Isolated elevated blood neutrophil concentration at altitude does not require NICU admission if appropriate reference ranges are used.

OBJECTIVE: The Intermountain Healthcare hospitals use a clinical pathway algorithm for early-onset infection, which is based on the 2002 Centers for Disease Control and Prevention (CDC) guidelines for perinatal group B streptococcal disease. As part of this pathway, neonates in the well baby nursery, who seem to be well but have risk factors for infection, receive a 'limited laboratory evaluation including a CBC', and if the complete blood cell count (CBC) is abnormal, antibiotic treatment and neonatal intensive care unit (NICU) monitoring are initiated. We recently found that reference ranges for absolute neutrophil counts (ANCs) are much wider at our altitude (4800 to 5000 ft) than at sea level. On this basis, we speculated that some well babies with risk factors for infection are mistakenly judged as having an abnormal CBC, and are unnecessarily admitted to the NICU. STUDY DESIGN: This was a retrospective observational cohort study of neonates of >37 weeks gestation admitted to either of two Intermountain Healthcare NICUs for intravenous antibiotic treatment during a recent 36-month period. RESULTS: During the study period 3217 patients were admitted to the two NICUs, 1049 (32.6%) of which were born at>37 weeks gestation. Of these, 14 (1.3%) were found to have been admitted to the NICU on the basis of an abnormal CBC (elevated ANC), when in retrospect, using the appropriate ANC chart, their CBCs were completely normal. None of the 14 neonates had a leukocyte left shift (immature to total neutrophil ratio >0.3) or thrombocytopenia. None were treated with supplemental oxygen or mechanical ventilation in the NICU. All 14 had sterile blood cultures. All had antibiotics stopped in 48 to 72 h, and all were discharged home as well babies. CONCLUSION: We identified 14 neonates who, while in the well baby nursery, were found to have risk factors for early-onset infection, but did not seem to be infected, and were subsequently admitted to a NICU for intravenous antibiotic treatment and monitoring under the mistaken impression that they had an abnormal CBC. We maintain that use of an appropriate neutrophil reference range chart can reduce NICU admissions and can limit unnecessary antibiotic exposure.

Photocatalytic degradation of water-soluble organic pollutants on TiO2 modified with gold nanoparticles.

Well characterised novel catalysts consisting of TiO2 modified with very small amounts of gold nanoparticles have been applied to the photocatalytic degradation of two important pollutants, methyl tert-butyl ether (MTBE) and 4-chlorophenol, in dilute aqueous solution using a fixed bed flow-through photocatalytic reactor. Although the thermal processing that was necessary for coating the reactor walls with the photocatalysts did lead to some loss of performance, the net gains in activity relative to unmodified TiO2 were nevertheless substantial and in excess of anything previously reported. Improvements in reaction rate by 50% and 100% for the removal of 4-chlorophenol and MTBE, respectively, were achieved. It was also found that effective removal of both pollutants could be achieved at water flow rates that are relevant to field applications involving the photocatalytic clean-up of contaminated groundwater. Due to their very small Au content, the cost of these materials is compatible with large scale use.

Adsorption geometry and core excitation spectra of three phenylpropene isomers on Cu(111).

Theoretical C 1s near edge x-ray absorption fine structure (NEXAFS) spectra for the C(9)H(10) isomers trans-methylstyrene, alpha-methylstyrene, and allylbenzene in gas phase and adsorbed at Cu(111) surfaces have been obtained from density functional theory calculations where adsorbate geometries were determined by corresponding total energy optimizations. The three species show characteristic differences in widths and peak shapes of the lowest C 1s-->pi(*) transitions which are explained by different coupling of the pi-electron system of the C(6) ring with that of the side chain in the molecules as well as by the existence of nonequivalent carbon centers. The adsorbed molecules bind only weakly with the substrate which makes the use of theoretical NEXAFS spectra of the oriented free molecules meaningful for an interpretation of experimental angle-resolved NEXAFS spectra of the adsorbate systems obtained in this work. However, a detailed quantitative account of relative peak intensities requires theoretical angle-resolved NEXAFS spectra of the complete adsorbate systems which have been evaluated within the surface cluster approach. The comparison with experiment yields almost perfect agreement and confirms the reliability of the calculated equilibrium geometries of the adsorbates. This can help to explain observed differences in the catalytic epoxidation of the three molecules on Cu(111) based on purely geometric considerations.

RG 12915: a potent 5-hydroxytryptamine-3 antagonist that is an orally effective inhibitor of cytotoxic drug-induced emesis in the ferret and dog.

RG 12915 [4-[N-(1-azabicyclo[2.2.2.]octan-3-(S)-yl)]2-chloro-cis 5a-(S)-9a-(S)-5a,6,7,8,9,9a-hexahydrobenzofurancarboxamide hydrochloride] is a potent and effective agent against cisplatin-induced emesis in the ferret after i.v. or p.o. administration. This agent (p.o.) is also highly protective against cisplatin-induced emesis in the dog, as well as cyclophosphamide/doxorubicin-induced emesis in the ferret. When administered either p.o. or i.v., RG 12915 has a lower ED50 value (0.004 mg/kg) than GR 38032F, BRL 43694 and metoclopramide for attenuating cisplatin-induced emetic episodes in the ferret. It also has a long duration of action against cisplatin-induced emesis in the ferret. In contrast to metoclopramide, RG 12915 lacks significant antidopaminergic activity both in vitro [( 3H]spiroperidol displacement), as well as in vivo (apomorphine-induced emesis). In radioligand binding assays, RG 12915 is a potent and selective displacer of binding of 5-hydroxytryptamine (5-HT)3 binding sites (IC50 value = 0.16 nM), whereas failing to displace binding of ligands for the alpha-1, alpha-2 and beta adrenergic, 5-HT1 or 5-HT2 or cholinergic-muscarinic sites with IC50 values less than 1 microM. At a p.o. dose (1 mg/kg) in which RG 12915 is highly protective against cisplatin-induced emesis in the dog, RG 12915 has no significant gastroprokinetic activity in the same species. In summary, RG 12915 is a potent and p.o. effective agent against cytotoxic drug-induced emesis in animal models. The antiemetic potency of RG 12915 against cisplatin is unrelated to antidopaminergic or gastroprokinetic activity, but may be related to its affinity for 5-HT3 binding sites.

Cognitive aspects of haptic form recognition by blind and sighted subjects.

Studies using haptic form recognition tasks have generally concluded that the adventitiously blind perform better than the congenitally blind, implicating the importance of early visual experience in improved spatial functioning. The hypothesis was tested that the adventitiously blind have retained some ability to encode successive information obtained haptically in terms of a global visual representation, while the congenitally blind use a coding system based on successive inputs. Eighteen blind (adventitiously and congenitally) and 18 sighted (blindfolded and performing with vision) subjects were tested on their recognition of raised line patterns when the standard was presented in segments: in immediate succession, or with unfilled intersegmental delays of 5, 10, or 15 seconds. The results did not support the above hypothesis. Three main findings were obtained: normally sighted subjects were both faster and more accurate than the other groups; all groups improved in accuracy of recognition as a function of length of interstimulus interval; sighted subjects tended to report using strategies with a strong verbal component while the blind tended to rely on imagery coding. These results are explained in terms of information-processing theory consistent with dual encoding systems in working memory.

The I, i, and HI blood group antigens in extracts of human erythrocytes.

Extracts of stromata of human adult and newborn (cord) erythrocytes were prepared with n-butanol. The aqueous phase and butanol phase extracts were examined for the presence of blood group I, i, HI and H substances in inhibition of agglutination experiments. The recovery of HI activity in both the aqueous and butanol phase extracts of adult red cells but only in the aqueous phase of cord cells is reported heare for the first time. The i specificity was present in the aqueous phase but not in the butanol phase of cord erythrocytes, also not previously reported. Although the recovery of I but not i substance in aqueous phase extracts of adult cells had been shown by other workers, examination of the butanol phase extracts for I and i substances had not been documented. In the present study, Ii substances were not demonstrable in any of the butanol phase extracts of adult and cord erythrocytes.

The H, HI, I and i blood group antigens in butanol extracts of rabbit tissues.

Aqueous and butanol phase extracts of rabbit erythrocytes and the tissues gastric mucosa, liver, lung and kidney were examined by inhibition of agglutination for the presence of H, HI, I and i blood group substances. Of the four specificities, only I substance was recovered from erythrocytes and only in the aqueous phase extracts. Both aqueous and butanol extracts of gastric mucosae contained H substance, but HI and I were present only in the aqueous extracts of this tissue. Extracts of rabbit lungs only had H and I activity and only in the aqueous phase. No H, HI, I or i substance was detected in any of the extracts of liver and kidney. Reduced levels of H substance were found in aqueous extracts of gastric mucosae of 'A-like' rabbits. Three H specificities were demonstrated in the butanol phase extracts of gastric mucosae of rabbits. These specificities were similar to those previously shown in extracts of gastric mucosae and erythrocytes of humans.

The A, M, N, and P1 blood group substances in butanol extracts of human erythrocytes.

Aqueous phase and butanol phase extracts of group A1, O, M, N, P1 and P2 human erythrocytes perpared by extraction of red cell stromata with n-butanol were examined for the presence of blood group substances in inhibition of agglutination experiments using antisera and test cells of human origin. Group A substance was recovered in both aqueous phase and butanol phase extracts, M and N substance in aqueous phase extracts only, and P1 substance only in butanol phase extracts. Use of high concentrations of extract resulted in detection of P1 activity in aqueous phase extracts and of N specific inhibition in the aqueous phase extracts of group M erythrocytes. Distilled water appeared to be superior to digitonin and hypotonic phosphate buffer solutions for preparation of stromata for the recovery of group A and M substances in the butanol extracts but not for group N and P1 substances.

The H specificities of butanol extracts of human erythrocytes.

A previous report of other researchers that aqueous phase fractions of erythrocyte stromata of secretors contained more ABH blood group activity than similar fractions of non-secretors was confirmed. The recovery of H activity in the butanol phase extracts of both secretors and non-secretors, which had not been seen previously, is reported here for the first time. Three H specificities were present when the aqueous and butanol phases of group O secretor stromata were examined in inhibition of agglutination studies with anti-H of group Oh and group A1 sera and three lectins. The anti-H (group Oh) sera were inhibited by both aqueous and butanol fractions. Anti-H serum (group A1) and the lectin Ulex europaeus were inhibited by the aqueous fraction only. The lectins Laburnum alpinum and Lotus tetragonolobus were not inhibited by either the aqueous or butanol phase extracts.