Intensive care units were developed in response to the perceived need for increased monitoring in critically ill medical patients. The same principle applies to elderly patients with severe agitated behaviors. These patients can be served by the Geriatric Behavioral Intensive Care Unit (BICU). The uniqueness of the program results from the application of a behavioral and environmental approach to the treatment of agitated behavior. The underlying strategy in the treatment process is to enhance the patient's ability to adapt to his or her home environment. Preliminary results have been encouraging, showing positive outcomes in diverse areas such as low level of institutional placement, patient quality of life, and caregiver symptoms of burden and depression.

Aged↗

PubMed1993

The Flexner Report and black academic medicine: an assignment of place.

Explore the source record for details and available documents.

Black or African American↗

PubMed1992

Nitrogenase activity, nodule respiration, and o(2) permeability following detopping of alfalfa and birdsfoot trefoil.

Gas exchange measurements and noninvasive leghemoglobin (Lb) spectrophotometry (nodule oximetry) were used to monitor nodule responses to shoot removal in alfalfa (Medicago sativa L. cv Weevlchek) and birdsfoot trefoil (Lotus corniculatus L. cv Fergus). In each species, total nitrogenase activity, measured as H(2) evolution in Ar:O(2) (80:20), decreased to <50% of the initial rate within 1 hour after detopping, and net CO(2) production decreased to about 65% of the initial value. In a separate experiment in which nodule oximetry was used, nodule O(2) permeability decreased 50% within 5 hours in each species. A similar decrease in the O(2)-saturated respiration rate (V(max)) for the nodule central zone occurred within 5 hours in birdsfoot trefoil, but only after 24 hours in alfalfa. Lb concentration, also measured by oximetry, decreased after 48 to 72 hours. The decrease in permeability preceded the decrease in V(max) in each species. V(max) may depend mainly on carbohydrate availability in the nodule. If so, then the decrease in permeability could not have been triggered by decreasing carbohydrate availability. Both oximetry and gas exchange data were consistent with the hypothesis that, for the cultivars tested, carbohydrate availability decreased more rapidly in birdsfoot trefoil than in alfalfa nodules. Fractional Lb oxygenation (initially about 0.15) decreased during the first 24 hours after detopping but subsequently increased to >0.65 for a majority of nodules of each species. This increase could lead to O(2) inactivation of nitrogenase.

Journal Article↗

PubMed1991

Surgical face masks in modern operating rooms--a costly and unnecessary ritual?

Following the commissioning of a new suite of operating rooms air movement studies showed a flow of air away from the operating table towards the periphery of the room. Oral microbial flora dispersed by unmasked male and female volunteers standing one metre from the table failed to contaminate exposed settle plates placed on the table. The wearing of face masks by non-scrubbed staff working in an operating room with forced ventilation seems to be unnecessary.

Air Microbiology↗

PubMed1991

Transplant coronary artery disease: histopathologic correlations with angiographic morphology.

Accelerated coronary artery disease is a major cause of morbidity and mortality among cardiac transplant recipients. Ten patients who died or underwent retransplantation within 2 months of coronary angiography had direct correlation of angiographic (normal discrete lesions, diffuse concentric narrowing) with histologic appearance of coronary arteries. Of the 26 angiographically normal segments, 73% showed mild to moderate fibrous intimal thickening by light microscopy. The remainder had intermediate lesions or atheromatous plaques. Discrete stenoses usually corresponded to lipid-rich intermediate or atheromatous disease. In contrast, angiographically diffuse, concentrically narrowed lesions usually were areas of severe fibrous intimal thickening. Fresh or organizing thrombus was most often associated with discrete lesions and accounted for all complete occlusions. Histologic and angiographic comparisons of the degree of luminal narrowing showed generally good correlation for high grade stenoses. Lesions graded as having less than 25% diameter narrowing were often underestimated angiographically as compared with histologic determinations. Transplant coronary artery disease has a heterogeneous histologic and angiographic appearance, with angiographic underestimation of disease in some patients.

Adult↗

PubMed1991

A comparison of the consistency of self-reported behavioural change within a study sample--postal versus home interviews.

Much health promotion research is directed towards increasing our understanding of the process of health-related behavioural change. However, little is known about the validity of self-reported changes in behaviour. This study aimed to assess the validity of self-reported changes in five behaviours--diet, cigarette smoking, alcohol consumption, weight control and physical activity--by comparing reports obtained from the same people through postal questionnaires and face-to-face interviews. It was found that overall there was a consistency between self-reports with interviewers confirming that in most cases change had taken place. However, in a large number of cases changes were reported that had occurred before the period specified in the questionnaire. The nature of the change, whether discrete or incremental, as well as the behaviour in question, were found to be related to the accuracy of self-reporting. The possible reasons for the observed discrepancies are discussed.

Adolescent↗

PubMed1991

Long-term results of cardiac transplantation.

Over 12,000 cardiac transplants have been performed worldwide and many recipients are alive between 10 and 20 years posttransplant. The results, complications, and pathology of the long-term survivors are discussed in this chapter.

Cardiomegaly↗

PubMed1991

The impact of screening sinus CT on the planning of functional endoscopic sinus surgery.

The clinical and radiologic records of 500 sequential patients who underwent screening sinus CT as a prelude to possible functional endoscopic sinus surgery (FESS) were reviewed in order to answer three clinical-radiologic questions: (1) Can distinct radiologic patterns of inflammatory disease be identified on screening sinus CT (SSCT)? (2) If so, what are these radiologic patterns? (3) How do the findings seen on SSCT influence the endoscopic surgical plan? Five basic radiologic patterns of sinonasal inflammatory disease were identified among the 500-member patient population. These were based on known patterns of mucociliary drainage correlated with obstructive patterns observed on the CT scans. These radiologic patterns included: (1) infundibular (129 of 500 or 26%), (2) ostiomeatal unit (126 of 500 or 25%), (3) sphenoethmoidal recess (32 of 500 or 6%), (4) sinonasal polyposis (49 of 500 or 10%), and (5) sporadia (unclassifiable) (121 of 500 or 24%) patterns. Normal SSCT was seen in 133 of the 500 patients (27%). Although the ostiomeatal unit is the central feature in sinonasal inflammatory disease, obstruction of the infundibulum alone or of the sphenoethmoidal recess can cause unique inflammatory patterns of disease that require tailored FESS. The identification of sinonasal polyposis raises a different set of FESS considerations. The sporadic pattern of inflammatory disease, when identified, creates unique FESS challenges, depending on the specific sinus or sinuses involved. Assignment of these patterns to the individual case also assists in patient management by grouping patients into nonsurgical (normal CT), routine (infundibular, ostiomeatal unit, and most sporadic patterns) and complex (sinonasal polyposis and sphenoethmoidal recess) surgical groups.

Acute Disease↗

PubMed1991

Hepatitis C virus in cadaver organ donors: prevalence and risk of transmission to transplant recipients.

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Adult↗

PubMed1991

Effects of long term 2% fish oil supplements on tissue fatty acids, phospholipids, cholesterol, and arterial histology in Japanese quail (Coturnix coturnix japonica).

The effects of 2% olive oil (OO) or fish oil (FO) (Super epa500) dietary supplementation (9 months) on Japanese "SEA" quail was investigated. The animals were examined for tissue biochemical changes and possible blood vessel fatty deposition. The fatty acids of blood and tissue extracts from heart, liver and fat were analyzed by gas-chromatography/mass spectrometry. The ratio of arachidonic acid to eicosapentaenoic or docosahexaenoic acid was markedly decreased in FO treated animals compared to OO or control diet treated animals. Tissue cholesterol and total phospholipids were present in elevated amounts in the heart and liver of FO treated animals. After the 9-month regimen many animals had residual atherosclerotic lesions but the FO treated birds had considerably more fatty streaks and fatty deposition in their large vessels compared to control or OO treated animals. Although the lipid composition of tissues of FO treated animals would indicate that the purported cardioprotective omega-3 fatty acids are enriched in the various tissues examined compared to olive oil and control diet treated animals, the possible detrimental effect of saturated fat, cholesterol, or some other component of the fish oil preparations is suggested from the histological appearance of fatty deposition in the blood vessels (aortae) of these inbred animals. These results in quail are strikingly similar to that seen in the omega-3 FA treated WHHL rabbit (15).

Adipose Tissue↗

PubMed1990

Pharmacokinetics of oral acetyl-L-carnitine in renal impairment.

Acetyl-L-carnitine 1.5 g and 3.0 g was administered as three divided doses on each of two occasions to 24 people with varying renal failure (creatinine clearance 127-8 ml.min-1). Plasma and urinary concentrations of total-L-carnitine, free (non-esterified) carnitine, short-chain esters and acetyl-L-carnitine were measured. The baseline (pre-study) concentrations of all four substances were related to renal function. Patients whose creatinine clearance was below about 30-40 ml.min-1 were had the highest concentrations. Renal elimination of all four substances was related to dose and to renal function. There was evidence for dose-related elimination, with greater elimination of the larger dose.

Acetylcarnitine↗

PubMed1990

Mechanism of Nitrogenase Inhibition in Soybean Nodules : Pulse-Modulated Spectroscopy Indicates that Nitrogenase Activity Is Limited by O(2).

A novel, pulse-modulated spectroscopic system for measuring fractional leghemoglobin oxygenation and infected cell O(2) concentration (O(i)) in intact attached nodules of soybean (Glycine max) is described. The system is noninvasive and uses a pulsed (1000 Hertz) light-emitting diode coupled to an optical fiber to illuminate the nodule with light at 660 nanometer. A second optical fiber receives a portion of the light reflected from the nodule and directs this to a photodiode. A lock-in amplifier measures only the signal from the photodiode which is in phase with the pulsed light from the light-emitting diode, and the voltage output from the amplifier, proportional to reflectance, is used to calculate fractional leghemoglobin oxygenation and the nanomolar concentration of free O(2) in the infected cells of the nodule (O(i)). The system was used to show that inhibition of nitrogenase activity in soybean nodules by NO(3) (-) treatment, stem-girdling, continuous darkness, or nodule disturbance is caused by a reduction in O(i) and limitation of respiration in support of nitrogenase activity. A plot of nitrogenase activity (measured as peak H(2) evolution in Ar:O(2)) versus O(i) for the various treatments was consistent with the concept that O(i) limits in vivo nitrogenase activity in legume nodules under adverse conditions. The potential for using O(i) to estimate nitrogenase activity in laboratory and field-grown legumes is discussed.

Journal Article↗

PubMed1989

Effects of gradual increases in o(2) concentration on nodule activity in soybean.

The objectives of this study were to determine whether attached nodules of soybean (Glycine max L. Merr.) could adjust to gradual increases in rhizosphere pO(2) without nitrogenase inhibition and to determine whether the nitrogenase activity of the nodules is limited by pO(2) under ambient conditions. A computer-controlled gas blending apparatus was used to produce linear increases (ramps) in pO(2) around attached nodulated roots of soybean plants in an open gas exchange system. Nitrogenase activity (H(2) production in N(2):O(2) and Ar:O(2)) and respiration (CO(2) evolution) were monitored continuously as pO(2) was ramped from 20 to 30 kilopascals over periods of 0, 5, 10, 15, and 30 minutes. The 0, 5, and 10 minute ramps caused inhibitions of nitrogenase and respiration rates followed by recoveries of these rates to their initial values within 30 minutes. Distinct oscillations in nitrogenase activity and respiration were observed during the recovery period, and the possible basis for these oscillations is discussed. The 15 and 30 minute ramps did not inhibit nitrogenase activity, suggesting that such inhibition is not a factor in the regulation of nodule diffusion resistance. During the 30 minute ramp, a stimulation of nitrogenase activity was observed, indicating that an O(2)-based limitation to nitrogenase activity occurs in soybean nodules under ambient conditions.

Journal Article↗