[Tropical destination. Poisoning by marine animals].
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Fish Venoms↗
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[Evaluative research on the distribution of health videocassettes destined for a disadvantaged Montreal population].
The present article describes the implementation and the evaluation of an intervention done in the context of a heart health community and multifactorial program. The intervention aimed to offer six videocassettes on cardiovascular health to a low-income and low-educated clientele through five video-clubs. All videoclubs (n = 5) from St. Henri/Petite Bourgogne agreed to distribute the videocassettes free of charge. Two components were examined: admissibility by videoclubs' owner and clientele's receptivity towards the intervention. Results showed that all videoclubs offered free display and service for the videocassettes. The article also presents a discussion of the feasibility and the possibilities to broaden this type of action.
Adult↗
Correlates of distances traveled to use recreational facilities for physical activity behaviors.
BACKGROUND: Information regarding how far people are willing to travel to use destinations for different types of recreational physical activity behaviors is limited. This study examines the demographic characteristics, neighborhood opportunity and specific-physical activity behaviors associated with distances traveled to destinations used for recreational physical activity. METHODS: A secondary analysis was undertaken of data (n = 1006) from a survey of Western Australian adults. Road network distances between respondents' homes and 1) formal recreational facilities; 2) beaches and rivers; and 3) parks and ovals used for physical activity were determined. Associations between distances to destinations and demographic characteristics, neighborhood opportunity (number of destinations within 1600 meters of household), and physical activity behaviors were examined. RESULTS: Overall, 56.3% of respondents had used a formal recreational facility, 39.9% a beach or river, and 38.7% a park or oval. The mean distance traveled to all destinations used for physical activity was 5463 +/- 5232 meters (m). Distances traveled to formal recreational facilities, beaches and rivers, and parks and ovals differed depending on the physical activity undertaken. Younger adults traveled further than older adults (7311.8 vs. 6012.6 m, p = 0.03) to use beaches and rivers as did residents of socio-economically disadvantaged areas compared with those in advantaged areas (8118.0 vs. 7311.8 m, p = 0.02). Club members traveled further than non-members to use parks and ovals (4156.3 vs. 3351.6 meters, p = 0.02). The type of physical activity undertaken at a destination and number of neighborhood opportunities were also associated with distance traveled for all destination types. CONCLUSION: The distances adults travel to a recreational facility depends on the demographic characteristics, destination type, physical activity behavior undertaken at that destination, and number of neighborhood opportunities. Knowing how far adults travel to undertake physical activity will assist in designing supportive neighborhoods and designing future ecological research.
Journal Article↗
Description and evaluation of a pilot physician-directed emergency medical services diversion control program.
OBJECTIVES: To describe the characteristics and feasibility of a physician-directed ambulance destination-control program to reduce emergency department (ED) overcrowding, as measured by hospital ambulance diversion hours. METHODS: This controlled trial took place in Rochester, New York and included a university hospital and a university-affiliated community hospital. During July 2003, emergency medical services (EMS) providers were asked to call an EMS destination-control physician for patients requesting transport to either hospital. The destination-control physician determined the optimal patient destination by using patient and system variables as well as EMS providers' and patients' input. Program process measures were evaluated to characterize the program. Administrative data were reviewed to compare system characteristics between the intervention program month and a control month. RESULTS: During the intervention month, 2,708 patients were transported to the participating hospitals. EMS providers contacted the destination-control physician for 1,866 (69%) patients. The original destination was changed for 253 (14%) patients. Reasons for redirecting patients included system needs, patient needs, physician affiliation, recent ED or hospital care, patient wishes, and primary care physician wishes. During the intervention month, EMS diversion decreased 190 (41%) hours at the university hospital and 62 (61%) hours at the community hospital, as compared with the control month. CONCLUSIONS: A voluntary, physician-directed destination-control program that directs EMS units to the ED most able to provide appropriate and timely care is feasible. Patients were redirected to maximize continuity of care and optimally use available emergency health care resources. This type of program may be effective in reducing overcrowding.
Ambulances↗
The site of origin and route and rate of migration of neurons to the hippocampal region of the rhesus monkey.
The site of origin and route and rate of migration of neurons in the developing hippocampal region of the rhesus monkey were studied with tritiated thymidine (3H-TdR) autoradiography. Analysis of specimens sacrificed approximately 1 hour after exposure to 3H-TdR shows that the neurons destined for the hippocampus and subiculum are generated exclusively in the ventricular zone lining the medial wall of the lateral cerebral ventricle. In contrast, neurons of the parahippocampal formation are generated in two proliferative zones: The majority of neurons destined for the lamina principalis interna arise from the ventricular zone, whereas most of those destined for the lamina principalis externa originate from the subventricular zone. The neurons of the dentate gyrus are also generated in two locations: in the ventricular zone (between E38 and E85) and within the prospective hilus of the dentate gyrus (from E58 up to approximately 3 months after birth). Analysis of specimens sacrificed at progressively longer intervals after exposure to 3H-TdR indicates that neurons destined for all of the subdivisions of the hippocampal region (except those cells generated in the hilus of the dentate gyrus) migrate through the intermediate zone, bypassing previously generated neurons on their way to the superficial limits of the developing cortical plate. Estimated migration rates are approximately 15 micrometer/day in the sector of the hippocampal formation, about 100 micrometer/day in the parahippocampal formation, and about 15 micrometer/day in the region of adjacent neocortex. Thus simultaneously generated neurons destined for three distinct cytoarchitectonic areas have significantly different rates of cell migration. These differences are unrelated to the length of cell trajectories and may depend on the mechanism of cell translocation and/or the timing of signals that initiate cell movement. The differential rate of migration indicates that the fate of postmitotic cells may be determined before they have reached their final destination.
Aging↗
TRICARE: the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); specialized treatment services (STS) program--DoD. Notice.
This notice is to advise interested parties that Brooke Army Medical Center (BAMC) and Wilford Hall Medical Center (WHMC), hereinafter referred to as Destination San Antonio, have been designated the Regional Specialized Treatment Service facilities (STSFs) for DRGs 1, 3, 4, 49, 104-107, 110-111, 191, 209, 491, 286, and 357. The application for the STSF designation was submitted by the Lead Agency for TRICARE Region 6 and approved by the Assistant Secretary of Defense (Health Affairs). The Lead Agent will oversee that the STSFs maintain the quality and standards required for specialized treatment services. DoD beneficiaries residing within a 200-mile radius of Destination San Antonio facilities falling into the above patient category must be evaluated by Destination San Antonio staff before receiving care for these DRGs under direct military care or TRICARE/CHAMPUS cost sharing. Travel and lodging for the patient and, if stated to be medically necessary by a referring physician, for a nonmedical attendant, will be reimbursed by Destination San Antonio facility in accordance with the provisions of the Joint Federal Travel Regulation. Although evaluation in person is preferred, it is possible to conduct the evaluation telephonically if the patient is unable to travel to a Destination San Antonio facility. If the care for these DRGs cannot be performed at the Destination San Antonio facilities, the TRICARE Managed Care Support Contractor for Region 6 will provide a medical necessity review prior to issuance of an Inpatient Care Authorization or Non-availability Statement.
Cardiology↗
Two years of routine patient movement in the U.S.A. (Jan. 1974-Dec. 1975).
During a 2-year period, Jan. 1974-Dec. 1975, a total of 102,547 routine patients were aeromedically evacuated from an originating medical facility to a destination hospital within the Continental United States (CONUS). It is the policy of the Department of Defense (DOD) that, in both peace and war, the movement of patients of the Armed Forces shall be accomplished by airlift when airlift is available and conditions are suitable for aeromedical evacuation, unless medically contraindicated. The DOD Regulation 4515.13-R states that a routine patient will be delivered to the destination hospital within 72 h after pickup from aerial ports or from the originating CONUS medical facility. During this 2-year period, 66% of all patients moved were delivered to their destination hospital the same-day they were picked up and 93% of all patients were delivered to their destination hospital within the 72-h DOD criteria for routine patients. In order to reach the destination medical facility, many patients had to remain overnight (RON) at an aeromedical staging facility (ASF). Contributing factors were weather, aircraft maintenance problems, expiration of the crew duty day, patients originating overseas, and patients moving out of originating areas and requiring a second mission to reach the destination hospital.
Aviation↗
De novo telomere addition to spacer sequences prior to their developmental degradation in Euplotes crassus.
During sexual reproduction, Euplotes crassus precisely fragments its micronuclear chromosomes and synthesizes new telomeres onto the resulting DNA ends to generate functional macronuclear minichromosomes. In the micronuclear chromosomes, the macronuclear-destined sequences are typically separated from each other by spacer DNA segments, which are eliminated following chromosome fragmentation. Recently, in vivo chromosome fragmentation intermediates that had not yet undergone telomere addition have been characterized. The ends of both the macronuclear-destined and eliminated spacers were found to consist of six-base, 3' overhangs. As this terminal structure on the macronuclear-destined sequences serves as the substrate for de novo telomere addition, we sought to determine if the spacer DNAs might also undergo telomere addition prior to their elimination. Using a polymerase chain reaction approach, we found that at least some spacer DNAs undergo de novo telomere addition. In contrast to macronuclear-destined sequences, heterogeneity could be observed in the position of telomeric repeat addition. The observation of spacer DNAs with telomeric repeats makes it unlikely that differential telomere addition is responsible for differentiating between retained and eliminated DNA. The heterogeneity in telomere addition sites for spacer DNA also resembles the situation found for telomeric repeat addition to macronuclear-destined sequences in other ciliate species.
Animals↗
Independent and linked migrants: determinants of African American interstate migration.
"Through kinship and other links to destinations, many African American interstate migrants in the United States join other people in destination households. These ¿linked' migrants contrast to ¿independent migrants' who move as individuals or intact groups and set up their own households at the destination. Using U.S. Census Public Use Micro Sample data, this paper first shows that, in the 1985-90 period, about 45 percent of all Black interstate migrants were independent, compared to 38 percent who were linked to housing at the destination and 17 percent who moved into group quarters. Second, a multinomial logit model, incorporating individual and state-level variables, is specified that contrasts the determinants of independent and linked migration.... It is concluded that the understanding of Black migration must take into account a variety of factors beyond traditional labor market conditions, including links to the destination and individual housing circumstances."
Black or African American↗
From Gateway to MultiSite Gateway in one recombination event.
BACKGROUND: Invitrogen Gateway technology exploits the integrase/att site-specific recombination system for directional cloning of PCR products and the subsequent subcloning into destination vectors. One or three DNA segments can be cloned using Gateway or MultiSite Gateway respectively. A vast number of single-site Gateway destination vectors have been created while MultiSite Gateway is limited to few destination vectors and therefore to few applications. The aim of this work was to make the MultiSite Gateway technology available for multiple biological purposes. RESULTS: We created a construct, pDONR-R4-R3, to easily convert any available Gateway destination vector to a MultiSite Gateway vector in a single recombination reaction. In addition, we designed pDONR-R4-R3 so that DNA fragments already cloned upstream or downstream of the Gateway cassette in the original destination vectors can still be utilized for promoter-gene or translational fusions after the conversion. CONCLUSION: Our tool makes MultiSite Gateway a more widely accessible technology and expands its applications by exploiting all the features of the Gateway vectors already available.
Cloning, Molecular↗
How important a priority is travel medicine for a typical British family practice?
BACKGROUND: Primary care teams have to supply travel health advice to increasing numbers of long haul travelers but there is a shortage of information derived from general practice settings about the risks patients are exposed to. We aimed to determine the numbers of our patients visiting high-risk destinations, to see if they reported complying with health advice, and whether or not they became ill. METHODS: We performed a retrospective study in a typical British, town center, family practice in Mansfield, Nottinghamshire. A postal questionnaire survey was sent to 200 adults, aged between 16 and 76, randomly selected from the practice register, and 351 adults who had attended the practice travel clinic over a 1-year period between 1997-1998. RESULTS: Responses were received from 84% of the random sample and 86% of the travel clinic group. Out of 11,000 patients registered with the practice, we identified 187 patients who had traveled to high-risk destinations such as Africa, Asia, South America or the Caribbean. The majority of these had attended the practice travel clinic. Despite this, 41% became ill (mainly diarrhea), 10% were sufficiently ill to be confined to bed. Fifty-nine percent of patients who required malaria chemoprophylaxis reported they had not complied fully with advice given. Reported illness rates for medium and low risk destinations were 27 and 19% respectively. CONCLUSIONS: The results suggest that giving health advice to long haul travelers should be an important priority for primary care teams. Travelers have a high episode rate of illness and put themselves at risk of acquiring malaria. Most travelers to high-risk destinations do attend the travel clinic for health advice but compliance with that advice is poor. People traveling to lower risk destinations still experience an appreciable rate of illness and are less likely to be seen in the travel clinic.
Adult↗
Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey.
BACKGROUND: The European Travel Health Advisory Board conducted a cross-sectional pilot survey to evaluate current travel health knowledge, attitudes and practices (KAP) and to determine where travelers going to developing countries obtain travel health information, what information they receive, and what preventive travel health measures they employ. Subsequently, the questionnaire used was improved and a cross-sectional, multicenter study was undertaken in airports in Europe, Asia, South Africa and the United States. This paper describes the methods used everywhere, and results from the European airports. METHOD: Between September 2002 and September 2003, 5,465 passengers residing in Europe and boarding an intercontinental flight to a developing country were surveyed at the departure gates of nine major airports in Europe. Questionnaires were self-administered, and checked for completeness and validated by trained interviewers. RESULTS: Although the majority of travelers (73.3%) had sought general information about their destination prior to departure, only just over half of the responders (52.1%) had sought travel health advice. Tourists and people traveling for religious reasons had sought travel health advice more often, whereas travelers visiting friends and relatives were less likely to do so. Hepatitis A was perceived as the most probable among the infectious diseases investigated, followed by HIV and hepatitis B. In spite of a generally positive attitude towards vaccines, 58.4% and 68.7% of travelers could not report any protection against hepatitis A or hepatitis B, respectively. Only one in three travelers to a destination country with at least some malaria endemicity were carrying antimalarial drugs. Almost one in four travelers visiting a high-risk area had an inaccurate risk perception and even one in two going to a no-risk destination were unnecessarily concerned about malaria. CONCLUSIONS: The large variation in destinations, age of the travelers and reasons for traveling illustrates that traveling to a developing country has become common practice. The results of this large-scale airport survey clearly demonstrate an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers, those visiting friends and relatives, and the elderly. Additionally, travel health advice providers should continue their efforts to make travelers comply with the recommended travel health advice. Our common objective is to help travelers stay healthy while abroad, and consequently to also reduce the potential importation of infectious diseases and the consequent public health and other implications.
Adolescent↗
The influence of wages and house prices on British interregional migration decisions.
The factors affecting choice of destination of U.K. internal migrants are analyzed using Labour Force Survey data. "A logit analysis of destination choice indicates that job movers are attracted to areas with high wages but are not affected by high house prices in such areas. In contrast, active non-job movers are deterred from areas of high house prices. Regional house price differences do not influence the destination choice of homemakers or the terminally sick but they do influence the destination choice of retirees. All groups prefer to travel the least distance when moving."
Demography↗
The migration of nurses: trends and policies.
This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States. We also examine the policy challenges for workforce planning and the design of health systems infrastructure. Data are derived from registries of professional nurses, censuses, interviews with key informants, case studies in source and destination countries, focus groups, and empirical modelling to examine the patterns and implications of the movement of nurses across borders. The flow of nurses to these destination countries has risen, in some cases quite substantially. Recruitment from lower-middle income countries and low-income countries, as defined by The World Bank, dominate trends in nurse migration to the United Kingdom, Ireland, and the United States, while Norway and Australia, primarily register nurses from other high-income countries. Inadequate data systems in many countries prevent effective monitoring of these workforce flows. Policy options to manage nurse migration include: improving working conditions in both source and destination countries, instituting multilateral agreements to manage the flow more effectively, and developing compensation arrangements between source and destination countries. Recommendations for enhancements to workforce data systems are provided.
Australia↗
Comparison of flow cytometry with the surgeon regarding ability to predict the ultimate success of surgery for proliferative vitreoretinopathy.
OBJECTIVE: To analyze vitreous specimens obtained from human eyes with proliferative vitreoretinopathy (PVR) by use of flow cytometery (FC) to compare the capacity of FC with that of the surgeon's in predicting the ultimate outcome after PVR surgery. METHODS: Thirty-one vitreous aspirates were obtained at vitrectomy or from postoperative fluid-gas exchanges for complicated retinal detachment due to PVR. Samples were analyzed by FC for the concentration of total and proliferating cells. These measurements were compared with the surgeon's preoperative prognosis (good, poor, or indeterminate) for the ultimate result. At 12 weeks, the eyes were evaluated for clinical outcome. An unsuccessful outcome was one in which the retina was attached with macular pucker or hypotony or was anatomically detached. Anatomic attachment of the retina anterior and posterior to the scleral buckle without these findings was considered a successful outcome. RESULTS: Flow cytometry was capable of quantifying the concentration of total and proliferating cells in eyes with PVR. Eyes destined for an ultimately successful outcome demonstrated fewer total and proliferating cells than did eyes destined for an unsuccessful outcome. No differences were observed between eyes destined for development of macular pucker and those destined for anatomic redetachment. The surgeon was able to accurately predict a good or a poor outcome in 64.5% of the cases, with a sensitivity of 92% and a specificity of 89%. Using the total number of recovered cells, FC was able to correctly predict a good or a bad outcome with a 77% accuracy, whereas the surgeon was able to do so with a 65% accuracy. Combining the surgeon's prediction with the result of FC increased the diagnostic power of the prediction to 87%. CONCLUSIONS: The diagnostic power of FC was similar to that of the surgeon's in predicting ultimate outcome, but the two techniques probably evaluate different features of the disease process. The combination of the two techniques was the most powerful approach to the prediction of ultimate outcome after PVR surgery.
Cell Count↗
Melatonin for preventing and treating jet lag.
BACKGROUND: Jet-lag commonly affects air travellers who cross several time zones. It results from the body's internal rhythms being out of step with the day-night cycle at the destination. Melatonin is a pineal hormone that plays a central part in regulating bodily rhythms and has been used as a drug to re-align them with the outside world. OBJECTIVES: To assess the effectiveness of oral melatonin taken in different dosage regimens for alleviating jet-lag after air travel across several time zones. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, PsychLit and Science Citation Index electronically, and the journals 'Aviation, Space and Environmental Medicine' and 'Sleep' by hand. We searched citation lists of relevant studies for other relevant trials. We asked principal authors of relevant studies to tell us about unpublished trials. Reports of adverse events linked to melatonin use outside randomised trials were searched for systematically in 'Side Effects of Drugs' (SED) and SED Annuals, 'Reactions Weekly', MEDLINE, and the adverse drug reactions databases of the WHO Uppsala Monitoring Centre (UMC) and the US Food & Drug Administration. SELECTION CRITERIA: Randomised trials in airline passengers, airline staff or military personnel given oral melatonin, compared with placebo or other medication. Outcome measures should consist of subjective rating of jet-lag or related components, such as subjective wellbeing, daytime tiredness, onset and quality of sleep, psychological functioning, duration of return to normal, or indicators of circadian rhythms. DATA COLLECTION AND ANALYSIS: : Ten trials met the inclusion criteria. All compared melatonin with placebo; one in addition compared it with a hypnotic, zolpidem. Nine of the trials were of adequate quality to contribute to the assessment, one had a design fault and could not be used in the assessment. Reports of adverse events outside trials were found through MEDLINE, 'Reactions Weekly', and in the WHO UMC database. MAIN RESULTS: : Nine of the ten trials found that melatonin, taken close to the target bedtime at the destination (10pm to midnight), decreased jet-lag from flights crossing five or more time zones. Daily doses of melatonin between 0.5 and 5mg are similarly effective, except that people fall asleep faster and sleep better after 5mg than 0.5mg. Doses above 5mg appear to be no more effective. The relative ineffectiveness of 2mg slow-release melatonin suggests that a short-lived higher peak concentration of melatonin works better. Based on the review, the number needed to treat (NNT) is 2. The benefit is likely to be greater the more time zones are crossed, and less for westward flights. The timing of the melatonin dose is important: if it is taken at the wrong time, early in the day, it is liable to cause sleepiness and delay adaptation to local time. The incidence of other side effects is low. Case reports suggest that people with epilepsy, and patients taking warfarin may come to harm from melatonin. REVIEWER'S CONCLUSIONS: Melatonin is remarkably effective in preventing or reducing jet-lag, and occasional short-term use appears to be safe. It should be recommended to adult travellers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet-lag on previous journeys. Travellers crossing 2-4 time zones can also use it if need be. The pharmacology and toxicology of melatonin needs systematic study, and routine pharmaceutical quality control of melatonin products must be established. The effects of melatonin in people with epilepsy, and a possible interaction with warfarin, need investigation.
Antioxidants↗
Rapid increase in mitochondrial volume in nucleus magnocellularis neurons following cochlea removal.
Second-order auditory neurons in nucleus magnocellularis (NM) of the chick brainstem undergo a series of rapid metabolic changes following unilateral cochlea removal, culminating in the death of 25% of NM neurons. Within hours of cochlea removal, ipsilateral NM neurons show marked increases in histochemical staining for the mitochondrial enzymes succinate dehydrogenase and cytochrome oxidase. We investigated corresponding ultrastructural changes in NM neurons by preparing animals undergoing unilateral cochlea removal for transmission electron microscopy. We quantified changes in NM mitochondrial volume by stereological methods and qualitatively compared mitochondrial morphology between NM neurons destined to survive and those destined to die after cochlea removal. Within hours of cochlea removal, ipsilateral NM neurons show striking increases in mitochondrial volume (84% at 6 hours and 236% at 12 hours after cochlea removal compared to unoperated, control animals). At 2 week survival times, ipsilateral NM neurons contain fewer mitochondria than contralateral neurons. Surprisingly, anesthesia alone causes short-term increases in NM mitochondrial volume. Animals anesthetized with pentobarbital and ketamine and sacrificed 6 or 12 hours later showed a 45% increase in mitochondrial volume compared to previously unanesthetized animals. NM neurons destined to die within days of cochlea removal can be identified within several hours after deafferentation by the appearance of their ribosomes. We observed qualitative differences in mitochondrial morphology in dying neurons. Mitochondria in neurons destined to die consistently showed mitochondrial swelling and vacuolization indicative of metabolic dysfunction. Similar mitochondrial changes have been reported when mitochondria take up excess calcium. Ultrastructural changes in NM after cochlea removal display features of both programmed and pathological cell death, in which increased intracellular calcium is thought to play a role.
Anesthesia↗
Guiding contact by coupling the taus of gaps.
Animals control contact with surfaces when locomoting, catching prey, etc. This requires sensorily guiding the rate of closure of gaps between effectors such as the hands, feet or jaws and destinations such as a ball, the ground and a prey. Control is generally rapid, reliable and robust, even with small nervous systems: the sensorimotor processes are therefore probably rather simple. We tested a hypothesis, based on general tau theory, that closing two gaps simultaneously, as required in many actions, might be achieved simply by keeping the taus of the gaps coupled in constant ratio. tau of a changing gap is defined as the time-to-closure of the gap at the current closure-rate. General tau theory shows that tau of a gap could, in principle, be directly sensed without needing to sense either the gap size or its rate of closure. In our experiment, subjects moved an effector (computer cursor) to a destination zone indicated on the computer monitor, to stop in the zone just as a moving target cursor reached it. The results indicated the subjects achieved the task by keeping tau of the gap between effector and target coupled to tau of the gap between the effector and the destination zone. Evidence of tau-coupling has also been found, for example, in bats guiding landing using echolocation. Thus, it appears that a sensorimotor process used by different species for coordinating the closure of two or more gaps between effectors and destinations entails constantly sensing the taus of the gaps and moving so as to keep the taus coupled in constant ratio.
Adult↗