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An outreach intervention for older rural African Americans.

This article describes the process, approaches, and selected outcomes of a rural care management outreach intervention for older African Americans in South Carolina. The model is a community-academic partnership between a federally qualified community health center, a rural health clinic, and the Medical University of South Carolina. Its aim is to improve access to and utilization of health care and social services to enhance the quality of life of older African Americans. This is being accomplished by using paid, trained outreach workers (called geriatric coordinators), who function as advocates in linking clients to needed health and social services through activities such as arranging transportation to health care, rescheduling missed medical appointments, providing health promotion, and making referrals to public benefits and indigent drug programs. Outcomes demonstrated that the use of geriatric coordinators as care managers is a feasible way of increasing quality of life for older African Americans. The most notable outcome showed that 54% of clients who were eligible but not receiving benefits prior to this intervention were signed on for programs such as Supplemental Security Income, Specified Low-Income Medicare Beneficiary (SLMB), Qualified Medicare Beneficiary (QMB), disability, railroad pensions, and Veterans Administration benefits. Health centers realized an increase in reimbursable services and new clients. Increased capacity for older adult services is being accomplished through geriatric-coordinator-directed collaborations with social service agencies and participation in community events and committees.

Black or African American↗

Neuropsychiatric symptoms among welders exposed to neurotoxic metals.

Neuropsychiatric symptoms in 65 welders exposed to aluminium and 217 railroad track welders were studied with the aid of a previously validated questionnaire. Semiquantitative data on exposure to the metals aluminium, chromium, lead, manganese, and nickel were also recorded by questionnaire. Logistic regression was employed to study the relation between exposure and the prevalence of symptoms. Welders exposed to aluminium, lead, or manganese for a long period had significantly more neuropsychiatric symptoms than welders not exposed to these metals. The results indicate that detailed psychometric studies should be performed on welders exposed long term to specific metals as such exposures might affect their nervous system.

Adult↗

Manganese encephalopathy: utility of early magnetic resonance imaging.

The use of magnetic resonance imaging (MRI) provides visual evidence of cerebral deposits of paramagnetic metals. The usefulness of MRI is described in connection with the manganese poisoning of a 44 year old arc welder who had been engaged in the repair and recycling of railroad track made of manganese steel alloy.

Adult↗

The genetics and molecular biology of the synaptonemal complex.

The synaptonemal complex (SC) is a protein lattice that resembles railroad tracks and connects paired homologous chromosomes in most meiotic systems. The two side rails of the SC, known as lateral elements (LEs), are connected by proteins known as transverse filaments. The LEs are derived from the axial elements of the chromosomes and play important roles in chromosome condensation, pairing, transverse filament assembly, and prohibiting double-strand breaks (DSBs) from entering into recombination pathways that involve sister chromatids. The proteins that make up the transverse filaments of the SC also play a much earlier role in committing a subset of DSBs into a recombination pathway, which results in the production of reciprocal meiotic crossovers. Sites of crossover commitment can be observed as locations where the SC initiates and as immunostaining foci for a set of proteins required for the processing of DSBs to mature crossovers. In most (but not all) organisms it is the establishment of sites marking such crossover-committed DSBs that facilitates completion of synapsis (full-length extension of the SC). The function of the mature full-length SC may involve both the completion of meiotic recombination at the DNA level and the exchange of the axial elements of the two chromatids involved in the crossover. However, the demonstration that the sites of crossover formation are designated prior to SC formation, and the finding that these sites display interference, argues against a role of the mature SC in mediating the process of interference. Finally, in at least some organisms, modifications of the SC alone are sufficient to ensure meiotic chromosome segregation in the complete absence of meiotic recombination.

Animals↗

Criminal justice procedures in civil commitment.

The actions of federal district courts and state legislatures in recent years have resulted in the growing application of procedures of the criminal justice system to the civil commitment process. Increasingly patients can be confined only if they are dangerous to others, and increasingly due-process procedures of the criminal law are required, to the detriment of the patient's treatment and his survival in the community. The author says that allegations of patients' being railroaded into hospitals are, with few exceptions, fictitious. Abuses thet do exist should be handled through writs of habeas corpus and malpractice suits, remedies much more available now than in the past. The principal abuse in commitment occurs not when patients are admitted, the author believes, but at discharge, when so many patients are turned out into communities that lack proper services for them.

Child Advocacy↗

Malignant mesothelioma in Rome, Italy 1980-1995. A retrospective study of 79 patients.

AIM AND BACKGROUND: To evaluate the characteristics of a case-series of 79 malignant mesothelioma patients collected from the main teaching hospital of Rome, Italy, and other local clinics of Latium Region and to assess the role of asbestos exposure, since previous studies on the occurrence of the disease in this area were lacking. METHODS: The study included cytohistologically diagnosed malignant mesothelioma (71 pleural, 7 peritoneal, and 1 testicular tunica vaginalis) detected or referred for consultation during the period 1980-1995. Information regarding occupational and/or nonoccupational exposures was derived from clinical records and interviews, when available. RESULTS: Patients were resident in Rome and other towns of Latium; a few were from other parts of central and southern Italy. Exposure to asbestos was assessed for 45.5% of patients, another 45.5% had unknown exposure, and for the remaining 9% such information was lacking. Occupational exposure occurred in 53% of men for whom information was available and nonoccupational exposure occurred in 20% of women. The study identified two clusters of cases from an asbestos-cement plant and a facility where asbestos was ubiquitous. Furthermore, most exposed subjects reported occupations in the construction industry, which is particularly active in the Latium Region; others were railroad workers, naval mechanics and navy personnel, bakers, explosive workers and car mechanics. A few patients reported indoor exposure to asbestos at home and/or in the workplace. CONCLUSIONS: The study confirmed that mesothelioma risk is present in several job titles of the construction industry, and it is no longer confined to workers employed in the manufacture or application of asbestos products. The occurrence of malignant mesothelioma in patients with unexpected occupational and nonoccupational exposures indicates the need for further investigation on previously underestimated exposures.

Adult↗

Fluoride exposure and respiratory symptoms in welders.

Welders inhale gases and respirable particles. To investigate the relationship between fluoride exposure and respiratory symptoms in welders using basic electrodes containing calcium fluoride, 63 railroad track welders were interviewed. Fluoride was measured in post-shift urine samples. Seventeen welders reported respiratory symptoms related to welding fume exposures. Respiratory symptoms were somewhat more common with increasing concentrations of fluoride in urine. The association between welding fume exposure and respiratory symptoms seems related more to fluorides than to other particles among welders using basic electrodes.

Adult↗

Palliative venting gastrostomy in malignant intestinal obstruction.

This retrospective clinical study reports on the experience of palliative venting gastrostomy (PVG) in an integrated acute teaching hospital and hospice-based palliative care service over a seven-year period (1989-97). PVG was performed for 51 patients with refractory nausea and vomiting resulting from varying degrees and levels of persisting or intermittent malignant bowel obstruction. There were 32 females and 19 males; the mean age was 61 years (range 25-86 years). All patients had advanced and incurable cancer with intra-abdominal spread, originating from the following primary sites: colon and rectum (27), ovary (16), breast (2), pancreas (2), and other (4). The venting gastrostomy tube was inserted endoscopically by a railroading technique in 46 patients (using a 16- to 20-French Dobhoff PEG tube), at open laparotomy in four cases and under radiological (abdominal computerized tomography) control in one case. Endoscopic insertion was attempted and abandoned for technical reasons in a further two cases. The median survival of all 51 patients from the time of gastrostomy insertion was 17 days (range 1-190). In 47/51 (92%), the symptoms of nausea and vomiting were relieved by the procedure, and these patients experienced restoration of some level of oral soft food and fluid intake. Twenty patients were discharged home, and six died at home. In a small group of highly selected patients, for whom pharmacological measures failed to palliate the effects of malignant bowel obstruction, PVG was shown to be a safe and effective means of abolishing or substantially improving vomiting. Provided that the intervention is appropriate to the given clinical situation and acceptable to the patient, it should be considered.

Abdominal Neoplasms↗

GroEL chaperone binding to beetle luciferases and the implications for refolding when co-expressed.

The folding of many proteins including luciferase in vivo requires the assistance of molecular chaperone proteins. To understand how a chaperone targets luciferase, we took three luciferases that give different bioluminescence with the same luciferin substrate and with differences in homology. The three luciferase genes, firefly luciferase (FF-Luc) (from Pyrocoelia miyako), and red (RE-Luc) and green (GR-Luc) bioluminescence-emitting luciferases (from Phrixothrix railroad-worms), were expressed in Escherichia coli to produce fusion proteins with predicted molecular masses. Subsequently, we observed that DnaK and GroEL were co-purified along with recombinant luciferase. Although the amount of co-purified DnaK was almost the same compared to FF-Luc, GroEL was 25 and 32 times higher in GR-Luc and RE-Luc respectively. Furthermore, co-expression of GroEL/GroES along with luciferase substantially refolded RE-Luc and GR-Luc compared to FF-Luc.

Animals↗

Reversing urban decay: brownfield redevelopment and environmental health.

While the United States government concentrates more of its political and financial resources on fighting terrorism, the continuing decay of older cities and industrial suburbs has fallen far down on the national political priority agenda. An exception is the redevelopment of so-called brownfields, which are abandoned, idled, or underutilized factories, railroad yards, bus stations, garages, electricity-generating stations, and other commercial facilities. A modest national government program to identify, clean up, and redevelop brownfields into job fields began during the administration of Bill Clinton and has continued into the George W. Bush administration (Powers et al. 2000; Simons 1998; Van Horn et al. 1999). The political reasons are apparent: Developing brownfields is a politically acceptable method of stimulating private enterprise, local government, and community groups into building new businesses, housing, and community facilities. Also, brownfields projects have a beginning and an end; the national government does not have an indefinite responsibility. In contrast, social assistance programs that grew during the 1960s and proliferated for more than three decades have been politically portrayed by some as give-away programs that build dependency with no ending. Whether this characterization of social programs is morally or empirically justified, the reality is that in today's political environment brownfields redevelopment is a politically acceptable way of helping distressed urban areas.

Cities↗

Industrial preparation of poly(vinyl chloride).

Vinyl chloride (VCM) is unloaded from railroad tank cars or tank trucks into pressurized storage spheres. VCM, emulsifiers, and catalysts are metered into polymerization vessels wherein PVC is produced through a chemical reaction in an aqueous medium under controlled conditions of temperature and pressure. After the reaction reaches a predetermined completion, the contents are transferred to a secondary vessel wherein steam is injected and the VCM containing vapors are pumped to a recovery system. The VCM-containing vapors are compressed, cooled, condensed, decanted, and recycled to the process for reuse. The stripped PVC resin water slurry is then pumped to blending tanks where the batches from multiple reaction vessels are blended for product uniformity. From the plant tanks the PVC resin water slurry is pumped to a dewatering centrifuge, where approximately 90% of the water is removed and subsequently discharged to the industrial sewer system. The PVC resin wet cake is conveyed from the centrifuge to a flash dryer where essentially all the remaining water is removed. At this point, the dry resin is buoyant in an air stream and enters a two-stage collection system for separation of conveying air. The PVC resin is then screened and air-conveyed to storage for bulk shipment, compounding, or bagging.

Air Pollutants, Occupational↗

Germinomas and teratoid siphon anomalies in softshell clams, Mya arenaria, environmentally exposed to herbicides.

Seminomas and dysgerminomas are epizootic in softshell clams, Mya arenaria, from three Maine estuaries contaminated with herbicides. The first epizootic was discovered in 22% of clams collected as Searsport near Long Cove Brook and three culverts that conveyed heating oil and jet fuel spilled from a tank farm in 1971. Data from subsequent epizootiological studies and a series of long-term experimental exposures of softshell clams to no. 2 fuel oil, JP-4, and JP-5 jet fuel at the U.S. EPA, Environmental Research Laboratory in Narragansett, Rhode Island, and in the field did not support an etiology by these petroleum products. In the two recent epizootics reported here, the germinomas have been observed in 3% of the softshell clams collected from Roque Bluffs near Machiasport and from 35% of softshell clams collected from Dennysville. Mya collected at Dennysville had pericardial mesotheliomas and teratoid siphon anomalies in addition to gonadal neoplasms. Estuaries at Dennysville had been contaminated by herbicides in a 1979 accidental spray overdrift during aerial application of Tordon 101 to adjacent forests. Further investigation determined widespread use of the herbicides Tordon 101, 2,4-D,2,4,5-T, and other agrochemicals in an extensive forestry and blueberry industry in both the Roque Bluffs and the Dennysville areas. Herbicide applications at Searsport were confirmed for railroad property bordering Long Cove estuary and for Long Cove Brook adjacent to the estuary where a highway department reportedly cleans its spray equipment. Herbicide contamination is the only common denominator identified at all three sites where Mya have been found with gonadal neoplasms.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Drug-Induced↗

Diesel engine exhaust and lung cancer: an unproven association.

The risk of lung cancer associated with diesel exhaust has been calculated from 14 case-control or cohort studies. We evaluated the findings from these studies to determine whether there is sufficient evidence to implicate diesel exhaust as a human lung carcinogen. Four studies found increased risks associated with long-term exposure, although two of the four studies were based on the same cohort of railroad workers. Six studies were inconclusive due to missing information on smoking habits, internal inconsistencies, or inadequate characterization of diesel exposure. Four studies found no statistically significant associations. It can be concluded that short-term exposure to diesel engine exhaust (< 20 years) does not have a causative role in human lung cancer. There is statistical but not causal evidence that long-term exposure to diesel exhaust (> 20 years) increases the risk of lung cancer for locomotive engineers, brakemen, and diesel engine mechanics. There is inconsistent evidence on the effects of long-term exposure to diesel exhaust in the trucking industry. There is no evidence for a joint effect of diesel exhaust and cigarette smoking on lung cancer risk. Using common criteria for determining causal associations, the epidemiologic evidence is insufficient to establish diesel engine exhaust as a human lung carcinogen.

Animals↗

Meta-analysis of rat lung tumors from lifetime inhalation of diesel exhaust.

Estimating the carcinogenic potential of exposure to diesel-engine exhaust particulates (DEPs) is problematic. In rats, high concentrations of DEPs (> 1,000 microg/m(3)) inhaled over a lifetime result in excess lung tumors. However, data for rats exposed to DEP at concentrations not associated with lung overload are consistent with no tumorigenic effect. Individual rat studies have only a limited number of exposure groups; therefore, we combined the tumor data from eight chronic inhalation studies in a meta-analysis. Statistical analysis identified a threshold of response between 200 and 600 microg/m(3) average continuous lifetime exposure, consistent with biological-effect thresholds reported by other investigators. Our exposure-response analysis of all rats with < 600 microg/m(3) average continuous lifetime exposure found no tumorigenic effect of DEP in these rats. When we evaluated all rat studies, accounted for a threshold and for inhomogeneity between experiments, and expressed the results in terms of human unit risk (UR), we found a negative maximum-likelihood human UR of -32 (times) 10(-6) per microgram per cubic meter (microg/m(3)), but this was not statistically significantly different from zero. Extrapolating the rat upper 95th percentile confidence limit to humans gave an upper-bound human UR of 9.3 (times) 10(-6) per microg/m(3)]. This upper-bound human UR, derived from all of the data points (including 1,087 animals below the estimated threshold and 1,433 in the control groups), falls entirely below the range of estimates derived from lung-overloaded rats or from epidemiology of railroad workers. Our meta-analysis of the low-exposure data in rats does not support a lung cancer risk for DEP exposure at nonoverload conditions. Average ambient concentrations of DEP (0-3 microg/m(3)) are < 1% of the concentration associated here with a threshold of tumor response in the rat bioassay.

Administration, Inhalation↗

Insulin and cardiovascular diseases in Japanese work-site population with borderline to mild hypertension.

To clarify whether significant interrelations between hyperinsulinemia and cardiovascular diseases exist in Japanese, we analyzed serum insulin levels, fasting and after oral glucose load, in relation to blood pressure (BP), serum lipids, and incidence of acute myocardial infarction (MI) and stroke in 584 male employees of a railroad company with borderline to mild hypertension (age: 49 +/- 7 years, BP: 139 +/-13/90 +/- 8 mmHg, body mass index: BMI 24.0 +/- 2.8, mean +/- SD). Those who were taking antihypertensive drugs and/or hypoglycemic agents were excluded. The subjects were classified into five groups of comparable size according to sigma IRI (area composed by insulin levels at 0, 1, 2 hours post glucose load). Although averaged age, levels of fasting glucose and HbA1c were not significantly different among quintiles, the hyperinsulinemic groups had higher levels of fasting IRI and sigma glucose. Multiple regression analysis revealed that sigma IRI was associated positively with BMI, sigma glucose, systolic BP, total cholesterol, and negatively with HDL-cholesterol. During 7-year follow-up 7 cases with MI and 15 cases with stroke were registered. The subjects with MI, but not with stroke were involved in higher deciles of insulin levels. These results indicate that the insulin resistance syndrome exists in Japanese middle-aged men with borderline to mild hypertension. The association with cardiovascular morbid events appeared to be evident in coronary heart disease but not in cerebrovascular disease.

Adult↗

The tracheostomy tube change: a review of techniques.

Tracheostomy tube changing is a routine procedure. However, occasional problems can arise and result in fatalities. This article reviews the various measures and techniques used to optimize the safeguarding of the airway during a tracheostomy tube change, including the 'railroad' technique. The management of accidental decannulations is also reviewed.

Device Removal↗

Regulatory effects in health care: philosophies, impacts, and free markets.

In spite of the fact that other service sectors such as airlines, retail banking, telecommunications, railroads, trucking, securities brokerage, and insurance have experienced remarkable transformations toward more deregulated environments, the health care industry continues to be very heavily regulated. This article first examines the major theories and general schools of thought surrounding the concept of regulation in general, followed by an examination of the influence governmental regulations have had on hospitals in particular, specifically as they relate to stimulating competitiveness, efficiencies, and cost control.

Cost Control↗

Federal investment in health information technology: how to motivate it?

Health care market failures include inefficient standard making, problems with coordination among local providers to optimize care, and inability to measure quality accurately, inexpensively, or reliably. Study of other industries suggests policy directions for health information technology and the magnitude of gains from improving market functioning, which are very large. A perspective drawn from U.S. industrial history--in particular railroads and the interstate highway system--suggests an investment level roughly consistent with recent estimates drawn from the medical literature. The benefits of quick action probably outweigh the benefits of delaying and choosing the perfect funding mechanism.

Consumer Behavior↗