African partnerships for patient safety: a vehicle for enhancing patient safety across two continents. [corrected].

African Partnerships for Patient Safety (APPS) aims to develop sustainable partnerships between hospitals in Africa and Europe to create a network of beacon hospitals for patient safety. The three core APPS objectives are focused on building strong patient safety partnerships between hospitals in Africa and Europe, implementing patient safety improvements in each partnership hospital on 12 patient safety action areas, and facilitating spread of patient safety improvements. APPS is working with six first wave hospital partnerships and will capture and report learning from implementation. A range of APPS resources will shortly be available to hospitals working on patient safety systems.

Meeting the needs of abused older women? A british columbia and yukon transition house survey.

ABSTRACT Older women victims of violence by a partner or family member are more often categorized as victims of elder abuse, not victims of family violence. Their needs are assessed, if at all, by social and health service agencies, often with little knowledge or understanding of domestic violence, while domestic violence policy initiatives, advocacy, and services focus on younger women and children. A survey of domestic violence services in British Columbia and the Yukon found that women over 60 years of age were a very small fraction, generally less than two percent, of women served, and those 50 to 59 years of age were also substantially under-represented. Only four percent of respondents had special services for older women. Comments from respondents confirm that abused older women face enormous difficulties in trying to establish a safe and secure future. It was also evident that better interaction is needed between those providing support and advocacy for abused women, and those who provide health and social services for older persons. A majority of the shelters provided community education to a wide range of agencies. Most have only partial accessibility to women with mobility handicaps.

Variation of 222Rn in public drinking water supplies.

The U.S. Environmental Protection Agency has proposed regulating 222Rn in public drinking water. When implemented, the regulation will require periodic sampling to demonstrate compliance. The work reported in this paper was conducted to evaluate how reliably grab samples can be used to characterize the average 222Rn concentration in a groundwater source. Periodic samples were collected from 14 wells over sampling periods ranging from 2 to 26 mo. Samples were collected using a "slow-flow" collection method, and samples were analyzed using liquid scintillation techniques. The results reveal variation in 222Rn concentration over the study period; however, for the 1,468 samples collected from the 14 wells, approximately 97% of the measurement results were within 30% of the mean value for the well.

222Rn in water: a study of two sample collection methods, effects of mailing samples, and temporal variation of concentrations in North Carolina groundwater.

The U.S. Environmental Protection Agency has proposed a drinking water standard for 222Rn in public water supplies. When promulgated, operators of public water supplies will be required to determine water 222Rn concentrations. Most likely, water samples will be collected and mailed to laboratories for analyses. Additionally, it is probable that homeowners will test private well water in a similar manner by collecting water samples and mailing them to a laboratory for 222Rn analyses. In anticipation of these actions, this study was conducted to evaluate two methods of water sample collection and to evaluate the potential losses of 222Rn from water samples mailed to a laboratory. Thirdly, temporal variations in 222Rn concentrations in several groundwater supplies in North Carolina were examined. Water supplies at four sites in eastern North Carolina and five sites in western North Carolina were sampled over a 7-mo period beginning in the fall of 1993 and continuing through the spring of 1994. Samples were analyzed using a liquid scintillation method. This study showed that a "slow-flow" method is not only suitable for sample collection, but may be the preferable method for water sample collection since slow-flow collection resulted in less 222Rn loss than was observed during syringe collection, i.e., the water 222Rn concentrations in samples collected by the slow-flow method were generally higher. Further, based on this study, mailing water samples to a laboratory for analysis should not have a substantial effect on the measured 222Rn concentrations. Consequently, water samples can be collected by the slow-flow method by water supply operators, as well as homeowners, and mailed to laboratories for 222Rn analyses with reasonable assurance that the samples have not suffered significant 222Rn loss. Temporal variations in water 222Rn concentrations were observed in this study. One factor complicating the study of temporal variations in 222Rn concentrations was the striking influence that inconstant water usage and inadequate well purging prior to sample collection had on 222Rn loss from the water.

Intramembranous bone matrix is osteoinductive.

All known bone-derived osteoinductive factors have been isolated from endochondral (EC) bones and all initiate bone induction via EC ossification. However, to date no attempt has been made to isolate comparable factors from bones which form initially and completely via intramembranous (IM) ossification. The purpose of this work was to isolate osteoinductive proteins from IM bones. To accomplish this, we extracted proteins from bovine frontal bone matrix (intramembranous origin) using methods previously described for endochondral (EC) bone matrix (i.e., femur). Bone powder (< 1 mm) was decalcified and proteins extracted with 4 M guanidine hydrochloride. Ultrafiltration was used to isolate and concentrate a 10-100 kilodalton (kDa) fraction, upon which heparin-Sepharose (HS) affinity chromatography was performed. HS-binding (HS-B) and non-binding proteins (HS-NB) were lyophilized with bovine type I collagen (Vitrogen) to form pellets which were implanted subcutaneously in rats. Radiology as well as brightfield, fluorescent, and polarizing microscopy were used to assess the formation of ectopic bone at the site of pellet implantation. In this report we demonstrate that a heparin-Sepharose binding, osteoinductive factor can be extracted and partially purified from bovine intramembranous bone matrix. This factor has a different sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) banding pattern than a comparable osteoinductive/chondroinductive factor isolated from EC bone.

Impact of community-based instruction on the development of adaptive behavior of secondary-level students with mental retardation.

The impact of community-based instruction on the development of adaptive behavior in 34 high school students with moderate to profound mental retardation was examined. Results were: (a) Students made statistically significant gains in three of four domains of the Scales of Independent Behavior; (b) student IQ, level of student ambulation, and presence of behavior problems were not significant predictors of the amount of community-based instruction students received; and (c) the amount of community-based instruction was a more powerful predictor of gains in these domains than were IQ, level of student ambulation, and the presence of behavior problems. Results were discussed in terms of implications for the design and implementation of secondary programs for students with mental retardation.

The matrix of endochondral bone differs from the matrix of intramembranous bone.

Osseous tissue develops via two distinctly different processes: endochondral (EC) ossification and intramembranous (IM) ossification. The present study tests the hypothesis that each type of osseous tissue contains unique inducing factors for the promotion of cartilage and bone development. Previous work suggests that subcutaneous implants of demineralized EC and IM bone matrices both induce endochondral ossification. Thus, it concludes that the bone growth promotion properties of the respective matrices are very similar. As it was unclear to us why EC and IM bone powders should possess identical osteoinductive properties, we attempted to reproduce these results. We implanted EC (femoral) demineralized bone matrix (DBM), IM (frontal) DBM, or a mixture of the two into the ventral thoracic subcutaneous tissue of 12 to 15-week-old male Sprague Dawley rats. Morphological and radiolabeling techniques in this study demonstrated that implants of EC bone matrix induce bone formation via EC ossification in contrast to implants of IM bone matrix which do not induce EC ossification. Our findings suggest that the matrix of EC bone differs qualitatively from the matrix of IM bone due to their respective abilities to induce cartilage and/or bone formation. These observations differ from those previously reported possibly because our IM DBM preparations were not contaminated with tissues of endochondral origin. In current clinical practice, EC DBM allografts are often used to induce new bone formation in defects involving both IM and EC bone. We conclude that there may be clinical settings in which it would be more appropriate to replace bone originally formed via IM ossification with IM DBM rather than EC DBM.

Regulation of acid secretion by bombesin/GRP neurons of the gastric fundus.

Intramural neurons in the fundus of the isolated mouse stomach were activated by 1,1-dimethyl-4-phenylpiperazinium (DMPP) or by electrical field stimulation and the participation of cholinergic and bombesin/gastrin-releasing peptide (GRP) neurons in the regulation of acid secretion evaluated with atropine and a selective bombesin/GRP antagonist, [Leu13-psi(CH2NH)-Leu14]bombesin. For both DMPP and field stimulation, atropine inhibited acid secretion and augmented somatostatin secretion. The bombesin/GRP antagonist had an opposite effect, augmenting acid secretion and inhibiting somatostatin secretion to below basal levels. The combination of the two antagonists restored DMPP- and field-stimulated acid and somatostatin secretion to basal levels. The results indicate that neurally stimulated acid secretion in the isolated mouse stomach is regulated by cholinergic neurons that mediate stimulation and bombesin/GRP neurons that mediate inhibition of acid secretion. Cholinergic neurons exert their stimulatory effect by acting directly on parietal cells and indirectly by eliminating the inhibitory influence of somatostatin. Bombesin/GRP neurons exert their inhibitory effect mainly by inducing release of somatostatin; an additional direct inhibitory effect of bombesin/GRP neurons on parietal cells is possible.

Functionally distinct muscarinic receptors on gastric somatostatin cells.

The present study was designed to examine the mode of action of muscarinic agonists on somatostatin secretion in intact gastric tissues, i.e., mucosal segments from the fundus and antrum of rat and the isolated luminally perfused mouse stomach. Methacholine caused similar decreases in somatostatin secretion in segments from the fundus (35 +/- 3%; P less than 0.001) and antrum (35 +/- 2%; P less than 0.001) of rat stomach, and in whole mouse stomach (43 +/- 3%; P less than 0.001). The decrease was the net effect of a dominant inhibition and a lesser stimulation of somatostatin secretion. Pretreatment with the permeant derivative of the acetomethoxy ester form of the calcium chelator 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (BAPTA/AM, 15 microM) caused a further decrease in methacholine-induced somatostatin secretion, implying that a stimulatory component existed that was mediated by intracellular calcium. Pretreatment with pertussis toxin (125 ng/ml) for 60 min converted the decrease in somatostatin secretion to an increase above basal levels. The increase induced by pretreatment with pertussis toxin was abolished by additional pretreatment with BAPTA/AM. Procaine (5 mM), which blocks release of calcium from intracellular stores, produced an effect on somatostatin secretion similar to that of BAPTA/AM. The results indicate that 1) methacholine exerts dual inhibitory and stimulatory effects on somatostatin cells of rat and mouse stomach, 2) the dominant effect is inhibitory and sensitive to pertussis toxin, and 3) a concurrent stimulatory effect, mediated by calcium, is unmasked after blockade of the inhibitory effect with pertussis toxin.

Employment preparation for high school students with severe handicaps.

An ecological model for employment preparation in high schools that is based upon successful postschool community job placement for students with severe handicaps was discussed. The functions of employment training were analyzed, the components of a community-referenced model for high school training described, and implications drawn for model utility in relation to curriculum and instruction in high school programs.

Inhibition of acid secretion by bombesin is partly mediated by release of fundic somatostatin.

The effect and mode of action of bombesin on gastric acid secretion was examined in the isolated, luminally perfused mouse stomach. Bombesin caused a concentration-dependent inhibition of basal and histamine-stimulated acid secretion and an increase in somatostatin secretion. Pertussis toxin was used to determine the contribution of somatostatin to the observed inhibition of acid secretion. Previous studies have shown that at a concentration of 125 ng/ml, pertussis toxin reverses completely the inhibition of acid secretion induced by exogenous and endogenous somatostatin. Preincubation of the stomach for 60 min with pertussis toxin (125 and 1250 ng/ml) reversed partially the inhibitory effect of bombesin on basal and histamine-stimulated acid secretion by 51%-59%, implying that bombesin-induced inhibition was partly mediated by release of somatostatin. The residual inhibition may represent a direct effect of bombesin on parietal cells.

Systemic injection of group A streptococcal peptidoglycan-polysaccharide complexes elicits persistent neutrophilia and monocytosis associated with polyarthritis in rats.

The perpetuation of inflammatory changes within joints elicited by persisting, poorly biodegradable group A streptococcal cell walls (peptidoglycan-polysaccharide complexes [PG-PS]) is well documented. Chronic changes in the bloodstream induced by PG-PS have not been described previously. We demonstrated that leukocytosis occurs within 3 days after intraperitoneal injection of PG-PS and remains elevated 20 weeks later. Chronic neutrophilia, monocytosis, and lymphocytosis were observed in all experiments. Chronic changes in platelet, erythrocyte, and reticulocyte counts were not seen. The newly documented leukocytosis, lasting for months after PG-PS administration, provided a circulating pool of leukocytes that may participate in chronic inflammatory events in the joint. Although the central role of the macrophage in PG-PS-mediated inflammation has been emphasized (F. G. Dalldorf, W. J. Cromartie, S. K. Anderle, R. L. Clark, and J. H. Schwab, Am. J. Pathol. 100:383-402, 1980), the polymorphonuclear cell may be involved in periods of exacerbation of streptococcal cell wall-mediated polyarthritis. This was supported by our observations that neutrophilia and monocytosis correlate well with the degree of chronic joint inflammation.

Linkage between somatostatin and acid secretion: evidence from use of pertussis toxin.

Pertussis toxin was used to examine the functional linkage between somatostatin and acid secretion and the mode of action of somatostatin at the cellular level in the isolated luminally perfused mouse stomach. Pretreatment of the stomach with pertussis toxin (125-1,250 ng/ml) for 60 min 1) caused a significant twofold increase in histamine-stimulated acid secretion (from 42 +/- 7 to 82 +/- 12 nmol/min; P less than 0.01) but not pentagastrin-stimulated secretion and 2) blocked the inhibitory effect of somatostatin on basal and histamine-stimulated acid secretion but not on pentagastrin-stimulated acid secretion. The ability of pertussis toxin to reverse selectively the inhibitory effect of somatostatin on histamine-stimulated acid secretion is consistent with the ability of pertussis toxin to inactivate a guanine nucleotide binding protein, which couples somatostatin receptors to inhibition of adenylate cyclase; histamine, but not gastrin, stimulates acid secretion via activation of adenylate cyclase. Secretagogue-stimulated acid secretion was accompanied by a parallel increase in somatostatin secretion that is largely determined by luminal acidity. The augmentation of histamine-stimulated acid secretion after treatment with pertussis toxin implied that the concomitant increase in somatostatin secretion is coupled to acid secretion and acts to attenuate it. The results confirm the role of gastric somatostatin as a paracrine regulator of acid secretion.

Effects of acute graft-vs-host disease on the liver of the brown Norway rat.

In this study we examined the effects of acute graft-vs-host disease (aGVHD) on the Brown Norway (BN) rat liver. When clinical signs of the disease appeared, rats were inoculated with fluorescent latex beads and 30 min later nonparenchymal cells were isolated from the liver. The cells were then analyzed via flow cytometry, histochemistry, and electron microscopy. Flow cytometry demonstrated that 58% of the cells from the 80 ml/min elutriation fraction (normally rich in Kupffer cells) of the non-GVHD liver had high fluorescence intensity compared to 8% in rats with aGVHD. Determination of the cellular composition of the various fractions with electron microscopy confirmed flow cytometry observations in that only 9% of the 80 ml/min elutriation fraction of GVHD livers had peroxidase-positive rough ER and the morphological appearance of macrophages as compared to 60% in the non-GVHD liver. The low percentage of fluorescent-positive Kupffer cells in the 80 ml/min elutriation fraction of the GVHD liver is attributed to a massive lymphocytic invasion of the liver and not necessarily to a defect in the mononuclear phagocyte system.

An ultrastructural examination of murine alveolar macrophages following intranasal administration of propionibacterium acnes.

Light and electron microscopic analysis of murine lungs or isolated pulmonary cells was performed three days after intranasal administration of the bacterial immunostimulant, Propionibacterium acnes (P. acnes). Our observations indicated that pulmonary alveolar and airway macrophages (PAMs) were the only cells with P. acnes bacilli in their cytoplasm. Bacilli were not observed in pulmonary interstitial macrophages, granulocytes, lymphocytes or pulmonary parenchymal cells such as type I and type II pneumocytes. Because of the morphological heterogeneity of PAMs observed in control and experimental animals, it was not possible from these studies to be certain about the relative abundance or complexity of lysosomes, endoplasmic reticulum, Golgi and other organelles in the two groups. However, we noted that it was not uncommon to observe in the same PAM, profiles of P. acnes and a well developed Golgi complex and endoplasmic reticulum. These P. acnes--associated morphological alterations occurred at a time when functional activities (e.g., phagocytosis, cytostasis) of PAMs were enhanced.