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PubMed2003

Behind the times: physician income, 1995-99.

This Data Bulletin is based on physicians' reports of net income from the practice of medicine from the HSC Community Tracking Study Physician Survey in 1996-97, 1998-99 and 2000-01. Net income equals income from the practice of medicine after expenses and before taxes. Reported income is lagged--for example, in the 2000-01 survey, physicians provide 1999 net income. Adjustments for inflation use the Bureau of Labor Statistics (BLS) online inflation calculator.

Forecasting↗
PubMed2002

The behaviours of the inhabitants of the Lublin region in the situations of sudden cardiac arrest as reflected in the opinions of the Ambulance Service doctors.

Diseases of blood circulation system constitute the major cause of sudden cardiac arrest and deaths in Poland. Approximately 70% of all the cases of cardiac arrest occurs outside hospitals, frequently at patient's home. In the case of applying immediate resuscitation by the event witness in the situation of sudden cardiac arrest the percentage of the victims' survival is estimated at approximately 43%. Each delay of the initiation of Basic (BLS) and afterwards Advanced Life Support (ALS) lowers the chance of survival. Thus, it is extremely significant to educate Polish society in the area of basic resuscitative actions, particularly due to the fact that laypeople are usually the first ones at the scene of an accident. The aim of the paper was to determine to what extent the inhabitants of the Lublin region are prepared to rescue victims of sudden accidents by means of cardiopulmonary resuscitation and proper response in the situation of the sudden cardiac arrest. As results from the executed survey the inhabitants of the Lublin region in the situation of sudden cardiac arrest mostly do nothing but call an ambulance. The witnesses of the sudden cardiac arrest more frequently apply only rescue breathing or only indirect heart massage rather than rescue breathing and indirect heart massage simultaneously. The competence for applying CPR among the inhabitants of the Lublin region is poor and the resuscitative actions are much more frequently taken up by men. Premedical aid trainings are considered insufficient to prepare witnesses of sudden cardiac arrest for applying first-aid. They should be conducted by doctors, in properly prepared and equipped training centers. The majority of the Ambulance Service doctors in Lublin indicated the demand for reminder premedical aid trainings.

Ambulances↗
PubMed1992

Cerebral and buccal neurons involved in buccal motor pattern generation in Achatina fulica.

In the African giant snail, Achatina fulica, two pairs of cerebral neurons, v-CDNs and Cls, and ten pairs of buccal neurons, Bls-B10s, were identified. B1-B6 and B10 were the excitatory motoneurons of buccal muscles. B7 and B8 innervated salivary ducts and B9 extended its axons to the cerebral ganglia although their functions were not clear yet. Serotonergic v-CDN exerted excitatory effects on various neurons in the buccal ganglia and had modulatory effects on buccal muscles. When v-CDN, Cl or B1 was continuously fired, each one could initiate and maintain the rhythmic motor activity (RMA) in the buccal ganglia of reduced preparation. Taste stimulation of the lip often elicited RMA. Nevertheless, v-CDN and B1 were not always excited by taste stimuli, and they appeared not to be critical elements in the generation of feeding rhythm. In contrast, Cl responded to taste stimuli with burst of spikes. Thus, C1 may play a role in taste-induced rhythm generation in intact animal.

Animals↗
PubMed1992

Delaware Emergency Medical Services System: cardiac resuscitation.

The Delaware EMS system has been in existence for 20 years. Initially begun as one paramedic unit serving New Castle County, it now comprises 15 units in a statewide system. The goal of this report is to detail the EMS system's impact on prehospital cardiac resuscitation and airway management. Emergency Medical Services (EMS) encompass all aspects of managing a sick or injured patient prior to arrival to the hospital. From the time a patient dials 911 until they arrive in the care of a doctor in an emergency room, the EMS system provides initial medical evaluation and care as well as transportation to the hospital. The components of Delaware's EMS system include: 1. Bystanders--the public is often called upon to perform CPR until trained rescuers arrive. 2. Medical Dispatchers--they receive incoming 911 calls and determine the personnel needed. 3. First responders--ambulance crews trained in basic life support (BLS). 4. Second responders--ambulance crews trained in advanced life support (ALS), paramedics. 5. Medical Control--doctors who are in radio contact with paramedics to provide medical advice.

Adult↗
PubMed2004

[Research progress on regulation of class II MHC expression].

Class II MHC antigens play a critical role in the induction of immune responses through presentation of processed antigen to CD4+ T lymphocytes. The absence of MHC II normal expression results in severe primary immunodeficiency diseases, such as the bare lymphocyte syndrome (BLS). Four different MHC II regulatory genes have been identified. These genes encode RFXANK, RFX5, RFXAP and CIITA. The first three are subunits of RFX, a ubiquitously expressed factor that binds to the promoters of all MHC II genes. CIITA is the master control factor for MHC II expression. The highly regulated expression pattern of CIITA ultimately dictates the cell type specificity, induction and level of MHC II expression. This review focuses on research progress on regulation of class II MHC expression in recent years.

Animals↗
PubMed2003

Immediate life support training in an operational environment.

The Immediate Life Support (ILS) course is a 1 day programme designed by the Resuscitation Council (UK) to bridge the gap between Basic Life Support (BLS) and Advanced Life Support (ALS). During the build up to Operation TELIC, the aim was to provide ILS training to all staff who may be involved in the acute care of patients within PCRF ARGUS, and also to members of staff from other units who may be involved in similar situations. In total, 101 staff received ILS training during Op TELIC, all of whom were successful in completing the course.

Cardiopulmonary Resuscitation↗
PubMed2005

Fatal injuries among volunteer workers--United States, 1993-2002.

In the United States, an estimated 59 million persons spend a median of 52 hours each year volunteering, most often in religious, educational, youth, or community service organizations; volunteers commonly perform activities such as coaching, campaigning, fundraising, delivering goods, and serving on boards or neighborhood associations. Few studies have analyzed fatal injuries to volunteers, and studies have typically focused on a specific volunteer group (e.g., Peace Corps). To characterize fatal injuries among volunteers in the United States, CDC analyzed data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) for 1993-2002. This report describes the results of that analysis, which indicated that a total of 501 persons died from injuries sustained while volunteering during this period; most often these persons were firefighters and other volunteers who were operating motor vehicles at the time of death. To reduce these fatalities, organizations that rely on volunteers need to provide adequate training (e.g., defensive driving and recognition of evacuation signals) on the basis of well-communicated and enforced safety and health policies.

Adolescent↗
PubMedDate not supplied

Fluid intake of community-living, independent elderly in Germany--a nationwide, representative study.

BACKGROUND: Age-related changes in kidney function and thirst sensation increase the susceptibility for dehydration in the elderly. Adequate fluid intake is the most important prerequisite for fluid homeostasis. Reliable data on fluid intake of older subjects in Germany are lacking. OBJECTIVE: To assess fluid intake from beverages and total fluid intake of independent, community-living elderly people in Germany. DESIGN: From a random sample of 4020 non-institutionalized German elderly, stratified into three age-groups (65-74 y., 75-84 y., 85+ y.), 1372 subjects filled in a prospective, standardised 3-day dietary record (cross-sectional study). Fluid intake by beverages and food was calculated on the basis of the German nutrient data base BLS II.2. RESULTS: Daily median beverage consumption (5. / 95. percentiles) amounted to 1567 (700 / 2967) ml in men and 1400 (600 / 2467) ml in women and thus met the actual recommendation (1310 ml per day). With increasing age beverage intake decreased in both sexes. Consequently, the proportion not meeting the reference value increased with age (33 % vs. 44 % vs. 51 %; p < 0.001). Median total water intake (2387 ml in men, 2224 ml in women) also was higher than the reference value (1990 ml per day) and showed similar differences between sex and age groups as fluid intake by beverages. In one third (28 % of the younger elderly and 41 % of the oldest old) total fluid intake was below the recommendation. CONCLUSION: The majority of independently living elderly without major health problems ingests sufficient amounts of fluid to compensate for fluid losses and to be adequately hydrated. Very old elderly, however, require special attention with respect to adequate supply of fluid.

Aged↗
PubMed2005

Cardiac case study. 50-year-old male with chest pressure.

This case study represented a patient with a relatively uncomplicated myocardial infarction that, after prompt prehospital care and transport, was successfully halted in the emergency department with fibrinolytic therapy. This patient was provided excellent care in the prehospital setting because the paramedic and his EMT-B partner worked together effectively as a team. Although ECG monitoring, IV therapy and medication administration are beyond the usual scope of practice of an EMTB, many EMS systems are training their EMT-Bs to assist with these important procedures and interventions. This involves preparing IV equipment and supplies, applying the cardiac monitor, and recognizing and handling the various paramedic medications. This enhanced role of the EMT-B allows the paramedic to perform a more focused and careful patient assessment. A cohesive working relationship between BLS and ALS personnel is absolutely crucial to the outcome of the patient. Although each level of prehospital provider possesses a different knowledge of pathophysiology and patient management, it is the combined contributions and efforts of each provider that will afford patients the high quality of care they deserve.

Chest Pain↗
PubMed2006

[Screening and identification of heterogeneous phenotype-associated genes in human bladder cancer].

OBJECTIVE: To screen and identify heterogeneous phenotype-associated genes of human bladder transitional cell carcinoma. METHODS: Subtractive cDNA libraries was established by means of suppression subtractive hybridization (SSH) on the basis of two human bladder transitional cell carcinoma cell lines (BLZ-211 and BLS-211) derived from the same patient, which had similar changes in chromosomes but different cell phenotypes (in terms of cell shape, susceptibility to 5-Fu and tumorigenic capacity). The positive clones in the library were selected for screening differentially expressed gene fragments by sequence analysis and blasting, and Northern blotting was performed to confirm the differentially expressed genes. RESULTS: The subtractive forward and reverse cDNA libraries consisted of 168 and 206 white clones containing 200-700 bp inserts. After differential screening, 55 cDNA clones containing 35 different transcripts were obtained, among which 15 were identified by homology analysis as known genes (such as those coding for vimentin, keratin 7, dihydrodiol dehydrogenase and thioredoxin reductase), 11 as unknown genes, and 9 as new ESTs (GenBank dbEST database accession number DY505708, DY230447-8, DR008207). CONCLUSION: SSH is a powerful method for identifying differentially expressed genes between different cell lines or clones, and characterization of the identified genes may provide useful information for understanding the genes responsible for different cell phenotypes.

Blotting, Northern↗
PubMed1991

Cell phenotype dependent expression of MHC class I antigens in Burkitt's lymphoma cell lines.

Burkitt's lymphoma (BL) is a highly malignant B cell tumor characterized by three types of chromosomal translocation which constitutively activate the c-myc oncogene by juxtaposing it to Ig coding sequences. Epstein-Barr virus (EBV) infection, hyperendemic malaria and HIV-caused immunosuppression are thought to contribute to the pathogenesis of the tumor. Cell lines derived from EBV carrying and EBV negative BLs often show altered MHC class I antigen expression. The defects include a lower expression of all HLA class I antigens compared to EBV transformed normal B-blasts, and selective down-regulation of certain HLA-A and HLA-C alleles. As a consequence BL cells are often resistant to cytotoxic T lymphocyte (CTL) mediated destruction. Alleles selective down-regulations are found only in cell lines that maintain the tumor cell phenotype while shift towards a more activated 'B-blast like' phenotype is accompanied by HLA class I up-regulation. A similar pattern of HLA class I expression can be found in a subpopulation of germinal center B cells which express a 'BL like' phenotype. Our findings suggest that the HLA class I expression of BL cells reflects the characteristics of the normal B cell precursor and is probably not the result of immune selection.

Antigens, CD↗
PubMedDate not supplied

[European Resuscitation Council guidelines for cardiopulmonary resuscitation in 2005].

ADULT BASIC LIFE SUPPORT: The ratio of compressions to ventilations is 30:2 for all adult victims of cardiac arrest. AUTOMATED EXTERNAL DEFIBRILLATION: A single defibrillatory shock is delivered, immediately followed by two minutes of uninterrupted CPR. ADULT ADVANCED LIFE SUPPORT: In out-of-hospital cardiac arrest attended, but unwitnessed, by healthcare professionals equipped with manual defibrillators, give CPR for 2 minutes before defibrillation. The recommended initial energy for biphasic defibrillators is 150-200 J, for second and subsequent shocks is 150-360 J. The recommended energy when using a monophasic defibrillator is 360 J for both the initial and subsequent shocks. Rhythm checks must be brief, and pulse cheks undertaken only if an organised rhythm is observed. Adrenaline is given 1 mg i.v. as soon as intravenous access is obtained, and repeated every 3-5 min thereafter until return of spontaneous circulation is achieved. Consider thrombolytic therapy when cardiac arrest is thought to be due to proven or suspected pulmonary embolus. Unconscious adult patinets, with spontaneous circulation, after out-of-hospital VF cardiac arrest should be cooled to 32-34 degrees C for 12-24 hours. PAEDIATRIC BASIC LIFE SUPPORT: Lay rescuers or lone rescuers witnessing paediatric cardiac arrest will start with 5 rescue breaths and continue with the 30:2 ratio as thaught in adult BLS. Two or more rescuers with a duty to respond will use the 15:2 ration in a child up to the onset of puberty. PAEDIATRIC ADVANCED LIFE SUPPORT: When using a manual defibrillator, a dose of 4 J/kg (biphasic or monophasic waveform) should be used for the first and subsequent shocks. Adrenaline iv. or i.o. should be given at the dose of 10 microg/kg (0.01 mg/kg) and repeated every 3-5 minutes. NEONATAL LIFE SUPPORT: Protect the newborn from heat loss. Standard resuscitation in delivery room should be made with 100% oxygen. Suctioning meconium from the baby's nose and mouth before delivery of the baby's chest (intrapartum suctioning) is not useful and no longer recommended.

Adult↗
PubMed1992

Synthesis and assembly of the synaptic cleft protein S-laminin by cultured cells.

S-laminin, a homologue of the B1 chain of laminin, is concentrated in a subset of basal laminae (BLs), including the BL at the skeletal neuromuscular junction and bears an adhesive site for motoneuron-like cells. Here, we have begun to characterize the native form of the protein. We show that several muscle- and glia-like cell lines synthesize and secrete S-laminin as well as the A, B1, and B2 subunits of the conventional laminin trimer. Experiments using subunit-specific antibodies showed that S-laminin is complexed with the A and B2 subunits of laminin but not with B1, suggesting that S-laminin replaces B1 to form a novel laminin-like trimer. Comparison of material precipitated by different antibodies provided evidence for two immunochemically distinct forms of S-laminin, both of which associate with B2 and A-like subunits. Analysis of tunicamycin-treated cells indicated that N-linked glycosylation is required neither for the selective association of S-laminin with B2 and A subunits nor for the distinction between two forms of S-laminin. Finally, a full-length S-laminin cDNA was constructed and transfected into muscle and non-muscle cells. S-laminin was detected intracellularly in both cell types, in extracellular matrix of muscle cells, and in two immunochemically distinct forms. Thus, the cDNA contains sufficient information to permit assembly, secretion, and post-translational modification of S-laminin.

Animals↗
PubMed1991

The identification of occupational lung disease from hospital discharge data.

The Bureau of Labor Statistics-State Health Department Select Committee on Occupational Illnesses and Injuries conducted a study of hospital discharge records to determine their usefulness for identifying cases of occupational disease. Four states searched the diagnosis fields on computerized hospital discharge records for selected occupational lung diseases; pneumoconiosis, extrinsic allergic alveolitis, and respiratory conditions due to chemical fumes and vapors. The hospital discharge data identified more cases of pneumoconiosis than did the BLS data systems. Numerous cases of extrinsic allergic alveolitis and respiratory conditions due to chemical fumes and vapors were also identified. Patterns evidenced in the data were generally consistent with current knowledge of the diseases. The inclusion of industry and occupation on the hospital discharge record, further study of the quality of diagnosis coding, and the use of these data by additional states will enhance the usefulness of these data for occupational disease surveillance.

Alveolitis, Extrinsic Allergic↗
PubMed1991

["Training the population in first aid"].

A pilot program of general training in Cardio-Pulmonary Resuscitation (C P R) and Basic Life Support (BLS) sponsored by Sicily Regional Administration is illustrated. A practical training in Basic C P R and Emergency Care is offerec to many categories of population and High School students (aged 14-16 years).

Education↗
PubMed1991

[Bloodless emergent laparotomy for acute abdominal syndrome].

Bloodless laparotomy (BL) is defined as an opened exploration of the abdominal cavity that yields negative results, i.e., "provides no information as to the cause of the clinical and paraclinical symptoms responsible for prompting the surgical investigation". The authors report a retrospective study spanning January 1975 to December 1989, on the incidence of and mortality associated with emergent BL in patients with acute abdominal syndrome, with the intent of reducing its frequency. Over this period, 24 BL occurred in 3480 emergent laparotomies, i.e., 0.63%. These involved 7 men, 5 women, 5 boys and 7 girls, aged 4 to 52 years (mean age = 19.5 years). Indications for surgery were based on clinical signs, as well as on laboratory findings such as chest X-ray and plain radiography and needle-puncture of the abdomen. Surgical data indicated:liver cirrhosis--3 cases; mesenteric adenopathy--3 cases; intestinal parasitosis--1 case; bilateral adnescitis--1 case; polycystic ovaries--1 case; wall abscess--1 case; unexplained pain--14 cases. The mortality rate was 2/24. Use of other paraclinical investigations, namely ultrasonography, laparoscopy and peritoneal lavage, and of computer science methods after a prior clinical examination initiated by history-taking, might help reduce the rate of BLs, which are non-devoid of mortality.

Abdomen, Acute↗
PubMed1986

Chromosomal translocations in B-cell derived tumors.

The regular activation of the c-myc oncogene by juxtaposition to one of the immunoglobulin loci by chromosomal translocation in Burkitt's lymphoma (BL), mouse plasmacytoma and rat immunocytoma indicates that these translocations represent an essential, i.e. rate limiting step in the development of these tumors. Since the myc-carrying chromosome appears to break at random, but preserves the integrity of the two coding exons, the exclusive involvement of myc (rather than other oncogenes) requires special comment. It must be relatable to the specific functional features of the precursor cells and to the normal role of the myc protein. Recent evidence indicates that the myc gene is regularly turned off before or at the time when the cell enters a pathway that is programmed to lead it towards a resting G0 state. Clonally expanded B-cells are believed to turn into resting memory cells upon waning of the antigenic stimulus. The normal, non-translocated myc-allele is regularly switched off in both BL and murine plasmacytoma (MPC), indicating that the cell has already obeyed a program that involves the down regulation of myc. The Ig-juxtaposed, translocated myc remains highly expressed, however, and may be responsible for keeping the cells in cycle. The possibility that BL and MPC may arise from candidate memory cells, rather than pre-B cells, is also suggested by the fact that all BL-tumors and derived lines make a heavy chain. Since the myc/Ig juxtaposition is a special case of a non-functional rearrangement, this is only expected if the precursor cell would have been preselected for a functional Ig-product. The memory cell hypothesis is further supported by the fact that the majority of BLs make IgM, most MPC make IgA and the rat immunocytomas make IgE. This could correspond to the most frequent type of the memory cell in the anatomical areas and under the physiological or pathophysiological conditions associated with the natural history of each tumor. This brief review is restricted to oncogene activation by chromosomal translocations in B-cell derived tumors.

B-Lymphocytes↗
PubMed1988

Basal lamina of rat myocardium. Its fate after death of cardiac myocytes.

As part of a study of the interactions between myocardial cells and extracellular matrix during healing of necrotic lesions, we have examined the fate of myocyte basal lamina (BL) after injury with ischemia, freeze-thawing, or isoproterenol. Using light and electron microscopy, and antibodies to three BL-associated antigens, we found that the BL of necrotic myocytes remained largely intact and continued to delineate the myocyte compartment from connective tissue space. Inflammatory cells entered the myocyte compartment through holes in the acellular BL and removed cell debris. The holes may have been produced by inflammatory cells and/or by the stretching force of the beating heart. After removal of debris, some BL sheaths of necrotic myocytes collapsed, resulting in spatial approximation of vessels. Interstitial cells deposited collagen and elastic fibers in the connective tissue space and within portions of the myocyte compartment. The acellular myocyte BL, collapsed or not, retained normal antigen staining for type IV collagen, laminin, and heparan sulfate for about 10 days, then showed diminished staining in patchy areas. These areas may correspond to BL disruption and degradation in conjunction with fibrosis, although a substantial amount of acellular BL remained in situ and became embedded in scar tissue. At least two types of granulo-vesicular bodies, measuring 25 to 60 and 60 to 160 nm respectively, were associated with the acellular BL; these were of unknown origin and function. The study shows that the fate of acellular BL in injured myocardium is similar to the fate of BL in other injured tissues; however, the appearance of holes in acellular BL, within hours after injury, is unusual and may enhance scar tissue formation. Whether the acellular BL contributes to regeneration of myocardium, as do acellular BLs in other injured tissues, remains to be determined.

Animals↗