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PubMed2004

[The choice of profession of medical doctors graduating from Leiden University].

OBJECTIVE: To determine what postgraduate courses Leiden medical students had completed after obtaining the degree in medicine. DESIGN: Descriptive. METHOD: The BIG-register [Dutch register of professionals in individual healthcare] was examined to determine how students who had passed their final examinations at Leiden University in 199o or in 1995 were registered at the beginning of February 2004. The findings were compared with the data on all physicians in the BIG-register as per 31 December 2002 (n = 54,624) and with those from a study in Groningen (n = 333). RESULTS: Of the 177 students who had passed their final examinations in 199o, more than 13 years earlier, 45% were registered as a medical specialist, 28% as a nonspecialised physician and 12% as a general practitioner. Of the 136 who had passed their final examinations in 1995, more than 8 years earlier, the corresponding percentages were 8%, 61% and 23%, respectively. Compared with data for the Netherlands as a whole and for Groningen, the percentage of specialists among those who had passed their final examinations in Leiden in 199o was high and the percentage of general practitioners was low, but the reverse was true of those who had passed their final examinations in 1995. Of those who had passed their final examinations in Leiden in 1990 and 1995, 5% and 4%, respectively, either were not registered as a physician or had emigrated. The specialities that were registered most often by physicians who had passed their final examinations in 199o were obstetrics and gynaecology (14%), internal medicine (9%), ophthalmology (9%), anaesthesiology (8%), surgery (8%) and psychiatry (8%).

Career Choice↗
PubMed1999

Unfolding and refolding of bovine beta-lactoglobulin monitored by hydrogen exchange measurements.

Bovine beta-lactoglobulin (beta-LG) is a widely studied protein belonging to the lipocalin family, whose structural characterisation has been reported by X-ray crystallography and NMR studies at physiological and acidic pH, respectively. Bovine beta-LG consists of nine antiparallel beta-sheets and a terminal alpha-helix segment. The beta-sheets form a calyx structure with a hydrophobic buried cluster conferring stability to the protein while a hydrophobic surface patch provides stabilising interactions between the barrel and the flanking terminal helix. Here, the stability and the folding properties of bovine beta-LG in the presence of a chemical denaturant is probed. The analysis of the NMR spectra recorded in aqueous solution with increasing amounts of urea revealed that the intensities of the backbone cross-peaks decrease upon increasing urea concentration, while their secondary shifts do not change significantly on going from 0 to 5 M urea, thus suggesting the presence of slow exchange between native and unfolded protein. Hydrogen exchange measurements at different urea concentrations were performed in order to evaluate the exchange rates of individual backbone amide protons. The opening reactions that determine protein exchange can be computed for the most slowly exchanging hydrogen atoms, and the measured exchange rates and the corresponding free energies can be expressed in terms of the equilibrium energetic for the global transition and the local fluctuations. Most of the residues converge to define a common isotherm identifying a unique cooperative folding unit, encompassing all the strands, except strand betaI, and the terminal region of the helix. The amides that do not join the same global unfolding isotherm are characterised by low DeltaGH20op and especially by low m values, indicating that they are already substantially exposed in the native state. A two-state unfolding model N <==> U is therefore proposed for this rather big protein, in agreement with CD data. Renaturation studies show that the unfolding mechanism is reversible up to 6 M urea and suggest a similar unfolding and refolding pathway. Present results are discussed in light of the hypothesis of an alpha-->beta transition proposed for bovine beta-LG refolding.

Amino Acid Motifs↗
PubMed1999

The structure of Turkish trait-descriptive adjectives.

This description of the Turkish lexical project reports some initial findings on the structure of Turkish personality-related variables. In addition, it provides evidence on the effects of target evaluative homogeneity vs. heterogeneity (e.g., samples of well-liked target individuals vs. samples of both liked and disliked targets) on the resulting factor structures, and thus it provides a first test of the conclusions reached by D. Peabody and L. R. Goldberg (1989) using English trait terms. In 2 separate studies, and in 2 types of data sets, clear versions of the Big Five factor structure were found. And both studies replicated and extended the findings of Peabody and Goldberg; virtually orthogonal factors of relatively equal size were found in the homogeneous samples, and a more highly correlated set of factors with relatively large Agreeableness and Conscientiousness dimensions was found in the heterogeneous samples.

Cooperative Behavior↗
PubMed1993

Production and characterization of monoclonal antibodies to the carboxyl-terminal heptapeptide of endothelin-1.

Two cell lines, RR5.ET-1 and RR1.ET-1, that produce monoclonal antibodies specific for the carboxyl-terminal heptapeptide of endothelin-1 (ET-1) have been cloned and stabilized. An RIA was developed to facilitate the evaluation and characterization of these monoclonal antibodies. The affinity constant of each MAb for ET-1, as determined by Scatchard analysis, was 5.74 x 10(8) M-1 for RR5.ET-1 and 4.15 x 10(7) M-1 for RR1.ET-1. The antibodies reacted specifically with the carboxyl-terminus (ET15-21) and did not cross-react with the amino-terminal amino acids (ET1-16). As expected, the antibodies cross-reacted with endothelin-2 (ET-2) and endothelin-3 (ET-3), and to a lesser extent, with the closely related sarafotoxins. Both MAbs retained about 55% reactivity with the ET-1 terminal sequence of Asp-Ile-Ile-Trp (ET18-21) but had no reactivity with the ET sequence His-Leu-Asp-Ile-Ile-Trp-Val-Asn (ET16-23) nor with Big ET-1 (ET1-39). These data strongly suggest that the terminal four amino acids of ET-1 are included in the MAb binding site. More importantly, the terminal Trp21 must be free, not linked to Val22 to retain reactivity with either of the MAbs.

Amino Acid Sequence↗
PubMed2000

Interdependence of spatial and temporal coding in the auditory midbrain.

To date, most physiological studies that investigated binaural auditory processing have addressed the topic rather exclusively in the context of sound localization. However, there is strong psychophysical evidence that binaural processing serves more than only sound localization. This raises the question of how binaural processing of spatial cues interacts with cues important for feature detection. The temporal structure of a sound is one such feature important for sound recognition. As a first approach, we investigated the influence of binaural cues on temporal processing in the mammalian auditory system. Here, we present evidence that binaural cues, namely interaural intensity differences (IIDs), have profound effects on filter properties for stimulus periodicity of auditory midbrain neurons in the echolocating big brown bat, Eptesicus fuscus. Our data indicate that these effects are partially due to changes in strength and timing of binaural inhibitory inputs. We measured filter characteristics for the periodicity (modulation frequency) of sinusoidally frequency modulated sounds (SFM) under different binaural conditions. As criteria, we used 50% filter cutoff frequencies of modulation transfer functions based on discharge rate as well as synchronicity of discharge to the sound envelope. The binaural conditions were contralateral stimulation only, equal stimulation at both ears (IID = 0 dB), and more intense at the ipsilateral ear (IID = -20, -30 dB). In 32% of neurons, the range of modulation frequencies the neurons responded to changed considerably comparing monaural and binaural (IID =0) stimulation. Moreover, in approximately 50% of neurons the range of modulation frequencies was narrower when the ipsilateral ear was favored (IID = -20) compared with equal stimulation at both ears (IID = 0). In approximately 10% of the neurons synchronization differed when comparing different binaural cues. Blockade of the GABAergic or glycinergic inputs to the cells recorded from revealed that inhibitory inputs were at least partially responsible for the observed changes in SFM filtering. In 25% of the neurons, drug application abolished those changes. Experiments using electronically introduced interaural time differences showed that the strength of ipsilaterally evoked inhibition increased with increasing modulation frequencies in one third of the cells tested. Thus glycinergic and GABAergic inhibition is at least one source responsible for the observed interdependence of temporal structure of a sound and spatial cues.

Acoustic Stimulation↗
PubMed2000

HCFA hit on settlements. Alleged provider 'sweetheart deals' seen as bad precedent.

Call it selective prosecution. Last week's disclosure of several alleged "sweetheart deals" involving the settlement of Medicare billing disputes has HCFA officials concerned that other healthcare providers could start demanding more favorable treatment. Former HCFA Administrator Bruce Vladeck (left) was among those testifying on those cases last week in Washington. Meanwhile, a look at data on federal fraud investigations shows big geographic disparities in those probes. See story on p. 36.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

[Characteristics of occupational accidents in the building industry and public works in Senegal].

The objectives of this study were to appreciate the magnitude of work accidents in a building construction sector, to specify their type and characteristics. A retrospective study was undergone in a big building construction industry in Senegal. Data were collected from records of accidents reported to the Social Security Administration between 1994--1996. We looked for characteristics of accidents as well as workers involved in accident. 244 accidents were collected in a three years period, i e 81.5/year, 132 work injuries involved temporaryworkers. 55.73% occurred in chantiers, and 1/3 in working room. Moving and handle objects generated most accidents (36,47%). Wounds and contusions were the most frequent lesion (51,62.%). Arms and feets were concerned in 51.63%, and ocular lesions were noticed in 13.94%. These accidents generate an overall number of 3055 days lost. Work injuries in the building construction sector in Senegal are identical to those described in othercountries. Prevention measures requires improvement of working conditions, education of workers and availability of personal protective equipment's.

Accidents, Occupational↗
PubMed1996

Alphavirus infection in mosquitoes at the Ross River reservoir, north Queensland, 1990-1993.

This study addresses the potential problem of alphavirus infection associated with recreational use of the Ross River reservoir in north Queensland, Australia. From 1990 to 1993, 51,497 adult female mosquitoes were collected mainly by CO2-supplemented light traps. Four localities within the reservoir were considered and compared with mosquitoes collected during 1991 from 2 public localities around Townsville City. Ten isolates of Ross River virus, one of Barmah Forest virus, and 2 of Sindbis virus were recovered from Aedes normanensis, Anopheles amictus, and Culex annulirostris. All isolates were collected during the wet seasons of 1991 and 1992 using an enzyme immunoassay and cross-checked using a polymerase chain reaction assay Estimation of relative hazard was based on total mosquito abundance, prevalence of vector species, and on mosquito infection rates. Based on 1990-93 data, it was concluded that the Big Bay area of the Ross River dam, currently being considered as a primary recreational locality, was relatively safer than Antill Creek, Ross River, and Toonpan and presented no greater hazard than localities around urban Townsville, away from the reservoir. However, because of the changing ecology of the reservoir and lack of a full understanding of annual alphavirus activity, periodic surveillance is recommended.

Aedes↗
PubMed1993

Plasma big endothelin-1 concentrations in congestive heart failure patients with or without systemic hypertension.

Plasma endothelin concentrations were evaluated in 53 chronic, congestive heart failure (CHF) patients with or without history of systemic hypertension, as well as in 9 with hypertension only and in 22 healthy control subjects. Plasma renin, aldosterone and atrial natriuretic peptide, as well as clinical and hemodynamic data were determined. In patients with CHF, big endothelin-1 was, independent of hypertension history, significantly greater than in hypertensive patients with normal cardiac function and in control subjects (both p < 0.0001). Patients with severe CHF had significantly greater big endothelin-1 values than did those with moderate CHF. During 12-month follow-up, 11 patients with CHF underwent heart transplantation, and 9 died; these patients had significantly greater big endothelin-1 concentrations than did the 33 clinically stable patients (p < 0.001). Big endothelin-1 and atrial natriuretic peptide correlated with right atrial pressure, pulmonary capillary wedge pressure, left ventricular ejection fraction, effort capacity and severity of CHF (New York Heart Association functional class).

Adult↗
PubMed2006

Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists.

BACKGROUND: Identification of locations with elevated plantar pressures is important in daily foot care for patients with rheumatoid arthritis, metatarsalgia and diabetes. The purpose of the present study was to evaluate the proficiency of podiatrists, pedorthists and orthotists, to distinguish locations with elevated plantar pressure in patients with metatarsalgia. METHODS: Ten podiatrists, ten pedorthists and ten orthotists working in The Netherlands were asked to identify locations with excessively high plantar pressure in three patients with forefoot complaints. Therapists were instructed to examine the patients according to the methods used in their everyday clinical practice. Regions could be marked through hatching an illustration of a plantar aspect. A pressure sensitive platform was used to quantify the dynamic bare foot plantar pressures and was considered as 'Gold Standard' (GS). A pressure higher than 700 kPa was used as cut-off criterion for categorizing peak pressure into elevated or non-elevated pressure. This was done for both patient's feet and six separate forefoot regions: big toe and metatarsal one to five. Data were analysed by a mixed-model ANOVA and Generalizability Theory. RESULTS: The proportions elevated/non-elevated pressure regions, based on clinical ratings of the therapists, show important discrepancies with the criterion values obtained through quantitative plantar pressure measurement. In general, plantar pressures in the big toe region were underrated and those in the metatarsal regions were overrated. The estimated method agreement on clinical judgement of plantar pressures with the GS was below an acceptable level: i.e. all intraclass correlation coefficient's equal or smaller than .60. The inter-observer agreement for each discipline demonstrated worrisome results: all below .18. The estimated mutual agreements showed that there was virtually no mutual agreement between the professional groups studied. CONCLUSION: Identification of elevated plantar pressure through clinical evaluation is difficult, insufficient and may be potentially harmful. The process of clinical plantar pressure screening has to be re-evaluated. The results of this study point towards the merit of quantitative plantar pressure measurement for clinical practice.

Adult↗
PubMed1996

Expressiveness and query complexity in an electronic health record data model.

OBJECTIVE: Describe a high-level conceptual electronic health record (EHR) data model, explain how the model is expressive, present an algorithm for querying the model and determine the complexity of this algorithm. DESIGN: Entity-Relationship diagramming is used to represent the model, which relies on variably nested relations to enable expressiveness. The algorithm complexity is described using "big-oh" or "O()" notation. RESULTS: The data model appears to be highly expressive. A tractable recursive query processing algorithm is presented which is polynomial in time and space complexity. CONCLUSION: Several hurdles remain before the model and algorithm described can be fully tested in a live setting, including the development of techniques to populate the model. However, the study does show the ability to formally analyze an EHR model to understand its particular expressiveness and query complexity.

Algorithms↗