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Biomedical subjects

J Stout

Publications and source records attributed to J Stout.

49 records · Page 3Linked to original sources
PubMed1982

Potable water supply as the hospital reservoir for Pittsburgh pneumonia agent.

Both legionnaires' disease and pneumonia caused by Pittsburgh pneumonia agent (PPA) are endemic in the Veterans Administration Medical Center, Pittsburgh. 85% of cases of legionnaires' disease and 100% of the cases of PPA were acquired in hospital. A selective dye-containing medium which allows visual discrimination of Legionella pneumophila and PPA has been used in a large-scale environmental survey of the hospital. Samples from 53 sites, including hot-water storage tanks, showerheads, mixing valves, and taps from 19 wards, were cultured. PPA was isolated from 2 sites and L. pneumophila from 33 sites. Water from a tap in the surgical intensive-care unit yielded 6 colony-forming units (CFU) of PPA/0.1 ml and 300 CFU of L. pneumophila/0.1 ml after centrifugation. Water from the outlet valve of a hot-water storage tank yielded 10 CFU of L. pneumophila/0.1 ml and when concentrated by centrifugation also yielded 2 CFU of PPA/0.1 ml. PPA and L. pneumophila share the same environmental niche, but isolation of PPA is more difficult. It seems that the reservoir for PPA in the VA Medical Center is the hot-water distribution system. PPA and L. pneumophila were simultaneously isolated from the lung tissue of a patient in this hospital who died of hospital-acquired pneumonia; this finding supports the hypothesis of a common reservoir and mode of transmission for the two organisms.

Cross Infection↗
PubMed1975

Persistent pancreatic glucagon but not insulin response to arginine in pancreatectomized dogs.

Effects of total pancreatectomy on plasma glucagon, insulin and glucose responses to arginine were determined in 5 dogs. Portal vein and femoral artery samples were obtained in response to an arginine infusion (10 g/30 min) prior to, 1 h, 1 day and 1 week after pancreatectomy. Glucagon was measured using pancreatic-specific antiserum 30K (Unger, Dallas). Before pancreatectomy arginine significantly increased portal vein glucagon from 373 plus or minus 36 to 595 plus or minus 31 pg/ml and femoral artery levels from 233 plus or minus 28 to 342 plus or minus 74 pg/ml. Portal vein and femoral artery insulin concentrations of 74 plus or minus 21 and 17 plus or minus 3 muU/ml increased significantly to 173 plus or minus 64 and 31 plus or minus 7 muU/ml. Glucose levels did not change. One h after pancreatectomy, portal vein glucagon decreased to 121 plus or minus 15 pg/ml but increased to 230 plus or minus 42 pg/ml after arginine. Elevated blood glucose and the necessity for insulin treatment established the adequacy of pancreatectomy. Furthermore portal vein insulin levels were undetectable and unresponsive to arginine or a combination of glucose, glucagon, and tolbutamide 1 week after pancreatectomy. One day after pancreatectomy arginine significantly increased portal vein glucagon from 343 plus or minus 42 to 776 plus or minus 152 pg/ml. One week after pancreatectomy basal glucagon values were 374 plus or minus 30 in the portal vein and 360 plus or minus 49 in the femoral artery and responded to 1226 plus or minus 641 and 825 plus or minus 270 pg/ml, respectively, with arginine. Chromatography of plasma from one pancreatectomized dog on Sephadex G-50 after arginine stimulation revealed that much of the material cross-reacting with antibody 30K was eluted from the column earlier than either 125I-insulin or 125I-glucagon. In contrast, peak glucagon activity in plasma obtained from a normal human given arginine eluted from the column between the peak of 125I-insulin and 125I-glucagon; glucagon added to human plasma also was recovered in this same area between the 125I-insulin and 125I-glucagon peaks. These results suggest that some of the material that reacted with 30K antibody and which increased after pancreatectomy in response to arginine has a molecular weight greater than pancreatic glucagon. At autopsy no pancreatic tissue could be identified. Thus, after pancreatectomy, validated by absent insulin responses, the glucagon response to arginine was normal or increased. Since arginine is not thought to increase intestinal glucagon-like immunoreactive material, the source and nature of the material measured as glucagon after pancreatectomy is unknown, but may be important to any understanding of plasma glucagon measurements.

Animals↗
PubMedDate not supplied

All-advanced life support vs tiered-response ambulance systems.

In this discussion, two principal types of ambulance deployment systems were compared and contrasted: 1) the multipurpose, sole-provider all-advanced life support (all-ALS) ambulance system in which all ambulance-related services (emergent and nonemergent) for a city or region are provided by one fleet of ambulances, each of which is staffed by ALS providers (paramedics); and 2) the tiered ambulance system (tiered) in which some 911 ambulances are staffed by paramedics and others are staffed by basic emergency medical technicians (EMT-Bs) who provide basic life support (BLS) care. When managed with advanced system status management (SSM) techniques, the multipurpose, sole-provider all-ALS ambulance system can significantly reduce response intervals while simultaneously providing both fiscal and operational efficiencies. It can also be used to readily integrate and expand the scope of services for the ambulance provider service, such as interfacility transfers, thus increasing revenues. On the other hand, in large urban centers, the tiered ambulance system can be used to reduce response intervals to critical calls, primarily through the use of sophisticated dispatch triage protocols. This approach requires fewer paramedics in the system and appears, in some systems, to also provide medical care advantages in terms of skills utilization for individual ALS providers as well as a more concentrated focus for medical supervision. Therefore, both of these deployment systems can offer certain advantages depending on local emergency medical services (EMS) system needs as well as the local philosophy of health care delivery. Applicability must therefore be considered in terms of local service demands and other factors that affect the EMS system, including catchment population, statutory and jurisdictional issues, available funding, accessibility of receiving facilities, and medical quality concerns.

Ambulances↗