Palliative care for the poor and disenfranchised: a view from the Robert Wood Johnson Foundation.
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Ethnicity↗
Biomedical subjects
R Gibson
Publications and source records attributed to R Gibson.
Some nemerteans (Nemertea) from Queensland and the Great Barrier Reef, Australia.
Three species of marine nemerteans described and illustrated from Queensland and the Great Barrier Reef, Australia, include one new genus and two new species: these are the monostiliferous hoplonemerteans Thallasionemertes leucocephala gen. et sp. nov. and Correanemertes polyophthalma sp. nov. A new colour variety of the heteronemertean Micrura callima is also reported, this species previously only being known from Rottnest Island, Western Australia. A key for the field identification of the marine nemerteans recorded from coastal Queensland and the Great Barrier Reef is provided.
Animals↗
Evidence of a chronic systemic cause of instability of atherosclerotic plaques.
BACKGROUND: Major thrombotic and embolic complications of atherosclerosis are closely associated with irregularity and rupture of atheromatous plaques in both the carotid and coronary arteries. Plaque instability is partly determined by local factors, but systemic factors, such as infection, autoimmunity, or genes, may also be important. If plaque stability is influenced by systemic factors that are present in only a proportion of patients, some individuals should be more prone to rupture of plaques than others--ie, irregular plaques should occur in multiple vascular beds in some individuals more frequently than would be expected by chance alone. METHODS: We studied 5393 carotid bifurcation angiograms from 3007 patients with a recently symptomatic carotid stenosis. We assessed the extent to which plaque-surface irregularity at the symptomatic carotid artery was associated with irregularity at a distant site, the contralateral carotid artery, and the extent to which plaque irregularity at these sites was associated with previous myocardial infarction or subsequent non-stroke vascular death (due mainly to coronary-artery disease). FINDINGS: Patients with plaque-surface irregularity (n=1897) in the symptomatic carotid artery were more likely than those with smooth plaque (n=110) to have irregularity in the contralateral carotid artery (odds ratio 2.21 [95% CI 1.62-3.01], p<0.001). Patients with irregular plaques in both arteries were more likely to have had a previous myocardial infarction than patients with smooth plaques (hazard ratio 1.82 [1.23-2.64], p<0.001), and were more likely to have a non-stroke vascular death on follow-up (hazard ratio 1.67 [1.15-2.44], p=0.007). However, there was no difference in the risk of non-vascular death (hazard ratio 0.92 [0.57-1.45], p=0.5). These associations were not explicable on the basis of differences in traditional vascular risk factors. INTERPRETATION: These data suggest that some individuals have a systemic predisposition to irregularity and rupture of atherosclerotic plaques that is independent of traditional vascular risk factors. This finding supports the hypothesis that other systemic factors are important in the cause of plaque instability.
Angiography↗
Utilization of docosahexaenoic acid from intravenous egg yolk phospholipid.
Docosahexaenoic acid (DHA, 22:6n-3) is provided directly to human premature infants during parenteral nutrition from the egg yolk fraction of an intravenous fat emulsion. This study aimed to determine whether the high egg yolk phospholipid content of Intralipid 10% (IL 10%, Pharmacia, Uppsala, Sweden) relative to the standard emulsion Intralipid 20% (IL 20%, Pharmacia) could be a strategy to increase the delivery of DHA to the developing brain. Male, Large White piglets were randomly selected from sows 3 d after birth. Piglets were assigned to receive a 9-d continuous intravenous infusion commencing 5 d after birth of either Intralipid (IL) 10%, IL 20%, or Lipofundin S 20% (LFS; B. Braun, Melsungen, Germany). There were four piglets in each treatment group. IL 10% provides twice as much DHA as IL 20%, while LFS provides no DHA. Protein and other nutrients were provided enterally using a low-fat milk formula. After 9 d, animals were killed, and the fatty acid compositions of blood, liver, and cerebral cortex were analyzed. IL 10% infusion approximately doubled the amount of plasma phospholipid DHA (microg/mL of plasma) in comparison to IL 20%. However, red blood cells, liver, and cerebral cortex phospholipid DHA levels were indistinguishable between these two groups. LFS was associated with reduced levels of DHA in plasma, red blood cell and liver phospholipids in comparison to IL 20%. We conclude that infusion of additional phospholipid is an ineffective strategy for increasing DHA delivery to piglet tissues. This may be due to the formation of inert phospholipid particles in plasma. The data do not support the concept of using IL 10% as a means of providing additional DHA to premature human infants.
Animals↗
Photolytic degradation of florasulam on soil and in water.
The rate and pathway of degradation in the presence of light for the triazolopyrimidine herbicide florasulam was determined on soil and in aqueous systems. Florasulam was exposed to natural sunlight for up to 32 days; solar irradiance was measured with either chemical actinometers or by radiometry. The quantum yield for direct photodegradation in a sterile, buffered aqueous solution was determined to be 0.096; an analogous quantum yield for the sum of direct and indirect photodegradation on soil was 0.245. The quantum yields were used to estimate half-lives due to photodegradation as a function of season and temperature. Estimated half-lives due to photodegradation in summer at 40 degrees N latitude were 14 days on soil and 36 days in sterile, buffered water. Photodegradation was much faster in a natural water system, with a measured half-life of 3.3 days in summer at 51.5 degrees N latitude, indicating that indirect photolytic processes will be important contributors to photodegradation of florasulam in aqueous environments.
Herbicides↗
Effects of massage in acute and critical care.
This is a discussion of the results of a systematic review of 22 articles examining the effect of massage on relaxation, comfort, and sleep. The most consistent effect of massage was reduction in anxiety. Eight of 10 original research studies reported that massage significantly decreased anxiety or perception of tension. Seven of 10 studies found that massage produced physiologic relaxation, as indicated by significant changes in the expected direction in one or more physiologic indicators. In the three studies in which the effect of massage on discomfort was investigated, it was found to be effective in reducing pain. In only three studies was the effect of massage on sleep examined. The methods for measuring sleep were unclear in two of the studies, and results were inconclusive in the other. Further research is needed to investigate the effect of massage on discomfort and promoting sleep.
Acute Disease↗
Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. On behalf of the European Carotid Surgery Trialists' Collaborative Group.
BACKGROUND AND PURPOSE: The risk of ischemic stroke distal to an atherothrombotic carotid stenosis increases with the degree of stenosis. The main mechanism of stroke is thought to be embolism from fissured or ruptured plaque, but there are few published data on the relationship between plaque morphology and severity of stenosis and their independent effects on the risk of ischemic stroke. We sought to determine the interrelation between plaque surface morphology, degree of carotid stenosis, and the risk of ipsilateral ischemic stroke. METHODS: Severity of stenosis and plaque surface morphology were assessed on angiograms of the symptomatic carotid artery in 3007 patients in the European Carotid Surgery Trial and were related to baseline clinical characteristics, pathological characteristics of plaques examined at endarterectomy, and the risks of carotid territory ipsilateral ischemic stroke and other vascular events on follow-up. RESULTS: The early risk of ipsilateral ischemic stroke on medical treatment was closely related to the degree of carotid stenosis. However, the initial degree of carotid stenosis was not predictive of strokes occurring >2 years after randomization. Angiographic plaque surface irregularity and plaque surface thrombus at endarterectomy increased in frequency as the degree of stenosis increased (both P<0.0001). However, the degree of stenosis was still predictive of the 2-year risk of stroke on medical treatment after correction for plaque surface irregularity. Angiographic plaque surface irregularity was an independent predictor of ipsilateral ischemic stroke on medical treatment at all degrees of stenosis (hazard ratio=1.80; 95% CI, 1. 14 to 2.83; P=0.01). This relationship was maintained when the analysis was confined to strokes occurring >2 years after randomization (hazard ratio=2.75; 95% CI, 1.30 to 5.80; P=0.01). Neither the degree of stenosis nor plaque surface irregularity was predictive of the "background" stroke risk after endarterectomy or the risk of nonstroke vascular events. CONCLUSIONS: Angiographic plaque surface irregularity is associated with an increased risk of ipsilateral ischemic stroke on medical treatment at all degrees of stenosis. The increase in stroke risk with degree of stenosis is partly accounted for by the parallel increase in plaque surface irregularity and thrombus formation, but the degree of narrowing of the vessel lumen is still an independent predictor of ischemic stroke within 2 years of presentation.
Aged↗
Genomic-sequence comparison of two unrelated isolates of the human gastric pathogen Helicobacter pylori.
Helicobacter pylori, one of the most common bacterial pathogens of humans, colonizes the gastric mucosa, where it appears to persist throughout the host's life unless the patient is treated. Colonization induces chronic gastric inflammation which can progress to a variety of diseases, ranging in severity from superficial gastritis and peptic ulcer to gastric cancer and mucosal-associated lymphoma. Strain-specific genetic diversity has been proposed to be involved in the organism's ability to cause different diseases or even be beneficial to the infected host and to participate in the lifelong chronicity of infection. Here we compare the complete genomic sequences of two unrelated H. pylori isolates. This is, to our knowledge, the first such genomic comparison. H. pylori was believed to exhibit a large degree of genomic and allelic diversity, but we find that the overall genomic organization, gene order and predicted proteomes (sets of proteins encoded by the genomes) of the two strains are quite similar. Between 6 to 7% of the genes are specific to each strain, with almost half of these genes being clustered in a single hypervariable region.
Duodenal Ulcer↗
Premature infants fed mothers' milk to 6 months corrected age demonstrate adequate growth and zinc status in the first year.
The objective of this investigation was to describe zinc status to 12 months corrected age in premature infants fed their mother's milk in relation to nutritional management in hospital and post-hospital discharge. Twenty-five premature infants fed their mother's milk in hospital were randomized to receive either a multi-nutrient fortifier (MNF), providing protein, calcium, phosphorus and zinc (MM + MNF) or calcium and phosphorus alone (MM + CaGP). Twelve preterm infants fed a preterm formula (PTF) served as a comparison group. At 35 weeks post-menstrual age zinc retention was determined using the stable isotope tracer 70Zn. After hospital discharge infants in MM + MNF and MM + CaGP were designated to a mother's milk-feeding group to 6 months corrected age (Post-MM) or formula feeding group (Post-FF) based on parental choice of feeding practice. Anthropometry was performed at term, three, 6 and 12 months corrected age. At 6 and 12 months corrected age a hair sample was obtained to determine hair zinc concentrations. Preterm infants receiving supplemental zinc in hospital, as MNF, had significantly greater zinc retention in hospital compared to MM + CaGP but not greater hair zinc concentrations at 6 or 12 months corrected age. Despite significantly lower zinc intakes to 6 months corrected age, Post-MM had significantly greater hair zinc concentrations at 6 months compared to PTF (median[25-75th percentile]: 146[106-190] versus 85[54-91] microg/g, P < 0.05). Hair zinc in Post-FF (124[77-163] microg/g) was lower than Post-MM, but this was not significant (P = 0.09). Only in Post-MM were hair zinc concentrations above the median of reference values from term born infants at 12 months corrected age. Mean values of weight, length and head circumference of the preterm infants in Post-MM, Post-FF and PTF groups were between the 3rd and 97th percentiles derived from WHO reference growth standards for mother's milk-fed term infants. Our findings suggest that supplemental zinc either in hospital or post-hospital discharge does not appear to be required for preterm infants fed their mother's milk.
Analysis of Variance↗
Low recall of local television health care news segment topics, sponsors and program names.
In an effort to examine the effectiveness of hospitals' sponsoring of local broadcast news health care segments, viewer recall of information presented in news reports, the program name of the reports, and the names of the hospital sponsors of those reports were analyzed. Despite the fact that telephone survey respondents said they place a higher value on televised health care information than they do for other mass media, recall was found to be generally poor. A majority of respondents could not name the topic of the televised health news report they had viewed, the program name or the program sponsor.
Adolescent↗
Proximal femoral fracture: achievements and prospects.
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Femoral Fractures↗
Characterization of fatty acid clearance in premature neonates during intralipid infusion.
This study reports the clearance of plasma triglyceride and phospholipid fatty acids during Intralipid 20% infusion (Pharmacia, Sweden) in nine ventilated preterm infants receiving parenteral nutrition. Blood samples were taken during lipid infusion and over a subsequent period of 36 h of fat-free parenteral nutrition. Plasma triglyceride fatty acids showed a uniform and rapid decline after lipid was stopped from the peak values recorded during infusion. In contrast, plasma phospholipid fatty acids showed a variable decline during fat-free nutrition. This variability appeared to be the result of a differing contribution of infused egg yolk phospholipid fatty acids to the measured plasma values, and to changing fatty acid composition of endogenous phospholipid in response to fat free nutrition. Red cell phospholipid fatty acid composition was stable over the 36-h clearance study period. These results indicate the complexity of interpretation of plasma fatty acids during lipid infusion. We conclude that red cell phospholipid fatty acids provide the only stable measure of tissue fatty acid composition in parenterally fed preterm infants.
Fat Emulsions, Intravenous↗
Three-dimensional volumetric assessment of abnormally low attenuation of the lung from routine helical CT: inspiratory and expiratory quantification.
OBJECTIVE: The purpose of this investigation was to quantitatively assess abnormally low attenuation of the lung by use of three-dimensional volumetric reconstructions from routine helical CT and to assess their correlation with pulmonary function tests. MATERIALS AND METHODS: Helical CT was performed in 100 patients in full inspiration. Examination was also performed in full expiration in 53 of these patients. Three-dimensional volumetric reconstructions were performed for total lung volumes at inspiration and at expiration, with a threshold of -896 H on inspiratory CT and -790 H on expiratory CT, to quantify emphysematous change. Correlation was made with pulmonary function tests in 79 patients. RESULTS: CT volumetric assessments of abnormally low attenuation of the lung at inspiration and expiration had a high correlation (r2 = .84, p < or = .0001). In comparison with pulmonary function tests, both inspiratory low attenuation of the lung and expiratory low attenuation of the lung correlated well with the logarithm of the ratio of the forced expiratory volume in 1 sec (FEV1) to the forced vital capacity (r2 = .74, p < or = .0001 and r2 = .74, p < or = .0001, respectively) and with the percentage of predicted ratio of the FEV1 to the forced vital capacity (r2 = .69, p < or = .0001 and r2 = .69, p < or = .0001, respectively). Linear correlations were also seen with FEV1, residual volume, and forced residual capacity. CONCLUSION: Three-dimensional volumetric reconstructions of hypoattenuating lung correlate well with pulmonary function tests. In addition, inspiratory and expiratory data are also correlative, suggesting that a dedicated expiratory examination is not needed. This easily obtainable information will prove useful for patients with obstructive lung disease from emphysema, providing a measure of pulmonary function status in this population.
Adolescent↗
Management of the critically ill pediatric patient with acute renal failure.
Acute renal failure in the critically ill child can be a devastating and sometimes fatal event. Pediatric critical care nurses assume significant responsibility for early recognition, prevention, and treatment of children who develop acute renal failure. Knowledge of renal anatomy and physiology, developmental risk factors, nursing and medical management strategies, and renal replacement therapies is necessary for the delivery of competent care. This article explores the precipitating causes and complications of acute renal failure, prevention strategies, diagnosis and management, continuous renal replacement therapies, and the nurse's role in each. Furthermore, consideration is given to future treatments for acute renal failure.
Acute Kidney Injury↗
Multiplex sequencing of 1.5 Mb of the Mycobacterium leprae genome.
The nucleotide sequence of 1.5 Mb of genomic DNA from Mycobacterium leprae was determined using computer-assisted multiplex sequencing technology. This brings the 2.8-Mb M. leprae genome sequence to approximately 66% completion. The sequences, derived from 43 recombinant cosmids, contain 1046 putative protein-coding genes, 44 repetitive regions, 3 tRNAs, and 15 tRNAs. The gene density of one per 1.4 kb is slightly lower than that of Mycoplasma (1.2 kb). Of the protein coding genes, 44% have significant matches to genes with well-defined functions. Comparison of 1157 M. leprae and 1564 Mycobacterium tuberculosis proteins shows a complex mosaic of homologous genomic blocks with up to 22 adjacent proteins in conserved map order. Matches to known enzymatic, antigenic, membrane, cell wall, cell division, multidrug resistance, and virulence proteins suggest therapeutic and vaccine targets. Unusual features of the M. leprae genome include large polyketide synthase (pks) operons, inteins, and highly fragmented pseudogenes.
Amino Acid Sequence↗
Selenium status of preterm infants: the effect of postnatal age and method of feeding.
Indicators of selenium (Se) status were measured in a longitudinal study of 63 preterm and 46 term infants. Se levels in both groups were similar in the first few days of life. Preterm infants fed parenteral nutrition (PN) for several weeks developed very low plasma Se levels (< 10 micrograms/l). In those receiving either breast milk or formula in conjunction with PN, plasma Se also declined over the first 6 weeks. In the breastfed term infants plasma levels increased by 50%, but there was no increase in the term formula-fed group. In healthy preterm infants who received mainly breast milk, plasma Se concentrations remained constant at newborn levels and were below those of breastfed term infants at 6 weeks. Erythrocyte GSHPx activity did not reflect plasma Se or Se intake. In conclusion, the type of feeding, and hence Se intake, influenced plasma Se concentration in preterm infants. Provision of enteral feeding in conjunction with PN was unable to prevent a decline in plasma Se and at 6 weeks levels were well below those of the reference breastfed term infants.
Age Factors↗
Complete genome sequence of Methanobacterium thermoautotrophicum deltaH: functional analysis and comparative genomics.
The complete 1,751,377-bp sequence of the genome of the thermophilic archaeon Methanobacterium thermoautotrophicum deltaH has been determined by a whole-genome shotgun sequencing approach. A total of 1,855 open reading frames (ORFs) have been identified that appear to encode polypeptides, 844 (46%) of which have been assigned putative functions based on their similarities to database sequences with assigned functions. A total of 514 (28%) of the ORF-encoded polypeptides are related to sequences with unknown functions, and 496 (27%) have little or no homology to sequences in public databases. Comparisons with Eucarya-, Bacteria-, and Archaea-specific databases reveal that 1,013 of the putative gene products (54%) are most similar to polypeptide sequences described previously for other organisms in the domain Archaea. Comparisons with the Methanococcus jannaschii genome data underline the extensive divergence that has occurred between these two methanogens; only 352 (19%) of M. thermoautotrophicum ORFs encode sequences that are >50% identical to M. jannaschii polypeptides, and there is little conservation in the relative locations of orthologous genes. When the M. thermoautotrophicum ORFs are compared to sequences from only the eucaryal and bacterial domains, 786 (42%) are more similar to bacterial sequences and 241 (13%) are more similar to eucaryal sequences. The bacterial domain-like gene products include the majority of those predicted to be involved in cofactor and small molecule biosyntheses, intermediary metabolism, transport, nitrogen fixation, regulatory functions, and interactions with the environment. Most proteins predicted to be involved in DNA metabolism, transcription, and translation are more similar to eucaryal sequences. Gene structure and organization have features that are typical of the Bacteria, including genes that encode polypeptides closely related to eucaryal proteins. There are 24 polypeptides that could form two-component sensor kinase-response regulator systems and homologs of the bacterial Hsp70-response proteins DnaK and DnaJ, which are notably absent in M. jannaschii. DNA replication initiation and chromosome packaging in M. thermoautotrophicum are predicted to have eucaryal features, based on the presence of two Cdc6 homologs and three histones; however, the presence of an ftsZ gene indicates a bacterial type of cell division initiation. The DNA polymerases include an X-family repair type and an unusual archaeal B type formed by two separate polypeptides. The DNA-dependent RNA polymerase (RNAP) subunits A', A", B', B" and H are encoded in a typical archaeal RNAP operon, although a second A' subunit-encoding gene is present at a remote location. There are two rRNA operons, and 39 tRNA genes are dispersed around the genome, although most of these occur in clusters. Three of the tRNA genes have introns, including the tRNAPro (GGG) gene, which contains a second intron at an unprecedented location. There is no selenocysteinyl-tRNA gene nor evidence for classically organized IS elements, prophages, or plasmids. The genome contains one intein and two extended repeats (3.6 and 8.6 kb) that are members of a family with 18 representatives in the M. jannaschii genome.
Anaerobiosis↗
Controlled portions of presweetened cereals present no glycemic penalty in persons with insulin-dependent diabetes mellitus.
OBJECTIVE: To determine metabolic responses to commercially sweetened flaked corn cereal, unsweetened flaked corn cereal, glucose, and sucrose in teenagers and young adults with insulin-dependent diabetes mellitus (IDDM). DESIGN: A crossover design in which each subject consumed test meals in random order on 4 separate days at least 72 hours apart. SETTING: The inpatient setting of the General Clinical Research Center of the Indiana University Medical Center Hospital. SUBJECTS: Sixteen males and eight females, aged 14 to 25 years, with IDDM. INTERVENTIONS: After fasting overnight, each subject underwent challenge tests with 50 g carbohydrate per 1.73 m2 of body surface area from sweetened flaked corn cereal, unsweetened flaked corn cereal, sucrose, and glucose. All subjects were maintained on continuous intravenous infusion of insulin overnight (euglycemic goal = 3.9 to 6.7 mmol/L), with a constant basal insulin dose infused before and throughout a 3-hour postprandial period. MAIN OUTCOME MEASURES: Plasma glucose, free insulin, triglycerides, and free fatty acid levels measured at baseline and 15, 30, 45, 60, 90, 120, 150, and 180 minutes after meals. STATISTICAL ANALYSES PERFORMED: Comparisons among the four meals were made using two-way repeated measures analyses of variance followed by the Newman-Keuls multiple comparison procedure to identify specific differences among meals. The areas under the response curves were compared using one-way repeated measures analysis of covariance, adjusted for baseline values. RESULTS: The response to glucose for the area under the 3-hour blood glucose response curve was significantly greater than the response to sucrose (P = .006 by repeated measures analysis of variance); the areas for the two cereals (not significantly different from one another) were between the glucose and sucrose areas. At 3 hours, glycemia differed significantly among three of the meals: unsweetened flaked corn cereal > sweetened flaked corn cereal > sucrose (P < .001). Glucose at 3 hours was greater than sucrose (P < .001). There were no significant differences for free insulin, triglycerides, or free fatty acids. APPLICATIONS: Equivalent gram amounts of carbohydrate as presweetened breakfast cereals are not detrimental to persons with IDDM compared with unsweetened cereals. Therefore, presweetened cereals can be used in the correct portion sizes and based on the number of carbohydrate or starch servings in a person's diabetic meal plan.
Adolescent↗