Effects of estradiol cypionate dosage and body condition on reproductive performance of Nellore cattle synchronized for timed-artificial insemination

This experiment was designed to evaluate the effects of increasing doses of estradiol cypionate (ECP) and different body condition score (BCS) on reproductive performance of Bos indicus beef females assigned to a timed-artificial insemination (TAI) management. In this experiment, 1683 Bos indicus Nellore cows were blocked by parity and assigned to receive 1) an intravaginal P4 device (1.9 g of P4) and 2.0 mg of estradiol benzoate on day -11, 12.5 mg (i.m.) of dinoprost tromethamine, 300 IU (i.m.) of equine chorionic gonadotrophin, 0.6 mg (i.m.) of estradiol cypionate and CIDR withdrawal on day -2, followed by TAI on day 0 (n = 849; 0.6ECP) or 2) the same synchronization protocol with 1.0 mg of ECP on day -2 (n = 834; 1.0ECP). In both treatments, estrus expression was measured between days -2 and 0. Body condition score (BCS) was evaluated on days -11, 31, and 71 of the experiment and the BCS variation (Δ) was also determined between these timepoints. Transrectal ultrasonography was performed on days 31, 71, and 111 for pregnancy rate determination. All binary data were analyzed using cow as the experimental unit with GLIMMIX, whereas continuous variables were analyzed with the MIXED procedure of SAS. No treatment effects were observed on estrus expression rate. Treatment × BCS interactions were observed for pregnancy rates in all time points (days 31, 71, and 111), as 1.0ECP cows with a LOW BCS also had a greater P/AI than cows assigned to 0.6ECP. In summary, increasing the dose of ECP benefited the reproductive performance of Nellore beef cows with a reduced BCS (≤2.75), whereas no benefits were seen when the BCS was considered adequate (>2.75).

Interplay between integrins and cadherins to control bone differentiation upon BMP-2 stimulation

Introduction: Upon BMP-2 stimulation, the osteoblastic lineage commitment in C2C12 myoblasts is associated with a microenvironmental change that occurs over several days. How does BMP-2 operate a switch in adhesive machinery to adapt to the new microenvironment and to drive bone cell fate is not well understood. Here, we addressed this question for BMP-2 delivered either in solution or physically bound of a biomimetic film, to mimic its presentation to cells via the extracellular matrix (ECM). Methods: Biommetics films were prepared using a recently developed automated method that enable high content studies of cellular processes. Comparative gene expressions were done using RNA sequencing from the encyclopedia of the regulatory elements (ENCODE). Gene expressions of transcription factors, beta chain (1, 3, 5) integrins and cadherins (M, N, and Cad11) were studied using quantitative PCR. ECM proteins and adhesion receptor expressions were also quantified by Western blots and dot blots. Their spatial organization in and around cells was studied using immuno-stainings. The individual effect of each receptor on osteogenic transcription factors and alkaline phosphatase expression were studied using silencing RNA of each integrin and cadherin receptor. The organization of fibronectin was studied using immuno-staining and quantitative microscopic analysis. Results: Our findings highlight a switch of integrin and cadherin expression during muscle to bone transdifferentiation upon BMP-2 stimulation. This switch occurs no matter the presentation mode, for BMP-2 presented in solution or via the biomimetic film. While C2C12 muscle cells express M-cadherin and Laminin-specific integrins, the BMP-2-induced transdifferentiation into bone cells is associated with an increase in the expression of cadherin-11 and collagen-specific integrins. Biomimetic films presenting matrix-bound BMP-2 enable the revelation of specific roles of the adhesive receptors depending on the transcription factor. Discussion: While β3 integrin and cadherin-11 work in concert to control early pSMAD1,5,9 signaling, β1 integrin and Cadherin-11 control RunX2, ALP activity and fibronectin organization around the cells. In contrast, while β1 integrin is also important for osterix transcriptional activity, Cadherin-11 and β5 integrin act as negative osterix regulators. In addition, β5 integrin negatively regulates RunX2. Our results show that biomimetic films can be used to delinate the specific events associated with BMP-2-mediated muscle to bone transdifferentiation. Our study reveals how integrins and cadherins work together, while exerting distinct functions to drive osteogenic programming. Different sets of integrins and cadherins have complementary mechanical roles during the time window of this transdifferentiation.

Integrin-based adhesion compartmentalizes ALK3 of the BMPRII to control cell adhesion and migration

The spatial organization of cell-surface receptors is fundamental for the coordination of biological responses to physical and biochemical cues of the extracellular matrix. How serine/threonine kinase receptors, ALK3-BMPRII, cooperate with integrins upon BMP2 to drive cell migration is unknown. Whether the dynamics between integrins and BMP receptors intertwine in space and time to guide adhesive processes is yet to be elucidated. We found that BMP2 stimulation controls the spatial organization of BMPRs by segregating ALK3 from BMPRII into β3 integrin-containing focal adhesions. The selective recruitment of ALK3 to focal adhesions requires β3 integrin engagement and ALK3 activation. BMP2 controls the partitioning of immobilized ALK3 within and outside focal adhesions according to single-protein tracking and super-resolution imaging. The spatial control of ALK3 in focal adhesions by optogenetics indicates that ALK3 acts as an adhesive receptor by eliciting cell spreading required for cell migration. ALK3 segregation from BMPRII in integrin-based adhesions is a key aspect of the spatio-temporal control of BMPR signaling.

Heparan sulfate co-immobilized with cRGD ligands and BMP2 on biomimetic platforms promotes BMP2-mediated osteogenic differentiation

The chemical and physical properties of the extracellular matrix (ECM) are known to be fundamental for regulating growth factor bioactivity. The role of heparan sulfate (HS), a glycosaminoglycan, and of cell adhesion proteins (containing the cyclic RGD (cRGD) ligands) on bone morphogenetic protein 2 (BMP2)-mediated osteogenic differentiation has not been fully explored. In particular, it is not known whether and how their effects can be potentiated when they are presented in controlled close proximity, as in the ECM. Here, we developed streptavidin platforms to mimic selective aspects of the in vivo presentation of cRGD, HS and BMP2, with a nanoscale-control of their surface density and orientation to study cell adhesion and osteogenic differentiation. We showed that whereas a controlled increase in cRGD surface concentration upregulated BMP2 signaling due to β₃ integrin recruitment, silencing either β₁ or β₃ integrins negatively affected BMP2-mediated phosphorylation of SMAD1/5/9 and alkaline phosphatase expression. Furthermore, the presence of adsorbed BMP2 promoted cellular adhesion at very low cRGD concentrations. Finally, we proved that HS co-immobilized with cRGD both sustained BMP2 signaling and enhanced osteogenic differentiation compared to BMP2 directly immobilized on streptavidin, even with a low cRGD surface concentration. Altogether, our results show that HS facilitated and sustained the synergy between BMP2 and integrin pathways and that the co-immobilization of HS and cRGD peptides optimised BMP2-mediated osteogenic differentiation. Statement of significance The growth factor BMP2 is used to treat large bone defects. Previous studies have shown that the presentation of BMP2 via extracellular matrix molecules, such as heparan sulfate (HS), can upregulate BMP2 signaling. The potential advantages of dose reduction and local specificity have stimulated interest in further investigations into biomimetic approaches. We designed a streptavidin model surface eligible for immobilizing tunable amounts of molecules from the extracellular space, such as HS, adhesion motifs (cyclic RGD) and BMP2. By studying cellular adhesion, BMP2 bioactivity and its osteogenic potential we reveal the combined effect of integrins, HS and BMP2, which contribute in answering fundamental questions regarding cell-matrix interaction.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Measuring elderly people's quality of life through the Beck Hopelessness Scale: a study with a Spanish sample

OBJECTIVES

Hopelessness is a key element of suicidal intent. It can instill a pessimistic outlook on the future, leading an individual to believe that suicide is the only answer to their problems. Hopelessness operates as a modulating variable between depression and suicidal behavior. The aim of this study was to confirm the factor structure of the Beck Hopelessness Scale (BHS) in a non-clinical sample.

METHOD

Three hundred and sixty-two Spanish individuals, aged over 60, free of cognitive impairment and depressive symptoms, completed the BHS scale. Participants were tested using confirmatory factor analysis (CFA), using one-, two- and three-factor models.

RESULTS

The one- and two-factor models presented adequate fit indices. Specifically, the indices of the two-factor models were better than those of the one-factor model. The two-factor model, without items 4, 9 and 14, provided the best fit, given that the indices obtained in the CFA and their internal consistency were better than those of the other models.

CONCLUSION

The validation of the BHS for a population of Spanish older adults provides a reliable and valid measure of hopelessness and could be useful in clinical practice and research as an effective tool for the early detection of suicidal behaviors.

Controlled placement of multiple CNS cell populations to create complex neuronal cultures

In vitro brain-on-a-chip platforms hold promise in many areas including: drug discovery, evaluating effects of toxicants and pathogens, and disease modelling. A more accurate recapitulation of the intricate organization of the brain in vivo may require a complex in vitro system including organization of multiple neuronal cell types in an anatomically-relevant manner. Most approaches for compartmentalizing or segregating multiple cell types on microfabricated substrates use either permanent physical surface features or chemical surface functionalization. This study describes a removable insert that successfully deposits neurons from different brain areas onto discrete regions of a microelectrode array (MEA) surface, achieving a separation distance of 100 μm. The regional seeding area on the substrate is significantly smaller than current platforms using comparable placement methods. The non-permanent barrier between cell populations allows the cells to remain localized and attach to the substrate while the insert is in place and interact with neighboring regions after removal. The insert was used to simultaneously seed primary rodent hippocampal and cortical neurons onto MEAs. These cells retained their morphology, viability, and function after seeding through the cell insert through 28 days in vitro (DIV). Co-cultures of the two neuron types developed processes and formed integrated networks between the different MEA regions. Electrophysiological data demonstrated characteristic bursting features and waveform shapes that were consistent for each neuron type in both mono- and co-culture. Additionally, hippocampal cells co-cultured with cortical neurons showed an increase in within-burst firing rate (p = 0.013) and percent spikes in bursts (p = 0.002), changes that imply communication exists between the two cell types in co-culture. The cell seeding insert described in this work is a simple but effective method of separating distinct neuronal populations on microfabricated devices, and offers a unique approach to developing the types of complex in vitro cellular environments required for anatomically-relevant brain-on-a-chip devices.

Can there be learning potential in Parkinson's disease? A comparison with healthy older adults

Patients with Parkinson's disease may show certain cognitive impairments, although it is unclear how these deficits can affect their learning potential. The study aims to use the testing-the-limits technique to compare the potential for cognitive plasticity in a group of Patients with Parkinson's disease (N = 33) and a group of healthy older adults (N = 33). Sixty-six participants performed verbal learning test to analyze the learning potential. Repeated-measures analysis of variance showed significant main effects of time, group, and the interaction. There is a lower learning potential in subjects with Parkinson's disease; however, those still maintain a certain capacity for learning and, therefore, for cognitive plasticity.

Nano- and microstructured materials for in vitro studies of the physiology of vascular cells

The extracellular environment of vascular cells in vivo is complex in its chemical composition, physical properties, and architecture. Consequently, it has been a great challenge to study vascular cell responses in vitro, either to understand their interaction with their native environment or to investigate their interaction with artificial structures such as implant surfaces. New procedures and techniques from materials science to fabricate bio-scaffolds and surfaces have enabled novel studies of vascular cell responses under well-defined, controllable culture conditions. These advancements are paving the way for a deeper understanding of vascular cell biology and materials-cell interaction. Here, we review previous work focusing on the interaction of vascular smooth muscle cells (SMCs) and endothelial cells (ECs) with materials having micro- and nanostructured surfaces. We summarize fabrication techniques for surface topographies, materials, geometries, biochemical functionalization, and mechanical properties of such materials. Furthermore, various studies on vascular cell behavior and their biological responses to micro- and nanostructured surfaces are reviewed. Emphasis is given to studies of cell morphology and motility, cell proliferation, the cytoskeleton and cell-matrix adhesions, and signal transduction pathways of vascular cells. We finalize with a short outlook on potential interesting future studies.

Gonadal Development of the Piau Leporinus copelandii (Characiformes, Anostomidae) in a Tropical River in South-eastern Brazil

Histological analysis of the gonadal development of Leporinus copelandii Steindachner, 1875, a rheophilic Characiformes species in the Paraiba do Sul River, South-eastern Brazil, was described. We expect that this species adapt gonadal development to succeed in this river basin that has its longitudinal profile blocked by several impoundments. Fishes were examined by routine macroscopic and histological techniques. Stages of oocyte and spermatocyte development were described, and gonadal maturation was proposed. Mean oocyte diameter obtained from histological observations increased from the pre-spawning (4.2-175.5 μm) to spawning (148.5-262.0 μm) phases, followed by a sharp decrease in the post-spawning (27.0-56.7 μm) phase. Based on occurrence of different oocytes phases and oocyte size distribution, this species has group-synchronic development of oocytes. Further studies are necessary to clarify the spawning grounds for L. copelandii in the Paraíba do Sul River basin, especially considering that several impoundments obliterate the natural river course and this could limit spawning grounds.

Histological and histochemical analysis of the gonadal development of males and females of Armases rubripes (Rathbun 1897) (Crustacea, Brachyura, Sesarmidae)

The objective of this study was to provide information on the histological characteristics of the gonads of male and female Armases rubripes crabs, and to try to establish a relationship between the microscopic and macroscopic stages previously identified. Thirty-six crabs were collected by hand between February 2003 and January 2004 in banks of Spartina alterniflora on Sahy Beach in Mangaratiba, Rio de Janeiro state, Brazil. The histological analysis of the ovaries of A. rubripes demonstrated a gradual process of development of the oocytes. According to their cellular characteristics, five types of cells were distinguished: oogonia, oocyte I, oocyte II, oocyte III and oocyte IV. The ovaries showed four stages during gonadal activity: stage I (rudimentary), stage II (developing or maturing), stage III (developed or mature) and stage IV (resting). The results of the histochemical analyses showed that the ovaries vary according to the gonad development stage. The histological aspect of one section of the male gonad was always the same in all of the seminiferous tubules, where the lumen of these tubules always contained spermatozoa and/or spermatids. It was not possible to characterize the three stages of gonad development in the males. This agrees with previous reports in the literature. However, in the females there was a relationship between the gonad stages distinguished macroscopically and the results obtained through the histological and histochemical analysis, due to the presence of different cell types, as well as the lysis process and reabsorption of the oocytes in spent females.

Immunocytochemical study of gastrintestinal endocrine cells in insectivorous bats (Mammalia: Chiroptera)

The regional distribution and relative frequency of endocrine cells in the stomach and intestine of Phyllostomidae: Lonchorhina aurita and Molossidae: Molossus molossus bats were studied immunohistochemically. Three types of immunoreactive (IR) endocrine cells - to serotonin (5-HT), gastrin (GAS) and enteroglucagon (GLUC) - were found in the gastric mucosa and four types of IR cells were identified in the intestinal mucosa. This study showed an interespecfic difference in the regional distribution and relative frequency of endocrine cells in the Chiropteran alimentary tract.

Nurse migration and its implications for Philippine hospitals

BACKGROUND

'Push' and 'pull' factors motivate Filipino registered nurses (RNs) to leave for employment in foreign countries making the Philippines the leading source country for nurses overseas.

OBJECTIVE

To assess the current RN-staffing situation in Philippine hospitals.

DESIGN

A self-administered survey was mailed to a sample of 200 Philippine hospital chiefs of nurses.

RESULTS

According to respondents, the majority of RNs in their hospitals (73%) were aged 40 years and younger and female (85%); government hospital RNs earned higher wages than private hospital RNs; and on average, RN vacancy rates and RN turnover rates were lower in government hospitals than private hospitals. All respondents reported no difficulty recruiting RNs with less than 12 months of work experience. However, recruitment of more experienced RNs was somewhat or very difficult for private hospitals compared with government hospitals. Higher salaries, better benefits and good career opportunities were identified as most effective incentives for both recruitment and retention.

CONCLUSIONS

RN staffing in government hospitals is more favourable than in private hospitals as measured by employment tenure, vacancy rates, turnover rates and ability to recruit and retain more experienced RNs. On average, respondents reported over half (59%) of total RN turnover was the result of nurse migration overseas.

Immunocytochemical study of the distribuition of endocrine cells in the pancreas of the Brazilian sparrow species Zonotrichia Capensis Subtorquata (Swaison, 1837)

In the present study, we investigated types of pancreatic endocrine cells and its respective peptides in the Brazilian sparrow species using immunocytochemistry. The use of polyclonal specific antisera for somatostatin, glucagon, avian pancreatic polypeptide (APP), YY polypeptide (PYY) and insulin, revealed a diversified distribution in the pancreas. All these types of immunoreactive cells were observed in the pancreas with different amounts. Insulin- Immunoreactive cells to (B cells) were most numerous, preferably occupying the central place in the pancreatic islets. Somatostatin, PPA, PYY and glucagon immunoreactive cells occurred in a lower frequency in the periphery of pancreatic islets.

Applying Telemedicine to Remote and Rural Underserved Regions in Brazil using eMedical Consulting Tool

In this paper, we are going to depict a medical tele-consultation network for medical imaging that has been deployed in Brazil. Preliminary outcomes of the medical network will be presented. In addition, the medical application used for tele-consultations will be shown. Eighty nine ultrasound acquisitions took place in the period of five months of the operation of the medical network and five hundred fifty six medical consultations performed.

[Antenatal screening for congenital heart disease: a retrospective analysis of 20 years of experience]

BACKGROUND

Congenital heart disease is often severe and outcome remains uncertain. In some cases, early intervention at birth can improve the prognosis. Prenatal detection of congenital heart disease by ultrasound may improve outcome for foetuses with congenital heart disease but today, results are not convincing. The purpose of this review was to describe the detection of congenital heart disease in a non selected population.

METHODS

A retrospective study was undertaken to evaluate the prenatal detection of congenital heart disease in our department from 1984 to 2003.

RESULTS

Incidence of congenital heart disease was 4.9. Sensitivity of detection was 60%, specificity was 99.9%. Most cases were severe heart diseases. In 57 fetuses (40%), congenital heart disease was not detected. Thirty-seven fetuses (65%) presented minor disease; in 20 fetuses (35%), congenital heart disease was found to be severe. Effectiveness of detection of major congenital heart diseases has increased since 2000.

CONCLUSION

Large-scale fetal heart screening is necessary for early detection of congenital heart disease and improved outcome.

The effect of different propolis harvest methods on its lead contents determined by ET AAS and UV-visS

Argentinean propolis is exported to different countries, specially Japan. The market demands propolis quality control according to international standards. The analytical determination of some metals, as lead in food, is very important for their high toxicity even in low concentrations and because of their harmful effects on health. Flavonoids, the main bioactive compounds of propolis, tend to chelate metals as lead, which becomes one of the main polluting agents of propolis. The lead found in propolis may come from the atmosphere or it may be incorporated in the harvest, extraction and processing methods. The aim of this work is to evaluate lead level on Argentinean propolis determined by electrothermal atomic absorption spectrometry (ET AAS) and UV-vis spectrophotometry (UV-visS) methods, as well as the effect of harvest methods on those contents. A randomized test with three different treatments of collection was made to evaluate the effect of harvest methods. These procedures were: separating wedges (traditional), netting plastic meshes and stamping out plastic meshes. By means of the analysis of variance technique for multiple comparisons (ANOVA) it was possible to conclude that there are significant differences between scraped and mesh methods (stamped out and mosquito netting meshes). The results obtained in the present test would allow us to conclude that mesh methods are more advisable than scraped ones in order to obtain innocuous and safe propolis with minor lead contents. A statistical comparison of lead determination by both, ET AAS and UV-visS methods, demonstrated that there is not a significant difference in the results achieved with the two analytical techniques employed.

Induction chemoradiotherapy and surgical resection for non-small cell lung carcinomas of the superior sulcus (pancoast tumors): Mature results of National Cancer Institute (INCa)-Brazil

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Background: The established treatment for T3 Pancoast tumors, radiation plus surgery, leads to a 50% R0 resection rate and a 30% 5 year survivals. T4 tumors are usually unresectable and incurable. Our group retrospectively analyzed the feasibility and efficacy of induction chemoradiotherapy plus surgery for T3 and T4 tumors. Methods: Eligible patients (pts) had biopsy proven, untreated, T3–4N0–1 Pancoast tumors. Induction therapy was cisplatin (50 mg/m2, days 1,8,29,36) and etoposide (50 mg/m2, days 1–5, 29–33) (PE) given concurrently with radiation (45 Gy, 25 daily fractions). Thoracotomy was done within 5 weeks of induction therapy for stable or responding disease. All pts were to receive postoperative chemotherapy (PE ×2). Median follow up was 19 months. Results: From 4/01–6/05, 13 eligible pts were enrolled: 6 men, 7 women, median age 53 years; 9 T3, 4 T4. All pts (100%) completed induction therapy. Grade 3–4 toxicities were neutropenia (n = 2), anemia (n = 1), fatigue (n = 1), esophagitis (n = 5). All pts had thoracotomy, 13 had R0 resection. Pathologic CR was found in 3 (23.1%), minimal microscopic disease in 1 (7.7%). Postoperative chemotherapy completed by only 1/13 pts. Median survival was not reached and Median Disease free (DFS) and 2 year overall survivals (OS) were 26 months (CI 95% 13.6–38.4) 67% for all pts, respectively. Relapse sites were brain only (n = 3) and local only (n = 1). Conclusion: This combined modality therapy was well tolerated and leads to high rates of complete resection, OS and local control that are strikingly better than with radiation and surgery. These results obtained in a population with T3 and T4 tumors reproduced those of the SWOG study in terms of resectability, safety and short-term survival Of note is the poor adherence to postoperative chemotherapy in this population.

No significant financial relationships to disclose.

On-line preconcentration/determination of lead in Ilex paraguariensis samples (mate tea) using polyurethane foam as filter and USN-ICP-OES

The present paper proposes an on-line preconcentration procedure for lead determination in Ilex paraguariensis (St. Hilaire) samples by ultrasonic nebulization associated to inductively coupled plasma optical emission spectrometry (USN-ICP-OES). It is based on the precipitation of lead(II) ion on a minicolumn packed with polyurethane foam using 2-(5-bromo-2-pyridilazo)-5-diethylaminophenol (5-Br-PADAP) as precipitating reagent. The collected analyte precipitate was quantitatively eluted from the minicolumn with 20% (v/v) nitric acid. An enhancement factor of 225-fold was obtained (15 for USN and 15 for preconcentration). The detection limit (DL) value for the preconcentration of 10.0 ml of sample was 40.0 ng/l. The relative standard deviation (R.S.D.) was 3.0% for a Pb concentration of 1 microg/l, calculated from the peak heights obtained. The calibration graph using the preconcentration system for lead was linear with a correlation coefficient of 0.9997, at levels near the detection limits up to at least 100 microg/l. The preconcentration procedure was successfully applied to the determination of lead in mate tea samples.

N-t-Boc-amino acid esters of isomannide Potential inhibitors of serine proteases

Hepatitis C, Dengue and West Nile virus are some of the most important flaviviruses, that share one important serine protease enzyme. Serine proteases are the most studied class of proteolytic enzyme and, in these cases, a primary target for drug discovery. In this paper, we describe the synthesis and preliminary molecular modeling studies of a novel class of N- t-Boc amino acid esters derived of isomannide as potential serine proteases inhibitors.

Entamoeba histolytica and Entamoeba dispar infections as detected by monoclonal antibody in an urban slum in Fortaleza, Northeastern Brazil

In this study the authors used the Elisa-based antigen detection tests that distinguish E. histolytica from E. dispar to examine the prevalence of E. histolytica infection in individuals from an urban slum in Fortaleza, Northeastern, Brazil. This test has a sensitivity and specificity that is comparable to PCR and isoenzyme analysis, which is the gold standard. Single stools samples were obtained from 735 individuals. The prevalence of E. histolytica infection was 14.9% (110/735) and 25.4%(187/735) for E. dispar-E. histolytica complex. The most affected age group for E. histolytica /E. histolytica-E. dispar infection was the 1-5 year olds but there was no remarkable decrease with age. There was no significant difference in colonization rates between males and females. The results from this survey demonstrate that E. histolytica is highly prevalent in the Community studied. Furthermore, it offers promise for the antigen detection test as a sensitive and technically simple tool for detecting E. histolytica infection in the field.

Effects of compensation method on physician behaviors

OBJECTIVE

To examine physician and leader perceptions of the relationship between physician compensation and the productivity of physicians practicing in medical groups.

STUDY DESIGN

Key informant interviews identified subjects' perceptions of factors influencing physician productivity and the behavioral effects of individual financial incentives. Interview transcripts were analyzed by a team of physicians, economists, and other researchers.

STUDY POPULATION

Physicians, medical leaders, and group practice administrators (n = 114) representing 46 medical group practices in California, Oregon, Washington, and Wisconsin were interviewed.

RESULTS

Five major themes emerged: (1) Most physicians reported that financial incentives did not substantially affect their own behavior, except for productivity. However, they suggested that specific compensation models do lead to certain seemingly undesirable physician behaviors. (2) By contrast, medical group leaders reported that financial incentives do affect a variety of physician behaviors. (3) Four productivity drivers emerged: financial incentives, demand-side factors, systems and infrastructure, and other individual or group attributes. (4) Physician compensation systems are evolving toward a blend of production-based and production-neutral incentives, plus new metrics aligned with the demands of managed care. (5) Culture, size, and specialty mix are significant determinants of group physician compensation systems.

CONCLUSIONS

Compensation method is perceived to be a significant influence on physician productivity, particularly among group practice leaders. The changing context of medical practice represents another powerful "macro" lever on physician behavior.

Vasopressin-induced neurotrophism in cultured neurons of the cerebral cortex: dependency on calcium signaling and protein kinase C activity

Neuronal process outgrowth has been postulated to be one of the fundamental steps involved in neuronal development. To test whether vasopressin can influence neuronal development by acting on the outgrowth of neuronal processes, we determined the neurotrophic action of the memory-enhancing peptide, vasopressin, in neurons derived from the cerebral cortex, a site of integrative cognitive function and long-term memory. Exposure to V(1) receptor agonist significantly increased multiple features of nerve cell morphology, including neurite length, number of branches, branch length, number of branch bifurcation points and number of microspikes. The dose-response profile of V(1) receptor agonist-induced neurotrophism exhibited a biphasic function, with lower concentrations inducing a significant increase while higher concentrations generally induced no significant effect. The neurotrophic effect of V(1) receptor activation did not require growth factors present in serum. Analysis of the regional selectivity of the vasopressin-induced neurotrophic effect revealed significant V(1) receptor agonist-induced neurotrophism in occipital and parietal neurons, whereas frontal and temporal neurons were unresponsive. Results of experiments to determine the mechanism of vasopressin-induced neurotrophism demonstrated that vasopressin-induced neurotrophism is dependent on V(1)a receptor activation, requires L-type calcium channel activation and activation of both pathways of the phosphatidylinositol signaling cascade, inositol trisphosphate and protein kinase C. These studies are the first to describe a functional cellular response for vasopressin in the cerebral cortex. The findings are discussed with respect to their implications for understanding the role of vasopressin-induced neurotrophism, the associated signaling pathways required for this response, and the ability of vasopressin to enhance memory function.

Implementing CQI projects in hospitals

BACKGROUND

Quality improvement approaches such as continuous quality improvement (CQI) and total quality management are widely used, but little is known about how much it costs to use the principles and techniques required to implement CQI processes. In the Robert Wood Johnson Foundation's Improving the Quality of Hospital Care (IQHC) program, four consortia of hospitals were funded in the early 1990s. Interviews with quality managers at 38 of the consortia hospitals were conducted in 1995 to determine the costs of conducting CQI projects to allow an estimation of the marginal cost of using CQI processes (particularly cross-disciplinary teams) to improve quality of care.

CQI PROJECTS

Quality managers described 69% of project outcomes as critical to clinical services. Team members identified the issues their teams addressed and selected the project 64% of the time, the methods of analysis 87% of the time, and the approaches to resolving the problem or issue 97% of the time. Most of the respondents agreed that the team members had the authority to resolve the problem without appealing to higher levels of management. Costs for hospitals' most recently completed projects varied widely, from $148 for the entire project to $18,590. The length or duration of the projects also varied widely, from 1 month to 66 months.

DISCUSSION

In the hospitals included in this sample, all of which were highly self-selected (evidenced by their participation in a voluntary consortium of hospitals focused on quality of care), knowledge of CQI processes appeared to be fairly thorough. Teams appeared to have a reasonable amount of autonomy. New CQI projects should be subjected to scrutiny in terms of their likely contribution to quality of care, as distinct from other positive outcomes.

Seropositivity for and intestinal colonization with Entamoeba histolytica and entamoeba dispar in individuals in northeastern Brazil

In a slum community in northeastern Brazil 20% of a sample population was colonized with Entamoeba histolytica or Entamoeba dispar and 10.6% was colonized with E. histolytica alone. No correlation between seropositivity for anti-Ga1NAc lectin antibody and colonization was found. These results suggest that colonization does not necessarily produce immunity to reinfection.

Reform follows failure: I. Unregulated private care in Lebanon

This first of two papers on the health sector in Lebanon describes how unregulated development of private care quickly led to a crisis situation. Following the civil war the health care sector in Lebanon is characterized by (i) ambulatory care provided by private practitioners working as individual entrepreneurs, and, to a small extent, by NGO health centres; and (ii) by a fast increase in hi-tech private hospitals. The latter is fuelled by unregulated purchase of hospital care by the Ministry of Health and public insurance schemes. Health expenditure and financing patterns are described. The position of the public sector in this context is analyzed. In Lebanon unregulated private care has resulted in major inefficiencies, distortion of the health care system, the creation of a culture that is oriented to secondary care and technology, and a non-sustainable cost explosion. Between 1991 and 1995 this led to a financing and organizational crisis that is the background for growing pressure for reform.

Reform follows failure: II. Pressure for change in the Lebanese health sector

This paper describes how, against a background of growing financial crisis, pressure for reform is building up in the Lebanese health care system. It describes the various agendas and influences that played a role. The Ministry of Health, backed by some international organizations, has started taking the lead in a reform that addresses both the way care is delivered and the way it is financed. The paper describes the interventions made to prepare reform. The experience in Lebanon shows that this preparation is a process of muddling through, experimentation and alliance building, rather than the marketing of an overall coherent blueprint.

Measuring seriousness of hospital quality of care issues

BACKGROUND

A 1995 article showed that the discipline of the person who determines what constitutes a serious quality of care issue is significantly associated with the type of issues identified as serious. Moreover, what is a serious issue for one organization or provider may be a minor issue for another.

METHODS

Six hundred hospital administrators, physicians, nurses, and quality managers in 72 hospitals rated the seriousness of issues they had identified in their own hospitals. A panel of 90 external hospital administrators, physicians, and quality managers rated a condensed set of the same issues.

RESULTS

Across all the hospitals, internal scores were significantly lower (less serious) than external scores. Internal respondents consistently rated issues identified in their hospital lower than did external raters. The mean internal rating was .60 times the score for the anchor issue ("late lab or x-ray results," assigned a score of 300), while the mean external rating was 1.73 times the anchor score.

DISCUSSION

Convergence of internal and external perceptions of the seriousness of quality of care issues in hospitals cannot be assumed. This raises questions about the effects of applying external judgments on seriousness of quality of care issues, such as those used in report cards or other external reports on hospital quality of care.

CONCLUSION

There is greater conformity of viewpoint when respondents are asked to adopt an industrywide perspective rather than an internal one. External raters are more likely to consider problems serious than are internal raters, possibly because they do not have local knowledge of mitigating circumstances.

Is quality in the eye of the beholder?

BACKGROUND

Relatively ignored in the literature on quality improvement (QI) in health care is the question of who defines the issues in quality of care and decides how those issues will be addressed.

METHODS

In late 1992, 669 hospital administrators, quality assurance (QA) coordinators, physicians, and nurses in 72 hospitals in six states were surveyed by telephone. Respondents were asked to identify the most serious issue related to quality of care in their hospital.

RESULTS

Of all the respondents, hospital administrators were most likely to identify quality issues related to organizational/institutional issues. QA coordinators, most of whom had nursing backgrounds, were most likely to identify organizational and patient care issues. Physician responses were distributed approximately evenly across issues related to physicians, to the organization, and to patient care. Nurses were most likely to identify issues related to patient care and patient satisfaction.

DISCUSSION

The findings validate the viewpoint that "quality is in the eye of the beholder" and that the eye is conditioned by the discipline in which hospital staff have been trained and socialized. As total quality management and continuous quality improvement approaches are implemented, and participants from many disciplines are involved in QI, a wide range of issues that have both a direct and indirect effect on patient care are likely to be addressed.

CONCLUSION

The findings of this study suggest that surveys that specifically target certain disciplinary groups may yield important information about issues related to quality of care.

A clinically based service limitation option for alternative model rural hospitals

Alternative model rural hospitals are designed to address problems faced by small, isolated rural hospitals. Typically, hospital regulations are reduced in exchange for a limit on the services that alternative models may offer. The most common service limitation is a limit on length of stay (LOS), a method with little empirical or conceptual support. The purpose of this article is to present a clinically based service limitation for alternative model rural hospitals, such as the rural primary care hospital. The proposal is based on an analysis of Medicare discharges from rural hospitals most likely to convert and the judgments of a technical advisory panel of rural clinicians.