Fifty years of somatosensory research: from the Semmes-Weinstein monofilaments to the Weinstein Enhanced Sensory Test

In this paper, the author's long history with somatosensation is overviewed with special emphasis on the creation of objective tests of sensibility. Objective testing is discussed using numerous examples from the author's experiences. The creation of the Semmes-Weinstein monofilaments is discussed. Tests employing the Semmes-Weinstein monofilaments, two-point discrimination, and point localization are discussed with reference to the fact that these tests reflect specific differences between the central and peripheral nervous systems. Towards that end, contrasts are made between the Semmes-Weinstein esthesiometer and both the two-point discrimination and the point-localization tests. A new enhancement of the original Semmes-Weinstein monofilament test, the Weinstein Enhanced Sensory Test (WEST), is introduced. Advantages of the WEST are discussed.

Reducing pathology test misuse

Our laboratory serves a 450-bed acute care hospital in the rapidly growing Gold Coast region. The problem facing the department comprised an almost 10 per cent yearly increase in patient numbers in the face of budgetary constraints and pressure to increase efficiency. In January and February 1992 a vigorous effort was made to reduce pathology test numbers without compromising quality of patient care. The approach adopted involved targeting 'unnecessary' tests, defined as those investigations that would not affect a clinician's management of the patient. A team effort by laboratory scientific staff and heads of clinical departments was aimed at scrutinizing the ordering patterns of junior medical staff, who generate most of the test requests. The result was a 'test per patient' figure of 8.2 for both months, calculated as the number of tests on each request form received. In comparison, for January and February of the preceding four years, 1988 to 1991, the number of tests per patient fluctuated between 9.9 and 11.8. Patterns of unnecessary ordering that emerged included duplicate ordering of identical tests due to poor communication between house-staff, too frequent repeats of tests (for example, daily liver function tests), crossmatch where low transfusion likelihood would make group-and-hold appropriate, tests generated by nursing staff, and numerous others where the result would not affect management (or indeed even be looked at!). The nearly 20 per cent drop in tests does not include those instances where all tests on a request form were disallowed and the encounter therefore not included as a 'patient' statistic.(ABSTRACT TRUNCATED AT 250 WORDS)

Total quality management at Bethesda, Inc

This article describes 4 years of TQM implementation at Bethesda, Inc., a private not-for-profit diversified healthcare organization. Bethesda has used a comprehensive implementation strategy involving the use of process improvement teams, hoshin planning, daily management of critical processes, and quality function deployment. The article includes four process improvement case studies demonstrating the use of the seven quality control tools and a nine-step process improvement model. Factors contributing to processes as well as obstacles are described.

Age-related changes in hyaluronan, proteoglycan, collagen, and osteonectin synthesis by human bone cells

Human bone cells grown in culture, representative of a preosteoblastic stage of maturation, produce an extracellular matrix composed of collagen, several noncollagenous glycoproteins, hyaluronan, and four distinct proteoglycans (PGs). The influence of donor age on the levels of expression of these molecules in vitro has not been well characterized. In this study, human bone cells derived from sources ranging from fetal to 60-year-old donors were grown in culture, radiolabeled for 24 h, and the amount of incorporation of [35S]sulfate into PGs, [3H]glucosamine into hyaluronan, [3H]leucine/proline into osteonectin, and [3H]proline into collagen was determined. Cell proliferation was most rapid in fetal-derived bone cells and decreased with increasing age. Total protein and PG synthesis also decreased with increasing age, falling to 1/3 and 1/4, respectively, of fetal levels after age 30. A large chondroitin sulfate PG (Mr approximately 600,000 Da) was the major fetal PG and its levels were highly correlated with cellular proliferation. [3H]Collagen and [35S]decorin levels increased with the increasing age of the donor, reached a maximum in puberty-derived cells, and decreased to 1/3 maximal levels after age 20. The heparan sulfate PG (Mr approximately 400,000 Da) exhibited steady-state levels regardless of donor age. [3H]Osteonectin and [35S]biglycan levels were high in fetal-derived cells and in cells derived from pubescent donors. The percentage of collagen and four proteoglycans associated with the cell layer pool changed with donor age. All fetal-derived PG core proteins possessed more N- and O-linked oligosaccharides than newborn or adult derived PGs.

The interplay between X-ray crystallography, neutron diffraction, image reconstruction, organo-metallic chemistry and biochemistry in structural studies of ribosomes

Crystals of ribosomes, their complexes with components of protein biosynthesis, their natural, mutated and modified subunits, have been subjected to X-ray and neutron crystallographic analyses. Electron microscopy and 3-dimensional image reconstruction, supported by biochemistry, genetic, functional and organo-metallic studies were employed for facilitating phasing of the crystallographic data. For example, a monofunctional multi heavy-atom cluster (undecagold) was designed for covalent and quantitative binding to ribosomes. The modified particles were crystallized isomorphously with the native ones. Their difference-Patterson maps contain indications for the usefulness of these derivatives for subsequent phasing. Models of the ribosome and its large subunit were reconstructed from tilt series of 2-dimensional sheets. The comparison of the various reconstructed images enabled an initial assessment of the reliability of these models and led to tentative assignments of several functional features. These include the presumed sites for binding mRNA and for codon-anticodon interactions, the path taken by the nascent protein chain and the mode for tRNA binding to ribosomes. These assignments assisted in the design of biologically meaningful crystal systems. The reconstructed models are being used to identify structural features in initial density maps derived from X-ray and neutron diffraction data.

AIDS: the disease, the demographics, the devastation

The etiology and pathophysiology of AIDS are reviewed: HIV-1 infection and changes in T4 lymphocytes; secondary infections, such as Pneumocystis carinii pneumonia and tuberculosis; and tumors, such as Kaposi's sarcoma. The CDC has classified HIV infection into four groups based on clinical manifestations and immune system changes. Male homosexuals and bisexuals are most at risk for HIV infection. The incidence of infection among infants and heterosexuals will increase. Public health education programs should focus on safe (monogamy, condom use) and unsafe (unprotected intercourse, anal-receptive sex) sexual practices, as well as on risky behavior, such as needle sharing. Home care management of AIDS patients is safe and cost-effective.

Orotactile sensation, gustation and palatability: a pilot study

The hypothesis that deficits in orotactile sensitivity may affect gustation and palatability is not new. It is supported by animal models employing deafferentation; however, little direct evidence supports the application of the model to humans. Indirect evidence comes from four separate fields: (1) neuroanatomy, (2) physiology, (3) developmental biology, and (4) learning theory. The results of a pilot study with humans provide additional direct evidence that implicates the role of orotactile sensitivity in human gustation. In this pilot study, the oral cavity was topically anesthetized to determine whether gustation would be compromised to a similar extent as orotactile sensitivity. The time course of the degree of anesthesia was determined by prior measurements of oral-tactile sensitivity using an oral air-based aesthesiometer. Different concentrations of NaCl-solution were presented to subjects in order to determine gustatory thresholds before and after anesthesia. Analysis of magnitude-estimation data indicated that there were statistically significant decreases in gustatory sensitivity after anesthesia. Basic and applied implications of this area of research are discussed.

Apoplectic headache and oculomotor nerve palsy: an unusual presentation of multiple sclerosis

A patient with a history of facial myokymia presented with apoplectic headache and a 3rd nerve palsy. Initial CT, lumbar puncture, and cerebral angiogram were unremarkable, but subsequent CSF examination revealed oligoclonal bands. MRI displayed over 30 white matter lesions. This case demonstrates that multiple sclerosis may present with severe headache and a 3rd nerve palsy, simulating the clinical picture of a posterior communicating artery aneurysm.

Crystals of complexes mimicking protein biosynthesis are suitable for crystallographic studies

A complex of 70S ribosomes from Thermus thermophilus together with an average of 1.5-1.8 equivalents of PhetRNA(Phe) and a short mRNA chain, composed of 35 +/- 5 uridines, was crystallized under the conditions used for the growth of crystals of isolated ribosomes from the same source. Considering the reproducibility of their growth, their internal order and their shape, the crystals of the complex are superior to those of isolated ribosomes. In accord with previous three-dimensional reconstruction and modeling experiments, we conclude that the complex is less flexible and that an average population of complexes is more homogeneous than that of isolated 70S ribosomes. The crystals of the complex diffract to higher than 15 A resolution and can be irradiated with synchrotron X-ray beam at cryo-temperatures for days without noticeable decay. Since the crystals of the complex are apparently isomorphous with these of the isolated 70S ribosomes (P4(1)2(1)2; a = b = 526; c = 315 A), they should provide tool for phasing as well as for locating the mRNA and tRNA binding sites.

Uses of orthoclone OKT3 for prophylaxis of rejection and induction in initial nonfunction in kidney transplantation

We have shown that OKT3 can be safely administered to a varied group of transplant recipients, including a high percentage of diabetics and older patients. Used as a prophylactic agent, OKT3 was associated with a decreased incidence and delayed onset of acute rejection. Effectiveness may be reduced by shortening the course of treatment and/or lowering the dose of concomitant azathioprine. Use of OKT3 in patients with ATN (thereby avoiding use of CyA) may be a beneficial strategy. Stimulation of significant titers of antimurine antibody has not been a common event in this study.

Late results of combined iodine-125 and external beam radiotherapy in carcinoma of prostate

A total of 96 patients were treated for localized carcinoma of the prostate using combined Iodine-125 (125I) implantation and external beam radiotherapy. The implant was tailored to deliver 10,000 rad to the periphery of the prostate. A significant incidence of serious late rectal complications was observed. Positive pelvic nodes were found in 28 percent of the patients. Disease-free survival at seven years was 76 percent for those with negative nodes and 46 percent for patients with positive nodes.

Novel procedures for derivatization of ribosomes for crystallographic studies

Undecagold and tetrairidium clusters have been used for the preparation of heavy-metal derivatives of ribosomal particles, necessary for the evaluation of phases in the x-ray structure determination of these large particles. To obtain specific binding, monofunctional reagents of the clusters were prepared and were covalently bound to free sulfhydryl groups on the surface of the ribosome. In addition, a mutant of Bacillus stearothermophilus which lacks one ribosomal protein (BL11) was grown. The heavy-atom clusters were covalently bound to isolated protein BL11, and the modified protein was consequently reconstituted into the mutated ribosomal subunits. Crystallographic data have been collected from crystals of native particles, from the mutated ones, and from the iridium- and gold-derivatized subunits. All these crystal forms are isomorphous within the experimental error.

OKT3 prophylaxis versus conventional drug therapy: single-center perspective, part of a multicenter trial

As part of a collaborative study, Orthoclone OKT3 (Ortho Pharmaceutical Corporation, Raritan, NJ) monoclonal anti-T-cell antibody was used prophylactically for 14 days following cadaveric renal transplantation. Patients were randomized before treatment and compared with a control group treated with triple-drug immunosuppressant therapy consisting of cyclosporine, azathioprine, and prednisone. The OKT3 group (also treated with prednisone and azathioprine) had significantly fewer patients with acute rejection during the first year (27% v 60%), significantly delayed onset of acute rejection (median number of days to rejection, 56 v 10), and shortened duration of delayed initial graft function (median number of days on nonfunction, 5.5 v 9.0). OKT3 was safely administered intraoperatively. The study group included diabetics and patients over the age of 50 years. There was an increased incidence of benign fungal infection in patients treated with OKT3. The outcome data of both the prophylactic and control groups in this single-center trial was different from the multicenter experience in that patient and graft survival was 100% in both groups. The only difference in the immunosuppressive protocol was the use of 2 g intravenous methylprednisolone intraoperatively. The combination of intraoperative OKT3 with 2 g methylprednisolone may merit further study. It was concluded that OKT3 prophylaxis reduces the incidence of rejection episodes, delays the occurrence of rejection, and may reduce the duration of delayed initial graft function. It is not associated with an increase in serious infection and can be administered safely to a variety of cadaver transplant recipients.

Routine excretory urography in follow-up of superficial transitional cell carcinoma of bladder

To determine cost-effective guidelines for the follow-up of patients with superficial transitional cell carcinoma of the bladder (STCCAB), we reviewed clinical histories, pathology reports, and intravenous pyelography results in 84 patients with Stage Ta or T1 disease. In 4 patients (4.8%) subsequent upper tract tumors developed with an average interval from initial presentation to the development of upper tract disease of 5.4 years. Three of these patients were treated successfully. We recommend upper tract surveillance in this group of patients with intravenous pyelography at diagnosis and every twenty-four months thereafter, or selection of those patients who are at high risk for development of upper tract disease (i.e., ureteral-vesical reflux) with voiding cystourethrography one month following each resection of tumors near a ureteral orifice. Refluxing patients should then either undergo surgical repair of their reflux or yearly pyelography.

Ocular infections and the industrial use of microscopes

A cluster of ocular infections occurred in one area of a computer fabrication facility that relied on the use of industrial microscopes. A questionnaire was administered to all employees in this area. Microscope oculars were cultured and compared with control microscopes from a nonindustrial setting. Risk of infection was correlated with the number of hours of microscope use per day and subjective indicators of cleanliness. Bacterial cultures confirmed increased colony counts in industrial oculars compared with control oculars. Hygienic practices were instituted similar to those employed in medical settings. No further outbreaks of conjunctivitis have been reported in a 1-year follow-up.

Senior adult sexuality in age segregated and age integrated communities

Middle-income older adults who select to reside in age-segregated (AS) leisure-type retirement communities exhibit significantly more sexual interest, sexual activities, and liberal sexual attitudes than do middle-income older adults residing in age-integrated (AI) mainstream communities. Data from 314 respondents on a senior adult sexuality scale were subjected to a discriminant analysis. Sexual activities and traditional sexual interests respectively make the strongest contribution to the group differences. The implications of these findings are discussed.

Four-year experience with exclusive use of cytomegalovirus antibody (CMV-Ab)-negative donors for CMV-Ab-negative kidney recipients

Because of unacceptable CMV related morbidity, mortality, and graft loss, we adopted a policy that (-) patients would receive renal allografts only from (-) donors. This policy has resulted in a significant decrease in (1) morbidity (10.6% v 1.7%, P less than .0001), (2) mortality (3.7%) v 0%, P = .002), and (3) graft loss (2.5% v 0%, P = .016). CMV-Ab-negative patients (1) constitute 26% of all patients tested (compared with 36% of all donors tested), (2) receive transplants at the same rate as (+) patients, (3) do not have a prolonged waiting time, and (4) received greater HLA-A, B, -DR mismatched kidneys (3.6 v 3.1, P less than .01).

Three-dimensional image reconstruction from ordered arrays of 70S ribosomes

A better understanding of the molecular mechanism of protein biosynthesis still awaits a reliable model for the ribosomal particle. We describe here the application of a diffraction technique, namely three-dimensional image reconstruction from two-dimensional sheets of 70S ribosomes from Bacillus stearothermophilus at 47 A resolution. The three-dimensional model obtained by these studies shows clearly the two subunits, the contact points between them, an empty space large enough to accommodate the components of protein biosynthesis, the location of regions rich in RNA and a possible binding site for mRNA. The tunnel within the 50S particle which may provide the path taken by the nascent polypeptide chain in partially resolved.

Mechanism of oligonucleotide loop formation in solution

We have studied the tridecadeoxynucleotide CGCGAATTACGCG (I), which contains an additional A at position 9 compared to the dodecanucleotide of which the crystal structure has been determined. Sequence I exhibits no distinct melting curve and also has a concentration-dependent pattern of peaks on reverse-phase chromatography. This behavior is explained by a slow equilibration between loop and duplex forms in solution. We have characterized this equilibrium by proton NMR spectroscopy and shown that it is fully reversible by monitoring the two thymine methyl resonances, each of which occurs in two environments. Lower temperature and higher concentration favor the duplex; the midpoint of the transition is such that the loop predominates at room temperature. We have measured the van't Hoff enthalpy of formation of the duplex and the activation energy by temperature-jump and saturation-transfer experiments. The results are compared with those for the 17-mer sequence CGCGCGAATTACGCGCG (II), which contains two additional base pairs in the stem of the loop. The thermodynamic parameters and the effect of increasing salt concentration on the rate of conversion of the loop and duplex forms lead us to presume that the mechanism of interconversion involves complete strand separation and re-formation rather than cruciform formation and branch migration.

Emotional and health impact of home monitoring on mothers: a controlled prospective study

The psychologic and health effects of home monitoring were evaluated in mothers, whose infants (epidemiologically not at high risk for sudden infant death syndrome) were placed on electronic surveillance because of results obtained from a laboratory sleep study conducted at 4 weeks of age. Mothers of these infants were studied prospectively at several periods following the infants' births: 6 weeks, 12 weeks, and 1 year. The initial sample consisted of 56 mothers. Evaluation procedures included the Neonatal Perception Inventories, Anxiety Inventory (State and Trait), Depression Inventory, Brief Symptom Inventory, and a Recent Life Changes Questionnaire. The results obtained from these women were compared with those of women who had delivered at about the same time but whose infants were not placed on a home monitoring program. A total of 57 women started in the control group. Very few statistically significant group differences were observed between the two subject groups: 2 weeks after initiating the home monitoring program, monitor mothers (when compared to nonmonitor mothers) perceived their infant's behavior differently (although not more bothersome) and had an increased degree of situational anxiety (although not to an abnormal degree). There were no statistically significant differences between the two groups 12 weeks or 1 year after giving birth. These results suggest that a home monitoring program, which includes an aggressive and readily available support system, does not impose a marked health hazard to mothers.

Effect of exercise training and diet modification on serum lipids and lipoproteins in coronary artery disease patients treated with thiazides

The effects of chronic exercise training and diet modification on serum lipids and lipoproteins were measured in 17 hypertensive males and 41 normotensive males with documented coronary artery disease (CAD). Exercise consisted of aerobic activities which were performed at approximately 75-85% of the symptom-limited maximum heart rate for 30-40 minutes, three times weekly for 3 months. Each participant's diet was also controlled, the recommended daily intake of fat and cholesterol was no more than 40 g/day and 200 mg/day, respectively. Significant increases in estimated VO2max and total cholesterol/high density lipoprotein (HDL) and a significant decrease in serum triglycerides were documented after training. Significant differences in serum cholesterol and triglycerides between the nondiuretic and diuretic patients were also noted. No significant changes were found in low density lipoprotein (LDL), HDL, or body weight. Vigorous aerobic training and diet modification can favorably modify the deleterious effects of diuretic medications on serum triglycerides and total cholesterol/HDL in patients with documented CAD.

Ataxia telangiectasia with hepatocellular carcinoma in a 15-year-old girl and studies of her kindred

We studied a case of familial ataxia-telangiectasia in a 15-year-old girl who had a clinical history of cerebellar ataxia and recurrent pulmonary infections. She was found at autopsy to have a hepatocellular carcinoma, which has been described twice previously in the literature as occurring with this disorder. Family studies on the majority of her seven siblings (the product of one father and two mothers who were identical twins) showed one brother to have classic features of cerebellar ataxia, IgA deficiency, markedly elevated alpha-fetoprotein levels, and characteristic chromosomal abnormalities. This boy also died later of hepatocellular carcinoma in 1984. An affected sister had previously died of a respiratory tract infection.

Conformation of the gramicidin A channel in phospholipid vesicles: a fluorine-19 nuclear magnetic resonance study

The membrane conformation of the peptide ionophore gramicidin A is shown by 19F NMR to be described by the N-terminal to N-terminal beta LD helical dimer model proposed by Urry [Urry, D.W. (1971) Proc. Natl. Acad. Sci. U.S.A. 68, 672-676]. Fully active analogues of gramicidin with 19F labels at both the N- and C-termini are prepared synthetically. Labeled peptides are incorporated into small unilamellar vesicles of dimyristoylphosphatidylcholine. Measurements of the accessibility of the labels to either aqueous or lipophilic paramagnetic probes show that the N-terminus of gramicidin is located in the membrane interior and the C-terminus is at the membrane surface. Of the specific models proposed for the structure of gramicidin, these data are consistent only with that of Urry. The C-terminal 19F NMR peak in vesicles actually consists of three overlapping peaks. Experiments with the aqueous shift reagent Tm3+ show that C-terminal 19F nuclei in the inner and in the outer leaflets of vesicles resonate at different frequencies. The outer leaflet peak in turn consists of two overlapping peaks, possibly due to a local rearrangement of the C-terminal label.

In vivo effects of snake venoms on passive and facilitated glucose transport across blood-ocular and blood-CSF barriers of the rat

The transport of (3H)-3-0-methyl-D-glucose (mD-glu) and (14C)-L-glucose (L-glu) across blood-ocular and blood-CNS barriers was studied in rats with previously introduced (i.v.) lethal doses of lyophilized venom from one of three venomous snakes; mojave rattlesnake, Crotalus scutulatus; cottonmouth mocassin, Agkistrodon piscivorus; yellow cobra, Naja nivea. Transport rate constants calculated for mD-glu are taken as an indication of carrier-mediated transport, whereas L-glu constants are considered a measure of passive barrier permeability. C. scutulatus venom increased L-glu transport (+121%) across the blood-vitreous barrier. A passive increase in blood-vitreous permeability was also observed with mD-glu. This venom also increased passive L-glu entry rate into CSF (+160%). A. piscivorus venom also increased passive L-glucose entry into vitreous. However, whereas rattlesnake venom had little effect on blood-aqueous transport, cottonmouth venom may have also decreased carrier transport across this barrier. In addition, mD-glu transport from blood into CSF is decreased, suggesting a loss of carrier function across this barrier. N. nivea venom decreased the transport of both L-glu and mD-glu across the blood-aqueous, blood-vitreous and blood-CSF barriers, suggesting a possible decrease in cerebral blood flow as causative. There is also a possible increase in passive transport across the vitreous barriers, which may be in part countered by the decreased blood flow. Transport from aqueous into lens and cornea remained unchanged by the three venoms tested. It is suggested that components of rattlesnake and cottonmouth venoms alter transport barrier properties, with the blood-vitreous barrier being most susceptible to damage, whereas cobra venom likely decreases the supply of blood-borne substances to brain and ocular fluids and tissues by decreasing cerebral blood supply.

Biclonal IgA and IgM gammopathy in lymphocytic lymphoma

We report the case of a 76-year-old white man with a diffuse, well-differentiated lymphocytic lymphoma at the base of his tongue. Although serum electrophoresis, immunoelectrophoresis, and immunofixation showed he had a biclonal IgA kappa and IgM kappa gammopathy, biopsy of the tumor showed a positive immunoperoxidase response only for IgM kappa. The biclonal pattern persisted after chemotherapy, despite shrinkage of the tumor mass. The association of IgA and IgM appears to be the least frequent combination of separate biclonal immunoglobulins, the clinical course of such patients being more often that of lymphoma or macroglobulinemia than of myeloma. However, the symptomatology can be highly variable, as our case uniquely demonstrates.

Extensibility characteristics of human cheek--visco-elastic properties

Using a hydraulic bellows system mounted on a maxillary partial denture, continuous force-displacement data were taken in an edentulous area in the maxillary bicuspid-molar region on ten adults. Both loading and unloading force-displacement curves showed three segments. Two visco-elastic properties - hysteresis and relaxation - were consistently evident. The maximum difference in force-magnitude of the hysteresis loop was 1.02 g. A pre-conditioning phenomenon of the cheek tissue, evidence by a reduction of the area of the hysteresis loop, was observed in a series of repeated runs. The significance of the study was that: (1) in some individuals, the cheek could be displaced, by expansion of the molars, up to 1 mm into a second stable position; and (2) the relaxation phenomenon suggests a limited adjustive capacity in cheek stiffness.

Biclonal IgA and IgM gammopathy in lymphocytic lymphoma

We report the case of a 76-year-old white man with a diffuse, well-differentiated lymphocytic lymphoma at the base of his tongue. Although serum electrophoresis, immunoelectrophoresis, and immunofixation showed he had a biclonal IgA kappa and IgM kappa gammopathy, biopsy of the tumor showed a positive immunoperoxidase response only for IgM kappa. The biclonal pattern persisted after chemotherapy, despite shrinkage of the tumor mass. The association of IgA and IgM appears to be the least frequent combination of separate biclonal immunoglobulins, the clinical course of such patients being more often that of lymphoma or macroglobulinemia than of myeloma. However, the symptomatology can be highly variable, as our case uniquely demonstrates.

A national task analysis of infection control practitioners, 1982 Part three: The relationship between hospital size and tasks performed

One aspect of the Certification Board of Infection Control's (CBIC) task analysis survey was to determine those tasks done most frequently and considered most important by ICPs. A randomized stratified sample of ICPs was taken from U.S. hospitals of various bed-size categories. There were 473 responses (78.8%) from a targeted sample of 600 ICPs. Statistical analyses were done to find if a relationship existed between hospital size and the tasks performed. The frequency of performance and importance of the majority of infection control tasks studied were found to vary in relation to hospital size. Some tasks were found to be both important and frequently performed by the majority of ICPs in all hospital bed-size categories. These included performing and reporting epidemiologic surveillance, educating personnel, developing infection control policies and procedures, and consulting with hospital personnel. Other tasks were found to be relatively less important and infrequently performed by the majority of ICPs in all hospital bed-size categories. These included performing bedside patient care procedures, recommending specific antimicrobial therapy, and using statistical methods. The greatest differences in the performance of tasks were found in the subsample of the ICPs from hospitals with less than or equal to 100 beds.

Morphologic analysis of upper lip area following maxillary osteotomy via the tunneling approach

Preservation of favorable upper lip morphology is a critical factor in assessing the success of maxillary osteotomy surgery. Unesthetic postsurgical lips often appear thin and tight, with the vermilion border shortened and rolled inward. Clinical observation of patients who had undergone total maxillary alveolar process osteotomies by means of vertical buccal incisions and a tunneling approach suggests that presurgical lip morphology is minimally changed. This study investigates the presence and degree of change in upper lip morphology following this technique. Pre- and postoperative cephalometric radiographs of ten patients were compared by superimposition of acetate tracings on cranial base landmarks. Cross-sectional lip area was calculated by compensating polar planimetry presurgically and at four intervals following intervention: 1 to 3 days, 1 to 3.5 months, 6 to 9 months, and more than 10 months. Analysis showed the cross-sectional upper lip area, compared to the presurgical baseline, to be as follows: Immediately following surgery, the area increased by a mean of 27.8% (range, 15.0% to 36.9%; SE = 4.72). At 1 to 3.5 months postsurgery, the increase was reduced to 3.3% (range, 0 to 7.7%; SE = 0.82). At 6 to 9 months, lip area remained minimally increased, at + 0.78% (range, -5.0% to 7.6%; SE = 1.68). At 10 months or longer, the mean increase from preoperative values was 0.61% (range, -6% to 6.4%; SE = 1.38). The results of this study indicate that the upper lip cross-sectional area returns to its presurgical value at 6 months following surgery and remains constant at subsequent measurements. The performance of maxillary surgery with this flap design appears to preserve presurgical lip morphology.

A national task analysis of infection control practitioners, 1982

Respondents (N = 473) from a randomized stratified sample (N = 600) of U.S. hospital ICPs in a national survey sponsored by the Certification Board of Infection Control were asked to rate specific task, knowledge, and ability statements related to infection control for frequency and importance. The questions included 175 items, of which 99 were for specific tasks and 76 were for knowledge and abilities for practice. Areas covered included patient care practices, infectious diseases, epidemiology and statistics, microbiologic practices, sterilization and disinfection, education, employee health services, and management and communications. A "profile respondent" group (N = 317) was defined as persons most likely to be practicing the full scope of infection control practice and was used to identify key tasks, knowledge, and abilities for practice. Results showed that patient care practices (i.e., suctioning, dressing changes, and catheterization) were rarely performed. The development of infection control policies and procedures were key tasks. Knowledge of microbiology and infectious diseases in order to interpret laboratory reports and other patient data was rated as essential; however, few respondents actually performed laboratory procedures. Epidemiologic principles were frequently used for surveillance and problem investigation. Although presentation of epidemiologic data was rated as important, analytic statistics were rarely used. Assessment of educational needs and teaching were large components of ICPs' activities.

A national task analysis of infection control practitioners, 1992 Part One: Methodology and demography

A task analysis survey was conducted in 1982 by the Certification Board of Infection Control ( CBIC ) to determine the tasks performed by ICPs and the knowledge and abilities needed to perform these tasks. Data were obtained from 473 (78.8%) respondents to a nationwide mail survey of 600 ICPs . The respondents represent a randomized, stratified sample of ICPs in various types of U.S. acute care hospitals ranging in size from fewer than 50 beds to more than 500 beds. The results of the survey were used, in part, to develop the Infection Control Certification Examination, offered for the first time on November 19, 1983. According to the survey results, the modal or typical ICP is a white woman between the ages of 31 and 50 years using the title of infection control nurse. She has been employed full time for 2 to 10 years in infection control practice in a Joint Commission on Accreditation of Hospitals (JCAH)--accredited community acute care hospital having 301 to 500 beds. She is working at the supervisory level, is on the nursing department payroll, votes as a member of the hospital's infection control committee, and received her last degree or diploma more than 15 years ago.

Photochemically induced nuclear polarization study of the accessibility of tyrosines in insulin

The accessible tyrosines of bovine insulin were studied by the photochemically induced dynamic nuclear polarization (photo-CIDNP) method. Tyrosine 1H nuclear polarization is observed in acidic, neutral, and basic solutions at all concentrations studied, in the absence of added salts as well as in the presence of 0.05-0.1 M chloride or phosphate. At pH 2.1 in the presence of chloride, at concentrations of 640 microM and above, most of the nuclear polarization at delta 6.82 originates from one group of tyrosines. On the basis of the crystallographic model, these are assumed to be the A14 tyrosines. We explored the possibility of a genuine concentration dependence of the photo-CIDNP intensity of insulin due to aggregation. In order to discern between such effects and trivial kinetic effects traceable to the optical irradiation method, the effects of concentration changes on polarization were examined in three apparently nonassociating trypsin inhibitor proteins. In insulin, the intensity of Tyr-A 14 polarization changes slowly at concentrations above 1 mM, suggesting that these residues are similarly accessible in all association states. At insulin concentrations below 320 microM, additional tyrosine emission signals were observed. These signals are probably due to B16 and B26 tyrosines of monomers. Polarization transfer effects from Tyr-A14 are evident in the tetramer and hexamer. Enhanced absorption effects in the two histidines (B5 and B10) of the insulin monomer were observed at pH 10 in the presence of 0.1 M phosphate.