On the road again: assessing driving ability in patients with neurological conditions.

Clinicians may not be aware of the specialised methods and adaptations that are used to help people with disabilities to drive a car. We describe a driving assessment process as carried out by one of the UK's flagship assessment centres, including an overview of the available assessments, adaptations and relevant legislation to guide practitioners about how best to signpost and counsel their patients appropriately about driving.

An Interface for the Direct Coupling of Small Liquid Samples to AMS.

We describe the moving wire interface attached to the 1-MV AMS system at LLNL's Center for Accelerator Mass Spectrometry for the analysis of nonvolatile liquid samples as either discrete drops or from the direct output of biochemical separatory instrumentation, such as high-performance liquid chromatography. Discrete samples containing at least a few 10s of nanograms of carbon and as little as 50 zmol 14C can be measured with a 3-5% precision in a few minutes. The dynamic range of our system spans approximately 3 orders in magnitude. Sample to sample memory is minimized by the use of fresh targets for each discrete sample or by minimizing the amount of carbon present in a peak generated by an HPLC containing a significant amount of 14C. Liquid Sample AMS provides a new technology to expand our biomedical AMS program by enabling the capability to measure low-level biochemicals in extremely small samples that would otherwise be inaccessible.

DNA-independent transport of plasmid primase protein between bacteria by the I1 conjugation system.

The ColIb-P9 (IncI1)-encoded conjugation system supports transfer of the plasmid T-strand plus hundreds of molecules of the Sog polypeptides determined by the plasmid primase gene. Here, we report that Sog primase is abundantly donated to the recipient cell from cells carrying a non-transferable ColIb plasmid deleted of the nic site essential for DNA export. Such DNA-independent secretion of Sog primase is typical of authentic conjugation, both in being blocked when the recipient cell specifies the entry exclusion function of ColIb and in requiring the thin I1 pilus encoded by the ColIb pil system under the mating conditions used. It is proposed that Sog polypeptides form a complex with the ColIb T-strand during conjugation and aid DNA transport through processive secretion of the proteins into the recipient cell. Functional and genetic relationships between the ColIb conjugation system and other type IV secretion pathways are discussed.

Transient transcriptional activation of the Incl1 plasmid anti-restriction gene (ardA) and SOS inhibition gene (psiB) early in conjugating recipient bacteria.

The ardA gene of the enterobacterial plasmid CollbP-9 acts to alleviate restriction of DNA by type I systems, while psiB inhibits induction of the bacterial SOS response. Both genes are transferred early in a round of bacterial conjugation as part of the plasmid leading region. We report here that ardA and psiB are transcribed transiently after their conjugative transport into the recipient cell. Transcript levels, monitored by competitive reverse transcription-polymerase chain reaction (RT-PCR) amplification of RNA templates, started to increase about 5 min after the initiation of conjugation in a cell population and probably before the first round of plasmid transfer was completed. Genetic evidence is given that the expression of ardA and psiB is activated when the genes enter the recipient cell on the transferring plasmid strand. It is proposed that these and other leading region genes function to promote the establishment of the immigrant plasmid in the new host and are expressed by transcription from promoters active only in single-stranded DNA.

Work process redesign at Vanderbilt University Medical Center's Transfusion Service.

Work process redesign is an effective tool to assist laboratories in identifying areas for improvement. This article presents the experiences and results of Vanderbilt University Medical Center's Transfusion Service in undergoing a work process redesign project to reduce costs and increase growth potential. Opportunities for improvement were identified, and processes were redesigned to enhance efficiencies and increase workload capacity. Areas where opportunities for improvement were identified included work-flow, work process, personnel usage, task delegation, information transfer, physical layout, and communication. The thorough review and redesign of the work processes resulted in a greater demonstrated workload capacity of 381% for pretransfusion testing (antibody screens ABO/D typing, and immediate-spin crossmatches), using no additional FTEs.

Distribution of restriction enzyme recognition sequences on broad host range plasmid RP4: molecular and evolutionary implications.

IncP alpha plasmids, exemplified by RP4, are remarkable for their broad host range. They contain strikingly few cleavage sites for many commonly used type II restriction enzymes but an overabundance of sites for certain enzymes that target G + C-rich sequences. To identify factors responsible for these distributions, the recently compiled nucleotide sequence of RP4 was analysed to determine the frequency of tetra- and hexanucleotide motifs in the 49 kb plasmid backbone. This is defined as the sectors encoding basic plasmid functions. The overabundant restriction targets in RP4 are concentrated in the backbone and contain overlapping copies of CGGC/GCCG, identified as the most abundant tetranucleotide motif in the plasmid. Motif frequencies in the RP4 backbone are shown to be similar to those in Pseudomonas aeruginosa, a natural host of RP4, with the notable exception that a number of 6-bp palindromes are underrepresented in the plasmid. It is proposed that 6-bp palindromes were counterselected as type II restriction enzyme recognition sequences. Conjugative transfer of RP4 and R751 (IncP beta) is unusually sensitive to restriction compared to enterobacterial plasmids of the IncFII and IncI1 groups, implying that IncP plasmids experienced particularly strong selection for loss of restriction targets. Pseudomonas spp. of rRNA homology group I specify many type II restriction enzymes that target 6-bp palindromes and are candidates for the evolutionary hosts of IncP alpha plasmids.

Evasion of type I and type II DNA restriction systems by IncI1 plasmid CoIIb-P9 during transfer by bacterial conjugation.

Transmission of unmodified plasmid CoIIb-P9 by bacterial conjugation is markedly resistant to restriction compared with transfer by transformation. One process allowing evasion of type I and II restriction systems involves conjugative transfer of multiple copies of the plasmid. A more specialized evasion mechanism requires the Ard (alleviation of restriction of DNA) system encoded by CoIIb. The ard gene is transferred early in conjugation and specifically alleviates DNA restriction by all known families of type I enzyme, including EcoK. CoIIb has no effect on EcoK modification but this activity is impaired by multicopy recombinant plasmids supporting overexpression of ard. Genetic evidence shows that Ard protects CoIIb from EcoK restriction following conjugative transfer and that this protection requires expression of the gene on the immigrant plasmid. It is proposed that carriage of ard facilitates transfer of CoIIb between its natural enterobacterial hosts and that the route of DNA entry is important to the restriction-evasion mechanism.

Autologous blood transfusion.

Autologous blood transfusion is emerging as a popular option in patients undergoing elective procedures. Predeposit and perioperative autotransfusion, the two major types of autologous transfusion, can be performed safely in a wide variety of conditions and in patients of all ages. We discuss the risks and benefits and outline the minimal requirements of donor-patients. Autologous blood transfusion is a safe and effective method of providing blood products. It is the safest transfusion practice.

Paralisia do olhar conjugado lateral associada a oftalmoplegia internuclear unilateral em hemorragia mesencéfalo-pontina alta: relato de um caso / Combined lateral gaze palsy with unilateral internuclear ophthalmoplegia in high mesencephalo-pontine hemorrhage: report of a case

Relata-se um caso de hemorragia mesencéfalo-pontina alta direita, com oftalmoplegia extrínseca, permanecendo apenas a convergência bilateral, a abduçäo voluntária e automático-reflexa do olho esquerdo, e a aduçäo deste olho na pesquisa dos reflexos vestíbulo-oculares ("one-and-a-half syndrome") Ainda, havia dissociaçäo voluntária-automático da motricidade das pálpebras e dos movimentos conjugados verticais e, também, hemiplegia sensitivo-motora à esquerda e asterixis

Edema pulmonar neurogênico: estudo de caso / Neurogenic pulmonary edema: study of a case

Relata-se um caso de edema pulmonar agudo como complicaçäo imediata de acidente vascular cerebral hemorrágico. Também revisa-se sumariamente a literatura quanto à fisiopatogenia e ao tratamento

Observaçöes sobre distúrbios dos movimentos oculares conjugados horizontais: as dissociaçöes voluntário-automático-reflexas / Conjugate horizontal eye movements disorders: the voluntary-automatic-reflexes dissociations

Estudam-se as dissociaçöes da motricidade ocular voluntária, automática e reflexa, segundo o modelo de Hughlings Jackson, baseados em dois casos com lesöes pontinas medianas, um caso com lesäo mesencéfalo-pontina alta e um caso com lesäo de gânglios da base e atrofia cortical (doença de Wilson). Também revisam sumariamente a interaçäo destes sistemas e as vias anatômicas envolvidas

Observacoes sobre disturbios dos movimentos oculares conjugados horizontais : as dissociacoes voluntario-automatico-reflexas

Os autores estudam as dissociacoes da motricidade ocular voluntaria, automatica e reflexa, segundo o modelo de Hughlins Jackson, baseados em dois casos em lesoes pontinas medianas, um caso com lesao mesencefalo-pontina alta e um caso com lesao de ganglios da base e atrofia cortical (doenca de Wilson). Tambem revisao sumariamente a interacao destes sistemas a as vias anatomicas envolvidas.

Edema pulmonar neurogenico: estudo de caso

Os autores relatam um caso de edema pulmonar agudo como complicacao imediata de acidente vascular cerebral hemorragico. Tambem revisam sumariamente a literatura quanto a fisiopatologia e ao tratamento.

Evaluative research on a therapeutic community for adolescents.

Findings from a 2-year research effort assessing the efficacy of the Young People's Unit (YPU) of Friends Hospital are presented. In one study, 79 patients were tested with the Offer Self-image Questionnaire for Adolescents (OSIQ) at the time of their admission to the YPU and at the time of their discharge (50 days later on the average). Data indicate significant improvements on all 11 scales of the OSIQ, but some subgroups improved more than others. A representative sample of 29 patients responded to a third administration of the OSIQ approximately 1 year after their discharge. As a group, these patients had maintained their level of improvement - there were no significant differences between discharge and followup OSIQs. Augmenting the followup sample through telephone contacts, 59 former patients could be separated into 44 treatment successes and 15 less well-adjusted adolescents: no significant differences on their admission OSIQs or on their demographic characteristics could be found. The findings permit the conclusion that the residential treatment approach used here can produce significant improvements which are stable over time, at least for the group as a whole, but that some exceptions exist. Further studies into the reasons for treatment failure are needed. Implications of this research for the reassessment of the unit are discussed.