Triage of ambulatory patients.
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Ambulatory Care↗
Biomedical subjects
S L Adams
Publications and source records attributed to S L Adams.
Carbon dioxide exchange of lettuce plants under hypobaric conditions.
Growth of plants in a Controlled Ecological Life Support System (CELSS) may involve the use of hypobaric pressures enabling lower mass requirements for atmospheres and possible enhancement of crop productivity. A controlled environment plant growth chamber with hypobaric capability designed and built at Ames Research Center was used to determine if reduced pressures influence the rates of photosynthesis (Ps) and dark respiration (DR) of hydroponically grown lettuce plants. The chamber, referred to as a plant volatiles chamber (PVC), has a growing area of about 0.2 m2, a total gas volume of about 0.7 m3, and a leak rate at 50 kPa of <0.1%/day. When the pressure in the chamber was reduced from ambient to 51 kPa, the rate of net Ps increased by 25% and the rate of DR decreased by 40%. The rate of Ps increased linearly with decreasing pressure. There was a greater effect of reduced pressure at 41 Pa CO2 than at 81 Pa CO2. This is consistent with reports showing greater inhibition of photorespiration (Pr) in reduced O2 at low CO2 concentrations. When the partial pressure of O2 was held constant but the total pressure was varied between 51 and 101 kPa, the rate of CO2 uptake was nearly constant, suggesting that low pressure enhancement of Ps may be mainly attributable to lowered partial pressure of O2 and the accompanying reduction in Pr. The effects of lowered partial pressure of O2 on Ps and DR could result in substantial increases in the rates of biomass production, enabling rapid throughput of crops or allowing flexibility in the use of mass and energy resources for a CELSS.
Atmosphere Exposure Chambers↗
Carbon dioxide exchange of lettuce plants under hypobaric conditions.
Growth of plants in a Controlled Ecological Life Support System (CELSS) may involve the use of hypobaric pressures enabling lower mass requirements for atmospheres and possible enhancement of crop productivity. A controlled environment plant growth chamber with hypobaric capability designed and built at Ames Research Center was used to determine if reduced pressures influence the rates of photosynthesis (Ps) and dark respiration (DR) of hydroponically grown lettuce plants. The chamber, referred to as a plant volatiles chamber (PVC), has a growing area of about 0.2 m2, a total gas volume of about 0.7 m3, and a leak rate at 50 kPa of <0.1%/day. When the pressure in the chamber was reduced from ambient to 51 kPa, the rate of net Ps increased by 25% and the rate of DR decreased by 40%. The rate of Ps increased linearly with decreasing pressure. There was a greater effect of reduced pressure at 41 Pa CO2 than at 81 Pa CO2. This is consistent with reports showing greater inhibition of photorespiration (Pr) in reduced O2 at low CO2 concentrations. When the partial pressure of O2 was held constant but the total pressure was varied between 51 and 101 kPa, the rate of CO2 uptake was nearly constant, suggesting that low pressure enhancement of Ps may be mainly attributable to lowered partial pressure of O2 and the accompanying reduction in Pr. The effects of lowered partial pressure of O2 on Ps and DR could result in substantial increases in the rates of biomass production, enabling rapid throughput of crops or allowing flexibility in the use of mass and energy resources for a CELSS.
Air Pressure↗
How accurate are waiting time perceptions of patients in the emergency department?
STUDY OBJECTIVE: To assess the ability of patients to accurately estimate specific waiting times in the emergency department. METHODS: A questionnaire was administered by telephone to a random sample of 776 patients (or parents or responsible caretakers, if appropriate) who had been treated within the previous 2 to 4 weeks in the ED of a suburban hospital. Respondents were asked their perceptions of two particular time frames: (1) the time elapsed from triage until initial examination by the emergency physician (physician waiting time [PWT]), and (2) the time elapsed from triage until departure from the ED (total waiting time [TWT]). Corresponding actual times were extracted from a computerized database. Time frames were divided into discrete periods for comparison. The correspondence between actual and perceived times was assessed by optimal data analysis. RESULTS: Only 22.3% of the respondents accurately estimated PWT. Although this level of accuracy is statistically significant (P < .0001), it reflects only 11% of the theoretically possible improvement in accuracy beyond chance. More respondents overestimated than underestimated PWT (49.9% versus 27.8%, respectively). In contrast, TWT was accurately estimated by 36.6% of the respondents (P < .0001), reflecting 18% of the theoretically possible improvement in accuracy beyond chance. Fewer respondents overestimated than underestimated TWT (24.5% versus 38.9%, respectively). CONCLUSION: Patients are not very accurate in their estimation of actual waiting times. Although fewer than one fourth of the respondents overestimated the TWT spent in the ED, almost half the respondents overestimated the PWT.
Emergency Service, Hospital↗
Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on patient satisfaction in the emergency department.
STUDY OBJECTIVE: To determine the effects of actual waiting time, perception of waiting time, information delivery, and expressive quality on patient satisfaction. METHODS: During a 12-month study period, a questionnaire was administered by telephone to a random sample of patients who had presented to a suburban community hospital emergency department during the preceding 2 to 4 weeks. Respondents were asked several questions concerning waiting times (ie, time from triage until examination by the emergency physician and time from triage until discharge from the ED), information delivery (eg, explanations of procedures and delays), expressive quality (eg, courteousness, friendliness), and overall patient satisfaction. RESULTS: There were 1,631 respondents. The perception that waiting times were less than expected was associated with a positive overall satisfaction rating for the ED encounter (P < .001). Satisfaction with information delivery and with ED staff expressive quality were also positively associated with overall satisfaction during the ED encounter (P < .001). Actual waiting times were not predictive of overall patient satisfaction (P = NS). CONCLUSION: Perceptions regarding waiting time, information delivery, and expressive quality predict overall patient satisfaction, but actual waiting times do not. Providing information, projecting expressive quality, and managing waiting time perceptions and expectations may be a more effective strategy to achieve improved patient satisfaction in the ED than decreasing actual waiting time.
Adolescent↗
The full moon and ED patient volumes: unearthing a myth.
To determine if there is any effect of the full moon on emergency department (ED) patient volume, ambulance runs, admissions, or admissions to a monitored unit, a retrospective analysis of the hospital electronic records of all patients seen in an ED during a 4-year period was conducted in an ED of a suburban community hospital. A full moon occurred 49 times during the study period. There were 150,999 patient visits to the ED during the study period, of which 34,649 patients arrived by ambulance. A total of 35,087 patients was admitted to the hospital and 11,278 patients were admitted to a monitored unit. No significant differences were found in total patient visits, ambulance runs, admissions to the hospital, or admissions to a monitored unit on days of the full moon. The occurrence of a full moon has no effect on ED patient volume, ambulance runs, admissions, or admissions to a monitored unit.
Ambulances↗
Prospective evaluation of emergency medicine instruction for rotating first-postgraduate-year residents.
OBJECTIVE: To determine whether either bedside teaching alone (group A) or bedside teaching with written course materials (group B) improved written examination scores, satisfaction with the rotation, or clinical grades of rotating PGY1 residents. METHODS: A prospective, controlled educational trial was conducted. Sixty-five PGY1 residents from diverse specialties rotated in the ED for one month over a ten-month study period, and were included in the study. The PGY1 residents were assigned to group by month of rotation. All the PGY1 residents received unstructured bedside teaching by emergency medicine (EM) residents and faculty. In addition, group B received written course materials on day 1. RESULTS: Mean posttest scores were higher than mean pretest scores for the interns considered as a whole (p < 0.0001), but mean pretest, posttest, and clinical grades were comparable across instructional groups. Mean satisfaction ratings were higher for group A than for group B (p < 0.015). The interns specializing in EM achieved higher mean test scores (p < 0.013) and clinical grades (p < 0.003) than did the interns specializing in another medical specialty. CONCLUSION: Both instructional methods were associated with improved written test performance. Written course materials did not augment bedside teaching in terms of test scores, clinical grades, or satisfaction with the rotation. At a university-based, high-volume ED, bedside teaching offers educational benefit to rotating PGY1 residents that may not be augmented by written course materials.
Curriculum↗
Injury with spontaneous deployment of an automobile air bag.
We report a case of significant injury to an automobile driver due to spontaneous air bag deployment not associated with a collision or application of external force to the automobile.
Air Bags↗
A prospective study of in-line skating: observational series and survey of active in-line skaters--injuries, protective equipment, and training.
OBJECTIVES: 1) To assess the relationship between types of injuries incurred and training and protective equipment worn by adults injured while in-line skating; 2) to observe the type and amount of protective equipment worn by in-line skaters while skating; and 3) to survey active in-line skaters about formal training, protective equipment, and history of injuries incurred, and the effect of such injuries on the protective equipment subsequently worn. METHODS: A prospective study of consecutive adult patients presenting to the ED for evaluation of in-line skating injuries; a consecutive-series observational study of active in-line skaters to assess protective equipment worn; and a survey of selected active in-line skaters. Eighty-five adult patients were included who presented with a history of injury related to in-line skating to the EDs of an urban academic medical center, a suburban academic-affiliated hospital, and a community hospital. Four hundred eleven active in-line skaters on the Chicago lakefront were observed for protective equipment worn, 91 of whom participated in the survey. RESULTS: Of those presenting to the ED with injuries, only 15% indicated that they had received formal in-line skating instruction. Of the ED patients, 50% wore no protective equipment; overall, 6% wore a helmet; 44%, wrist protection; 23%, knee protection; and 19%, elbow protection. Only 2% wore all of the above equipment. The primary mechanism of injury reported was a loss of balance (58%); others included collision with objects (25%), collision with bicycles (11%), and collision with cars (5%). Fractures or dislocations occurred in 48% of the patients; 6% had head injuries necessitating CT scans. Those who wore no protective gear were more likely to require hospital admission (p < 0.05). Of the 411 in-line skaters observed, 157 (38%) wore no protective equipment. Compared with the injured group presenting to the ED, fewer observed participants were without protection (p < 0.05). Among those surveyed, prior injury was not associated with the subsequent use of protective gear. CONCLUSION: Patients who present to the ED for evaluation of in-line skating injuries have a high incidence of fractures/dislocations. Few injured or surveyed in-line skaters had formal training. Use of protective equipment by injured skaters was associated with a decreased likelihood of hospitalization. Observed in-line skaters more commonly wore protective gear than did those who presented to the ED with injuries.
Athletic Injuries↗
Inability to follow up ED patients by telephone: there must be 50 ways to leave your number.
OBJECTIVE: To determine the ability to complete follow-up home telephone calls to ED patients. METHODS: A retrospective review of the ability to reach 4,741 patients called during a posttreatment patient satisfaction survey of visits to a suburban community hospital ED. RESULTS: Only 54.9% of all patients called could be contacted after three or fewer phone calls. Of the 2,139 (45.1%) who could not be reached, there was no answer for 1,260 (58.9%), despite three telephone calls to a number currently in service. A significant minority (21.1%) had given nonworking numbers. Another 12.4% indicated that no one by the name of the patient lived at the number called and 2.9% of the respondents alleged that the patient was deceased. CONCLUSIONS: Almost half of the patients who present to the ED and supply home telephone numbers give telephone numbers at which they cannot be reached in follow-up. Using telephone follow-up alone to reach patients seen in the ED may be an unreliable method of communication.
Data Collection↗
A skeletal model for the efficacy of automobile safety restraints.
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Accidents, Traffic↗
Detection of maternal cells in human umbilical cord blood using fluorescence in situ hybridization.
Cord blood is a potential source of hematopoietic stem cells for transplantation and is being used on a growing number of patients. However, there are concerns that cord blood might be contaminated with maternal cells that could lead to graft-versus-host disease. To ascertain the extent to which maternal cell contamination of cord blood occurs, we examined 49 cord blood samples from male babies for maternal cells by fluorescence in situ hybridization using probes to the X and Y chromosomes. A minimum of 1,000 nuclei were scored from each sample, and maternal cells were found in 7 of the 49 cord bloods, at levels ranging from 0.04% to 1.0%. In addition, in 39 and 27 of the cord blood samples, respectively, we examined the CD8+ and CD34+ cell populations for maternal cells. Maternal cells were found in 5 of the 39 CD8 fractions and in 1 of the 27 CD34 fractions, at levels similar to that found in the unfractionated cord blood. In sum, maternal cells were found in either the unseparated mononuclear fraction or the CD8 or CD34 fractions in 10 of the 49 cord blood samples (20%). These results show that maternal cells are present in a substantial number of cord bloods, and that some of these maternal cells are T cells.
Antigens, CD↗
Human N-methyl-D-aspartate receptor modulatory subunit hNR3: cloning and sequencing of the cDNA and primary structure of the protein.
Several cDNA clones encoding the human N-methyl-D-aspartate receptor modulatory subunit hNR3, were isolated from a human fetal brain library. The hNR3 cDNA demonstrated a 91.3-91.5% nucleotide (nt) identity with the rat NR2B and mouse epsilon 2 cDNAs. The nt sequence of hNR3 would encode a 1484 amino acid (aa) protein that has a 98.4-98.5% identity with the mouse epsilon 2 and rat NR2B subunits.
Amino Acid Sequence↗
Impact of an EM club on senior student elective enrollment.
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Education↗
Effect of learning objectives on the performances of students and interns rotating through an emergency department.
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Education, Medical, Undergraduate↗
Retinoic acid is a major regulator of chondrocyte maturation and matrix mineralization.
During the process of endochondral bone formation, chondrocytes undergo a series of complex maturational changes. Our recent studies indicate that this maturational process is influenced by the vitamin A derivative retinoic acid (RA). To learn how this agent regulates chondrocyte development, we characterized matrix gene expression during maturation of cartilage cells in chick sternum. RNAs were isolated from the cephalic portion of day 13, 14, 16, 18, and 20 chick embryo sternum and analyzed via northern blots. Type II collagen RNA levels remained fairly constant during this developmental period. In contrast, expression of type X collagen and alkaline phosphatase (APase) genes was first detected at day 16, followed by that of osteonectin (ON) and osteopontin (OP). To explore the mechanisms triggering these changes, chondrocytes were isolated from the cephalic portion of day 17-18 sternum (US cells) and grown in monolayer in standard serum-containing medium. After 3 weeks in culture, most of the cells enlarged and became type X collagen-positive, but they exhibited low APase activity and contained only trace amounts of ON and OP mRNAs. Treatment of parallel 3-week-old cultures with RA (10-100 nM) rapidly increased expression of the APase, ON, and OP genes severalfold. In concert with a significant increase in APase activity, there was abundant calcium accumulation in the RA-treated cultures. Electron microscopy confirmed the formation of large matrix-associated mineral crystals and the presence of numerous matrix vesicles. The effects of RA were also studied in cultures of immature chondrocytes isolated from the caudal portion of sternum (LS cells).(ABSTRACT TRUNCATED AT 250 WORDS)
Alkaline Phosphatase↗
Human N-methyl-D-aspartate receptor modulatory subunit hNR2A: cloning and sequencing of the cDNA and primary structure of the protein.
Several cDNA clones encoding the human N-methyl-D-aspartate receptor modulatory subunit hNR2A, were isolated from human hippocampus and fetal brain libraries. DNA sequence analysis revealed overlapping clones permitting the reconstruction of full-length hNR2A cDNA. The hNR2A cDNA demonstrated an 88-89% nucleotide (nt) identity with the corresponding rodent cDNAs. The nt sequence of hNR2A would encode a 1464-aa protein that has a 95.2% identity with the rodent NR2A subunits.
Amino Acid Sequence↗
An alternative transcript of the chick type III collagen gene that does not encode type III collagen.
Type III collagen, a ubiquitous protein found in most connective tissues, is not present in hyaline cartilage. However, we have identified an alternative transcript of the type III collagen gene in cultured chondrocytes from several embryonic chick cartilages. This RNA contains exons 24-52, but exons 1-23 are replaced by 70 nucleotides of unique sequence, suggesting that transcription initiates at an alternative promoter. Two of the open reading frames in the alternative transcript are out of frame with the collagen coding sequence; a third open reading frame encodes the carboxyl-terminal two-thirds of the collagen sequence. Thus, this RNA cannot serve as a template for synthesis of normal type III collagen and may encode noncollagenous proteins and/or a truncated collagen. The alternative transcript has been detected as early as 2.5 days of embryogenesis and at later stages is present at low levels in many tissues, including limb mesenchyme and cartilage. These results, together with our previous identification of an alternative transcript of the chick alpha 2(I) collagen gene (Bennett, V. D., and Adams, S. L. (1990) J. Biol. Chem. 265, 2223-2230), suggest that some collagen genes may have alternative functions that are independent of their roles in collagen production.
Alternative Splicing↗