Comparison of community based service with hospital based service for people with acute,severe psychiatric illness.

OBJECTIVE--To compare the burden on relatives and outcome of people treated for severe acute psychiatric illness by a community service and a traditional hospital based service. DESIGN--Follow up of patients aged 16-65 who required admission to hospital or home treatment for psychiatric illness during January 1990 to February 1991. SETTING--Two Birmingham electoral wards, Sparkbrook and Small Heath; Sparkbrook has a community based service and Small Heath a traditional hospital based service. SUBJECTS--69 patients from Sparkbrook and 55 from Small Health. MAIN OUTCOME MEASURES--Scores on present state examination, social behaviour assessment schedule, and general health questionnaire. RESULTS--24 (35%) of Sparkbrook patients received some treatment in hospital during the initial episodes. Relatives of Sparkbrook patients were less distressed by their burden at the initial assessment than relatives of Small Health patients (mean score 0.11 v 0.29, p < 0.01). Relatives were also more satisfied with the support they received and the treatment received by patients. More patients from Sparkbrook than Small Health were in contact with a psychiatrist (81% (95% confidence interval 71% to 91%) v 62% (44% to 68%)) and community nurse (56% (44% to 68%) v 14% (13% to 24%)) one year after the initial episode. Sparkbrook patients spent significantly fewer days in hospital during the initial episode (8 days v 59 days) and the first year (20.6 v 67.9 days). CONCLUSION--The community based service is as effective as the hospital based service and is preferred by relatives. It is more effective in keeping people in long term contact with psychiatrists.     

Performance of skin biopsies by general practitioners.

OBJECTIVE--To evaluate and appraise skin biopsies performed by general practitioners and compare their performance with that of hospital doctors. DESIGN--Retrospective analysis of histology records. SETTING--University hospital. SUBJECTS--Records of 292 skin biopsy specimens obtained by general practitioners and 324 specimens obtained by general and plastic surgeons. MAIN OUTCOME MEASURES--Clinical and pathological diagnoses and completeness of excision. RESULTS--The number of specimens received from hospital surgeons and general practitioners increased over the study period; the proportion of specimens from general practitioners rose from 17/1268 (1.3%) in 1984 to 201/2387 (8.7%) in 1990. The range of diagnoses was similar among hospital and general practitioner cases, although malignancy was commoner in hospital cases (63/324 (19%) v 14/292 (5%) in general practitioner cases; chi 2 = 28, p less than 0.00001). Completeness of excision was less common among general practitioners than hospital surgeons (150/233 (3/15 malignant) v 195/232 (57/63); chi 2 = 22, p less than 0.00001). CONCLUSIONS--The increase in minor surgery has implications for the staffing and finance of histopathology departments. General practitioners must be given proper training in performing skin biopsies, and all specimens should be sent for examination.     

Use of reminders to increase compliance with tetanus booster vaccination.

OBJECTIVE: To assess the effect of three computerized reminder systems on compliance with tetanus vaccination. DESIGN: Prospective randomized controlled trial. SETTING: Ottawa Civic Hospital Family Medicine Centre. PARTICIPANTS: Of 8069 patients 20 years of age or more who were not in a hospital or institution 5589 were randomly assigned, by family, to a control group, a physician reminder group, a telephone reminder group or a letter reminder group. The remaining 2480 patients were not included in the randomized portion of the study but were monitored. Results are presented for the 5242 randomized patients and the 2369 nonrandomized patients for whom there was no up-to-date record of tetanus vaccination at the start of the trial. INTERVENTIONS: For the patients in the physician reminder group the physician was reminded at an office visit to assess the patient''s tetanus vaccination status and to recommend vaccination; those in the other two reminder groups received a telephone call or letter enquiring about their tetanus vaccination status and recommending a booster dose. MAIN OUTCOME MEASURE: Proportion of patients who received tetanus toxoid during the study year or who had a claim of vaccination in the previous 10 years. MAIN RESULTS: The rate of recorded tetanus vaccination in the randomized control group was 3.2%. The difference between that rate and those for the three reminder groups was 19.6% in the physician reminder group (95% confidence interval [CI] 17.1% to 22.2%, p less than 0.00001), 20.8% in the telephone reminder group (95% CI 18.3% to 23.5%, p less than 0.00001) and 27.4% in the letter reminder group (95% CI 24.8% to 30.2%, p less than 0.00001)). The letter reminders were more effective than either the telephone reminders (p = 0.00013) or the physician reminders (p less than 0.00001) in improving compliance. The cost to the practice per additional vaccination recorded was 43 for the physician reminders, $5.43 for the telephone reminders and $6.05 for the letter reminders. CONCLUSIONS: Although all three reminder systems increased the rate of recorded tetanus vaccination they fell far short of achieving complete population coverage. More intensive interventions would be required to approach that goal. However, such interventions do not appear to be justified given the rarity of tetanus.     

Organisation of telephone services and patients' access to doctors by telephone in general practice.

OBJECTIVES--To assess how accessible general practitioners are to patients by telephone and to examine the relations between organisation, number of lines, and number of patient-doctor calls. DESIGN--Postal survey of a random sample of general practitioners stratified by rural and urban practice areas, with differential sampling fractions. SETTING--General practices in England and Wales. SUBJECTS--2000 general practitioners, of whom 1459 (74%) responded. MAIN OUTCOME MEASURES--Number of calls received by general practitioner a day, time reserved for patients'' calls, and communication of availability of telephone contact. RESULTS--1421 general practitioners said that they accepted non-emergency calls from patients during the day and 285 reported reserving specific times of the day for this purpose. 848 estimated that they received four or fewer patient calls a day. The number of calls was significantly related to reserving time for calls (p less than 0.001), informing patients that the doctor was accessible by telephone (p less than 0.00001), and the number of periods when calls were accepted (p less than 0.00001). On average there were 3659 patients per incoming line; the number of patients per incoming line rose significantly as practice size increased (p less than 0.00001). CONCLUSIONS--The apparent willingness of general practitioners to accept calls was not reflected in the number of calls received. Reserving time, increasing periods of availability, and publicising telephone access increased the number of doctor-patient telephone contacts. Line congestion may be a problem, and impartial advice and guidance on telephone organisation and line requirements would be helpful.     

Symptoms and signs: physical disease or illness behaviour?

The amount of treatment received by 380 patients with backache was found to have been influenced more by their distress and illness behaviour than by the actual physical disease. Patients showing a large amount of inappropriate illness behaviour had received significantly more treatment (p less than 0.001). The symptoms and signs of illness behaviour need to be clearly distinguished from those of physical disease, and better assessment of illness behaviour is essential if everyday clinical practice is to fulfil the ideal of treating patients as well as diseases.     

What happens to defaulters from a diabetic clinic?

The annual rate at which patients defaulted from follow up at the Wolverhampton diabetic clinic between 1971 and 1981 was 4.1% overall and 3.5% in white patients. In 1982 a study was started to discover what happened to white patients, born after 1919, who defaulted from the hospital clinic. There were 162 defaulters, of whom 19 had died. Of the remaining 143 patients, 19 were attending another hospital diabetic clinic, 22 had moved out of the area, and 28 refused to participate in the study. Seventy four agreed to participate: 39 were treated with diet, 15 with oral hypoglycaemic agents, and 20 with insulin. They were matched for sex, age, treatment, and duration of diabetes with patients attending the clinic. Non-insulin dependent defaulters were significantly more overweight at diagnosis (40% v 25%; p less than 0.05) and remained more obese. They developed significantly higher diastolic blood pressure (94 v 86 mm Hg; p less than 0.02) and higher haemoglobin A1 (HbA1) concentrations (11.7% v 8.4%; p less than 0.01). They had significantly more neuropathy at reassessment (15 v 6 out of 54; p less than 0.05) and a greater incidence of new retinopathy (p less than 0.02), which correlated with their higher diastolic blood pressures (p less than 0.01) and HbA1 concentration (p less than 0.02). In defaulters who were treated with insulin only the prevalence of neuropathy was significantly different from that in controls (p less than 0.05). Defaulters received minimal medical supervision and suffered greater morbidity than regular attenders at the clinic.     

Disinfection of contaminated water by using solar irradiation

Contaminated water causes an estimated 6 to 60 billion cases of gastrointestinal illness annually. The majority of these cases occur in rural areas of developing nations where the water supply remains polluted and adequate sanitation is unavailable. A portable, low-cost, and low-maintenance solar unit to disinfect unpotable water has been designed and tested. The solar disinfection unit was tested with both river water and partially processed water from two wastewater treatment plants. In less than 30 min in midday sunlight, the unit eradicated more than 4 log10 U (99.99%) of bacteria contained in highly contaminated water samples. The solar disinfection unit has been field tested by Centro Panamericano de Ingenieria Sanitaria y Ciencias del Ambiente in Lima, Peru. At moderate light intensity, the solar disinfection unit was capable of reducing the bacterial load in a controlled contaminated water sample by 4 log10 U and disinfected approximately 1 liter of water in 30 min.     

Comparison between entrapment methods for phenol removal and operation of bioreactor packed with co-entrapped activated carbon and Pseudomonas fluorescence KNU417

A microorganism capable of degrading phenol was isolated from crude oil contaminated soil and identified as Pseudomonas fluorescence. A porous polymer bead of polyvinyl alcohol (PVA) and Xanthan gum was found to be the best entrapment for phenol degradation in terms of bead shape (spherical form), bead strength, non-agglomeration, phenol degradation rate, and cell holding inside the bead. Activated carbon was co-immobilized with the microorganism in the bead, which readily adsorbed phenol to decrease initial phenol concentration. Due to the decreased phenol concentration, the cells needed shorter adaptation time after which the microorganism stably degraded phenol. When the bead containing microorganism with 1% of activated carbon was packed in a packed-bed bioreactor, the start-up period was shortened by 40 h and the removal efficiency of phenol during the period was increased by 28% than the case with only microorganism.     

Micromechanics of the fibrosa and the ventricularis in aortic valve leaflets.

The elastic response of aortic valve cusps is a summation of its fibrous components. To investigate the micromechanical function of valve leaflet constituents, we separated the fibrosa and the ventricularis from fresh and glutaraldehyde-fixed leaflets and tested them individually. The ventricularis was stiffer circumferentially than radially (7.41 kPa vs 3.68 kPa, p less than 0.00001) and was more extensible radially (62.7% vs 21.8% strain to high modulus phase, p less than 0.00001). The fibrosa was also stiffer circumferentially than radially (13.02 kPa vs 4.65 kPa, p less than 0.0008), but had uniform extensibility. Glutaraldehyde fixation did not affect the circumferential elastic modulus of the fibrosa, but reduced its radial modulus from 4.65 kPa to 2.32 kPa (p less than 0.0078). The elastic modulus of the ventricularis remained unchanged. Fixation also reduced the extensibility of the ventricularis circumferentially (from 21.8% to 15.2% strain, p less than 0.018), but not radially, and increased the radial extensibility of the fibrosa from 27.7% to 46.1% (p less than 0.0048). These data show that while the ventricularis contains a large amount of elastin, the amount of radially oriented collagen is similar to that of the fibrosa. The fibrosa, by itself, has the same extensibility in both directions (about 23% strain), but can extend much more radially when connected to the rest of the leaflet because it is attached to the ventricularis in a highly folded configuration. The two layers therefore complement each other during aortic valve function, and become detrimentally altered by fixation in glutaraldehyde.     

Combined solvent and water activity stresses on turgor regulation and membrane adaptation in Oceanimonas baumannii ATCC 700832

Oceanimonas baumannii ATCC 700832 is a Gram negative marine bacterium capable of utilising phenol as a sole carbon source. The ability of the bacterium to tolerate low water activity when utilising either succinate or phenol as a substrate in minimal medium was studied. The membrane lipid and protein composition showed two discreet adaptive phases as salinity increased. Firstly, when NaCl concentration was increased from 0.15% (w/v), the minimum at which growth was observed, to 1% NaCl (w/v), the ratio of zwitterionic to anionic phospholipids in the membrane increased significantly. At the same time the ratio of saturated to unsaturated fatty acids and the total membrane protein decreased significantly. The second phase was observed when salinity was increased from 1% to 7% NaCl (w/v) as the ratio of zwitterionic to anionic phospholipids decreased and membrane protein increased. However, the ratio of saturated to unsaturated fatty acids was unaffected. Salinity also affected the tolerance of cultures to elevated levels of phenol. Cultures grown in 0.15% NaCl (w/v) could tolerate 12 mM phenol, whereas in the presence of 1% NaCl (w/v) cultures continued to grow in up to 20 mM phenol and in 7% NaCl (w/v) cultures 8 mM phenol could be tolerated. Changes to the composition of the membrane phospholipids and fatty acids were also observed when phenol concentrations were at the maximum that could be tolerated. Under such conditions the ratio of zwitterionic to anionic phospholipids decreased twofold compared to cultures utilising 4 mM phenol as the substrate, in all salinities except in 7% NaCl (w/v) cultures, where there was no significant effect. The ratio of saturated to unsaturated fatty acids increased significantly in all salinities compared to cultures grown with 4 mM phenol. This revised version was published online in June 2006 with corrections to the Cover Date.     

Treatment of phenolic wastes byAureobasidium pullulans adhered to the fibrous supports

Summary Biological treatment of waste water containing a large amount of phenol was carried out by using a phenolassimilating fungus,Aureobasidium pullulans No. 14 adhered (semi-immobilized) to fibrous asbestos. The column reactor employed for oxidative degradation of phenol consisted of a cylindrical glass column containing plastic nets.During 27 days operation, it was observed that: 1) The phenol removal capacity of the reactor gradually increased during the first 10 days, reaching a stable level. 2) The best phenol removal capacity (50 mg phenol removed/h/ liter of reactor volume) was obtained when an artificial waste water containing up to 1,200 g/ml phenol was applied to the reactor. 3) Much higher concentrations of phenol (e.g. 1,700 g/ml) brought about a marked decrease in the phenol removal capacity (40–50 mg/h/liter). 4) Satisfactorily stable operation was achieved using the semiimmobilized mycelia ofAureobasidium pullulans, whose active state could be checked by observing the thick, black-colored biomass which is characteristic of the genusAureobasidium and covered the plastic nets inside the glass column reactor.     

Disinfection of Contaminated Water by Using Solar Irradiation

Contaminated water causes an estimated 6 to 60 billion cases of gastrointestinal illness annually. The majority of these cases occur in rural areas of developing nations where the water supply remains polluted and adequate sanitation is unavailable. A portable, low-cost, and low-maintenance solar unit to disinfect unpotable water has been designed and tested. The solar disinfection unit was tested with both river water and partially processed water from two wastewater treatment plants. In less than 30 min in midday sunlight, the unit eradicated more than 4 log₁₀ U (99.99%) of bacteria contained in highly contaminated water samples. The solar disinfection unit has been field tested by Centro Panamericano de Ingenieria Sanitaria y Ciencias del Ambiente in Lima, Peru. At moderate light intensity, the solar disinfection unit was capable of reducing the bacterial load in a controlled contaminated water sample by 4 log₁₀ U and disinfected approximately 1 liter of water in 30 min.     

Kinetics of mineralization of phenols in lake water.

The kinetics of mineralization of phenol and p-nitrophenol in lake water was determined at concentrations from 200 pg/ml to 5 micrograms/ml. The mineralization data were fit by nonlinear regression to equations for 14 kinetic models that describe patterns of biodegradation by nongrowing cells or by microorganisms growing on either the test chemical or other organic substrates. The kinetics od mineralization of phenol in water samples collected in July was best described by first-order models for 0.5 ng of phenol per ml; by Monod-without-growth, logistic, and logarithmic models for 1.0 and 2.0 ng/ml and 5.0 ng/ml to 1.0 micrograms/ml, respectively, if it is assumed that the mineralizing population uses phenol as the sole carbon source for growth; by models (for phenol at concentrations of 2.0 ng/ml to 1.0 micrograms/ml) that assume that the phenol-mineralizing populations do not grow or grow logarithmically or logistically on uncharacterized carbon compounds but metabolize the phenol when present at levels below and above Km, respectively, for that compound; and by a logarithmic model at 5.0 micrograms/ml. Under the test conditions, usually less than 10% of the phenol C that was metabolized was incorporated into microbial cells or retained by other particulate material in the water at substrate concentrations of 10 ng/ml or less, and the percentage increased at higher substrate concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Kinetics of mineralization of phenols in lake water

The kinetics of mineralization of phenol and p-nitrophenol in lake water was determined at concentrations from 200 pg/ml to 5 micrograms/ml. The mineralization data were fit by nonlinear regression to equations for 14 kinetic models that describe patterns of biodegradation by nongrowing cells or by microorganisms growing on either the test chemical or other organic substrates. The kinetics od mineralization of phenol in water samples collected in July was best described by first-order models for 0.5 ng of phenol per ml; by Monod-without-growth, logistic, and logarithmic models for 1.0 and 2.0 ng/ml and 5.0 ng/ml to 1.0 micrograms/ml, respectively, if it is assumed that the mineralizing population uses phenol as the sole carbon source for growth; by models (for phenol at concentrations of 2.0 ng/ml to 1.0 micrograms/ml) that assume that the phenol-mineralizing populations do not grow or grow logarithmically or logistically on uncharacterized carbon compounds but metabolize the phenol when present at levels below and above Km, respectively, for that compound; and by a logarithmic model at 5.0 micrograms/ml. Under the test conditions, usually less than 10% of the phenol C that was metabolized was incorporated into microbial cells or retained by other particulate material in the water at substrate concentrations of 10 ng/ml or less, and the percentage increased at higher substrate concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Double blind comparative study of omeprazole 10 mg and 30 mg daily for healing duodenal ulcers.

Healing of duodenal ulcers was assessed in 66 patients who received omeprazole either 10 mg or 30 mg daily for four weeks in a double blind study. Healing was rapid in both groups. At two weeks the ulcers in 15 of the 30 patients taking 10 mg daily had healed compared with 28 of the 36 (78%) taking 30 mg daily (p less than 0.03). At four weeks the respective proportions had risen to 83% (25/30) and 94% (33/35) (p greater than 0.05). In non-smokers the proportion of ulcers healed did not differ significantly with the two doses, although there was a trend for less healing at two weeks with 10 mg daily; in smokers significantly fewer ulcers (p less than 0.05) were healed with 10 mg than 30 mg daily at two weeks (7/16 (44%) v 17/21 (81%] and at four weeks (12/16 (75%) v all 21 (100%]. Adverse reactions were few and transient and were considered unlikely to be due to omeprazole.     

Fat-rich diet induces inflammatory changes in the intact rat pancreas

The effects of chronic ethanol ingestion combined with fat-rich, protein-rich or carbohydrate-rich diets on the histology of the intact rat pancreas were studied. 192 male Wistar rats were randomly divided into four different dietary groups. Half of each group received 15% (v/v) ethanol in their drinking solution and the rest were used as controls and given tap water. After a 12-week diet period the pancreas were removed and histological specimens were stained with hematoxylin and eosin. No significant difference was observed between the groups in occurrence of edema, but inflammatory cells were found in (9/24) rats in the fat-rich group receiving water (p less than 0.01. In the fat-rich diet group receiving ethanol this finding was observed in 5 of 24 rats. In these groups slight parenchymal cell necrosis was also observed in conjunction with the inflammatory cells. All specimens in the other groups were normal. It is suggested that inflammatory changes caused by a fat-rich diet may be due to unknown toxic effects of this diet.     

Self-Reported Household Impacts of Large-Scale Chemical Contamination of the Public Water Supply,Charleston, West Virginia,USA

A January 2014 industrial accident contaminated the public water supply of approximately 300,000 homes in and near Charleston, West Virginia (USA) with low levels of a strongly-smelling substance consisting principally of 4-methylcyclohexane methanol (MCHM). The ensuing state of emergency closed schools and businesses. Hundreds of people sought medical care for symptoms they related to the incident. We surveyed 498 households by telephone to assess the episode’s health and economic impact as well as public perception of risk communication by responsible officials. Thirty two percent of households (159/498) reported someone with illness believed to be related to the chemical spill, chiefly dermatological or gastrointestinal symptoms. Respondents experienced more frequent symptoms of psychological distress during and within 30 days of the emergency than 90 days later. Sixty-seven respondent households (13%) had someone miss work because of the crisis, missing a median of 3 days of work. Of 443 households reporting extra expenses due to the crisis, 46% spent less than $100, while 10% spent over $500 (estimated average about $206). More than 80% (401/485) households learned of the spill the same day it occurred. More than 2/3 of households complied fully with “do not use” orders that were issued; only 8% reported drinking water against advice. Household assessments of official communications varied by source, with local officials receiving an average “B” rating, whereas some federal and water company communication received a “D” grade. More than 90% of households obtained safe water from distribution centers or stores during the emergency. We conclude that the spill had major economic impact with substantial numbers of individuals reporting incident-related illnesses and psychological distress. Authorities were successful supplying emergency drinking water, but less so with risk communication.     

Vanadium containing bromoperoxidase: An example of an oxidoreductase with high operational stability in aqueous and organic media

The conversion is described of phenolsulphonephtalein (phenol red) to 3,3',5,5'-tetrabromophenolsulphonephthalein (bromophenol blue) by bromoper-oxidase from the brown alga Ascophyllum nodosum. This reaction provides a convenient assay for the detection of bromoperoxidase activity in vitro. Bromoperoxidase was shown to be stable under turnover conditions for three weeks at room temperature, catalyzing the bromination of phenol red into bromophenol blue. When stored at room temperature in organic sol vents such as acetone, methanol, ethanol [present up to 60% (v/v)], and 1-propanol [40% (v/v)], bromoperoxidase was stable for more than one month. As far as we know this is the first example of an oxidoreductase which displays such great stability. This enhances the applicability of the enzyme in organic synthesis.