Dietary practices in propionic acidemia: A European survey

Background

The definitive dietary management of propionic acidaemia (PA) is unknown although natural protein restriction with adequate energy provision is of key importance.

Aim

To describe European dietary practices in the management of patients with PA prior to the publication of the European PA guidelines.

Methods

This was a cross-sectional survey consisting of 27 questions about the dietary practices in PA patients circulated to European IMD dietitians and health professionals in 2014.

Results

Information on protein restricted diets of 186 PA patients from 47 centres, representing 14 European countries was collected. Total protein intake [PA precursor-free L-amino acid supplements (PFAA) and natural protein] met WHO/FAO/UNU (2007) safe protein requirements for age in 36 centres (77%). PFAA were used to supplement natural protein intake in 81% (n = 38) of centres, providing a median of 44% (14–83%) of total protein requirement. Seventy-four per cent of patients were prescribed natural protein intakes below WHO/FAO/UNU (2007) safe levels in one or more of the following age groups: 0–6 m, 7–12 m, 1–10 y, 11–16 y and > 16 y. Sixty-three per cent (n = 117) of patients were tube fed (74% gastrostomy), but only 22% received nocturnal feeds.

Conclusions

There was high use of PFAA with intakes of natural protein commonly below WHO/FAO/UNU (2007) safe levels. Optimal dietary management can only be determined by longitudinal, multi-centre, prospective case controlled studies. The metabolic instability of PA and small patient cohorts in each centre ensure that this is a challenging undertaking.

Dietary practices in isovaleric acidemia: A European survey

Background

In Europe, dietary management of isovaleric acidemia (IVA) may vary widely. There is limited collective information about dietetic management.

Aim

To describe European practice regarding the dietary management of IVA, prior to the availability of the E-IMD IVA guidelines (E-IMD 2014).

Methods

A cross-sectional questionnaire was sent to all European dietitians who were either members of the Society for the Study of Inborn Errors of Metabolism Dietitians Group (SSIEM-DG) or whom had responded to previous questionnaires on dietetic practice (n = 53). The questionnaire comprised 27 questions about the dietary management of IVA.

Results

Information on 140 patients with IVA from 39 centres was reported. 133 patients (38 centres) were given a protein restricted diet. Leucine-free amino acid supplements (LFAA) were routinely used to supplement protein intake in 58% of centres. The median total protein intake prescribed achieved the WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Centres that prescribed LFAA had lower natural protein intakes in most age groups except 1 to 10 y. In contrast, when centres were not using LFAA, the median natural protein intake met WHO/FAO/UNU [2007] safe levels of protein intake in all age groups. Enteral tube feeding was rarely prescribed.

Conclusions

This survey demonstrates wide differences in dietary practice in the management of IVA across European centres. It provides unique dietary data collectively representing European practices in IVA which can be used as a foundation to compare dietary management changes as a consequence of the first E-IMD IVA guidelines availability.

Fuzzy modeling to predict chicken egg hatchability in commercial hatchery

Experimental studies have shown that hatching rate depends, among other factors, on the main physical characteristics of the eggs. The physical parameters used in our work were egg weight, eggshell thickness, egg sphericity, and yolk per albumen ratio. The relationships of these parameters in the incubation process were modeled by Fuzzy logic. The rules of the Fuzzy modeling were based on the analysis of the physical characteristics of the hatching eggs and the respective hatching rate using a commercial hatchery by applying a trapezoidal membership function into the modeling process. The implementations were performed in software. Aiming to compare the Fuzzy with a statistical modeling, the same data obtained in the commercial hatchery were analyzed using multiple linear regression. The estimated parameters of multiple linear regressions were based on a backward selection procedure. The results showed that the determination coefficient and the mean square error were higher using the Fuzzy method when compared with the statistical modeling. Furthermore, the predicted hatchability rates by Fuzzy Logic agreed with hatching rates obtained in the commercial hatchery.

A simple and practical method to acquire geometrically correct images with resonant scanning-based line scanning in a custom-built video-rate laser scanning microscope

Most currently available confocal or two-photon laser scanning microscopes (LSMs) allow acquisition rates of the order of 1-5 images s(-1), which is too slow to fully resolve dynamic changes in intracellular messenger concentration in living cells or tissues. Several technologies exist to obtain faster imaging rates, either in the video-rate range (30 images s(-1)) or beyond, but the most versatile technology available today is based on resonant scanners for horizontal line scanning. These scanning devices have several advantages over designs based on acousto-optical deflectors or Nipkow discs, but a drawback is that the scanning pattern is not a linear but rather a sinusoidal function of time. This puts additional constraints on the hardware necessary to read-in the image data flow, one of which is the generation of a pixel clock that varies in frequency with the position of the pixel on the scanned line. We describe a practical solution to obtain a variable pixel clock add-on that is easy to build and is easy to integrate into a custom-built LSM based on resonant scanning technology. In addition, we discuss some important hardware and software design aspects that simplify the construction of a resonant scanning-based LSM for high-speed, high-resolution imaging. Finally, we demonstrate that the microscope can be used to resolve calcium puffs triggered by photolytically increasing the intracellular concentration of inositol trisphosphate.

A heminested polymerase chain reaction for the detection of Brazilian rabies isolates from vampire bats and herbivores

A heminested-PCR (hn-PCR) using primers to the nucleoprotein-coding gene in a nested set was evaluated in the detection of Brazilian strains of rabies virus (RV). A representative number of RV nucleoprotein sequences belonging to genotype 1 were aligned. Based on such alignment, primers were directed to highly conserved regions. All 42 clinical samples positive by both fluorescent antibody and mouse inoculation tests were also positive by the hn-PCR. Brain tissue that had been left to decompose, obtained from an experimentally inoculated mouse was tested by hn-PCR and yielded positive results. In conclusion, primers designed here were capable of amplifying Brazilian RV isolates obtained from a rural epidemiological cycle.

Asystolic cardiac arrest in Melbourne, Australia

OBJECTIVE

To study the outcome of victims of out-of-hospital cardiac arrest presenting to the Metropolitan Ambulance Service in asystole, in Melbourne, Australia.

METHODS

A retrospective case-note review of all patients presenting to the Metropolitan Ambulance Service in asystole for 1997 was performed. Metropolitan Ambulance Service case notes and hospital records were examined to determine the presenting rhythm and the patients' outcome.

RESULTS

In a 12-month period, 778 patients met the entry criteria. Age mean was 67 years, 36% female, 64% male. Metropolitan Ambulance Service response time to scene time was a mean of 9.76 min. Resuscitation was commenced on 37% of patients. There was one survivor (0.12%).

CONCLUSION

Adult victims of out-of-hospital cardiac arrest presenting as asystole should not receive treatment.

Automatic external defibrillators: changing the way we manage ventricular fibrillation

OBJECTIVE

To discuss recent developments in automatic defibrillation and to review the evidence that first-responders equipped with automatic external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest.

DATA SOURCES

MEDLINE search from 1966 to 1999 (articles in English only) and examination of bibliographies.

STUDY SELECTION

Published studies of out-of-hospital cardiac arrest and first-responders equipped with AEDs. Studies had to have a control group and to report survival to hospital discharge from ventricular fibrillation (VF).

DATA EXTRACTION

Six studies met the selection criteria (two prospective randomised trials, two prospective controlled trials, and one cohort study and one retrospective study, both with historical controls).

DATA SYNTHESIS

A random effects meta-analysis of odds ratios for survival from VF.

CONCLUSIONS

Meta-analysis suggests that equipping first-responders with AEDs increases the probability of survival to hospital discharge after out-of-hospital cardiac arrest (odds ratio, 1.74; 95% CI, 1.27-2.38; P < 0.001). However, most of the studies lacked sufficient power to draw definitive conclusions. Until the impact of wide deployment of AEDs is fully understood, first-responder defibrillation in Australia should only occur as part of coordinated multicentre research studies.

Clink, a nanovirus-encoded protein, binds both pRB and SKP1

Clink, a 20-kDa protein of faba bean necrotic yellows virus, a single-stranded DNA plant virus, interacts with pRB family members and a SKP1 homologue from Medicago sativa. An LxCxE motif and an F-box of Clink mediate the interactions with the respective proteins. The capacity of Clink to bind pRB correlates with its ability to stimulate viral replication. Interaction of a single protein with the cell cycle regulator pRB and SKP1, a constituent of the ubiquitin-protein turnover pathway, appears to be a novel feature. Hence, Clink may represent a new class of viral cell cycle modulators.

Jumping from the Westgate Bridge, Melbourne

OBJECTIVE

To describe characteristics of people who jumped from the Westgate Bridge (identifying risk factors for attempted suicide) and to determine why people may survive such a jump.

DESIGN AND SETTING

A retrospective case review (coroners' reports and hospital records) of all people known to have jumped from the Westgate Bridge between 1991 and 1998.

RESULTS

We identified 62 people who jumped from the Westgate Bridge over the study period. Seven survived. Forty-one (74%) of those who jumped were male. The average age was 33.8 years (range, 15-58 years). Forty-four (71%) had known mental illness (23 schizophrenia, 21 depression). Thirty-nine (63%) landed in water, falling from a height of 58.5 m. Nineteen (31%) fell onto land and in four cases (6%) the landing site was not determined. All survivors landed in water. Six people died from drowning after the fall, and in eight more deaths drowning was a major or contributing factor. All jumps resulted from suicidal intent, and 12 people (19%) had positive toxicology screens for alcohol or other non-prescription drugs at postmortem.

CONCLUSIONS

Each year the Westgate Bridge is the scene of about eight suicide attempts by jumping (particularly by men with active psychiatric illness). Some deaths by drowning could be prevented by early detection and rapid emergency service response. The erection of an effective safety barrier would probably prevent more deaths.

Intra-articular lignocaine versus Entonox for reduction of acute anterior shoulder dislocation

We assessed, in a prospective randomised trial, the relative analgesic effects of Entonox and intra-articular lignocaine (IAL) in patients with acute anterior dislocation of the shoulder. A statistically significant reduction in pain scores was achieved with IAL (7.9 vs 5.2, P < 0.05), but the effect with Entonox was greater (7.8 vs 2.9, P < 0.001). We conclude that Entonox provides better analgesia than IAL in patients with acute anterior shoulder dislocation.

A tobacco homologue of the Ri-plasmid orf13 gene causes cell proliferation in carrot root discs

The tobacco genome contains genes, called cellular rol (c-rol) genes, that are very similar in sequence to genes present in the T-DNA of the Agrobacterium rhizogenes Ri-plasmid. We have cloned two homologues (torf13-1 and torf13-2) of the Ri-plasmid orf13 gene from Nicotiana tabacum L. cv. Havana 425. The clone torf13-1 has a 594-bp open reading frame (ORF) which is similar in sequence (77-82% for DNA and 67-77% for the deduced amino acid sequence) to orf13 genes of the agropine, mikimopine, and mannopine Ri-plasmids and the N. glauca homologue Ngorf13. Southern analyses showed that there are at least two torf13 genes derived from the N. tomentosiformis ancestor of tobacco, strongly suggesting that torf13 resulted from an ancient transfer between ancestors of modern A. rhizogenes and tobacco. Steady-state expression of torf13 mRNA is high in sepals, petals, shoot tips and in younger leaves, but considerably lower in stem tissues, lower leaves and roots. Treatment of cultured leaf discs for 5-20 days on medium containing auxin (10.7 microM alpha-naphthaleneacetic acid) and cytokinin (1.4 microM kinetin) resulted in a marked down-regulation of torf13 mRNA accumulation. Therefore, torf13 is transcriptionally active in normal tobacco tissues and the steady-state mRNA level is regulated. Inoculation of carrot-root discs with A. tumefaciens strains carrying the mannopine Ri-plasmid orf13 and torf13-1 regulated by the strong cauliflower mosaic virus 35S RNA promoter induced the formation of dense green callus on the disc surface. These findings indicate that at least one function of the orf13 ORF is conserved in the tobacco homologue, and provide direct evidence that a c-rol gene can influence cell proliferation.

Prehospital emergency rapid sequence induction of anaesthesia

OBJECTIVE

To determine the number of and reasons for rapid sequence inductions done by accident and emergency (A&E) doctors out of hospital as part of the activities of the MEDIC 1 Flying Squad. "Rapid sequence induction" was defined as any attempted endotracheal intubation accompanied by use of drugs to assist intubation and ventilation, including opiates, benzodiazepines, intravenous and topical anaesthetics, and neuromuscular blocking drugs.

METHODS

Retrospective study of all MEDIC 1 and A&E records over the period 1 February 1993 to 28 February 1996 (37 months). The anaesthetic technique used, drugs used, complications, difficulties, reasons for induction out of hospital, and grade of doctor performing the technique were determined.

RESULTS

Various anaesthetic techniques were used to secure the airway definitively by endotracheal intubation. Several difficulties were encountered in the prehospital setting, all of which were dealt with successfully.

CONCLUSIONS

The lack of complications related to rapid sequence induction in prehospital care suggests that this technique is safe when done by A&E doctors on appropriate patients.

Tobacco plants carrying a tms locus of Ti-plasmid origin and the Hl-1 allele are tumor prone

The autonomous growth of plant tumor cells is believed to result from their persistent loss of the requirement for growth hormones such as auxin and cytokinin. The partially dominant gene Habituated leaf-1 (Hl-1) regulates the requirement of cultures tissues of Havana 425 tobacco (Nicotiana tabacum L.) for cytokinins. The Hl-1 allele can partially restore the tumor phenotype in tobacco cells transformed with a Agrobacterium tumefaciens Ti plasmid defective in the isopentenyl transferase locus, which encodes a key enzyme in cytokinin biosynthesis and is required for neoplastic growth. To investigate the oncogenic function of Hl-1, we transformed wild-type (hl-1/hl-1) and Hl-1/Hl-1 tobacco plants with the tms locus derived from the limited-host-range Ti plasmid pTiAg162. This locus encodes enzymes for biosynthesis of the auxin indole-3-acetic acid. Grafting tests and measurements of the hormone requirement of cultured explants show that wound-induced overgrowths arising in tms transformed Hl-1 plants are tumorous. While some wound-induced overgrowths also formed in hl-1/hl-1 transformants, these showed slight hormone-autotrophic growth and weak tumorigenicity in grafting tests. In addition, Hl-1/Hl-1 tms/tms plants, but not hl-1/hl-1 tms/tms plants, spontaneously developed rooty teratomatous overgrowths, showed flowering abnormalities, and formed calli at the base of the stem in young seedlings. Thus, Hl-1 tms plants exhibit a tumor-prone phenotype, and in this regard closely resemble tumor-prone hybrids that arise in certain interspecific crosses of Nicotiana species. Our results show that the interaction of just two genetic elements-the mutant Hl-1 allele of the tobacco host with tms genes of Ti plasmid origin-are sufficient for a tumor-prone phenotype.

Horizontal gene transfer: regulated expression of a tobacco homologue of the Agrobacterium rhizogenes rolC gene

A tobacco homologue (trolC) of the rolC gene of the Agrobacterium rhizogenes Ri-plasmid was cloned and sequenced from Nicotiana tabacum L. cv. Havana 425. The coding region of trolC is similar in sequence (69-87% for DNA and 54-89% for the deduced amino acid sequence) to rolC genes of the agropine, mannopine, and mikimopine strains of Ri-plasmids and the N. glauca rolC homologue. Southern analyses showed that trolC is encoded by a small gene family derived from the tomentosiformis ancestor of tobacco. This suggests that trolC resulted from an ancient transfer of DNA between A. rhizogenes and a progenitor of modern tobacco. Transcripts of trolC were detected in three morphologically distinct cultivars of tobacco. trolC mRNA accumulated in young leaves and shoot tips, but not in lower leaves and roots of mature plants. Accumulation of trolC mRNA in cultured leaf tissues was strongly down-regulated by auxin and induced by cytokinin. These results are of particular interest because they suggest that a gene of bacterial origin introduced during evolution can have a function in a modern plant.

Antibiotic susceptibility of streptococci isolated from blood from neutropenic patients

MICs were performed on 62 streptococci isolated from the blood of neutropenic patients from 1986 to 1992 using the NCCLS broth microdilution procedure. Species isolated were 43 S. mitis, 6 S.pneumoniae, 5 S.sanguis, 1 S.pyogenes, 1 beta-hemolytic streptococcus of the group G, 1 S.adjacens, 1 S.intermedius, 4 not identified isolates (2 alpha-hemolytic, 1 non-hemolytic and 1 nutritionally variant strains). 26% of all strains were resistant or intermediate to penicillin (MIC 90: 2 mg/l) and 89% to norfloxacine (MIC 90: 32 mg/l). All were susceptible to vancomycin. Among cephalosporins, all strains were susceptible to cefotaxime (MIC 90: 1 mg/l), ceftriaxone (MIC 90: 1 mg/l) and cefepime (MIC 90: 2 mg/l) while 19% were R or I to ceftazidime (MIC 90: 16 mg/l). All were susceptible to imipenem (MIC 90: 0.5 mg/l) and meropenem (MIC 90: 1 mg/l). Among the third generation cephalosporins, ceftazidime--the agent of this class of antibiotics that is most often used for the empirical therapy of febrile episodes in neutropenic patients (in combination but also in monotherapy)--has a high resistance rate as compared to the other compounds.

Intracellular transport and processing of a tobacco vacuolar β-1,3-glucanase

The class I β-1,3-glucanases are basic, vacuolar enzymes implicated in the defense of plants against pathogen infection. The tobacco (Nicotiana tabacum L.) enzyme is synthesized as a preproprotein with an N-terminal signal peptide for targeting to the lumen of the endoplasmic reticulum and an N-glycosylated C-terminal extension which is lost during protein maturation. The transport and processing of β-1,3-glucanase in cellsuspension cultures of the tobacco cultivar Havana 425 was investigated by pulse-chase labelling and cell fractionation. We verified that mature β-1,3-glucanase is localized in the vacuole of the suspension-cultured cells. Comparison of the time course of processing in homogenates, the soluble fraction, and membrane fractions indicates that proglucanase is transported from the endoplasmic reticulum via the Golgi compartment to the vacuole. Processing to the mature form occurs in the vacuole. Treatment of cells with tunicamycin, which inhibits N-glycosylation, and digestion of the (35)S-labelled processing intermediates with endoglycosidase H indicate that β-1,3-glucanase has a single N-glycan attached to the C-terminal extension. Glycosylation is not required for proteolytic processing or correct targeting to the vacuole.

Impact of therapeutic management on use of seclusion and restraint with disruptive adolescent inpatients

Use of seclusion and restraint on three inpatient adolescent psychiatric units was examined during two five-month periods before and after implementation of a "therapeutic management" protocol. Under the protocol, staff classified disruptive behaviors into four stages and provided verbal and behavioral interventions to control behavior at each stage. Patients who required seclusion and restraint had significant latitude to determine the timing of their release from the interventions and met with staff one hour and 24 hours after their release to explore alternatives to aggression. The number of episodes of seclusion and restraint fell by 64 percent after the protocol was adopted, and the number of patients who required those interventions dropped by 39 percent. The mean duration of episodes of seclusion and restraint was reduced by 59 percent. Therapeutic management provides a corrective experience by addressing the developmental needs, deficient cognitive skills, and poor internalized controls of disruptive adolescents.

Physical therapists' notes and outcomes of physical therapy. A case of insufficient evidence

This article addresses the problem of documenting the outcomes of physical therapy. This is a timely issue because new approaches to reimbursing health-care costs will favor those providers and professions able to demonstrate sufficient benefits to patients to justify prospective cost reimbursement. To assess the adequacy of existing outcome data, we conducted detailed longitudinal audits of 63 geriatric patients' medical records. For nearly half of these patients, the records contained insufficient data to document any improvement in physical functioning. The number of treatments administered correlated with functional improvements documented, but diagnostic related group classifications and patient demographics did not. We found practicing physical therapists overestimated the amount of outcome data recorded and documented some areas of physical functioning more frequently than others. A wider scope for functional assessment and greater standardization in record keeping are advocated. We discuss implications for clinical practice and research and offer a new instrument for quantifying outcomes.

[Changes in antibiotic resistance of organisms isolated from blood cultures in a recently built hospital]

The change in antimicrobial resistance of organisms isolated from blood cultures was studied in a university hospital that opened in July 1977 and had 550 beds by December 1982. Minimal inhibitory concentrations (MIC) were studied by an automatic microdilution technique. Analysis of MICs in the different groups of organisms in relation with time demonstrated no enhancement of resistance during these first 5 1/2 years, except for Pseudomonas aeruginosa that became significantly more resistant (p less than 0.05) to five of the seven antibiotics tested. However, comparison of the two periods July 1977-December 1980 and january 1981-December 1982 evidenced a trend towards a decrease in Enterobacteriaceae (p. less than 0.001) and increase in P. aeruginosa (p less than 0.01) and S. aureus (p less than 0.001). This suggests that the selective pressure from hospital use of antibiotics caused no increase in resistance of different organisms but rather a modification of their relative frequency.

Mingling decision making metaphors

Organizational decisions provide conceptual playing fields wherein scientists adhering to rival theories based on different metaphors skirmish in-decisively. Organizational decisions, however, are also empirical arenas wherein practitioners espousing discordant theories-in-use reconcile their differences pragmatically. Practitioners' decision-making metaphors encountered while studying capital budgeting suggest how disjoint perspectives are assimilated and shifts from instrumental to symbolic actions are triggered. Implications for decision theories are discussed, and potential benefits of incorporating practitioners' knowledge into organizational science are considered.

Adapting to environmental jolts

This paper examines organizational adaptations to an environmental jolt--a sudden and unprecedented event (in this case, a doctors' strike)-- that created a natural experiment within a group of hospitals. Although adaptations were diverse and appeared anomalous, they are elucidated by considering the hospitals' antecedent strategies, structures, ideologies, and stockpiles of slack resources. Assessments of the primacy of the antecedents suggest that ideological and strategic variables are better predictors of adaptations to jolts than are structural variables or measures of organizational slack. Although abrupt changes in environments are commonly thought to jeopardize organizations, environmental jolts are found to be ambiguous events that offer propitious opportunities for organizational learning, administrative drama, and introducing unrelated changes.

Reacting to surprises: hospital strategy, structure and ideology

A physicians' strike in San Francisco caused a severe environmental jolt to hospitals in the area. A look at the responses of three of those hospitals reveals striking differences among them regarding their market strategies, administrative structures and ideologies. An analysis of these differences can help administrators prepare for and cope with unpleasant surprises.

Organizational strategy, structure, and process

Organizational adaptation is a topic that has received only limited and fragmented theoretical treatment. Any attempt to examine organizational adaptation is difficult, since the process is highly complex and changeable. The proposed theoretical framework deals with alternative ways in which organizations define their product-market domains (strategy) and construct mechanisms (structures and processes) to pursue these strategies. The framework is based on interpretation of existing literature and continuing studies in four industries (college textbook publishing, electronics, food processing, and health care).