Routine portable chest radiographs in the medical intensive care unit: effects and costs

OBJECTIVE: To determine the effects and net costs of routine chest radiographs in a medical intensive care unit (ICU). DESIGN: A prospective, cohort study. A survey of experts in critical care and pulmonary diseases was undertaken to assess the effect of routine radiographs on patient management. SETTING: Medical ICU of a university hospital. PATIENTS: Eighty randomly selected patients admitted to a medical ICU. Two hundred fourteen experts were surveyed; 118 (55%)/214 responded. MEASUREMENTS AND MAIN RESULTS: Daily interviews with medical ICU clinicians were conducted to assess the radiographic findings in the routine radiographs and actions taken based on these findings. Experts evaluated the findings, their importance, the actions taken, and the probability of complications if the actions had not been taken at that time. Experts also predicted increases in length of stay associated with these complications. Presence of radiographic findings, changes in management because of the findings, net costs of routine chest radiographs, cost per finding that prompted an action, and expected changes in length of stay resulting from the actions were also assessed. Seventy-two (33%) of 221 routine radiographs (95% confidence interval: 25% to 39%) had findings, of which 44 (61%) were judged important, and 18 (8%, 95% confidence interval: 5% to 12%) prompted actions. Experts predicted that each action averted, on average, 2.1 +/- 1.7 days (SD) in the medical ICU. Mean savings per routine radiograph was $98. Net savings from routine chest radiographs remained after sensitivity analysis for expected change in length of stay, percentage of patients with routine radiographs, and percentage of routine radiographs that produce changes in management. CONCLUSION: The policy of obtaining routine chest radiographs in the medical ICU is effective and results in net savings.     

Nonclinical model for assessing gastric effects of bisphosphonates

Mechanisms by which ketones potentiate manganese-bilirubin (Mn-BR)-induced cholestasis are unknown. The purpose of the present study was to investigate the effect of methyl isobutyl ketone (MiBK), a widely used ketonic solvent, at the level of the bile canalicular membrane (BCM) and to verify if altered membrane lipid dynamics could be involved in MiBK-potentiated Mn-BR cholestasis. Male Sprague-Dawley rats were exposed 4 hr/day for 3 days to MiBK vapors (200 or 600 ppm). Eighteen hours after the last exposure, manganese (Mn, 4.5 mg/kg) was given i.v. followed 15 min later by bilirubin (BR, 25 mg/kg). Rats were killed 30 min after BR; liver cell plasma membranes (bile canalicular and sinusoidal), microsomes, mitochondria, and cytosol were isolated by differential centrifugation. Lipids were extracted and cholesterol was measured in each fraction. After Mn-BR and MiBK exposure (600 ppm), results indicated a marked increase in BCM cholesterol content compared to rats exposed to air only. This increase was greater than that due to Mn-BR or MiBK given alone. Also, results indicated that cholesterol increased in a dose-related fashion in BCM after MiBK exposure, whereas PM cholesterol remained unaltered. To identify the source of the increased BCM cholesterol and to permit distinction between de novo cholesterol synthesis and subcellular shifts, the hepatic lipid pool was labeled in vivo with [3H]-cholesterol and [2-14C]-mevalonic acid, a cholesterol synthesis precursor. Results showed that after 600 ppm MiBK exposure, 14C-labeled cholesterol was greater than 3H-labeled cholesterol, indicating that the contribution of de novo cholesterol synthesis to the total cholesterol content of the various isolated hepatocellular fractions was more important than the contribution of intracellular pools. Therefore, increased BCM cholesterol content and enhanced accumulation of newly synthesized cholesterol appear to be involved in MiBK potentiation of Mn-BR-induced cholestasis.     

A novel small conductance Ca2+-activated K+ channel blocker from Oxyuranus scutellatus taipan venom. Re-evaluation of taicatoxin as a selective Ca2+ channel probe

Taicatoxin, isolated from the venom of the Australian taipan snake Oxyuranus scutellatus, has been previously regarded as a specific blocker of high threshold Ca2+ channels in heart. Here we show that taicatoxin (in contrast to a range of other Ca2+ channel blockers) interacts with apamin-sensitive, small conductance, Ca2+-activated potassium channels on both chromaffin cells and in the brain. Taicatoxin displays high affinity recognition of 125I-apamin acceptor-binding sites, present on rat synaptosomal membranes (Ki = 1.45 +/- 0.22 nM) and also specifically blocks affinity-labeling of a 33-kDa 125I-apamin-binding polypeptide on rat brain membranes. Taicatoxin (50 nM) completely blocks apamin-sensitive after-hyperpolarizing slow tail K+ currents generated in rat chromaffin cells (mean block 97 +/- 3%, n = 12) while only partially reducing total voltage-dependent Ca2+ currents (mean block 12 +/- 4%, n = 6). In view of these findings, the use of taicatoxin as a specific ligand for Ca2+ channels should now be reconsidered.     

Phenol recovery with tributyl phosphate in a hollow fiber membrane contactor: Experimental and model analysis

The extraction and stripping of phenol using a solution of tributyl phosphate in kerosene in a hydrophobic polypropylene hollow fiber membrane contactor has been studied. The effect of the aqueous and the organic phase flow rates on the overall mass transfer coefficient for both extraction and stripping steps was investigated. Experimental values of the overall mass transfer coefficient were determined and compared with predicted values from the resistance in series model. Results showed that the overall mass transfer coefficients for extraction were about one order of magnitude greater than those measured during the stripping process. The experimental values were in good agreement with the predicted values for the extraction module. However, the predicted values were slightly overestimated for the stripping module. The individual mass transfer resistances were analyzed and the rate-controlling steps of mass transfer were also identified in both extraction and stripping modules. The major resistance in extraction and stripping was in the aqueous phase and in the membrane phase, respectively.     

Aqueous leachability of metakaolin-based geopolymers with molar ratios of Si/Al = 1.5-4

The leachability in water of metakaolin based geopolymers with molar ratios of Na/Al = 1 and Si/Al = 1.5-4.0 has been investigated in order to optimise the composition for the immobilisation of nuclear waste. Formulations with Si/Al of around 2 are the most suitable using the ASTM/PCT leach test method. The variability of the leach results is discussed with reference to the microstructure, compressive strength and the degree of polymerisation of the geopolymers as observed here by solid state nuclear magnetic resonance, XRD and infrared measurements.     

Full 1H NMR assignment of a 24-nucleotide RNA hairpin: application of the 1H 3D-NOE/2QC experiment

A mixed general linear model analysis of the development of sleep-wake states was conducted on 37 high-risk preterm infants and replicated with a second cohort of 34 infants. Most dependent variables showed significant development over the preterm period: active sleep decreased, and active waking, quiet waking, and the organization of active sleep and quiet sleep increased over the preterm period in both cohorts. The amount of quiet sleep also increased over age, but this change was significant only for Cohort 1. Seven infant characteristics used as covariates had only minor effects. There were no significant differences in the developmental trajectories (slopes) of the two cohorts. The amounts of four variables differed between cohorts: Cohort 2 infants had less sleep-wake transition, more active sleep, less active sleep without REM, and more regular quiet sleep. These findings suggest that developmental patterns of sleep wake states are stable enough in the preterm period that deviant individual patterns might be used to identify infants with neurological problems.     

Variability in function measurements of three sensory foot nerves in neuropathic diabetic patients

Although most short, linear peptide fragments of proteins are unstructured in aqueous solution, a number of immunogenic and antigenic peptides have been shown to have conformational preferences for structured forms. By using mainly NMR and CD spectroscopy, it has been possible to detect and quantify quite small populations of beta-turn, helical, and nascent helical conformations. Recent studies have been published indicating that the presence of structured forms is correlated with the location of T cell and/or B cell epitopes in peptide sequences. X-ray crystal structures of complexes between peptides and anti-peptide antibodies frequently show the peptides bound in beta-turn conformations, and the presence of helix in one peptide-antibody complex has been shown by NMR spectroscopy. Studies of peptides free in solution and bound to anti-peptide antibodies in the crystal indicate that the structure of the principal neutralizing determinant of HIV-1 probably includes at least one beta-turn in a highly conserved region. These results can potentially be used in the design of peptide-based vaccines.