Charged-particle multiplicity near midrapidity in central Au+Au collisions at sqrt[SNN]=56 and 130 GeV

We present the first measurement of pseudorapidity densities of primary charged particles near midrapidity in Au+Au collisions at sqrt[s(NN)] = 56 and 130 GeV. For the most central collisions, we find the charged-particle pseudorapidity density to be dN/deta|(|eta|<1) = 408+/-12(stat)+/-30(syst) at 56 GeV and 555+/-12(stat)+/-35(syst) at 130 GeV, values that are higher than any previously observed in nuclear collisions. Compared to proton-antiproton collisions, our data show an increase in the pseudorapidity density per participant by more than 40% at the higher energy.

Academic performance and participation in physical activity by secondary school adolescents

This study investigated the relationship between adolescents' academic performance and participation in physical activity. 232 boys and girls from Years 8-11 (ages 13-16 years) were randomly selected, and their academic performance was assessed on previous examination scores in English, Mathematics, and Science. Participants were also asked to list all the sports based physical activities in which they normally participated during a typical week and to indicate how many times per week they took part in each activity and the duration of each. Overall, no significant correlations were found, although weak negative correlations were recorded between the amount of time (in minutes) in sport and exercise and English scores for children ages 13, 14, and 16 years. A similar association was also noted for Science scores of children 16 years old.

Next day telephone follow up of the elderly: a needs assessment and critical incident monitoring tool for the accident and emergency department

BACKGROUND

Patients over the age of 75 years comprise an increasing proportion of accident and emergency (A&E) department attendances. Within this group there is a high incidence of comorbidity, which mandates effective discharge coordination from the A&E department.

OBJECTIVES

The aims of this study were to assess the needs of these patients the day after discharge, target patients for appropriate interventions and identify critical incidents.

SETTING

The study was undertaken in a district general hospital A&E department that has 62000 new patient attendances per year.

INCLUSION CRITERIA

Patients aged 75 years or over who were discharged from the A&E department.

EXCLUSION CRITERIA

Nursing home patients. Patients without a telephone.

STUDY DESIGN

Pre-discharge information was collected from the medical notes. A community liaison nurse (CLN) then contacted patients by telephone. A semistructured questionnaire was used to assess patients. Patients were risk stratified and appropriate interventions made. Interventions initiated by the CLN were scored from 1 to 6 based on the level of input required.

RESULTS

551 patients or their carers were contacted by telephone. Existing home support was felt to be insufficient in 44 (8%) cases and in need of immediate intervention in a further 45 (8%) cases. Sixty five (11%) Category 1 patients required no intervention, 223 (42%) Category 2 patients required advice only, 107 (19%) Category 3 patients were referred to their GP, 127 (23%) Category 4 patients required a domicillary visit by a GP or a nurse, 26 (5%) Category 5 patients were at risk requiring urgent home assessment and three Category 6 patients had to re-attend A&E. Advice was given by the CLN on a broad range of issues and a wide range of health care services was accessed. Five hundred and fifty nine referrals were made by the CLN after telephone assessment.

CONCLUSIONS

Telephone follow up of patients over 75 attending our A&E department identified a number of areas where care could be improved before and after discharge. This low cost, high quality intervention has the potential for decreasing inappropriate return visits to the department by a vulnerable group of patients as well as improving overall quality of care.

Coeliac disease. Update 2000

BACKGROUND

Coeliac disease is increasingly recognised as a cause of nutritional disturbance in the Australian community. Diagnosis may be delayed because the presentation is highly variable.

OBJECTIVE

To outline an approach to diagnosis and management of coeliac disease.

DISCUSSION

Newer, more specific serological testing is helpful in screening asymptomatic individuals but endoscopic small intestinal biopsy is required for diagnostic certainty. A gluten free diet induces remission but not cure. Lifelong adherence reduces the risk of complications, including malignancy. All patients diagnosed with coeliac disease require expert dietetic assessment and counselling and all should be encouraged to join their state Coeliac Society. Excellent internet based sites now offer appropriate information for patients and their families.

Maternal caffeine consumption during pregnancy does not affect preimplantation development but delays early postimplantation growth in rat embryos

Models for studying prenatal drug-induced intrauterine growth retardation (IUGR) have, without exception, measured growth-related factors in the postimplantation embryo, fetus or neonate. Therefore, it is not known whether effects of drug exposure on growth and metabolism begin early in the preimplantation embryo, or whether IUGR is exclusively a postimplantation phenomenon. The present study investigates whether caffeine, a drug known to induce a dose-dependent fetal IUGR, affects embryo development before and/or after implantation or is exclusively a fetal phenomenon. Preimplantation embryo assessment (with treatment from Days 2 to 4 of pregnancy) included glucose utilization, cell number evaluation and stage of development (morula to hatched blastocyst); whereas, postimplantation embryo assessment (treatment from Days 2 to 10, 10.5 or 11 of pregnancy) included somite number evaluation and extent of neural tube closure, as seen using scanning electron microscopy. Comparing control preimplantation embryos with those exposed to 30 and 60 mg kg(-1) caffeine did not reveal any effects of caffeine exposure, as assessed on Day 5 of gestation. However, postimplantation embryo development assessed on Day 12 of gestation revealed that caffeine exposure of 15 and 30 mg kg(-1) significantly reduced, at both dosage levels, somite number and the extent of neural tube closure. In addition, comparisons of control and experimental groups revealed that in the high-dose caffeine group the forebrain cavity was significantly enlarged and bounded by a reduced, irregularly aligned neuroepithelium. The findings suggest that IUGR is a phenomenon first identifiable during late postimplantation embryogenesis and continues in fetal life.

Team nursing and ITU--a good combination?

Deficits in 'measurable care', in an 11-bedded intensive care unit, prompted a pilot study of team nursing. Team nursing was introduced for three beds out of the total 11 for a period of six months. In order to evaluate the effects, aspects of care and job satisfaction were measured and compared between the team nursing beds and the rest of the unit. The study revealed that job satisfaction and the levels of 'measurable care' did not improve whilst team nursing was practised. Based on this evidence, the authors question the relevance of team nursing in this particular intensive therapy unit (ITU) and maintain that the best method of delivering nursing care in ITU remains unclear.

Automated registration of frontal and lateral radionuclide lung scans with digital chest radiographs

RATIONALE AND OBJECTIVES

The purpose of this study was to develop and evaluate a fully automated method that spatially registers anterior, posterior, and lateral ventilation/perfusion (V/Q) images with posteroanterior and lateral digital chest radiographs to retrospectively combine the physiologic information contained in the V/Q scans with the anatomic detail in the chest radiographs.

MATERIALS AND METHODS

Gray-level thresholding techniques were used to segment the aerated lung regions in the radiographic images. A variable-thresholding technique combined with an analysis of image noise was used to segment the adequately perfused or ventilated lung regions in the scintigraphic images. The physical dimensions of the segmented lung regions in images from both modalities were used to properly scale the radiographic images relative to the radionuclide images. Computer-determined locations of anatomic landmarks were then used to rotate and translate the images to achieve registration. Pairs of corresponding radionuclide and radiographic images were enhanced with color and then merged to create superimposed images.

RESULTS

Five observers used a five-point rating scale to subjectively evaluate four image combinations for each of 50 cases. Of these ratings, 95.5% reflected very good, good, or fair registration.

CONCLUSION

The automated method for the registration of radionuclide lung scans with digital chest radiographs to produce images that combine functional and structural information should benefit nuclear medicine physicians and radiologists, who must visually correlate images that differ greatly in physical size, resolution properties, and information content.

Evaluating the use of computerised clinical guidelines in the accident and emergency department

OBJECTIVES

To investigate the pattern and frequency of use of computerised clinical guidelines (CCG) in an accident and emergency department.

METHODS

A software program was written to record information on a central database each time the CCG were used. Data were collected prospectively for a six month period. Users were blind to the study. The date, time of use and guidelines consulted were recorded.

RESULTS

1974 individual sessions were logged comprising of 10204 "hits". The CCG were used for a median of 10 sessions per day (range 1-38, SD 5.49). A median of three subjects were accessed during each session (range 1-39, SD 5). The CCG were used most often during peak daily activity; 11 am (609 hits), 5 pm (678 hits) and 12 pm (604 hits) and on Sundays (1875 hits), Thursdays (1770 hits) and Saturdays (1608 hits). The most frequently used guidelines concerned orthopaedics and fracture management (1590 hits), wound care (546 hits), poisoning (473 hits), medical emergencies (267 hits) and radiological policy (148 hits).

CONCLUSIONS

In this department CCG have become easily integrated as part of normal day to day working practice. The CCG are accessible 24 hours a day. They can also be easily updated according to best evidence, local policy or national guidelines. The results of this study have helped the authors to focus education to areas of clinical need.

Do patient age and medical condition influence medical advice to stop smoking?

OBJECTIVE

to determine whether the age and medical condition of a patient influences hospital-based doctors' decision making when advising patients to stop smoking cigarettes.

METHODS

we presented 142 doctors from four grades (consultant, registrar, senior house officer and house officer) and four specialities (medicine, surgery, psychiatry and anaesthetics), based in a Dublin teaching hospital, with 20 clinical vignettes. Each vignette described a patient from one of five age groups with one of four levels of health. The vignettes were randomly mixed. We asked doctors to say whether they would advise the patient in each case to quit smoking.

RESULTS

hospital-based doctors are significantly less likely to advise patients aged over 65 years than younger patients of the hazards of cigarette smoking, irrespective of the person's physical or mental health (P < 0.001).

CONCLUSION

the advice given to patients about their cigarette smoking habits by hospital doctors is strongly influenced not only by the patient's health, but also by the patient's chronological age.

University of Iowa Hospital and Clinics: outcomes management

Delivery of quality patient care and management of patient outcomes is critical to the success of academic medical centers in the ever-changing health care market. The University of Iowa Hospitals and Clinics (UIHC) promotes quality care through the provision of organizational structures and processes that are described in this article. In addition, quality of care and outcomes management are described by members in various roles within the UIHC health care system. It is the authors' belief that understanding quality from these various perspectives helps UIHC work across departments to achieve excellence in patient care.

Disaster medicine: an emerging specialty

The diverse nature of natural and man-made disasters demands a wide range of medical skills and resources from any attendant clinician. Working in a hostile environment may also require armed protection. This article considers the types of disasters, their medical requirements and the training of doctors wishing to be involved in this field of medicine. It includes a description of the Diploma in the Medical Care of Catastrophes.

Scrapie surveillance in Great Britain: results of an abattoir survey, 1997/98

A randomised sample of 2,809 apparently healthy sheep, 55 per cent of them less than 15 months of age, which were slaughtered for human consumption at abattoirs in Great Britain in 1997/98, was taken to establish the prevalence of scrapie infection. The medulla oblongata of each sheep was examined histopathologically at the level of the obex, and fresh brain tissue was examined for scrapie-associated fibrils (SAF) to establish whether there was evidence of scrapie. In addition, histological sections of the medulla from 500 of the sheep were immunostained with an antiserum to PrP, and the same technique was also applied to any animal found positive or inconclusive by the histological or SAF examinations. Any sheep which was positive by any of these diagnostic methods was also examined by Western immunoblotting, for the detection of the disease-specific protein PrP(Sc). A total of 2,798 sheep (99.6 per cent) were negative by all the methods applied. Ten animals were SAF-positive but negative by all the other methods, and in one animal there was immunohistochemical staining which could not be interpreted unequivocally as disease-specific. A mathematical model was used to estimate the prevalence of scrapie infection in the national slaughtered sheep population which would be consistent with these results. By this model, the absence of unequivocally substantiated cases of scrapie in the sample was consistent with a prevalence of infection in the slaughter population of up to 11 per cent.

Radiation somnolence syndrome

Although initially described 7 decades ago, somnolence syndrome remains a poorly understood subacute effect of cranial irradiation. Despite the relatively transient and benign nature of somnolence syndrome, its symptoms can be distressing for children and caregivers. Anticipatory guidance related to radiation-induced somnolence remains a critical nursing intervention. This article reviews what is known about somnolence syndrome, including its causes, symptoms, and management.

Abuse during and before pregnancy: prevalence and cultural correlates

This study examined the prevalence of abuse during pregnancy and the influence of cultural norms and acculturation on abuse in 1,004 Mexican American, Puerto Rican, Cuban American, Central American, African American and Anglo American women. Women were recruited from consecutive delivery logs in general community hospitals in Florida and Massachusetts. The Index of Spouse Abuse and the Abuse Assessment Screen ascertained history of adult physical, sexual, and emotional abuse, abuse during pregnancy, and childhood sexual abuse. An Interview Protocol assessed cultural attitudes, acculturation, and demographic information. Hispanic American women, as a whole, did not differ significantly from Anglo American women in their prevalence of abuse during pregnancy, after controlling for sociodemographic variables. However, Cuban American and Central American partners were significantly less likely to abuse their pregnant partners than were other groups even after adjustment. Women who spoke only Spanish (less acculturated) were less likely to report physical abuse from their partners both before and during pregnancy. Cultural norms, such as a partner's belief in wife/mother role supremacy and cultural group acceptability of men hitting women, were significantly positively related to both physical and emotional abuse. Other risk factors for abuse were the abuser not being the biological father of the baby, low income and little education, and being unmarried.

Retrospective study on Escherichia coli infection in broilers subjected to postmortem examination and antibiotic resistance of isolates in Trinidad

An 8-yr retrospective study was conducted to evaluate the rate of Escherichia coli infection and antibiotic resistance of isolates from diseased broilers submitted for diagnosis in Trinidad from 1990 to 1997. Of a total of 906 cases of diseased birds subjected to postmortem examination, 603 (66.6%) had E. coli infection. The number of cases increased over the years from 16 in 1990 to a peak of 294 in 1996. For every year, at least 50% of all broiler cases had E. coli infection. The rate of infection was significantly higher during the rainy season (74.1 +/- 6.9%) than during the dry season (57.8 +/- 7.0%). Approximately 50% of all E. coli isolates were resistant to 9 out of a total of 11 antimicrobial drugs selected for the study. The isolates showed an increasing trend of resistance to amoxicillin, apramycin, gentamicin, nitrofurantoin, norfloxacin, and sulfamethoxazole-trimethoprim. However, only the trends of resistance to apramycin and norfloxacin were statistically significant. Overall, of the antimicrobial drugs selected, norfloxacin relatively appeared as the best choice for treatment. From this study, we conclude that the high rate of E. coli infection in broilers submitted for diagnosis along with the high resistance of isolates to antimicrobial drugs constitute a threat to the poultry industry on the island.

Lessons from analysis of World Wide Web server activity data: http://www.swsahs.nsw.gov.au/livtrauma

OBJECTIVE

To establish visiting patterns and use of resources within an educational world wide web site, to develop strategies for its more effective use as a teaching medium.

DESIGN

Prospective descriptive study.

SETTING

A web site maintained by a major Australian metropolitan trauma service.

SUBJECTS

All visitors to the web site over a 40 day period.

MAIN OUTCOME MEASURES

Number of visitors, requests for pages, and transfer of files; timing and duration of visits; first and last pages viewed during visits; pages viewed most often; source of referral and country of origin of visitors.

RESULTS

There were 2237 visits, and a mean of 5.8 pages/visit were viewed. Mean duration of each visit was 4 minutes 35 seconds, and only half the visitors entered through the home page. The collection of radiographs was most commonly consulted. Visitors came from 26 different countries, 42% from Australia.

CONCLUSIONS

Factors that influenced the use of the site were identified and have altered our plans for development.