Electronic communication between providers of primary and secondary care.

OBJECTIVE--To study the effects of the introduction of electronic data interchange between primary and secondary care providers on speed of communication, efficiency of data handling, and satisfaction of general practitioners with communication. DESIGN--Comparison of traditional paper based communication for laboratory reports and admission-discharge reports between hospital and general practitioners and electronic data interchange. SETTING--Twenty-seven general practitioners whose offices were equipped with a practice information system and two general hospitals. OUTCOME MEASURES--Paper based communication was evaluated by questionnaire responses from and interviews with care providers; electronic communication was evaluated by measuring time intervals between generation and delivery of messages and by assessing doctors'' satisfaction with electronic data interchange by questionnaire. RESULTS--Via paper mail admission-discharge reports took a median of 2-4 days, and laboratory reports 2 days, to reach general practitioners. With electronic data interchange almost all admission-discharge reports were available to general practitioners within one hour of generation. When samples were analysed on the day of collection (as was the case for 174/542 samples in one hospital and 443/854 in the other) the laboratory reports were also available to the general practitioner the same day via electronic data interchange. Fifteen general practitioners (of the 24 who returned the questionnaire) reported that the use of electronic admission-discharge reports provided more accurate and complete information about the care delivered to their patients. Ten general practitioners reported that electronic laboratory reports lessened the work of processing the data. CONCLUSION--Electronic communication between primary and secondary care providers is a feasible option for improving communication.     

Hospital Topics: The Hospital Consultant's Secretary

Analysis of work done by the secretaries attached to one medical unit in a general hospital showed that much was discretionary in character and entailed making decisions. Work in the unit was made easier and more efficient by this intelligent use of initiative by the secretaries. At present the pay given to medical secretaries in hospital is below a level that would be commensurate with their responsibility.     

Design and positioning of a reference information model for clinical laboratories

Clinical laboratories produce on a daily basis huge amounts of data, i.e., test results of chemical determinations. The production and the use of these data should be extremely well structured. This and the urge to improve quality was the reason to design a reference information model for clinical laboratories, abbreviated as RILA. A software toolbox facility was used to the design. RILA can be used in any clinical laboratory, but it can also be made laboratory situation-specific. This is done through the implementation of location-specific and detailed information concerning procedures, instruments, capacities, etc. By doing this, the interaction with the laboratories environment has to be defined as well. Certain application areas such as total quality management, workflow analysis and cost analysis can be facilitated through the implemented reference information model. Furthermore, RILA has to be positioned at a proper location with regard to the existing hospital and laboratory automation modules.     

Generic Darwinian selection in catalytic protocell assemblies

To satisfy the minimal requirements for life, an information carrying molecular structure must be able to convert resources into building blocks and also be able to adapt to or modify its environment to enhance its own proliferation. Furthermore, new copies of itself must have variable fitness such that evolution is possible. In practical terms, a minimal protocell should be characterized by a strong coupling between its metabolism and genetic subsystem, which is made possible by the container. There is still no general agreement on how such a complex system might have been naturally selected for in a prebiotic environment. However, the historical details are not important for our investigations as they are related to assembling and evolution of protocells in the laboratory. Here, we study three different minimal protocell models of increasing complexity, all of them incorporating the coupling between a 'genetic template', a container and, eventually, a toy metabolism. We show that for any local growth law associated with template self-replication, the overall temporal evolution of all protocell's components follows an exponential growth (efficient or uninhibited autocatalysis). Thus, such a system attains exponential growth through coordinated catalytic growth of its component subsystems, independent of the replication efficiency of the involved subsystems. As exponential growth implies the survival of the fittest in a competitive environment, these results suggest that protocell assemblies could be efficient vehicles in terms of evolving through Darwinian selection.     

Hydroelectricity and fish: a synopsis of comprehensive studies of upstream and downstream passage of anadromous wild Atlantic salmon, <Emphasis Type="Italic">Salmo salar</Emphasis>, on the Exploits River,Canada

Microalgal biofilms are associated with considerable variability in the properties of natural sediments, yet little effort has been made to isolate micro-scale spatial and temporal changes in sediment properties caused by the growth of a biofilm. Understanding the changes associated with biofilm growth and quantifying the time scales over which these changes occur is important for developing suitable experimental designs and for understanding how biofilms mediate sediment properties and processes. The development of a microphytobenthic biofilm and associated changes in the sediment was investigated over 45 days in the laboratory. The biogeochemical properties of the sediment: bulk density, water content, chlorophyll a concentration and colloidal carbohydrate concentration were measured on a sub-millimetre scale in the top 2 mm. The erosion threshold was measured with a Cohesive Strength Meter (CSM). Biofilm development was rapid, with changes in the properties occurring after 1 day and a visible film forming after just 3 days. The largest changes in sediment properties tended to occur in the surface 200 μm through time, with some variables also showing a differing response with depth. There were significant changes in water content, chlorophyll a concentration, colloidal carbohydrate concentration and erosion threshold in the surface 2 mm, with a general trend to increase with time. Bulk density was highly variable and did not show a consistent pattern of change with time. Erosion threshold was positively correlated with water content, chlorophyll a and colloidal carbohydrate in the surface 200 μm and these were also positively correlated with each other. Low Temperature Scanning Electron Microscopy (LTSEM) images revealed changes in the surface sediment structure and the formation of a thick multi-layer biofilm. The rapidity of biofilm growth and development and the associated changes to the sediment should be considered when designing experiments that investigate biofilms and properties of sediments and/or that involve biocide treatments or disturbance to the sediment.     

Contribution of a General-practitioner Hospital

A properly functioning general-practitioner hospital with good facilities including visiting consultants can greatly lighten the work load of the district general hospital. A general-practitioner hospital is described, run entirely by general practitioners, which cares for over 70% of the inpatients of a group practice. It deals with 98% of all who attend casualty, and carries out almost all of its x-ray work. Its facilities reduce the estimated demand for outpatient appointments at the district general hospital by almost half.The social advantages of a general-practitioner hospital are obvious, and there may be economic advantages as well. Moreover, such a hospital increases the attractiveness of general practice and improves its quality. It is suggested that the general-practitioner hospital is good for the patient, the community, and the doctor—and even the Treasury. There is room for many more.     

Pulmonary Actinomycosis Simulating Bronchogenic Carcinoma

During a 2½-year period, in a 360-bed general hospital, three cases of pulmonary actinomycosis were encountered in men aged 38, 47 and 49 years. In each instance the symptoms, signs and radiological and laboratory findings were such as to warrant a presumptive clinical diagnosis of bronchogenic carcinoma. Thoracotomy was performed in each case. This experience suggests that a definitive clinical diagnosis of bronchogenic carcinoma should not be made without histological evidence. Furthermore, such individuals should have the benefit of exploratory thoracotomy on the off-chance that the pulmonary lesion may be benign and amenable to treatment. Above all it should be remembered that pulmonary actinomycosis can simulate bronchogenic carcinoma to a marked degree.     

General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements

The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P < 0.01) when compared with the mean score for hospital rotations of 149.0. Significant differences between general practice and hospital rotations exist in the domains of students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?     

Secondary metabolism as an expression of microbial growth and development

A case is made out for regarding secondary metabolism as part of normal cell growth, related to its interactions with the environment. Secondary metabolism is widespread, especially in fungi and actinomycetes, and is not to be regarded as confined to the production of antibiotics and other special substances. It is part of the normal maturation process. Examples are given of the influence of secondary metabolism in ecological systems. It is also shown that cell productivity can be related to age structure. Secondary metabolism is thus linked with growth, although in many cases this may not be obvious in laboratory work. Initiation of production will arise from the system which regulates growth and differentiation. These processes are little understood at present, but it is clear that the factors involved differ in different instances and that they involve a very great variety of biochemical and physiological processes.     

The American General Practitioner in Hospital

In the U.S.A. and Canada full access of general practitioners to hospital beds and facilities is regarded as an essential privilege of their work. All hospital constitutions require a review of the credentials of staff applicants and continuing evaluation of their performance. Staff appointment carries administrative as well as clinical responsibilities and hospital work occupies a considerable proportion of the general practitioner''s day. The disciplinary machinery for safeguarding standards is strict by comparison with British hospital practice.This system produces an obvious excellence of clinical standards, postgraduate education, and communication between specialist and general practitioner and is attractive to the more able young British graduate. A pilot experiment of hospital staffing on North American lines in one of our new district general hospitals would be a worthwhile proposition.     

The genetic basis of thermal reaction norm evolution in lab and natural phage populations

Two major goals of laboratory evolution experiments are to integrate from genotype to phenotype to fitness, and to understand the genetic basis of adaptation in natural populations. Here we demonstrate that both goals are possible by re-examining the outcome of a previous laboratory evolution experiment in which the bacteriophage G4 was adapted to high temperatures. We quantified the evolutionary changes in the thermal reaction norms—the curves that describe the effect of temperature on the growth rate of the phages—and decomposed the changes into modes of biological interest. Our analysis indicated that changes in optimal temperature accounted for almost half of the evolutionary changes in thermal reaction norm shape, and made the largest contribution toward adaptation at high temperatures. Genome sequencing allowed us to associate reaction norm shape changes with particular nucleotide mutations, and several of the identified mutations were found to be polymorphic in natural populations. Growth rate measures of natural phage that differed at a site that contributed substantially to adaptation in the lab indicated that this mutation also underlies thermal reaction norm shape variation in nature. In combination, our results suggest that laboratory evolution experiments may successfully predict the genetic bases of evolutionary responses to temperature in nature. The implications of this work for viral evolution arise from the fact that shifts in the thermal optimum are characterized by tradeoffs in performance between high and low temperatures. Optimum shifts, if characteristic of viral adaptation to novel temperatures, would ensure the success of vaccine development strategies that adapt viruses to low temperatures in an attempt to reduce virulence at higher (body) temperatures.     

A correction for allele frequency estimates derived from isofemale lines

Isofemale lines are commonly used inDrosophila and other genera for the purpose of assaying genetic variation. Isofemale lines can be kept in the laboratory for many generations before genetic work is carried out, and permit the confirmation of newly discovered alleles. A problem not realized by many workers is that the commonly used estimate of allele frequency from these lines is biased. This estimation bias occurs at all times after the first laboratory generation, regardless of whether single individuals or pooled samples are used in each well of an electrophoretic gel. This bias can potentially affect the estimation of population genetic parameters, and in the case of rare allele analysis it can cause gross overestimates of gene flow. This paper provides a correction for allele frequency estimates derived from isofemale lines for any time after the lines are established in the laboratory. When pooled samples are used, this estimator performs better than the standard estimator at all times after the first generation. The estimator is also insensitive to multiple inseminations. After the lines have drifted oneN _e generations, multiple inseminations actually make the new estimator perform better than it does in singly inseminated females. Simulations show that estimates made using either estimator after the lines have drifted to fixation have a much greater error associated with their use than do those estimates made earlier in time using the correction. In general it is better to use corrected estimates of gene frequency soon after lines are established than to use uncorrected estimates made after the first laboratory generation. This work was supported by an NSERC fellowship to A.D.L.     

Sensing environmental temperature change through imbalances between energy supply and energy consumption: Redox state of photosystem II

A basic requirement of all photosynthetic organisms is a balance between overall energy supply through temperature-independent photochemical reactions and energy consumption through the temperature-dependent biochemical reactions of photosynthetic electron transport and contiguous metabolic pathways. Since the turnover of photosystem II (PSII) reaction centers is a limiting step in the conversion of light energy into ATP and NADPH, any energy imbalance may be sensed through modulation of the redox state of PSII. This can be estimated in vivo by chlorophyll a fluorescence as changes in the redox state of PSII, or photosystem II excitation pressure, which reflects changes in the redox poise of intersystem electron transport carriers. Through comparisons of photosynthetic adjustment, we show that growth at low temperature mimics growth at high light. We conclude that terrestrial plants, green algae and cyanobacteria do not respond to changes in growth temperature or growth irradiance per se, but rather, respond to changes in the redox state of intersystem electron transport as reflected by changes in PSII excitation pressure, We suggest that this chloroplastic redox sensing mechanism may be an important component for sensing abiotic stresses in general. Thus, in addition to its role in energy transduction, the chloroplast may also be considered a primary sensor of environmental change through a redox sensing/signalling mechanism that acts synergistically with other signal transduction pathways to elicit the appropriate molecular and physiological responses.     

What does the future hold for clinical microbiology?

In the past decade, clinical microbiology laboratories have undergone important changes with the introduction of molecular biology techniques and laboratory automation. In the future, there will be a need for more rapid diagnoses, increased standardization of testing and greater adaptability to cope with new threats from infectious microorganisms, such as agents of bioterrorism and emerging pathogens. The combination of the new tools that are now being developed in research laboratories, the general reorganization of clinical laboratories and improved communication between physicians and clinical microbiologists should lead to profound changes in the way that clinical microbiologists work.     

THE PAPANICOLAOU-TRAUT METHOD OF CANCER DIAGNOSIS,Its Use as a Routine Pathologic Laboratory Procedure

In a series of 450 examinations by the smear technique in the pathologic laboratory of a small private hospital, the total diagnostic error on all smears was 6.6 per cent. The error on vaginal smears was 4.7 per cent. These figures include false positives, false negatives, and all those smears classified as suspicious even though positive or negative diagnoses were made on subsequent examinations.The Papanicolaou-Traut method of cancer diagnosis can easily be made one of the routine pathologic procedures in the small hospital laboratory. Technicians with little previous cytologic experience can be trained to screen vaginal and other smears accurately after a short training period. This cytologic method is proving to be of value in the early detection of some neoplasms, and if its application is to be extended, the practicing pathologist should add the test to his diagnostic routine.     

The Papanicolaou-Traut method of cancer diagnosis; its use as a routine pathologic laboratory procedure

In a series of 450 examinations by the smear technique in the pathologic laboratory of a small private hospital, the total diagnostic error on all smears was 6.6 per cent. The error on vaginal smears was 4.7 per cent. These figures include false positives, false negatives, and all those smears classified as suspicious even though positive or negative diagnoses were made on subsequent examinations. The Papanicolaou-Traut method of cancer diagnosis can easily be made one of the routine pathologic procedures in the small hospital laboratory. Technicians with little previous cytologic experience can be trained to screen vaginal and other smears accurately after a short training period. This cytologic method is proving to be of value in the early detection of some neoplasms, and if its application is to be extended, the practicing pathologist should add the test to his diagnostic routine.     

A comparison of stress tolerance in YPD and industrial lignocellulose-based medium among industrial and laboratory yeast strains

In general, it is believed that fermentation by yeast under harsh industrial conditions, especially if substrates such as wood hydrolysate or lignocellulosic substrates are used, requires the use of so-called industrial strains. In order to check whether this is always true, a comparison of performance was made using two industrial strains and four commonly used laboratory strains, the haploid and diploid versions of CEN-PK and X2180, under industrially relevant stress conditions. The industrial strains were a Swedish commercial baker’s yeast strain and a strain previously isolated from an industrial bioethanol production plant using lignocellulosic substrate. Stress conditions included, apart from growth in the lignocellulosic substrate itself, elevated concentrations of glucose, NaCl, ethanol, and lactate as well as low pH. Results showed that, indeed, the strain adapted to lignocellulosic substrate also possessed the highest growth rate as well as shortest duration of the lag phase in this type of medium. However, the higher the additional stress level, the lower the difference compared to other strains, and X2180 in particular displayed a high resistance to these additional stress conditions. Furthermore, no difference in performance could be detected between the haploid or diploid versions of the laboratory strains. It might be that, at least under some circumstances, a laboratory strain such as X2180 could be an industrially attractive production organism with the advantage of facilitating the possibilities for making controlled genetic manipulations.     

Comparative Study of District and Community Hospitals

Opinions conflict on whether there is a place in the Health Service for general practitioner (community) hospitals in which the patients'' treatment is mainly the responsibility of their family doctors. The authors therefore analysed a sample of the patients admitted in the course of a year to a group of two general district hospitals with a comparable sample of the patients admitted to a general practitioner hospital. The aim was to analyse the type of care provided in the general practitioner hospital, to assess whether it was appropriate for the type of cases treated, and to decide whether the patients would have been better off in the district general hospital (and vice versa). The main conclusions are that a district hospital is best for serious illnesses needing skilled decisions and assessments but that most of the work of these hospitals is not of this kind and a community hospital staffed by general practitioners offers many advantages to patients—provided the work being done is constantly under critical assessment. The authors plead for special refresher courses under the N.H.S. for general practitioners working in community hospitals.     

Bacterial bio-mediated calcite precipitation for monumental stones conservation: methods of evaluation.

The weathering of monumental stones is a complex process inserted in the more general 'matter transformation cycle' operated by physical, chemical and biological factors. The consequence of these combined actions is a loss of cohesion with dwindling and scaling of stone material and the induction of a progressive mineral matrix dissolution. In the case of calcareous stones, calcite leaching increases the material porosity and decreases its mechanical features with a general weakening of the superficial structural strength. Attempts to stop, or at least to slow down, deterioration of monumental stones has been made by conservative treatments with both inorganic or organic products. More recent studies show a new approach to hinder these phenomena by inducing a bio-mediated precipitation of calcite directly inside the stone porosity. This can be achieved either through the application of organic matrix macromolecules extracted from sea shells or of living bacteria. The effectiveness of the treatment using calcinogenic bacteria has been evaluated with laboratory tests specifically developed to evaluate the parameters such as : porosity, superficial strength and chromatic changes, influenced by the treatment itself. The results obtained seem to indicate that this type of treatment might not be suitable for monumental stone conservation.     

Microbial maximal specific growth rate as a square-root function of biomass yield and two kinetic parameters

Understanding how growth rates changes under different perturbations is fundamental to many aspect of microbial physiology. In this work, we experimentally showed that maximal specific growth rate is a square-root function of the biomass yield, the substrate turnover number, and the maximum synthesis rate of the substrate transporter under that condition. We used Escherichia coli cultures in lactose minimal medium as a model system by introducing genetic modifications, in vitro evolution, and ethanol stress to the cell. Deletion of crr affected all three parameters in different directions while deletion of ptsG decreased only the biomass yield. Ethanol stress negatively impacted all three parameters, while anaerobicity decreased biomass yield and transporter synthesis rate. In addition, laboratory evolution increased the growth rate in lactose mostly through enhancing the expression rate of the lac operon. Despite all these changes, the growth rate of the perturbed strain was successfully related to the three parameters by the square-root equation. Thus, this square-root relationship provides insight into how growth rate is altered by different physiological parameters.