We have isolated a complementary DNA clone containing sequences homologous to those encoding the alpha-subunit of a mouse muscle nicotinic acetylcholine receptor. Based on the structural similarities between the encoded protein and the muscle acetylcholine receptor alpha-subunit, and the presence of hybridizing RNA species in the brain, we propose that this clone codes for a neural nicotinic acetylcholine receptor alpha-subunit.

Amino Acid Sequence↗

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Acute care functional assessment begins at the bedside.

Patient functional ability is a determining factor in successful discharge and self-care. A model for improving the use of functional assessment in the acute care setting gives the bedside registered nurse a tool to manage care.

Activities of Daily Living↗

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Integrated treatment for the survivor of childhood trauma who is chemically dependent.

A substantial percentage of individuals who are chemically dependent also suffer from posttraumatic stress disorder and other survivor syndromes related to childhood abuse. The synergism of these multiple conditions creates unique treatment challenges. An enhanced, integrated treatment approach increases the chances of a successful clinical outcome. This article discusses a treatment model for chemical dependence and trauma-related syndromes that blends mental health and 12-Step and other chemical dependence treatment notions into an integrated approach that treats both disorders simultaneously and comprehensively. The model uses the strategic principle of "safety first" to drive all interventions and has five stages to organize the selection and timing of treatment tactics: crisis, skills, education, integration, and maintenance. This article also presents specific therapeutic tactics for each stage and a composit case example blending the history and recovery process of a survivor to illustrate the model in action.

Child↗

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An outbreak of hepatitis A associated with an infected foodhandler.

OBJECTIVE: The recommended criteria for public notification of a hepatitis A virus (HAV)-infected foodhandler include assessment of the foodhandler's hygiene and symptoms. In October 1994, a Kentucky health department received a report of a catering company foodhandler with hepatitis A. Patrons were not offered immune globulin because the foodhandler's hygiene was assessed to be good and he denied having diarrhea. During early November, 29 cases of hepatitis A were reported among people who had attended an event catered by this company. Two local health departments and the Centers for Disease Control and Prevention, in collaboration with two state health departments, undertook an investigation to determine the extent of the outbreak, to identify the foods and event characteristics associated with illness, and to investigate the apparent failure of the criteria for determining when immune globulin (IG) should be offered to exposed members of the public. METHODS: Cases were IgM anti-HAV-positive people with onset of symptoms during October or November who had eaten foods prepared by the catering company. To determine the outbreak's extent and factors associated with illness, the authors interviewed all case patients and the infected foodhandler and collected information on menus and other event characteristics. To investigate characteristics of events associated with transmission, the authors conducted a retrospective analysis comparing the risk of illness by selected event characteristics. To evaluate what foods were associated with illness, they conducted a retrospective cohort study of attendees of four events with high attack rates. RESULTS: A total of 91 cases were identified. At least one case was reported from 21 (51%) of the 41 catered events. The overall attack rate was 7% among the 1318 people who attended these events (range 0 to 75% per event). Attending an event at which there was no on-site sink (relative risk [RR] = 2.3, 95% confidence interval [CI] 1.4, 3.8) or no on-site kitchen (RR = 1.9, 95% Cl 1.1, 2.9) was associated with illness. For three events with high attack rates, eating at least one of several uncooked foods was associated with illness, with RRs ranging from 8 to undefined. CONCLUSION: A large hepatitis A outbreak resulted from an infected foodhandler with apparent good hygiene and no reported diarrhea who prepared many uncooked foods served at catered events. Assessing hygiene and symptoms s subjective, and may be difficult to accomplish. The effectiveness of the recommended criteria for determining when IG should be provided to exposed members of the public needs to be evaluated.

Adult↗

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Quality assurance--a positive approach.

Explore the source record for details and available documents.

Humans↗

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Introducing total quality management.

Total quality management is a system that could pay dividends for National Health Service managers and employees but would require a change of culture, from one of crisis response to problems to one preventing them from happening in the first place. This article introduces the concept and describes the preconditions for its successful application.

Health Personnel↗

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Emergency services for children and young people.

The health care needs of a child are very different to those of an adult but when it comes to paediatric care in the accident and emergency department there is little or no consideration of children's specific needs. This article describes the present situation and makes recommendations for the future.

Adult↗