Cost implications of the British Pacing and Electrophysiology Group's recommendations for pacing.

OBJECTIVE--To compare present pacing practice with the recommendations recently published by the British Pacing and Electrophysiology Group and to assess the increase in annual budget required to implement these recommendations in a regional cardiothoracic unit. DESIGN--Retrospective analysis of pacemaker implantation for 1991 with calculation of the costs required to implement the group''s recommendations based on average 1991 costs of the types of pacing generators and electrode leads used. SETTING--Regional cardiothoracic unit for South West Thames Health Authority. PATIENTS--433 consecutive patients receiving permanent pacemaker generators: 76 (18%) with sinus node disease; 270 (62%) with atrioventricular block; 25 (6%) with both sinus node disease and atrioventricular block; 59 (14%) with chronic atrial fibrillation and atrioventricular block; and 3 (1%) with carotid sinus or malignant vasovagal syndromes. RESULTS--Only 102 (24%) patients received pacemaker generators recommended by the British Pacing and Electrophysiology Group; however, 355 (82%) patients were older than 65 years, and 264 (61%) were aged 75 or over. The cost of hardware for pacing was 462,885 pounds. Using generators as recommended would have cost 810,525 pounds for "optimal" systems (an increase of 75%) and 710,750 pounds for "alternative" systems (an increase of 54%). These increases would have been considerably reduced by limiting the use of sophisticated pacing to younger patients (aged under 75). Further savings could be made by using the least expensive pacing models available. CONCLUSIONS--Implementing these recommendations should reduce morbidity related to bradyarrhythmia but will lead to major increases in pacing costs. Age and patients'' expected activity may be used to select simple pacing systems and thus to contain cost. More research is needed to determine which patient groups will benefit most from complex pacing systems.     

The oxidation of methyl α-D-glucopyranoside with methyl sulproxide and acetic anhydride

The relative proportions of carbonyl, O-acetyl, and O-(methylthio)methylsugars resulting from the partial oxidation of methyl α-D-glucopyranoside with methyl sulphoxide and acetic anhydride have been investigated@ the preparation of the 2- and 6-(methylthio)methyl ethers of methyl α-D-glucopyranoside is described.     

Crop performance, nitrogen and water use in flooded and aerobic rice

Irrigated aerobic rice is a new system being developed for lowland areas with water shortage and for favorable upland areas with access to supplementary irrigation. It entails the cultivation of nutrient-responsive cultivars in nonsaturated soil with sufficient external inputs to reach yields of 70–80% of high-input flooded rice. To obtain insights into crop performance, water use, and N use of aerobic rice, a field experiment was conducted in the dry seasons of 2002 and 2003 in the Philippines. Cultivar Apo was grown under flooded and aerobic conditions at 0 and at 150 kg fertilizer N ha^–1. The aerobic fields were flush irrigated when the soil water potential at 15-cm depth reached –30 kPa. A ¹⁵N isotope study was carried out in microplots within the 150-N plots to determine the fate of applied N. The yield under aerobic conditions with 150 kg N ha^–1 was 6.3 t ha^–1 in 2002 and 4.2 t ha^–1 in 2003, and the irrigation water input was 778 mm in 2002 and 826 mm in 2003. Compared with flooded conditions, the yield was 15 and 39% lower, and the irrigation water use 36 and 41% lower in aerobic plots in 2002 and 2003, respectively. N content at 150 kg N ha^–1 in leaves and total plant was nearly the same for aerobic and flooded conditions, indicating that crop growth under aerobic conditions was limited by water deficit and not by N deficit. Under aerobic conditions, average fertilizer N recovery was 22% in both the main field and the microplot, whereas under flooded conditions, it was 49% in the main field and 36% in the microplot. Under both flooded and aerobic conditions, the fraction of ¹⁵N that was determined in the soil after the growing season was 23%. Since nitrate contents in leachate water were negligible, we hypothesized that the N unaccounted for were gaseous losses. The N unaccounted for was higher under aerobic conditions than under flooded conditions. For aerobic rice, trials are suggested for optimizing dose and timing of N fertilizer. Also further improvements in water regime should be made to reduce crop water stress.     

Cumulative funnel plots for the early detection of interoperator variation: retrospective database analysis of observed versus predicted results of percutaneous coronary intervention

Objective To use funnel plots and cumulative funnel plots to compare in-hospital outcome data for operators undertaking percutaneous coronary interventions with predicted results derived from a validated risk score to allow for early detection of variation in performance.Design Analysis of prospectively collected data.Setting Tertiary centre NHS hospital in the north east of England.Participants Five cardiologists carrying out percutaneous coronary interventions between January 2003 and December 2006.Main outcome measures In-hospital major adverse cardiovascular and cerebrovascular events (in-hospital death, Q wave myocardial infarction, emergency coronary artery bypass graft surgery, and cerebrovascular accident) analysed against the logistic north west quality improvement programme predicted risk, for each operator. Results are displayed as funnel plots summarising overall performance for each operator and cumulative funnel plots for an individual operator’s performance on a case series basis.Results The funnel plots for 5198 patients undergoing percutaneous coronary interventions showed an average observed rate for major adverse cardiovascular and cerebrovascular events of 1.96% overall. This was below the predicted risk of 2.06% by the logistic north west quality improvement programme risk score. Rates of in-hospital major adverse cardiovascular and cerebrovascular events for all operators were within the 3σ upper control limit of 2.75% and 2σ upper warning limit of 2.49%.Conclusion The overall in-hospital major adverse cardiovascular and cerebrovascular events rates were under the predicted event rate. In-hospital rates after percutaneous coronary intervention procedure can be monitored successfully using funnel and cumulative funnel plots with 3σ control limits to display and publish each operator’s outcomes. The upper warning limit (2σ control limit) could be used for internal monitoring. The main advantage of these charts is their transparency, as they show observed and predicted events separately. By this approach individual operators can monitor their own performance, using the predicted risk for their patients but in a way that is compatible with benchmarking to colleagues, encapsulated by the funnel plot. This methodology is applicable regardless of variations in individual operator case volume and case mix.     

Increased damage by western flower thrips Frankliniella occidentalis in chrysanthemum intercropped with subterranean clover

Suppressive effects of intercropping on Frankliniella occidentalis (Pergande) infestations have been reported in several crops. However, this study demonstrates that in year-round chrysanthemum, Dendranthema grandiflora Tzvelev, undersowing with subterranean clover, Trifolium subterraneum L., results in an increased thrips feeding damage. In a pot experiment, performed with chrysanthemum plants (cultivars Reagan and Tiger) grown with or without subterranean clover, significantly more leaves with silver and growth damage were found in the chrysanthemum plants with subterranean clover in comparison with the monocropped chrysanthemum plants. Similarly, the degree of deformation of leaf perimeter and leaf surface was higher in the top leaves of the intercropped chrysanthemum plant. In the soil experiment (only performed with Tiger and plants were grown in the soil in the greenhouse) intercropped chrysanthemum plants suffered a higher feeding damage as well. Analysis of the relation between silver or growth damage and the thrips pressure demonstrates that at similar thrips pressure in the intercropped chrysanthemum plants suffered significantly more damage. The higher thrips pressure in the intercropped chrysanthemum only explains the differences in damage partly. Changes in the reaction of chrysanthemum plants to thrips feeding or in the behaviour of the thrips, mediated by the presence of the non-host crop, are discussed. Our explanation is that chrysanthemum plants grown with clover are more susceptible to thrips feeding than monocropped plants. We conclude that undersowing with clover does not contribute to reduce damage by F. occidentalis in year-round chrysanthemum. Also, the influence of crop diversification on a pest cannot be foreseen until the specific characteristics of each individual crop – pest system are studied.     

Methods of assessing population increase in aphids and the effect of growth stage of the host plant on population growth rates

Realistic values of population growth rates are needed when used in forecasting programmes, e.g., in a programme of integrated control. Therefore, comparisons were made in a chrysanthemum – aphid system between different methods of assessing population growth rates. The reproductive performances of the aphid species Aphis gossypii and Myzus persicae were measured on two chrysanthemum cultivars using three plant growth stages (young vegetative, budding and flowering). In the first set of experiments, development time and reproduction were used to estimate the population growth rate r_m. The mean relative growth rates (MRGR) were also assessed. It was shown for the first time that the relationship between r_m and MRGR was influenced by aphid species. In a second experiment, the aphid population increase on a whole plant was measured and r_m was estimated by calculating the slope of the (ln transformed) population increase. It is shown that population growth rate is affected by the growth stage of the plant, and that cultivar and aphid species interact with plant growth stage in influencing population growth rate. Thus, no single growth stage of chrysanthemum for maximal aphid population growth can be assigned, but the budding and flowering stage are the most suitable in three out of four aphid × cultivar combinations. Comparison between the results from both experiments demonstrates clearly that more realistic values for r_m are obtained when measured on whole plants.     

Overexpression, solubilization and refolding of a genetically engineered derivative of the penicillin-binding protein 3 of Escherichia coli K12

Replacement of the amino-terminal 40-amino-acid region of the 588-amino-acid precursor of the membrane-bound penicillin-binding protein 3 (PBP3) by the decapeptide MKGKEFQAWI was carried out by altering the amino-coding end of the ftsI gene. Insertion of the modified gene into a runaway-replication plasmid under the control of a fused lpp promoter and lac promoter/operator, resulted in the overexpression by Escherichia coli of the modified PBP3 (designated PBP3**) in the cytoplasm. About 80% of the accumulated PBP3** underwent sequestration in the form of insoluble protein granules that were isolated by cell breakage or cell lysis. After selective removal of contaminants by an EDTA-lysozyme/DNase (deoxyribonuclease)/Nonidet extraction, treatment of the granules with guanidinium chloride followed by dialysis against buffer containing 0.5 M NaCl yielded a refolded, water-soluble PBP3**, which, upon chromatography on Superose 12, exhibited the expected 60,000 molecular mass. The refolded PBP3** bound benzylpenicillin in a 1 to 1 molar ratio, was highly sensitive to aztreonam and showed the same degree of thermostability, in terms of penicillin-binding capacity, as the parent, membrane-bound PBP3, suggesting that protein refolding occurred with formation of the correct intramolecular interactions. Two to three mg of refolded PBP3** can be obtained from 1 litre of culture of the overproducing strain.     

Serial Position Markers in Space: Visuospatial Priming of Serial Order Working Memory Retrieval

Most general theories on serial order working memory (WM) assume the existence of position markers that are bound to the to-be-remembered items to keep track of the serial order. So far, the exact cognitive/neural characteristics of these markers have remained largely underspecified, while direct empirical evidence for their existence is mostly lacking. In the current study we demonstrate that retrieval from verbal serial order WM can be facilitated or hindered by spatial cuing: begin elements of a verbal WM sequence are retrieved faster after cuing the left side of space, while end elements are retrieved faster after cuing the right side of space. In direct complement to our previous work—where we showed the reversed impact of WM retrieval on spatial processing—we argue that the current findings provide us with a crucial piece of evidence suggesting a direct and functional involvement of space in verbal serial order WM. We outline the idea that serial order in verbal WM is coded within a spatial coordinate system with spatial attention being involved when searching through WM, and we discuss how this account can explain several hallmark observations related to serial order WM.     

Preparation and properties of fluorescein-labelled hyaluronate.

Hyaluronate has been labelled with fluorescein groups by two procedures. Products with degrees of substitution ((d.s.) between 0.05 and 0.001 were obtained. Physico-chemical analysis (viscometry, gel chromatography, and measurements of sedimentation and diffusion coefficients) of the parent compound and the products showed that the labelling procedures caused only a limited degradation of the polysaccharide.