It's the journey, not the destination. Grief and its complications.
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Gibberellins, fatty acids and the polyketides bikaverin and fusarin C are synthesized from a common precursor, acetyl-CoA. The production of these compounds in Gibberella fujikuroi was strongly influenced by aeration, determined by the air/medium ratio in shaken batch cultures. Higher aeration resulted in increased growth and the production of bikaverin and gibberellins. Low aeration stimulated fatty acid and fusarin C production. Feeding experiments with labeled leucine or acetate resulted in different proportions of labeled palmitic acid and bikaverin, indicating that these compounds are synthesized from independent acetate pools.
The travel patterns of individuals living in rural areas of New York State who were discharged from short-term general hospitals in New York State in 1983 are examined. Counties are used as the geographical unit, and rural individuals who cross geographic boundaries to obtain inpatient hospital care are compared with those who receive such care in their own geographic area. Hospital serving the rural population of New York are classified into three types: urban, consisting of all hospitals located in MSAs; rural referral centers; and other rural hospitals. Next, the rural patients who are admitted to each of these three types of hospitals are characterized in terms of distance traveled, case mix, length of stay, and age. Individuals who travel beyond the counties adjacent to their county of residence had a higher case mix index but were less likely to be more than 75 years old. Distance traveled and the expected cost of care were strongly positively related for patients admitted to urban and rural referral center hospitals, but were only weakly related for other rural hospitals. Finally, comparisons of rural patients in these three types of hospitals were performed adjusting for DRG mix, a comparison which is relevant to hospital reimbursements under the Medicare Prospective Payment System. Using several measures of illness severity, rural patients in urban hospitals and rural referral center hospitals were more severely ill than rural patients in other rural hospitals after adjusting for DRG mix. We conclude that somewhat higher payments to urban hospitals and rural referral center hospitals in New York are justified based on the more severely ill patients which they treat
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1. Rat facial motoneurones axotomized on the day after birth were examined morphologically, and their electrical properties were characterized using the whole-cell recording technique in thin slices of the brainstem. 2. About 40% of facial motoneurones were lost within 4 days of axotomy, and only about 20% of the neurones survived 9 days after axotomy. 3. The surviving facial motoneurones examined 4 or 6 days after axotomy were reduced in size, and this was associated with a decrease in their input capacitance. 4. Both the resting potential and the amplitude of action potentials remained unchanged in axotomized facial motoneurones. 5. Facial motoneurones examined 4 or 6 days after axotomy showed an increase in the spike duration. When the preparation was superfused with a Ca(2+)-free solution, the spike duration of axotomized facial motoneurones was shortened, whereas the spike duration of control facial motoneurones was prolonged. 6. The voltage-gated transient K+ current (IA) density was significantly reduced in axotomized motoneurones, whereas the Ca(2+)-dependent transient K+ current (IK, Ca) density was not affected. 7. Voltage-gated Ca2+ currents in facial motoneurones showed inactivation, displaying an initial transient phase followed by a sustained phase. The rate of inactivation of Ca2+ currents was significantly faster in axotomized neurones than in control neurones. 8. A small subpopulation of facial motoneurones examined 4 or 6 days after axotomy had a disproportionately high input resistance and a significantly longer after-hyperpolarization. The probability of this occurring was correlated with the time course of cell death induced by axotomy. 9. It is concluded that facial motoneurones axotomized in neonatal rats comprise two subpopulations. The subpopulation characterized by a markedly high input resistance is suggested to represent the neurones which are at the 'prelethal' stage or in the process of cell death.
Mycobacteria were isolated from defrost water and tissue of sole (Solea solea), hake (Merluccius merluccius), cod (Gadus morhua), ling (Genypterus blacodes), and monkfish (Lophius piscatorius) on Löwenstein-Jensen medium after incubation at different temperatures. Samples of frozen fish were obtained under sterile conditions inside a refrigeration chamber (-18 to -22 degrees C) in a wholesale market from which these products are distributed to shops for retail sale and human consumption.
Twenty four hour tape recordings of electrocardiogram and breathing movement were made prospectively in 6914 full term and 2337 preterm infants or infants of low birth weight during their first six weeks of life. These recordings included 40 obtained in 29 infants who subsequently suffered the sudden infant death syndrome and 13 obtained in 10 other infants who died suddenly and unexpectedly. None of the recordings obtained in the infants who suffered the sudden infant death syndrome showed prolonged apnoea (cessation of breathing movement for 20 seconds or more) or pre-excitation. One infant had multiple ventricular premature beats (38/hour). Compared with recordings obtained in 211 control infants who did not die none of the recordings obtained in the infants who suffered the syndrome showed abnormal prolongation of the QT interval.
From a prospective study in which 24 hour recordings of the electrocardiogram and respiratory activity (abdominal wall movement) were made on a population of full term infants, 22 recordings were obtained from 16 infants who later were victims of the sudden infant death syndrome. The average heart rate, average heart rate variability, average breath to breath interval, and average breath to breath interval variability over the whole of each recording for the 22 recordings were compared with those from a control group of 324 infants selected at random from the rest of the population. No significance was found in the number of recordings from those infants who suffered the sudden infant death syndrome which lay outside the 5th-95th percentile range of the control group for the four variables studied. In a group comparison no difference was found between the sudden infant death syndrome group and the controls either in terms of the respiratory variables studied or in terms of the average heart rate variability. The results did, however, suggest that there may be a group difference in terms of the average instantaneous heart rate.
Cohort studies of doctors' career choices and career progression since the mid-1970s have shown important changes in the medical workforce, in specialist training, and in employment. Examples of these changes are the increasing proportion of women doctors and of doctors who wish to work part time, the emigration patterns of doctors, and the development of vocational training for general practice. Studies enable the effects of longer term changes to be assessed, and sometimes they inform current debate.
OBJECTIVE: This study updates work published in 1998, which found that of 47 rating instruments appearing on websites offering health information, 14 described how they were developed, five provided instructions for use, and none reported the interobserver reliability and construct validity of the measurements. DESIGN: All rating instrument sites noted in the original study were visited to ascertain whether they were still operating. New rating instruments were identified by duplicating and enhancing the comprehensive search of the internet and the medical and information science literature used in the previous study. Eligible instruments were evaluated as in the original study. RESULTS: 98 instruments used to assess the quality of websites in the past five years were identified. Many of the rating instruments identified in the original study were no longer available. Of 51 newly identified rating instruments, only five provided some information by which they could be evaluated. As with the six sites identified in the original study that remained available, none of these five instruments seemed to have been validated. CONCLUSIONS: Many incompletely developed rating instruments continue to appear on websites providing health information, even when the organisations that gave rise to those instruments no longer exist. Many researchers, organisations, and website developers are exploring alternative ways of helping people to find and use high quality information available on the internet. Whether they are needed or sustainable and whether they make a difference remain to be shown.
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Fine flexible wire microelectrodes chronically implanted in the fifth lumbar ventral root (L5 VR) of 17 cats rendered stable records of the natural discharge patterns of 164 individual axons during locomotion on a treadmill. Fifty-one out of 164 axons were identified as motoneurons projecting to the anterior thigh muscle group. For these axons, the centrifugal propagation of action potentials was demonstrated by the technique of spike-triggered averaging using signals recorded from cuff electrodes implanted around the femoral nerve. The axonal conduction velocity was measured from the femoral nerve cuff records. For 43/51 motoneurons, the corresponding target muscle was identified by spike-triggered averaging of signals recorded from bipolar EMG electrodes implanted in each of the anterior thigh muscles: vastus intermedius, medialis and lateralis, sartorius anterior and medialis, and rectus femoris. For 32/51 motoneurons, the recruitment threshold during locomotion was determined from the mean value of the rectified digitally smoothed EMG of the target muscle measured at the time when the motoneuron fired its first spike for each step. The recruitment threshold of every motoneuron was relatively constant for a given speed of walking, but for some units there were small systematic variations as a function of treadmill speed (range: 0.1-1.3 m/s). Recruitment thresholds were standardized with respect to the mean value of peak EMG activity of the target muscle during 16 s of walking at 0.5 m/s. For 28/51 motoneurons recorded in nine cats, recruitment thresholds (range: 3-93% of peak target muscle EMG) were linearly correlated (r = 0.51, P less than 0.02) to axonal conduction velocities (range: 57-117 m/s). In addition, for seven recorded pairs of motoneurons that projected to the same muscle in the same cat, the recruitment thresholds were ordered by relative conduction velocities. Taken together, these results are consistent with the notion that, in normal cat locomotion up to a medium trot, anterior thigh motoneurons are progressively recruited in an orderly fashion.
The Flowmaker left ventricular assist device (formerly known as the Jarvik 2000) is an axial-flow pump that provides continuous flow from the left ventricle to the aorta. Designed for either temporary or permanent use, the Flowmaker is undergoing clinical trials in the United States and Europe. The goal of this therapy is to provide adequate circulatory flow while partially reducing the left ventricular size and end-diastolic pressure. This gives the native ventricle an opportunity to remodel itself. Those who benefit the most from this technology are patients who require only true left ventricular assistance rather than total capture of the left ventricular output. Because of the Flowmaker's simplicity and safety of implantation, as well as the absence of late pump failure, its use may be justified in severely impaired class III and IV (but not preterminal) heart failure patients.