the pilin protein. Finally, it is shown that expression of the 14 genes in the bfp cluster from an IPTG-inducible promoter, in the absence of pJPN14, is sufficient to reconstitute BFP biogenesis in a laboratory E. coli strain, but is insufficient for LA. This is the first report demonstrating the reconstitution of a type IV pilus in a laboratory E. coli strain with a defined set of genes. The BFP system should prove to be a useful model for studying the molecular mechanisms of type IV pilus biogenesis.

Creating healthier communities: challenge for the 21st Century.

The challenge for the 21st century will be to create healthier communities. Health is the ultimate cost-reduction strategy and the defining outcome for future health care systems. The challenge for those managing care will be to influence the web of factors from which health arises. Across the country, communities are working to redesign underlying conditions, forge new partnerships, and create high-level health. They will do for themselves what Washington cannot.

The future of healthcare. Seven experts look ahead.

If there were ever a time to have a crystal ball, it's now. In today's healthcare environment the only thing that seems certain is change. To help marketers make some educated guesses about the future of healthcare, hospitals, and the market, PROFILES invited seven experts to prognosticate. They considered what might happen in this decade, and what could be reality in 25 to 50 years. They address topics ranging from surgery of the future to how consumers will find healthcare information. Here are a few of their predictions: 1. Managed care will dominate the market. 2. More hospitals will close. Those remaining will consolidate or collaborate and draw closer to their communities. 3. Doctors and hospitals will build partnerships. More doctors will be salaried. 4. Cost controls will increase. 5. Quality will differentiate hospitals and drive marketing. 6. Patients will become more involved in their care and in their selection of hospitals. 7. Drug treatments will play an increased role as surgery declines.