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PubMed2003

Waiting for scheduled services in Canada: development of priority-setting scoring systems.

RATIONALE, AIMS AND OBJECTIVES: An Achilles' heel of Canadian Medicare is long waits for elective services. The Western Canada Waiting List (WCWL) project is a collaboration of 19 partner organizations committed to addressing this issue and influencing the way waiting lists are structured and managed. The focus of the WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled waiting lists. METHODS: Scoring tools for priority setting were developed through extensive clinical input and highly iterative exchange by clinical panels constituted in five clinical areas: cataract surgery; general surgery procedures; hip and knee replacement; magnetic resonance imaging (MRI) scanning, and children's mental health. Several stages of empirical work were conducted to formulate and refine criteria and to assess and improve their reliability and validity. To assess the acceptability and usability of the priority-setting tools and to identify issues pertaining to implementation, key personnel in the seven regional health authorities (RHAs) participated in structured interviews. Public opinion focus groups were conducted in the seven western cities. RESULTS: Point-count scoring systems were constructed in each of the clinical areas. Participating clinicians confirmed that the tools offered face validity and that the scoring systems appeared practical for implementation and use in clinical settings. Reliability was strongest for the general surgery and hip and knee criteria, and weakest for the diagnostic MRI criteria. Public opinion focus groups endorsed wholeheartedly the application of point-count priority measures. Regional health authorities were generally supportive, though cautiously optimistic towards implementation. CONCLUSIONS: While the WCWL project has not 'solved' the problem of waiting lists and times, having a standardized, reliable means of assigning priority for services is an important step towards improved management in Canada and elsewhere.

Canada↗
PubMed1997

Aneuploidy in sclerosing adenosis may predict an increased risk of malignancy. A study using the AgNOR silver stain.

Sclerosing adenosis (SA) of the breast if a disease associated with an increase relative risk of malignancy. The exact incidence and factors influencing malignant transformation in association with SA are not well established. Two counts of the AgNOR silver staining technique have been correlated with ploidy and proliferative activity. The first count which is the mean number of AgNOR granules (mAgNOR), correlates with ploidy. The second count is the percentage of nuclei exhibiting > or = 5 AgNORs/nucleus (pAgNOR) and reflects proliferative activity. The hypothesis in the current study was that aneuploidy, as determined by the AgNOR silver staining technique, may potentially identify lesions of SA with an increased association with malignant breast disease. The AgNOR silver staining technique was performed on 69 cases of SA with the application of the two counts. Of these cases 53 were not associated with malignancy and 16 were associated with synchronous or metachronous carcinoma of the breast, these being 11 cases of invasive ductal carcinoma (IDC), four cases of ductal carcinoma in situ (DCIS) and one case of lobular carcinoma in situ (LCIS). The patient ages ranged from 27 to 84 years (median 53 years) with a median follow up of 28 months. Six of the 53 cases of SA no associated with malignancy (11%) had aneuploid mAgNOR counts of > or = 2.4 whereas 12 of the 16 cases associated with carcinoma (80%) had such counts (p < 0.0005). This included nine cases of IDC, two cases of DCIS and the case of LCIS. Of the six aneuploid cases not associated with malignancy, two cases showed cytological atypia, one case was associated with atypical ductal hyperplasia and one case was seen in a leukemic patient who had received chemotherapy and radiation therapy. The pAgNOR counts showed a statistically less significant correlation with malignancy (p < 0.03). These findings suggest that aneuploidy, measured by the AgNOR silver stein, seen in SA may help identify lesions with a higher relative risk of being associated with breast carcinoma and hence that may require more aggressive management than diploid ones.

Adult↗
PubMed1996

Chromomycin A3-staining as an indicator of protamine deficiency and fertilization.

Mature mammalian spermatozoa have a compact and stable nuclear structure conferred by protamines instead of histones, which are present in all other cellular types. Chromomycin A3 (CMA3) is a useful tool for the detection of protamine deficiency in sperm chromatin. The purpose of this study was to correlate the percentage of spermatozoa staining positively for CMA3 with sperm parameters and in-vitro fertilization of human oocytes. Spermatozoa were collected from 56 fertile and 18 infertile men, and washed twice in PBS, fixed in two changes of methanol : acetic acid (3 : 1 v : v) spread on rinsed slides treated with APES and dried. Twenty-four of the semen samples were subjected to both Percoll and swim-up, and were stained subsequently with CMA3. CMA3-stained spermatozoa were expressed as a percentage in a count of 200 spermatozoa. A substantial variation in the percentage of CMA3-stained cells was observed in ejaculated human spermatozoa, varying between 8% and 77%. A strong negative correlation (r = -0.64, p < 0.001) was found between sperm count and the percentage of CMA3-stained spermatozoa. No correlation was found between CMA3-stained spermatozoa and their motility, while excessive sperm morphological abnormalities were related positively to CMA3-staining. Spermatozoa in samples exhibiting low (8-62%) CMA3-staining had significantly higher fertilizing rates in vitro than did samples exhibiting high (49-77%) CMA3-staining. The mean percentage of CMA3-stained spermatozoa after swim-up or Percoll preparation (26% vs 31%) did not differ significantly. These results demonstrate a close relationship between CMA3-staining, fertilization and sperm count, and suggest potential application of this marker for the prediction of sperm quality and fertilizing capacity.

Chromomycin A3↗
PubMed2001

Statistical data evaluation in mobile gamma spectrometry: an optimization of on-line search strategies in the scenario of lost point sources.

There is a potential risk that hazardous radioactive sources could enter the environment, e.g., via satellite debris, smuggled radioactive goods, or lost metal scrap. From a radiation protection point of view there is a need for rapid and reliable methods for locating and identifying sources. The methods could also be used to locate hot spots after radioactive fallout. Carborne and airborne gamma spectrometry systems are suitable for the task. This work focuses on a situation where the radionuclide to search for is known, which is not an unlikely scenario. The possibility that the source is located near a road can be high, and thus motivating a carborne spectrometer system. The main object is to optimize on-line statistical methods in order to achieve a high probability for locating the point source and still have reasonably few false alarms caused by variations in the natural background radiation. Data were obtained from a carborne 3-L NaI(Tl) detector and two point sources located at various distances from the road. The nuclides used were 137Cs and 131I. Spectra were measured stationary on the road. From these measurements we have reconstructed counts in spectral windows applicable to different speed and sampling times; the time 3 s and speeds 32 and 54 km h(-1) are used in this work. The maximum distance a source can be located from the road and still be detected is estimated with four different statistical analysis methods. This distance is called the critical distance, CD. The method is applied on gross counts in the full energy peak spectral window. For each method alarm levels have been calculated from background data obtained in Scania (Skåne), in the south of Sweden. The results show large differences in CD. With the best approach, the two sources could be detected from about 180 m (137Cs, 6 GBq) and 170 m (131I, 4.5 GBq).

Automobiles↗
PubMed1992

Topical or systemic 16, 16 dm prostaglandin E2 or WR-2721 (WR-1065) protects mice from alopecia after fractionated irradiation.

Our previous studies in mice demonstrated that systemic or topical 16,16 dm PGE2 protected against single dose radiation-induced hair loss. We have now investigated prostaglandin, or WR-2721, protection against murine alopecia produced by varying doses and schedules of fractionated radiation. On days one to eight after hair was plucked from the thighs of B6D2F1 mice, groups of 6 animals each were given daily exposures of 4.0 or 4.5 Gy for 5 days; 2.5, 3.5, 4.5 or 5.5 Gy for 10 days; or 2 Gy for 15 days. One hour before irradiation each mouse received 10 microgram 16,16 dm PGE2, either by subcutaneous injection into the neck or topical application, 8 mg WR-2721 by injection, or 0.3 mg WR-1065 by topical application. Three weeks later counts of regrowing hairs were recorded from excised skin samples. For the radioprotectors used, hair regrowth was increased 25-100% in the various radiation groups in comparison to irradiated-only control sites. In some studies with the radioprotector given systemically, WR-2721 afforded slightly greater radioprotection than 16,16 dm PGE2. The two compounds were essentially equally radioprotective in the topical application studies. Since both systemic and topical applications of the agents tested enhanced hair regrowth following radiation, we conclude that clinical use of these compounds may provide some protection of hair follicles, and perhaps other tissues, lying within a radiation therapy field.

16,16-Dimethylprostaglandin E2↗
PubMed2006

Thin-layer chromatography analysis of human CYP3A-catalyzed testosterone 6beta-hydroxylation.

Testosterone and other steroid hormones have been studied as prototypic examples of endogenous substrates for hepatic cytochrome P450 (P450) enzymes. CYP3A enzymes from various species, including human, metabolize testosterone by a 6beta-hydroxylation reaction, which is unique to this P450 subfamily. A thin-layer chromatographic method is described for the determination of 6beta-hydroxytestosterone formed enzymatically by incubation of [14C]-testosterone with cDNA-expressed CYP3A enzymes or liver microsomes. 14C-labeled enzymatic products are applied to silica gel thin-layer plates, which are developed sequentially with methylene chloride:acetone (80:20) followed by chloroform, ethyl acetate, and absolute ethanol (80:20:14). Metabolite quantification is performed by autoradiography and liquid scintillation counting. This method is applicable to enzymatic studies for the determination of CYP3A-dependent testosterone 6beta-hydroxylation activity in both human and animal liver microsomes.

Autoradiography↗
PubMed2006

The dynamics of major fibrolytic microbes and enzyme activity in the rumen in response to short- and long-term feeding of Sapindus rarak saponins.

AIMS: To investigate the short- and long-term effects of an extract of Sapindus rarak saponins (SE) on the rumen fibrolytic enzyme activity and the major fibrolytic micro-organisms. METHODS AND RESULTS: Two feeding trials were conducted. In the short-term trial, four fistulated goats were fed a basal diet containing sugar cane tops and wheat pollard (65:35, w/w) and were supplemented for 7 days with SE at a level of 0.6 g kg(-1) body weight. Rumen liquor was taken before, during and after SE feeding. In the long-term trial, 28 sheep were fed the same basal diet as the goats and were supplemented for 105 days with 0.24, 0.48 and 0.72 g kg(-1) body mass of the extract. Rumen liquor was taken on days 98 and 100. Protozoal numbers were counted under the microscope. Cell wall degradation was determined by enzyme assays and the major fibrolytic micro-organisms were quantified by dot blot hybridization. Sapindus extract significantly depressed rumen xylanase activity in both trials and carboxymethylcellulase activity in the long-term trial (P < 0.01). Fibrobacter sp. were not affected by the SE in both trials, while ruminococci and the anaerobic fungi showed a short-term response to the application of saponins. Protozoal counts were decreased only in the long-term trial with sheep. CONCLUSION: These data suggest that there is an adaptation of Ruminococcus albus, Ruminococcus flavefaciens and Chytridiomycetes (fungi) to saponin when fed over a long period. The fact that no correlation between the cell wall degrading enzyme activities and the cell wall degrading micro-organisms was observed suggests that the organisms tracked in this experiment are not the only key players in ruminal cell wall degradation. SIGNIFICANCE AND IMPACT OF THE STUDY: Sapindus rarak saponins partially defaunate the rumen flora. Their negative effect on cell wall degradation, however, is not related to rumen organisms currently recognized as the major cell wall degrading species. The adaptation of microbes in the long-term feeding experiment suggests that the results from short-term trial on the ruminal microbial community have to be interpreted carefully.

Animal Feed↗
PubMed1990

Comparative effects of toothpaste brushing and toothpaste rinsing on salivary bacterial counts.

The persistence of antimicrobial action of compounds and formulations in the mouth can be demonstrated by recording the magnitude and duration of the reduction of salivary bacterial counts following a single application. Such measures of substantivity appear to correlate with the plaque inhibitory properties of antimicrobial agents. For toothpastes, studies on the short-term inhibition of plaque formation use a number of delivery methods to measure the direct effect of the preparation divorced from toothbrushing. Such methods include paste slurries, paste in trays or cap splints. This study determined whether toothbrushing with a toothpaste produced the same effects on salivary bacterial counts compared to rinsing with a slurry. A group of 24 volunteers brushed or rinsed with a slurry of a commercial toothpaste. Each regimen was repeated twice on 4 separate days by all volunteers and salivary bacterial counts recorded at baseline and time periods to 7 hours. There were no significant differences between brushing or slurry rinsing on salivary bacterial counts and each method produced reproducible effects. This supports the use of the slurry method where the direct plaque inhibitory action of an antimicrobial toothpaste is to be assessed; and indicates that both methods equally make available and activate the relevant ingredients in formulations.

Adult↗
PubMed1993

Hair cortical cell counts (HCCC), a new sensitive in vivo assay with possible applications for biological dosimetry.

In the region of a growing hair follicle where terminal keratinization takes place, the nuclei of the medulla and cortex are gradually degraded. In the zone between rapid cell proliferation in the matrix and the complete loss of the nuclei in the formed hair, the number of medullary cells in the hair proved to be a sensitive-radiation-dose-dependent endpoint (Potten et al. 1990). Nuclei in the cortex of the hair are similarly degraded but are more difficult to quantitate since they form a circumferential ring of cells round the medulla. However, using the confocal microscope to obtain discrete optical sections just above and below the medulla, the number of cortical cells was reproducibly counted. The maximum reduction in cortical cell count occurred on the 3rd day after irradiation. Here, the dose-response curve (0.5-4.0 Gy) is presented, for the population of cortical cells in awl guard hairs of the mouse for 137Cs gamma-rays at 4 Gy/min, which was exponential with no significant shoulder, (the D0 was 2.4 +/- 0.2 Gy and the extrapolation number 1.2 +/- 0.1). The cortical cells exhibited a slightly higher D0 value than the medullary cells but differed in that there was no evidence of a shoulder. The effects of 0.5 Gy could be detected. The degree of sensitivity, and the fact that cortical cells are readily detected in human hair follicles, unlike the medullary cells, make this a potentially valuable human biological dosimeter.

Animals↗
PubMed2004

An efficient filling algorithm for counting regions.

Region filling has many applications in computer graphics and image analysis. Some region filling tasks can be performed by fast scan line filling algorithms. Other region filling tasks require seed filling algorithms which are more general but slower. This paper introduces a seed filling algorithm that is designed to count regions irrespective of their shape. The method is described and its performance is compared with three alternative algorithms by applying them to a collection of 34 test images. The four methods showed complete agreement with respect to the counted numbers of regions. The proposed method was found to be fastest and requiring least memory.

Algorithms↗
PubMed2003

Care of patients with long-term indwelling urinary catheters.

The complications and management of long-term indwelling catheters used for urinary retention and incontinence were reviewed. Research evidence from 1992 - 2002 was located through searches of CINAHL (38 articles), and Medline (89 articles). Fifty studies were critiqued for this review. The most common complications of long-term indwelling catheters are bacteriuria, encrustation, and blockage. Less common is the prevalence of bacteremia and renal disease. Risk factors for bacteriuria include female gender, older age, and long-term indwelling catheter use. Urinary white blood cells are the best indicator of urinary tract infection. For drainable catheter systems used by community dwelling adults, daily bag cleaning with a diluted bleach solution (1:10) is effective in reducing bacterial counts to negligible numbers. Application of topical antibiotic cream to the meatus around the catheter does not reduce bacteriuria. Silicone catheters and larger lumen size catheters are more resistant to encrustation than other catheter types and smaller lumen size catheters. Acidifying the urine without removing the urease-producing bacteria does not reduce encrustation. Removal of catheter blockage is preventive for renal disease. Because of the complications of long-term indwelling catheter usage, periodic assessment and voiding trials should be used to determine the continued need for a catheter. Evidence-based recommendations for managing indwelling urinary catheters include screening for risk factors and evaluating urinary white blood cell count for infection, and assessment of the continued need for a catheter. Interventions include consideration of closed versus open drainage systems, type of catheter, and size of catheter lumen.

Aged↗
PubMed1982

Fiber optics in medicine.

The most significant and prevalent applications of fiber optics in medicine are in the imaging and illumination components of endoscopes. Flexible and rigid multifibers composed of step-index fibers and graded-index imaging rods are extensively used for visualization of internal organs and tissue which are accessible through natural openings or transcutaneously. This article reviews the evolution of the fiber-optic endoscope over the past 20 years. The fabrication techniques of optical fibers for imaging and illumination are considered in juxtaposition to their current applications in communications with emphasis on the different technologies involved. The design of distinct endoscopes is described with a detailed review of their use in various medical specialities. Low-loss optical fibers are employed to transmit laser energy for surgery and photocoagulation. Multicolor laser light is transmitted through a single thin optical fiber to provide adequate illumination for viewing and color photography. Past attempts to develop plastic imaging multifibers and their future potential viewing and color photography. Past attempts to develop plastic imaging multifibers and their future potential are discussed. Other uses of fiber optics in medicine include remote spectrophotometry, pressure and position sensing, or scintillation counting. These and other applications, such as intravascular pressure transducers and in vivo oximeters, are described.

Bronchoscopes↗
PubMedDate not supplied

Influence of fosfomycin on the intestinal and pharyngeal flora of man.

The influence of 5 g fosfomycin i.v. every 12 hours on the intestinal and pharyngeal flora was studied in eight healthy, male volunteers. The Escherichia coli counts were markedly reduced during application and returned to normal in all subjects within a maximum period of 12 days. The total count of Enterococci was reduced by one to two decimal potencies under medication. There was no change in the counts of Bacteroides and anaerobic lactobacteria. No selection of Clostridium difficile was observed. Throughout the study period the pharyngeal flora of all subjects was consistent, and no changes were seen. No selection of Candida spp. was observed.

Adult↗
PubMed2006

Particle emissions from diesel passenger cars equipped with a particle trap in comparison to other technologies.

Tail pipe particle emissions of passenger cars, with different engine and aftertreatment technologies, were determined with special focus on diesel engines equipped with a particle filter. The particle number measurements were performed, during transient tests, using a condensation particle counter. The measurement procedure complied with the draft Swiss ordinance, which is based on the findings of the UN/ECE particulate measurement program. In addition, particle mass emissions were measured by the legislated and a modified filter method. The results demonstrate the high efficiency of diesel particle filters (DPFs) in curtailing nonvolatile particle emissions over the entire size range. Higher emissions were observed during short periods of DPF regeneration and immediately afterward, when a soot cake has not yet formed on the filter surface. The gasoline vehicles exhibited higher emissions than the DPF equipped diesel vehicles but with a large variation depending on the technology and driving conditions. Although particle measurements were carried out during DPF regeneration, it was impossible to quantify their contribution to the overall emissions, due to the wide variation in intensity and frequency of regeneration. The numbers counting method demonstrated its clear superiority in sensitivity to the mass measurement. The results strongly suggest the application of the particle number counting to quantify future low tailpipe emissions.

Automobiles↗
PubMed2001

Spotting neural spike patterns using an adversary background model.

The detection of a specific stochastic pattern embedded in an unknown background noise is a difficult pattern recognition problem, encountered in many applications such as word spotting in speech. A similar problem emerges when trying to detect a multineural spike pattern in a single electrical recording, embedded in the complex cortical activity of a behaving animal. Solving this problem is crucial for the identification of neuronal code words with specific meaning. The technical difficulty of this detection is due to the lack of a good statistical model for the background activity, which rapidly changes with the recording conditions and activity of the animal. This work introduces the use of an adversary background model. This model assumes that the background "knows" the pattern sought, up to a first-order statistics, and this "knowledge" creates a background composed of all the permutations of our pattern. We show that this background model is tightly connected to the type-based information-theoretic approach. Furthermore, we show that computing the likelihood ratio is actually decomposing the log-likelihood distribution according to types of the empirical counts. We demonstrate the application of this method for detection of the reward patterns in the basal ganglia of behaving monkeys, yielding some unexpected biological results.

Action Potentials↗
PubMed2001

Effects of intraocular cefotaxime on the human corneal endothelium.

PURPOSE: To ascertain whether 0.4 mL of cefotaxime 0.25% applied intracamerally causes toxic alteration of the human corneal endothelium. METHODS: In this prospective randomized masked study, 66 patients had cataract extraction using phacoemulsification, a frown incision, and implantation of a poly(methyl methacrylate) intraocular lens. This was followed by intraocular injection of 0.4 mL of cefotaxime 0.25% or balanced salt solution (BSS(R)). Contact specular microscopy and photography were performed preoperatively and 1 to 4 days and 3 months postoperatively. RESULTS: In the cefotaxime group, the mean endothelial cell count was 2729 cells/mm(2) +/- 474 (SD) preoperatively, 2520 +/- 462 cells/mm(2) 1 to 4 days postoperatively, and 2560 +/- 495 cells/mm(2) 3 months postoperatively. The mean endothelial cell count in the BSS (control) group was 2657 +/- 413 cells/mm(2), 2475 +/- 384 cells/mm(2), and 2486 +/- 427 cells/mm(2), respectively. There was no significant difference in cell count or morphology between groups (P <.05). CONCLUSIONS: Intraocular application of cefotaxime produced no significant changes in endothelial cell count or morphology when compared with application of a control substance. With its broad spectrum of antibiotic activity, cefotaxime might be an appropriate alternative to other intraocularly administered antibiotics in anterior segment surgery for prophylaxis and management of infection.

Adult↗
PubMed1993

Large-volume hemocytometer chamber for accurate counting of white cells (WBCs) in WBC-reduced platelets: validation and application for quality control of WBC-reduced platelets prepared by apheresis and filtration.

A detailed description is provided of a method using a large-volume (50 microL) hemocytometer to count very low numbers of white cells (WBCs) in platelet components. A method employing a Nageotte hemocytometer uses crystal violet stain and a standard microscope with a reading time of 5 to 10 minutes. The method is validated by using serial dilutions of known concentrations of WBCs in platelets and by correlation with a flow cytometric technique. The interobserver coefficient of variation was 11.9 percent for WBC concentrations > 2 per microL. Use of the method for the evaluation of 203 WBC-reduced platelet components prepared by apheresis or by filtration revealed that over 94 percent of components had WBC content < 5 x 10(6). This method could easily be applied in the routine quality control of WBC-reduced platelet components and in clinical studies employing these components.

Blood Component Removal↗
PubMed1992

A fast algorithm for counting the arrangements for packing identical items on a one-dimensional grid with application in DNA-protein and similar interactions.

An algorithm is described, originally developed for use with DNA-protein complexes, which precisely counts the number of possible arrangements for non-overlapping items, each occupying M points, on a lattice of N such points. The algorithm counts the total number of arrangements for a given number of items and can be readily extended to count the number of arrangements which meet an additional criterion. Examples are given of two such classifications and of the application of one of them to a problem in DNA-protein interactions.

Algorithms↗