Health gains from home energy efficiency measures: The missing evidence in the UK net-zero policy debate

Objectives

This study examined the health gains from a programme of external wall insulation works to homes in south-west Scotland, and in particular the impact upon hospitalisations for respiratory and cardiovascular conditions. Furthermore, to consider how evidence on health outcomes could form part of the debate around actions to meet net-zero goals in the UK.

Study design

This was a two-part study. Part one involved before-and-after interviews with 229 recipient households. The second part comprised an observational study of hospital admissions in 184 postcode areas.

Methods

Across three years, interviews collected thermal comfort and self-reported health data(Sf-36) in the winter months prior to installation, and again in follow-up interviews the next winter. Standarised monthly data on non-elective admissions for each set of conditions were compared between the intervention postcodes and the wider health board area over a ten year period.

Results

Following receipt of wall insulation, inability to achieve thermal comfort in winter reduced by two-thirds. Improvements in thermal comfort were associated with gains in physical health scores. Relative standardised admissions fell in the treatment areas, remaining lower than the district-wide standardised rate for the majority of a five year period, this effect ending during the Covid-19 pandemic. The impact on admissions was greater for respiratory conditions than for cardiovascular conditions.

Conclusion

A weak policy commitment to energy efficiency could be strengthened with further evidence of the cost-savings and reduced hospital bed demand resulting from insulations works. The potential health gain may also encourage more home owners to participate.

Abstract OT3-08-01: Interview data from women contemplating LORIS trial entry during the feasibility study

Background: LORIS is a multi-centre, randomised (1:1) controlled trial of Surgery v Active Monitoring with annual mammography in patients with low risk ductal carcinoma in situ (DCIS). During a 2 year Feasibility Study potential patients were invited to complete the Clinical Trials Questionnaire (CTQ)1 and participate in a semi structured telephone interview about the verbal, written and DVD based trial information. The DVD was produced to complement the patient information sheet (PIS) and incorporates simple graphics and a Q&A session with women asking the Chief Investigator questions about the trial.

Aims:To examine the reasons for trial participation/rejection and obtain feedback about the clarity, timing and usefulness of the PIS and DVD in order to identify potential communication drivers and barriers to trial recruitment.

Methods: Participants completed the CTQ1 prior to randomisation and with their consent were contacted following randomisation for an interview. Women declining the trial were issued with an optional pack containing the CTQ1 and the researchers' contact details if they wanted an interview. The CTQ1 comprises16 reasons that might influence a decision to either accept or decline a trial. For each statement participants register their agreement or disagreement on a scale of 1 (strongly agree) to 5 (strongly disagree) and indicate the most important reason for their decision. Interviews explored factors such as, attitudes about randomisation, and usefulness of the trial information provided.

Results: 41 patients were randomised during feasibility; 20 surgery, 21 active monitoring, 16 patients declined the trial. 40/41(98%) acceptors and 9/16 (56%) decliners completed the CTQ1. The main reason for joining LORIS was:- “I thought the trial offered the best treatment available” 13/40 (32%) and for decling the trial was “The idea of randomisation worried me” (4/9; 44%).

35 interviews were conducted (31/41 (76%) accepted and 4/16 (25%) declined LORIS). At interview acceptors commented that the PIS was very useful and clear (84%; 26/31 & 90%; 28/31, respectively). 74% (23/31) of women who joined LORIS watched the DVD and the majority (19/23; 83%) found it “very useful” and 22 (22/23; 96%) “very easy to understand”. A third of women (10/31) said the PIS and the DVD helped them decide to participate in LORIS. Women who declined the trial had clear treatment preferences; 2/4 did not watch the DVD. Three quarters of women interviewed (19/25) watched the DVD with family members/friends and found it reassuring. One commented it was “Put in words you can understand and not be baffled by”. The most popular aspect was the Q&A session (13/25; 52%).

Conclusions:The LORIS DVD was a useful, easy to understand recruitment tool, complementing the PIS. Many women felt reassured that the content was consistent with, and added to that provided by healthcare professionals. Opinions of family and friends, worries about randomisation and personal preferences exert an influence of those declining these types of trial.

Fallowfield LJ, Jenkins V, et al. (1998) Attitudes of patients to randomised clinical trials of cancer therapy. Eur J Cancer 34(10):1554–1559.

Citation Format: Fallowfield LJ, Matthews L, Jenkins VA, May SF, Francis A, Rae D, Wallis M. Interview data from women contemplating LORIS trial entry during the feasibility study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-08-01.

Investigation into sampling strategies in response to potential outbreaks of low pathogenicity notifiable avian influenza initiated in commercial duck holdings in Great Britain

The aim of this study was to evaluate potential sampling strategies for detection of infected flocks that could be applied during an outbreak of low pathogenicity notifiable avian influenza (LPNAI) initiated in duck holdings, following initial detection. A simulation model of avian influenza virus transmission and spread within and between holdings, respectively, was used to predict the impact on the size and duration of an outbreak of (i) changing the tracing window within which premises that might be the source of infection or that may have been infected by the index premises were sampled and (ii) changing the number of birds sampled in the flock being tested. It has shown that there is potential benefit in increasing the tracing window in terms of reducing the likelihood of a large outbreak. It has also shown that there is comparatively little benefit from increasing the number of birds sampled per flock.

N-terminal pro-B-type natriuretic peptide levels and early outcome after cardiac surgery: a prospective cohort study

BACKGROUND

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a powerful predictor of cardiovascular outcome in many circumstances. There are, however, limited data regarding the utility of NT-proBNP or BNP levels in patients undergoing cardiac surgery. The current study assesses the ability of NT-proBNP to predict early outcome in this setting.

METHODS

One thousand and ten patients undergoing non-emergent cardiac surgery were recruited prospectively. Baseline clinical details were obtained and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Parsonnet score were calculated. Preoperative NT-proBNP levels were measured using the Roche Elecsys assay. The primary endpoint was 30 day mortality.

RESULTS

Median NT-proBNP levels were 624 ng litre(-1) among patients who died within 30 days of surgery (n=29), compared with 279 ng litre(-1) in survivors [odds ratio (OR) 1.03 per 250 ng litre(-1), 95% confidence interval 1.01-1.05, P=0.001). NT-proBNP levels remained predictors of 30 day mortality in models including either the additive EuroSCORE (OR 1.03 per 250 ng litre(-1), P=0.01), the logistic EuroSCORE (OR 1.03 per 250 ng litre(-1), P=0.004), or the Parsonnet score (OR 1.02 per 250 ng litre(-1), P=0.04). Levels of NT-proBNP were also predictors of prolonged (>1 day) stay in the intensive care unit (OR 1.03 per 250 ng litre(-1), P<0.001) and of a hospital stay >1 week (OR 1.07 per 250 ng litre(-1), P<0.001). They remained predictive of these outcomes in regression models that included either the EuroSCORE or the Parsonnet score and in a model that included all study variables.

CONCLUSIONS

NT-proBNP levels predict early outcome after cardiac surgery. Their prognostic utility is modest-but is independent of traditional indicators and conventional risk prediction scores.

Discovery and SAR of org 24598-a selective glycine uptake inhibitor

The discovery of Org 24598, one of the first potent and selective inhibitors of the glycine transporter is discussed. In vitro structure-activity relationships (SARs) data for interaction of a ligand with this system is discussed.

A comparison of LDL size determination using gradient gel electrophoresis and light-scattering methods

This study compared gradient gel electrophoresis (GGE) and light-scattering (LS) methods of determining low density lipoprotein (LDL) particle size. LDL was isolated from 27 fasting subjects. Peak particle size was determined by GGE on 3-13% gradient gels (Gradipore, Sydney, Australia) and by LS using a Zetasizer 3000 (Malvern Instruments, Malvern, UK). Repeated measurements on a single specimen indicated a coefficient of variation (CV) of 0.3%. A correlation was noted (P < 0.0001; r = 0.78) when comparing LDL particle size determined by LS methodology and GGE. Particle diameter results obtained by LS were smaller than those obtained by GGE (23.1 +/- 0.1 vs. 26.1 +/- 0.1 nm; P < 0.0001). LDL particle size determined by LS methodology correlated inversely with the log of triglyceride level (P < 0.0001; r = -0.77) and positively with high density lipoprotein (HDL) cholesterol level (P < 0.002; r = 0.57).

Factors influencing Lp[a]- particle size as determined by gradient gel electrophoresis

This study examined factors influencing the particle diameter of Lp[a]-, the low density lipoprotein (LDL)-like moiety of Lp[a], in 26 subjects chosen to provide a range of Lp[a] and triglyceride levels. Lp[a] and LDL fractions were isolated by vertical density ultracentrifugation. Lp[a] was further purified using a lysine-Sepharose affinity column and Lp[a]- obtained by incubating Lp[a] with dithiothreitol. Lp[a], LDL, and Lp[a]- fractions were run on 3-13% gradient gels to determine particle diameter. Lp[a] size correlated positively with LDL size (r = 0.62; P < 0.001), but the association between Lp[a]- size and LDL size was stronger (r = 0.82; P < 0.0001). Log triglyceride level correlated inversely with Lp[a]- size (r = -0.72; P < 0.0001) and LDL size (r = 0.69; P < 0.0001). HDL cholesterol level correlated positively with Lp[a]- size (r = 0.67; P < 0.0005) and LDL size (r = 0.64; P < 0.0005). The strong correlation between LDL size and Lp[a]- size may be due to extracellular utilization of circulating LDL in the production of Lp[a] or may reflect the same metabolic processes influencing both these particles once Lp[a] has been formed.

Activation of human granulocyte type 1-prophospholipase A2

Using an assay for measurement of released type 1-prophospholipase A2 (type 1-proPLA2) propeptides (PROP assay), we have shown that human granulocytes, but not lymphocytes or macrophages, abundantly express this 'pancreatic' type 1-proPLA2 zymogen. Stimulation with tumour necrosis factor-alpha (TNF-alpha) and other cytokines results in the immediate release from granulocytes of a mixture of free propeptides and type 1-proPLA2 precursor. We also found that granulocytes contain an approximately 29 kDa trypsin-like endogenous type 1-proPLA2 activator. PROP assay and TAP (trypsinogen activation peptide) assay of plasma samples accurately predicts the segregation of acute pancreatitis into three clearly defined categories of severity--mild, intermediate and severe--at the time of first hospital admission and over the next few hours of observation. Mild and intermediate pancreatitis are associated with a degree of granulocyte stimulation limited to the release of the unactivated type 1-proPLA2 precursor. Progression to severe disease is accompanied by the activation of granulocyte type 1-proPLA2, apparently carried to completion. This identifies the approximately 29 kDa endogenous activator of type 1-proPLA2 in granulocytes as a critical mediator at a threshold stage in acute pancreatitis, which marks the transition from uncomplicated pancreatitis to the potentially lethal disease. Specific inhibitors of this key regulatory enzyme modelled on the P3-P1 domain of the type 1-proPLA2 activation peptide would seem to be promising candidates for a new class of chemotherapeutic agents.

Type 1-prophospholipase A2 propeptide immunoreactivity is released from activated granulocytes

OBJECTIVE

To establish a ELISA assay to measure release of type 1-phospholipase A2 propeptide from activated granulocytes. Human type 1-prophospholipase A2 (1-proPLA2) is biosynthesized and stored as inactive zymogen. Activation involves tryptic-like cleavage at the N-terminus, with equimolar release of the heptapeptide DSGISPR.

METHODS

Using antibodies directed to the carboxyterminus of synthetic DSGISPR we developed a sensitive solid-phase ELISA specific for the released propeptide that accurately reports the activation of 1-proPLA2. The presence of the 1-proPLA2 precursor itself can be determined by trypsinization of the sample and subsequent assay for free DSGISPR.

RESULTS

Using this ELISA, we demonstrated the presence of immunoreactive DSGISPR and its 14 kDa 1-proPLA2-like precursor in human granulocytes, but their absence in human macrophages and lymphocytes. Stimulation of cultured granulocytes with 1 pM of TNF alpha or GM-CSF caused rapid release of DSGISPR and precursor into the surrounding medium. The immunoreactive signal coeluted with standard synthetic DSGISPR on G50 Sephadex chromatography.

CONCLUSION

Release of DSGISPR immunoreactivity appears to be a specific consequence of granulocyte activation of potential relevance to the clinical pathophysiology of conditions like acute lung injury.

Type 1 prophospholipase A2 propeptide in acute lung injury

Neutrophil sequestration and activation in the pulmonary vasculature and interstitium are important in acute lung injury. Phospholipase A2 plays an important part in the production of potent inflammatory mediators in this syndrome. We used our ELISA for type 1 prophospholipase A2 activation peptides, which have the aminoacid sequence Asp-Ser-Gly-Ile-Ser-Pro-Arg (DSGISPR), to show that DSGISPR concentrations in plasma and urine are a sensitive and specific marker of acute lung injury in patients admitted to intensive care. The detection of DSGISPR in the plasma of 11 of 50 unselected patients had a sensitivity of 100% and a specificity of 93% for the presence or future development of acute lung injury.

Nurses' Knowledge About and Attitudes Toward Patients With AIDS

With the increasing incidence of AIDS, it is probably inevitable that most nurses working in acute care settings will at some time come in contact with a patient who has AIDS. Nurses must be prepared to give safe, competent, and compassionate care to patients with AIDS. This article reports the results of a survey of registered nurses' knowledge and attitudes related to AIDS and AIDS patients. The respondents displayed moderate scores on the knowledge questions, high scores on transmission and treatment, but low scores on epidemiology and pathophysiology. On the attitude subscales, scores were above three on a five-point scale, indicating a lack of negative attitudes. Recommendations for educational programming are included.

Dependence on cell-mediated mechanisms for the appearance of crisis forms during Plasmodium chabaudi AS infection in C57BL/6 mice

The appearance of crisis forms or degenerate, intraerythrocytic parasites in the peripheral blood of C57BL/6 hosts during the course of Plasmodium chabaudi AS infection was analysed. Following intraperitoneal injection with 10(6) parasitized erythrocytes, C57BL/6 hosts, which are resistant to this species of rodent Plasmodium, eliminate the parasite from the peripheral blood by 4 weeks and recover from acute infection. Elimination of the parasite coincides with the appearance in the peripheral blood of almost all the parasites as crisis forms. A role for cell-mediated immunity in the induction of crisis forms of Plasmodium species has previously been suggested. To define the role of cell-mediated immunity in the appearance of intraerythrocytic crisis forms in the peripheral blood during acute malaria, the outcome of P. chabaudi AS infection, the course of parasitemia and the appearance of crisis forms in mice with either genetically determined or experimentally induced immunodeficiencies on the resistant C57BL-derived background were examined. The mice used were either B-cell deficient (mu-suppressed from birth). T-cell deficient (nu/nu mice), C5 deficient or splenectomized prior to infection. The appearance of intraerythrocytic crisis forms in the peripheral blood during the course of P. chabaudi AS infection is shown to be dependent on cell-mediated mechanisms which require the presence of T cells as well as an intact spleen for the most efficient elimination of this parasite.

The Effect of Knowledge on Nursing Students' Attitudes Toward Individuals With ATOS

The purpose of this study was to determine if increased knowledge changes nursing students' attitudes toward individuals with AIDS. A pretest/post-test design was used to administer a questionnaire, developed and validated in the United States, and adapted for use in this study. Subjects were total population of first to fourth year baccalaureate undergraduate nursing students attending a 1-day AIDS workshop. Questions dealt with knowledge and fears concerning AIDS and caring for AIDS patients, and attitudes toward homosexuality and toward the terminally ill. With the level of significance set at (p less than .05), post-test results indicated that all groups of students displayed a knowledge gain (p = .000) and a more positive attitude toward caring for AIDS patients (p = .001), particularly by e, first and third year students (p = .001). Although positive, younger students and students who had cared for AIDS patients were less positive. In this study, AIDS education had a positive influence on attitudes of nursing students. This finding supports the use of education to foster positive attitudes toward AIDS and individuals with AIDS.

Role of mononuclear phagocytes in elimination of Plasmodium chabaudi AS infection

The role of mononuclear phagocytes in acquired immunity resulting in the intraerythrocytic destruction and elimination of malarial parasites was investigated in the murine model of infection with Plasmodium chabaudi AS. Mice were treated 1 day before or 6 days after infection with agents which either result in augmentation or activation of the non-specific, microbicidal effector function of mononuclear phagocytes or in depletion of cells of this lineage. To examine the effect of agents which activate mononuclear phagocytes. A/J mice, which are susceptible to P. chabaudi AS and exhibit fulminant parasitaemia and death within 10 days of intraperitoneal infection with 10(6) P-RBC, were treated intravenously with muramyl dipeptide (MDP) or liposome-encapsulated MDP-glycerol dipalmitate (MDP-GDP). Treatment administered 1 day before infection was ineffective. Treatment on day 6 post-infection with liposome-encapsulated MDP-GDP (1 microgram) resulted in a significant decrease in parasitaemia on day 8 and survival, while treatment with free MDP (100 micrograms) resulted only in a significant decrease in parasitaemia. To examine the effect of depletion of mononuclear phagocytes, C57BL/6 mice, which are resistant to P. chabaudi AS infection and eliminate the parasite by 4 weeks, were treated intravenously with 3 mg silica. Silica administered 1 day before or 6 days post-infection abrogated resistance resulting in a delay in elimination of the parasite and host mortality. Treatment on day 6 was more effective, with death by day 13 post-infection of 70% of the normally resistant C57BL/6 mice which exhibited fulminant parasitaemia levels. These results thus provide in-vivo evidence that mononuclear phagocytes play a critical role in the elimination of infection with the murine malaria species P. chabaudi AS. Furthermore, these results suggest that the time of administration of agents which alter mononuclear phagocyte function may be important in determining their effect on host antimalarial defences.

Papillary necrosis in experimental renal transplantation in the rat

Renal papillary necrosis is a frequent complication of unsuccessful renal transplantation in rats, occurring in both isografts and allografts. Papillary necrosis does not occur alone, but only and inevitably in association with severe cortical damage. The pattern of the lesion is different from other forms of papillary necrosis in that the least severe lesions occur in the outer medulla and the more severe lesions involve both medulla and papilla. The incidence of papillary necrosis is increased in isografts, but not in allografts, by longer preservation times. It is suggested that the principal underlying cause may be damage to medullary capillaries, occurring either during preservation or as a consequence of rejection and leading to medullary ischemia.

The pharmacological profile of Org 6906, a potential non-sedative antidepressant that combines monoamine uptake inhibition with alpha 2-adrenolytic activity

(dl)-(5 alpha,8 alpha,9 alpha)-5,8,9,10-Tetrahydro-5,9- methanobenzocycloocten-8-amine hydrochloride (Org 6906) is a potential new antidepressant agent, with a neurochemical profile quite different from that of the classical tricyclic antidepressant drugs. The compound was found active in behavioural tests which are considered to be predictive for antidepressant activity, such as the muricidal test in the rat and the acquired immobility model. Neurochemical studies showed that Org 6906 was an inhibitor of the reuptake of monoamines both in vitro and ex-vivo without having appreciable anticholinergic, antihistaminergic or alpha 1-adrenolytic activity. The facilitatory effect on monoaminergic neurotransmission was confirmed by the reversal of hypothermia induced by reserpine. The drug Org 6906 appeared to have selective alpha 2-adrenolytic properties. It facilitated potassium-stimulated release of noradrenaline from slices of cortex, displaced [3H]rauwolscine and [3H]dihydroergocryptine from their binding sites but only weakly blocked alpha 1-adrenoceptors. The alpha 2-adrenolytic properties were also apparent in behavioural interaction models. The compound antagonized the sleep-inducing effects of clonidine in chicks and mice and it antagonized the mydriasis induced by clonidine in the rat. Finally, it was shown that the two enantiomers of Org 6906 contributed almost equally to the relevant neurochemical and behavioural properties.

Glomerular epithelial cell lesions in rat renal isografts

Visceral glomerular epithelial cell lesions--microvillus formation, loss of foot processes, osmiophilic inclusion droplets, balloon-like malformation of cell processes, degeneration, necrosis, and loss of cell processes from capillary basement membranes--are found in rat renal isografts 1 mth after transplantation. The lesions, which are most readily recognized in perfusion-fixed material, are essentially focal, affecting neither all glomeruli, nor all cells in any glomerulus, bear no relation to the degree of interstitial nephritis in the graft, and are associated with albuminuria and with focal capillary sclerosis in some glomeruli. They are not restricted to renal isografts but are found in aging rats, in different experimental models of glomerular disease and in clinical glomerular disorders, again in association with proteinuria and glomerulosclerosis. It is therefore proposed that glomerular epithelial cell damage increases capillary permeability and impairs maintenance of the integrity of the capillary wall, leading to proteinuria and focal glomerulosclerosis.

Glomerular damage after kidney preservation

Severe proteinuria occurs during isolated organ perfusion of kidneys removed from SD and DA rats and subjected to 24-hr cold preservation. In both strains increased glomerular permeability was associated with changes in glomerular visceral epithelial cells, particularly cytoplasmic edema and detachment of cells from capillary basement membranes. Foot processes were intact and staining for sialoglycoprotein was retained. The changes were compatible with survival of the isograft kidney after transplantation, but moderate proteinuria was found in some rats after one month. Protein loss in the urine during isolated organ perfusion is very much less in kidneys subjected to 4-hr cold preservation, and the glomerular epithelial cells are normal or show only minimal cytoplasmic edema on electron microscopy. The experiment shows that significant damage to glomeruli may occur during preservation prior to transplantation, and the model itself can be usefully exploited to determine the relation between increased glomerular permeability to albumin and the associated changes in the glomerular capillary wall.

Cyclosporine and the ischemic rat kidney

The effects of cyclosporine (CsA) on renal function and morphology have been studied in the rat after unilateral nephrectomy and warm renal ischemia. There is evidence of an enhanced CsA nephrotoxic effect after unilateral nephrectomy alone and of an additive or synergistic effect of CsA and renal ischemia upon renal function and morphology. These enhanced effects are most evident after longer periods of ischemia (60 min) and with higher doses of CsA (25 mg/kg/day). The findings may be relevant to clinical practice and suggest that the nephrotoxic effects of CsA upon the donor kidney may be greatest when there is coincident renal damage from other causes.

The influence of the contralateral kidney upon recovery from unilateral warm renal ischemia

Unilateral warm renal ischemia of 90 min duration was induced in rats and the contralateral normal kidney was removed either immediately or after 1, 2, 4 or 14 d. Contralateral nephrectomy at 2, 4, 14 d increased survival and modified the functional and morphological events of the recovery period. Optimal recovery was obtained by 4 d delay. When contralateral nephrectomy was delayed by 14 d, scarring of the ischemic kidney was more severe suggesting that regeneration of damaged nephrons was impaired when renal homeostasis was sustained by the contralateral kidney. Such biphasic and inverse effects of normal kidney tissue are likely to be important determinants of the natural history of severe unilateral renal damage.

Studies in renal preservation using a rat kidney transplant model: II. The effect of reflushing with citrate

This study investigated the possible beneficial effects of reflushing renal grafts with isotonic citrate solution. Rat kidneys were initially flushed with isotonic citrate or with Hartmann's solutions at O C. After 2 hr, half the kidneys of each group were reflushed with isotonic citrate; 22 hr later, all kidneys were transplanted into rats of the same inbred strain. All animals receiving kidneys flushed with Hartmann's solution died, whereas reflushing such kidneys with isotonic citrate significantly ameliorated the deleterious effects of Hartmann's solution. All animals receiving citrate-flushed kidneys survived with relatively good renal function and morphology. However, reflushing itself is not a beneficial procedure and is only of value where an ineffective preserving solution has been used to flush the kidneys initially. There is evidence that some of the adverse effects of flushing develop in the renal medulla.

Sodium absorption with bacterial fatty acids and bile salts in the proximal and distal colon as a guide to colonic resection

Rates of sodium absorption in the presence of bacterial fatty acids and bile salts are unknown along the length of the colon. Such information may guide resection of colon with a view to leaving colon most optimal for ion absorption. Absorption of sodium and permeability of the colonic mucosa to 51Cr EDTA was measured in the proximal (PC) and distal colon (DC) instilled with NaCl (120 mM), n-butyrate (40 mM) and chenodeoxycholic acid (1 or 2 mM) in varying combinations. Sodium absorption in the PC was 123.6 +/- 19 (nmoles/min/cm2)(n = 7) with saline alone and was doubled (P less than .001) when 40 mM n-butyrate replaced chloride anions. Sodium absorption in the DC with saline alone was 106.9 +/- 18 without significant alteration by addition of n-butyrate. CDC (1 mM) diminished sodium absorption in the PC and DC. Diminished sodium absorption induced by bile salts was significantly reversed by n-butyrate in the PC but not DC. Permeability of 51Cr EDTA was greatest with 2 mM CDC in the distal colon. Mucosal function--sodium absorption with SCFAs, permeability changes, and protection by bacterial fatty acids from sodium losses due to bile salts--was superior in the PC compared with DC. Our results suggest that it may be preferable to preserve the proximal rather than distal colon in operations of the colon to secure optimal absorption of sodium.

Recovery of renal function after warm ischemia. I. The effect of chlorpromazine and phenoxybenzamine

The effects of treatment with chlorpromazine (4 mg/kg) and phenoxybenzamine (1 and 5 mg/kg) on renal function and morphology after warm ischemia and contralateral nephrectomy were studied. Chlorpromazine pretreatment by intravenous injection 15 min before warm ischemia of 60 min resulted in the survival of all animals (cf. 75% in untreated group), with better renal function in the first week. Necrosis of the proximal convoluted tubule and ultimate residual cortical damage were less severe than in the untreated groups. Chlorpromazine was also beneficial after 75 min warm ischemia, although mortality was not reduced. Administration of chlorpromazine just prior to revascularization was ineffective, suggesting that sufficient concentration of the drug must be present in the kidney during the ischemic period or immediately after revascularization. Chlorpromazine probably protects the proximal tubular cells from ischemic damage. Phenoxybenzamine (1 mg/kg) was ineffective when administered 15 min before warm ischemia. A higher (5 mg/kg) dosage of the drug proved to be detrimental.

Studies of renal preservation using a rat kidney transplant model. Evaluation of citrate flushing

Rat kidneys were flushed with isotonic citrate solution, hypertonic citrate solution, or Collins's C2 solution, and were stored hypothermically for 24 hr before transplantation into another rat of the same inbred colony. The number of animals surviving for one month was greatest with isotonic-citrate-flushed kidneys (82%), and least with Collins's C2 solution (27%). Functional and morphological damage after transplantation was consistently greater in Collins's-flushed grafts, as compared with citrate-flushed grafts. Best results were attained with the isotonic-citrate flushed grafts. Seven days after contralateral nephrectomy all surviving animals had elevated serum creatinine and urea concentrations, along with decreased creatinine clearance, and they had secreted large volumes of dilute urine. Renal function was best in animals with isotonic-citrate-flushed grafts. After one month, significant improvement in urine osmolality, creatinine clearance, and serum creatinine had occurred only in the rats with citrate-flushed grafts. There were no significant differences between the citrate groups. All surviving rats had some residual renal cortical damage, but severe interstitial nephritis (greater than 30%) was much less frequent in the citrate groups.

A comparison of in-patient costs of treatment and care in a Scottish psychiatric hospital

A comparison has been made of costs within in-patient units in a large Scottish psychiatric hospital. Cost differences were found between short-stay, rehabilitation and long-stay psychosis units and beds for the elderly with mental disorder. These differences reflected staffing levels, particularly of nurses. The costs were greater than average for psychiatric hospitals and approximated to geriatric units—a finding in keeping with the high occupancy of beds by the elderly. Existing long-stay elderly patients require to be considered separately in distinguishing elderly in-patient costs without total psychogeriatric care offered by society.

Facial recognition memory deficits in normal aging and senile dementia

Recognition memory for faces was studied in 167 subjects comprised of young normals, elderly normals and elderly senile dementia patients with mild to moderate cognitive impairment. A continuous recognition paradigm was used which required an "old-new" decision to be made for each facial stimulus. The design of the stimulus sequence produced delay intervals of .5, 1, 2, and 4 min between the first and second presentations of each face, and a long delay of 40 min was also evaluated. A signal detection analysis revealed large recognition memory deficits at all delay intervals for the two elderly groups as compared to the young normals, but no differences between the normal and impaired elderly groups. In addition, there were no group differences in response criterion. The results suggest a deficit in nonverbal encoding/storage due to normal aging but no further deficit due to mild to moderate senile dementia. The data also fail to confirm an age-related increase in "cautiousness" in recognition memory tasks.