Estimation of External Dose Rates to Hotel Workers from bed linens Contaminated by 131I Patients.

Iodine-131 is commonly used in medical diagnosis and therapy for patients with hyperthyroidism or differentiated thyroid cancer. Following treatment, patients may recuperate in a hotel room to avoid exposing family members. The main purpose of this study was to estimate external effective dose rate coefficients to a hotel worker who handles potentially contaminated bed linens due to secretions from I patients as sweat or urine. The external dose rate estimates were derived using Monte Carlo radiation transport code and the phantom with movable arms and legs to model a housekeeper standing in an upright position holding a pile of bed linens. Simulations further integrated the body burden of time-dependent biokinetic metabolism of I in the patient's body, differentiating between biokinetic excretion models of hyperthyroid vs. cancer patients. Organ absorbed dose rate and effective dose rate coefficients were calculated for three scenarios of bed linen contamination and estimated out to 5 d postadministration and compared to past I patient contamination measurements.

Dynamic processing of DOM: Insight from Exometabolomics, Fluorescence Spectroscopy, and Mass Spectrometry.

Dissolved organic matter (DOM) in freshwater environments is an important source of organic carbon, supporting bacterial respiration. Frozen environments cover vast expanses of our planet, with glaciers and ice-sheets storing upwards of six petagrams of organic carbon. It is generally believed that DOM liberated from ice stimulates downstream environments. If true, glacial DOM is an important component of global carbon cycling. However, coupling the release of DOM to microbial activity is challenging due to the molecular complexity of DOM and the metabolic connectivity within microbial communities. Using a single environmentally relevant organism, we demonstrate that processing of compositionally diverse DOM occurs, but, even though glacially derived DOM is chemically labile, it is unable to support sustained respiration. In view of projected changes in glacier DOM export, these findings imply that biogeochemical impacts on downstream environments will depend on the reactivity and heterogeneity of liberated DOM, as well as the timescale.

Relationship between dissolved organic matter quality and microbial community composition across polar glacial environments.

Vast expanses of Earth's surface are covered by ice, with microorganisms in these systems affecting local and global biogeochemical cycles. We examined microbial assemblages from habitats fed by glacial meltwater within the McMurdo Dry Valleys, Antarctica and on the west Greenland Ice Sheet (GrIS), evaluating potential physicochemical factors explaining trends in community structure. Microbial assemblages present in the different Antarctic dry valley habitats were dominated by Sphingobacteria andFlavobacteria, while Gammaproteobacteria and Sphingobacteria prevailed in west GrIS supraglacial environments. Microbial assemblages clustered by location (Canada Glacier, Cotton Glacier and west GrIS) and were separated by habitat type (i.e. ice, cryoconite holes, supraglacial lakes, sediment and stream water). Community dissimilarities were strongly correlated with dissolved organic matter (DOM) quality. Microbial meltwater assemblages were most closely associated with different protein-like components of the DOM pool. Microbes in environments with mineral particles (i.e. stream sediments and cryoconite holes) were linked to DOM containing more humic-like fluorescence. Our results demonstrate the establishment of distinct microbial communities within ephemeral glacial meltwater habitats, with DOM-microbe interactions playing an integral role in shaping communities on local and polar spatial scales.

Which aspects of health care are most valued by people living with HIV in high-income countries? A systematic review.

BACKGROUND: Increasing numbers of people with HIV are living into older age and experiencing comorbidities. The development of new models of care to meet the needs of this population is now a priority. It is important that the views and preferences of patients inform the development of services in order to maintain high levels of patient satisfaction and engagement. The aim of this systematic review was to determine which aspects of healthcare are particularly valued by people living with HIV. METHODS: We searched electronic databases and reference lists of relevant articles. The search strategy was developed to identify articles reporting on HIV positive patients' perceptions, evaluations or experiences of healthcare services and factors associated with satisfaction with care. Peer-reviewed papers and conference abstracts were included if the study reported on aspects of health care that were valued by people living with HIV, data were collected during the era of combination therapy (from 1996 onwards), and the paper was published in English. A thematic approach to data synthesis was used. RESULTS: Twenty-three studies met the inclusion criteria. Studies used both qualitative and quantitative methods. Six studies specifically reported on relative importance to patients of different aspects of care. The valued aspects of care identified were grouped into seven themes. These highlighted the importance to patients of: a good health care professional-patient relationship, HIV specialist knowledge, continuity of care, ease of access to services, access to high quality information and support, effective co-ordination between HIV specialists and other healthcare professionals, and involvement in decisions about treatment and care. We were unable to determine the relative importance to patients of different aspects of care because of methodological differences between the studies. CONCLUSIONS: This review identified several attributes of healthcare that are valued by people living with HIV, many of which would be relevant to any future reconfiguration of services to meet the needs of an ageing population. Further research is required to determine the relative importance to patients of different aspects of care.

Dose titration of the clinical efficacy of intravenously administered flunixin meglumine in a reversible model of equine foot lameness.

REASONS FOR PERFORMING STUDY: There are no refereed controlled documentations of the skeletal analgesic efficacy of different dosages of flunixin meglumine (FM). OBJECTIVES: The objective of this experiment was to compare the efficacy of various dosages of FM with a negative control. The hypothesis was that higher doses would result in improved efficacy in a dose-dependent manner when tested in a reversible model of foot lameness. METHODS: Ten horses shod with adjustable heart bar shoes had weekly modified AAEP grade 4.0/5.0 lameness induced by tightening a set screw against the heart bar. Heart rate (HR) and lameness score (LS) were monitored by one double-blinded investigator at rest; every 20 min after lameness induction for 5 h and hourly for another 8 h. One hour after lameness induction, treatments were administered i.v. in a randomised order: negative control (isotonic saline: SAL) or FM at 0.55 (half-dose), 1.1 (single-dose) or 2.2 (double-dose) mg/kg bwt. Results were compared using RM ANOVA and Student-Newman-Keul's test with the level of significance set at P < 0.05. RESULTS: Compared to SAL, half-dose FM reduced HR at 2.33, 2.67, 4.0-8.0, and 10.0 h and LS at 1.33-12.0 h (P < 0.05). Single- and double-dose FM reduced HR from 0.67 to 12.0 h and LS from 1.0 to 12.0 h post administration (P < 0.05). Compared with half-dose FM, single- and double-dose LS were further decreased from 1.67 to 12.0 h post administration (P < 0.05). Mean peak and decaying plasma FM concentrations were different between dosages in a dose-dependent manner through 6 h post administration (P < 0.05). CONCLUSIONS: Flunixin meglumine administration affected dependent variables in a dose-dependent manner with half-dose FM clinically effective for a shorter period. Higher dosages did not perform differently from one another. POTENTIAL RELEVANCE: Practitioners must be aware that half-doses of FM are less efficacious than single doses but double doses are not more efficacious and yet are potentially more toxic.

ABO-incompatible heart transplantation: a perfusion strategy.

Infants with fatal cardiac disease often die awaiting transplantation because of the shortage of donor hearts. The Hospital for Sick Children (HSC), Toronto, Canada, has researched and applied the concept of crossing the blood group compatibility barrier. Heart transplantation at HSC unrestricted by ABO compatibility greatly contributed to decreasing the mortality rate among infants on the waiting list from 58% to 10%. From January 1996 to January 2002, 16 infants less than 14 months of age received ABO-incompatible heart transplants at our institution. The cardiopulmonary bypass (CPB) circuit is primed with additional volume to replace the patient's blood volume. Packed red blood cells (PRBC) used in priming must be ABO-compatible with the recipient. All plasma components and platelets must contain no anti-A or anti-B antibodies to donor or recipient. CPB is initiated and the patient's venous blood is collected into a transfusion bag and sent to the blood bank. The total amount collected should be one and a half to two times the patient's blood volume. The plasma is separated and discarded, returning only the PRBC, thus reducing the concentration of circulating antibodies to blood group antigens. Our team has experienced an 87% survival rate with this technique. The success is believed to be associated with the recipients' immunologic immaturity. Newborns do not produce isohemagglutinins, and serum anti-A and anti-B antibody titers usually remain low until 12-14 months of age. The complement system is not fully developed, therefore, the mediators of hyperacute rejection are absent during early infancy. Heart transplantation unrestricted by the need for ABO compatibility would effectively expand the available donor pool and decrease waiting times.

Measuring lung function in infancy.

Although the earliest reliable lung function tests in infants were performed as long as 40 years ago, there has only recently been a growth in this area, as simpler methods and better equipment and IT resources have been developed. Exciting information is accumulating about the normal physiology and pathology of the infant lung. Many basic questions are still unanswered and the ability to perform these tests remains confined to a few specialized centres. To co-ordinate the development of ILFT and establish standardization in a number of areas including measurement conditions, equipment specifications, methodology protocols and data analysis, international collaboration is necessary between the teams working in this field (Table 5). Collaborative groups are currently addressing these issues and are also developing recommendations regarding the design of randomized clinical trials, multi-centre studies and research agendas. Infant lung function testing remains primarily a research tool. Our aim should be not only to refine and develop the techniques of physiological measurement but to apply ILFT to the objective study of respiratory illness in infants in the clinical setting so as to aid in the prevention and treatment of these common, debilitating and costly diseases.

Measuring pulmonary function in infancy.

In recent years there has been a growing interest in the measurement of pulmonary function in infants for both clinical and research purposes. Such measurements remain limited by the complexity of the equipment as well as by the technical and physiological challenges of testing infants and neonates. Despite these problems, assessment of respiratory function in early life provides exciting information about the post-natal growth and development of lungs in health and disease. The aim of this paper is to discuss the physiological, technical and ethical problems surrounding these procedures, as well as reviewing the current methods of testing pulmonary function in the very young. Consideration is given to the developments needed if infant pulmonary function tests are to realise fully, their potential as research and clinical tools.

Dietary fiber, Hispanics, and breast cancer risk?

The cancer rates of immigrant populations in the United States must be taken into account when looking at the importance of diet and culture as it relates to cancer prevention. Unfortunately, some nutrition studies targeted toward nontraditional white populations have not adequately confronted the issue of cultural meaning in efforts to gather dietary data accurate enough to support nutritional analyses, identify marginal diets, or relate risk to dietary patterns. The study presented here resolves many of the culturally specific issues utilizing awareness, attention, and judicious combination of culturally sensitive qualitative and quantitative research techniques. The importance of such a study in an Hispanic population is based on the fact that the age-adjusted rate of breast cancer in countries such as Mexico is among the lowest in the world. In addition, although one of the fastest-growing minority groups in the United States, Hispanic women living in this country have been shown to have the lowest incidence of the mortality rates from this disease across most geographic regions of the United States. Therefore, one might speculate that dietary factors, which have been shown to play a role in breast cancer prevention, may account for this difference. It is well recognized that the traditional Hispanic diet is rich in protective nutrients such as dietary fiber. It is known that through complex mechanisms, dietary fiber works to reduce the amount of estrogens in the body. Research also indicates that it is the level of endogenous estrogen in the body that may influence the onset of breast cancer. In order to better understand how dietary factors may be associated with breast cancer in Hispanic women, it is important that one develop the proper tools to discern any potential differences. Therefore, we developed an approach to obtaining dietary fiber information from a small cohort of 22 Houston-area Hispanic women as a vanguard study for a larger breast cancer prevention trial. Two separate dietary assessment instruments were utilized, a three-day food record and the Southwest Food Frequency Questionnaire. The mean intake of dietary fiber was 16 g/day according to the food record and 21 g/day according to the SWFFQ. Fruits, vegetables, breads, cereals, and beans provided for most of the participants' dietary fiber intake. These results support evidence that the Hispanic population's dietary fiber intake is higher than that for other groups, and this may help explain the lower incidence of breast cancer among some Hispanic populations.

Intermediate-term outcome of transcatheter secundum atrial septal defect closure using the Bard Clamshell Septal Umbrella.

Of 31 patients who underwent transcatheter atrial septal defect occlusion with the Bard Clamshell Septal Umbrella, only 1 had a clinically significant residual atrial septal defect at a mean follow-up of 41 months. All patients were asymptomatic despite the occurrence of device arm fractures in 84% of these patients.

Management of pediatric patients with isolated valvar aortic stenosis by balloon aortic valvuloplasty.

Moderate to severe aortic stenosis in children requires an initial procedure to improve the stenosis and often additional procedures for recurrent stenosis or aortic insufficiency before adulthood. The purpose of this study was to evaluate children who underwent balloon valvuloplasty and were followed with a specific management plan. Twenty-two children with aortic stenosis underwent balloon valvuloplasty and were followed on a regular basis. Repeat valvuloplasty was performed if indicated. The initial gradient was reduced from 63 +/- 9 mmHg to 28 +/- 8 mmHg (P < 0.001). There were no deaths and only one major complication, which had no sequelae. Average follow-up was 61 +/- 23 months. Three patients required valve replacement 39-76 months after valvuloplasty for progressive insufficiency. Seven patients underwent successful repeat valvuloplasty. The overall probability of survival without surgical intervention was 75% at 100 months. Balloon valvuloplasty is an effective intermediate palliation for aortic stenosis and is an acceptable alternative to surgical valvotomy. Repeat valvuloplasty is successful without additional risk. In a subgroup of patients, aortic insufficiency is progressive and will require surgical intervention.

Stress responses of emergency services personnel to the Loma Prieta earthquake Interstate 880 freeway collapse and control traumatic incidents.

A three-group quasi-experimental design contrasted the responses of rescue workers to the 1989 Loma Prieta earthquake Interstate 880 freeway collapse (n = 198) with responses to critical incident exposure of Bay Area Controls (n = 140) and San Diego Controls (n = 101). The three groups were strikingly similar with respect to demographics and years of emergency service. The I-880 group reported higher exposure, greater immediate threat appraisal, and more sick days. The three groups did not differ on current symptoms. For the sample as a whole EMT/Paramedics reported higher peritraumatic dissociation compared with Police. EMT/Paramedics and California road workers reported higher symptoms compared with Police and Fire personnel. Nine percent of the sample were characterized as having symptom levels typical of psychiatric outpatients. Compared with lower distress responders, those with greater distress reported greater exposure, greater peritraumatic emotional distress, greater peritraumatic dissociation, greater perceived threat, and less preparation for the critical incident.

Improvement in noninvasive electrophysiologic findings in children after transcatheter atrial septal defect closure.

To evaluate whether transcatheter closure of secundum atrial septal defects (ASD) affected noninvasive electrophysiologic variables in children, we reviewed the pre-procedural and 1-year postprocedural electrocardiograms and Holter recordings of 18 consecutive children referred for ASD closure. Patients included in the study were a mean of 5.0 years old (SD 1.1) and weighed a mean of 17.9 kg (SD 4.1). ASDs had a mean diameter of 14.0 mm (SD 2.4) and average shunt ratio (pulmonary-to-systemic flow) of 2.1:1. One year after occluder device placement, 9 children (50%) had detectable residual shunts by transthoracic echocardiograms, but only 2 (11%) had shunts that were felt to be possibly significant. One or more fractured occluder legs were noted by chest roentgenogram in 15 patients (83%). Electrocardiograms at follow-up demonstrated improvement in right ventricular dilation in 4 of 7 patients, right atrial enlargement in 3 of 4 patients, and 1 degree atrioventricular block in 2 of 3 patients. Holter recordings showed a decreased incidence of accelerated atrial rhythm in 3 of 7 patients, prolonged junctional escape rhythm in 2 of 2 patients, and premature atrial contractions in 2 of 2 patients. No finding correlated with patient age, defect or occluder diameter, occluder leg fracture(s), or residual defects. These improvements in electrophysiologic abnormalities compare favorably with changes seen 1 year after surgical closure. In conclusion, placement of a transcatheter ASD device in children diminishes noninvasive electrophysiologic abnormalities at 1-year follow-up. By relieving hemodynamic stress caused by an ASD in childhood, a transcatheter device may prevent arrhythmia disturbance later in life.

Massive ascites as a complication of severe preeclampsia. A case report.

A woman with severe preeclampsia and a vertex presentation at 31 weeks' gestation delivered by cesarean section, at which time massive abdominal ascites was found. Over 2 L of ascitic fluid was removed at the time of the section. Due to the rate at which ascitic fluid was accumulating at the time of the section, an abdominal drain was placed. Over the next three days 12 L more of ascitic fluid was removed.

Effect of centrally administered oxytocin on the association between cortical electroencephalogram and milk ejection in the rat.

Abstract The milk-ejection reflex of the rat is closely associated with synchronized activity of the cortical electroencephalogram (EEG), and the frequency of milk ejections has been shown to be greatly facilitated by central oxytocin. The following experiments were undertaken to examine the changes in the EEG during facilitation of the reflex by central oxytocin. Intracerebroventricular injection of 1 mU (2.2 ng) oxytocin during suckling caused a rapid increase in the frequency of milk ejections but no change in the predominantly synchronized pattern of the EEG. However, after a delay (11.3 +/- 0.8 min, mean +/- SE) there appeared to be an increasing proportion of desynchronization, which correlated with cessation of the facilitated milk-ejection responses. Hence, the observed EEG desynchronization may signal activation of mechanisms inhibitory to the milk-ejection reflex. In the absence of the suckling stimulus oxytocin also caused a change to desynchronization. However, this effect was more pronounced and commenced after a much shorter latency (1.7 +/- 0.4 min, mean +/- SE; P < 1.001), suggesting that the desynchronizing effect of oxytocin on the EEG can be attenuated by the suckling stimulus. These results demonstrate two phases in the action of central oxytocin in the suckled rat. During the initial phase, the milk-ejection reflex is facilitated and although there may be a concomitant desynchronizing influence on the EEG this is prevented by the influence of the suckling stimulus. In the later phase, this desynchronizing influence predominates and is accompanied by cessation of milk-ejection responses. Although milk ejections were generally restricted to periods of a synchronized EEG as previously reported, during the oxytocin-induced change to desynchronization a number of milk ejections were observed to occur in the absence of a synchronized EEG. These results provide further evidence that the association between milk ejection and the EEG state is not an absolute causal relationship.

Chronic massive fetomaternal hemorrhage: a case report.

We report a case of massive chronic fetomaternal hemorrhage with remarkable fetal compensation. The labor course was complicated by a fetal heart rate pattern showing decreased long- and short-term variability and the eventual development of persistent late decelerations. The fetal scalp blood pH and cord blood pH values were normal. A living male infant was delivered by cesarean section for persistent late decelerations. A Kleihauer-Betke stain on a maternal blood sample was positive at 14.5%, which is equivalent to 700 mL of fetal blood in the maternal circulation.

An analysis of policies regulating medication in Ohio public schools.

The development of medicines, state and federal laws requiring the enrollment and mainstreaming of handicapped students and the use of behavior modifying drugs has resulted in more requests by parents to have medication administered to their children during school hours. The problem in schools without immediate access to nurses is to accommodate students who need medication while at the same time avoid the dangers that are inherent in administering medication to children. The purpose of this investigation was to determine what guidelines are being followed in Ohio schools on the storage and administration of prescribed medication. Policies and regulations on the administration of medication, solicited from a random sample of Ohio school districts, were found to be not in keeping with pertinent legislation, litigation and recommended procedures. The investigation of the sample districts revealed enough inadequacies to suggest that: 1) many Ohio school districts need formal policies and regulations in the administration of medication; and 2) Ohio school districts having policies and regulations in the administration of medication should seriously consider eliminating whatever inadequacies exist for the safety and well-being of students and staff. A sample board policy statement, regulations for administering prescription and nonprescription medication in schools, a request form and a model statute designed to protect the employee from tort liability as a result of ordinary negligence in the administration of medication were developed in keeping with the findings of this study and are recommended for consideration as models by school districts nationwide.