A combined electrochemical quartz-crystal microbalance probe beam deflection (EQCM-PBD) study of solvent and ion transfers at a poly

The oxidative polymerisation of the complex2,3-dimethyl-N,N'-bis-(salicylidene)butane-2,3-diaminatonick-el(II), [Ni(saltMe)], was monitored by the electrochemical quartz microbalance (EQCM) and crystal impedance techniques. Polymerisation efficiency was maintained throughout deposition of a film, which behaved rigidly, on the electrode. A combined EQCM-PBD (probe beam deflection) study of the redox process of the film exposed to a monomer-free solution of 0.1 M tetraethylammonium perchlorate (TEAP) in acetonitrile showed an electroneutrality mechanism dominated by anion movement accompanied by co-transfer of solvent above 0.8 V. The individual contributions of all the mobile species involved in the redox switching of the poly[Ni(saltMe)] film were determined quantitatively by temporal convolution analysis; the estimated solution-phase diffusion coefficient of the exchanged species was 1.24 x 10(-5) cm2s-1.

Quality of life and locus of control of migraineurs

Advanced practice nurses (APNs) are essential primary healthcare providers actively engaged in health promotion, illness prevention, and the management of acute and chronic diseases. The purpose of this study was to measure the quality of life and locus of control (LOC) among three different groups of migraineurs. A retrospective quantitative study was conducted using Ferrans and Powers' (1985) Quality of Life Index and Martin, Holroyd, and Penzien's (1990) Headache Specific Locus of Control questionnaire. The analysis of 79 adult migraineurs indicated that those who received headache education had a higher quality of life and higher external LOC scores than those without the intervention. This study's findings reinforce the notion that disease-specific education is an effective practice intervention. APNs can positively affect the quality of life for migraineurs by providing an educational intervention as part of high-quality, accessible, and cost-effective primary care.

Plasma creatinine rises dramatically in the first 48 hours of life in preterm infants

OBJECTIVE

Published data show that plasma creatinine falls steadily during the first 28 days of life and that creatinine levels in the neonatal period are higher in more premature infants. However, the best reference data commence on day 2 of life. The objective of this study was to document how plasma creatinine changes in the first 48 hours of life and to examine the reason for the apparently high levels of creatinine in preterm infants, compared with maternal levels.

DESIGN

A prospective observational study on a regional neonatal intensive care unit.

PATIENTS

A total of 42 preterm infants, mean gestational age of 29.4 weeks (range: 23-35), mean birth weight of 1.42 kg (.55-2.77), divided into 4 gestation groups: 23 to 26 weeks (n = 9), 27 to 29 weeks (n = 13), 30 to 32 weeks (n = 12), and 33 to 35 weeks (n = 8).

INTERVENTIONS

Measurement of plasma creatinine and urea concentration in cord blood and in serial samples taken for routine arterial blood gas analysis.

OUTCOME MEASUREMENTS

Changes in creatinine concentration with time and relationship to gestational age, birth weight, and illness severity.

RESULTS

Mean creatinine at birth was 73 micromol/L (95% confidence interval [CI]: 68-79 micromol/L). Plasma creatinine rose significantly over the first 48 hours. Mean peak creatinine in the most preterm infants (23-26 weeks) was 221 micromol/L (CI: 195-247 micromol/L). Peak plasma creatinine was inversely related to gestation (Spearman's coefficient: -.73) and birth weight (Spearman's coefficient: -.76). Significant differences in creatinine concentration were seen among different gestational groups at 24 and 48 hours of life. Peak creatinine correlated with a high Clinical Risk Index for Babies score (Spearman's coefficient:. 64). The fall in creatinine began later in more premature infants. All 38 surviving infants had normal renal function; their mean plasma creatinine at discharge was 52 micromol/L (CI: 46-58 micromol/L).

CONCLUSIONS

Rather than falling steadily from birth, creatinine rises dramatically in the first 48 hours of life, especially in infants of <30 weeks' gestation. Even large rises in creatinine in the first 48 hours may be expected and should not be used in isolation to diagnose renal failure.

Validation of cocaine and marijuana effect expectancies in a treatment setting

This study sought to establish the validity of the Cocaine Effect Expectancy Questionnaire (CEEQ), and the Marijuana Effect Expectancy Questionnaire (MEEQ) in discriminating between patterns of drug use in a clinical population. Prior research with these questionnaires has involved primarily nonclinical samples. Expectancy literature has yielded ambiguous results in demonstrating the role of both positive and negative expectancies in regards to drug use patterns. The sample consisted of 149 males on an inpatient V.A. substance abuse unit. On the CEEQ, cocaine users, particularly frequent users, endorsed fewer global positive cocaine expectancies than infrequent or nonusers. Present-infrequent users endorsed greater arousal effects than either present-frequent or nonusers. Nonusers of cocaine endorsed greater relaxation than present users. On the MEEQ, nonusers expected more negative effects from marijuana than users. Present users expected greater relaxation and craving effects than past users or nonusers. These results indicate different roles for positive and negative expectancies in cocaine and marijuana use.

Measurement of phenylalanine and tyrosine in plasma by high-performance liquid chromatography using the inherent fluorescence of aromatic amino acids

An isocratic high-performance liquid chromatography (HPLC) method is described using the natural fluorescence of phenylalanine and tyrosine compared with that of an internal standard N-methyl phenylalanine. Plasma precipitated with 6% perchloric acid was separated isocratically using a base-deactivated C18 column with 5% acetonitrile in water as the mobile phase. Fluorescent measurements at an excitation wavelength of 215 nm and emission 283 nm showed only three peaks for tyrosine, phenylalanine and the internal standard eluting within 9 min. Inter-batch coefficients of variation for phenylalanine were 2.9% and 1.8% at levels of 70 and 567 mumol/L, respectively, and 2.9% at a level of 63 mumol/L for tyrosine. The results for phenylalanine for this method showed a small mean positive bias (11 mumol/L) when compared with the target all-method means for UK National External Quality Assessment Scheme samples (n = 31). The results for tyrosine showed a small positive mean bias (10 mumol/L) when compared with an ion-exchange chromatographic method (n = 40). This method provides a quick and simple alternative to those using HPLC with pre- or post-column derivatization for monitoring patients with phenylketonuria. It is also less subject to interferences than HPLC methods using ultraviolet detection, particularly for the early eluting tyrosine peak.

Extracorporeal circuit design considerations for giant intracranial aneurysm repair

Clinical perfusionists must be able to modify the existing extracorporeal circuit in order to accommodate a specific surgical pathology. The clipping of a giant intracranial middle cerebral artery aneurysm, unapproachable with conventional neurosurgical techniques, required the use of a modified closed cardiopulmonary bypass circuit combined with deep hypothermia and total circulatory arrest. In-hospital discussions with anaesthesia, cardiac surgery, neurosurgery, and cardiology enabled an informed team approach directed towards the successful treatment of this complex neurosurgical lesion.

The utility of novelty seeking, harm avoidance, and expectancy in the prediction of drinking

To test the hypothesis that two temperament scales (Novelty Seeking and Harm Avoidance) are differentially related to alcohol expectancies and drinking patterns, 140 adolescents from an inpatient psychiatric facility completed several self-report questionnaires measuring temperament, alcohol expectancies, and alcohol consumption. Moderated multiple regression analyses indicated that Novelty Seeking was significantly related to frequency of drinking and problem drinking, but that Harm Avoidance was not related to these variables. Results of the MANOVA indicated that high novelty seeking and low harm avoidant (Type 2) individuals had a significantly higher frequency of drinking than did individuals who were high on Harm Avoidance and low on Novelty Seeking (Type 1). Results also showed that expectancy and Novelty Seeking contributed significant independent and overlapping variance in the prediction of amount of drinking. Although Novelty Seeking was related to expectations of social functioning, other hypothesized relationships between temperament and expectancy were not supported.

Amino acid profile in Down's syndrome

Fasting plasma and urinary amino acid concentrations were studied under carefully controlled conditions in 22 children with Down's syndrome and in age matched controls. The only significant difference between the groups was a higher mean plasma lysine concentration in Down's syndrome patients compared to controls.

Carbon dioxide: an alternative to iodinated contrast media

OBJECTIVES

To study the use of carbon dioxide as a contrast medium for arteriography.

METHODS

Carbon dioxide was used as a contrast medium for intra-arterial digital subtraction lower limb angiography in 12 examinations on 11 patients.

RESULTS

No complication was encountered and no significant changes occurred in the arterial pH, PaCO2 and PaO2. The quality of images as assessed by an independent observer was adequate for the majority of the vessels (77%).

CONCLUSIONS

Carbon dioxide is a safe alternative in patients at an increased risk of adverse reaction to iodinated ionic or non-ionic contrast medium and is very cheap.

Trends in the inpatient care of persons with schizophrenia

This report analyzes nationally representative data to examine inpatient services provided to persons with schizophrenia. The data are for patients admitted to general hospitals, private psychiatric hospitals, and State and county mental hospitals between 1970 and 1986 (weighted n = 860,637). The proportion of admissions diagnosed as having schizophrenia decreased from 21 percent in 1970 to 16 percent in 1986; this proportion decreased in public general hospitals and increased in private general hospitals. The rate of admissions for schizophrenia decreased in public general hospitals and State and county mental hospitals and increased in private general hospitals. The overall admissions rate decreased for whites with schizophrenia and increased for African-Americans, owing entirely to increased admissions of African-American males. Private general hospitals and State and county mental hospitals relied less over time on private insurance; the use of Medicare increased in both public and private general hospitals; and Medicaid use increased in private general hospitals. Further research on services for this population is necessary as a baseline for health care reform.

Healing of incisions in the tongue: a comparison of results with milliwatt carbon dioxide laser tissue welding versus suture repair

The healing of carbon dioxide laser weld closures produced by two commercial instruments of differing design were compared. Healing after laser welding was also compared to healing following conventional suture closure. Healing was evaluated histologically and by measurement of tensile strength over time. No histologic differences were found between closures produced by different lasers; however, in all cases suture closure resulted in slower healing times consistent with a foreign body reaction prolonging the healing process. Tensile strength measurements were performed at intervals over the first 21 days after the operation. Laser repair was found to be equivalent to or stronger than suture repair at every interval measured. The clinical use of the carbon dioxide laser for tissue welding of oral injuries should be investigated further, since it appears to be a good alternative to suture repair.

Covariance structure models of expectancy

Antecedent variables under the broad categories of genetic, environmental and cultural influences have been linked to the risk for alcohol abuse. Such risk factors have not been shown to result in high correlations with alcohol consumption and leave unclear an understanding of the mechanism by which these variables lead to increased risk. This study employed covariance structure modeling to examine the mediational influence of stored information in memory about alcohol, alcohol expectancies in relation to two biologically and environmentally driven antecedent variables, family history of alcohol abuse and a sensation-seeking temperament in a college population. We also examined the effect of criterion contamination on the relationship between sensation-seeking and alcohol consumption. Results indicated that alcohol expectancy acts as a significant, partial mediator of the relationship between sensation-seeking and consumption, that family history of alcohol abuse is not related to drinking outcome and that overlap in items on sensation-seeking and alcohol consumption measures may falsely inflate their relationship.

The new informatics of national healthcare reform

The President's Health Security Act has succeeded in attracting America's attention. Several of its initiatives have been well-publicized and hotly debated in Congress. The act also includes a number of implications for healthcare informatics, and devotes an entire chapter to this subject, although this area has not received as much publicity. Every behavioral healthcare provider's information system would be significantly affected by enactment of the Health Security Act. Selected forms and data elements for the management and delivery of behavioral healthcare services would need to be standardized. Organizations of behavioral healthcare providers, managed care companies and purchasers would increasingly share selected patient and subscriber information in aggregated form, for a variety of purposes. As a result, tougher laws to protect patient data privacy will likely be forthcoming. The following article gives an overview of the informatics needs of the soon-to-be reformed American healthcare system, into which behavioral healthcare will be integrated. As part of the larger system, behavioral healthcare services and information systems will need to comply with the same guidelines and requirements, outlined below, as other healthcare providers. Preparation to meet the information demands of the evolving healthcare system will require adaptation of existing computerized information systems, utilization of new technology, consultation with the system's major shareholders and attention to continuous quality improvement processes.