Risk factors for noncompliance with glaucoma follow-up visits in a residents' eye clinic

OBJECTIVE: This study aimed to identify factors associated with compliance with glaucoma follow-up visits. DESIGN: Computer records of a university residents' eye clinic were reviewed to identify a random sample of all persons who had an examination with International Classification of Disease (ICD) 9 coding (ICD9) for glaucoma suspect or glaucoma during a 2-year period (1991-1993) to undergo telephone interview. PARTICIPANTS: Those who were seen at least every 6 months regardless of earlier return instructions were defined as compliant with follow-up (controls, n = 362). Those who had any lapse between visits of longer than 6 months were defined as noncompliant (cases, n = 362). RESULTS: Interviews were completed for 196 cases and 242 controls. Noncompliant persons were significantly more likely to be suspects for glaucoma rather than to have definite glaucoma and to be dissatisfied with waiting time in the clinic (29.1% vs. 17.8%, P < 0.005) and to state that they did not take their glaucoma medications as prescribed (25.4% vs. 13.4%, P < 0.004). They also were less likely to have been prescribed eyedrop medication. A high percentage of both patients and controls knew that glaucoma can lead to blindness (85.2% and 88.4%, respectively). The most common reasons patients gave for not keeping follow-up visits were the perception that their eye problem was "not serious enough," the cost of examinations, and that the doctor did not tell them to come back. CONCLUSION: Compliance with follow-up visits for glaucoma is associated with markers for early disease. Attempts to improve compliance might focus on improved communication of the seriousness of the disease and improvements in clinic waiting time.     

Solid-state 2H NMR study of methyl-d3-cobalamin

A solid-state 2H NMR study of methyl-d3-cobalamin has been performed as a function of temperature to provide information concerning the character and energetics of the motion performed by this unique bioorganometallic methyl group. Analysis of the 2H NMR line shape indicates that the methyl group undergoes rapid three-fold rotation, and that the Co-C-2H angle lies between 105.9 and 109.5 degrees. Determination of the spin-lattice relaxation times T1 shows that the relaxation is anisotropic, consistent with a "jumping" motion of the methyl group rather than rotational diffusion. This also provides the activation energy to methyl jumps as 8.3 +/- 1.3 kJ/mol. It is proposed that this energetic barrier may be a useful probe of changes in the electronic character of the Co-C bond that accompany the biological role of this molecule in such enzymes as methionine synthase.     

Immunomicroscopy: resin techniques and on-section labelling with immunocolloidal gold or immunoperoxidase--planning a protocol

On-section immunocytochemistry is divided into two parts: (i) processing of biological tissue for section microscopy and (ii) immunolabelling of sections. Many of the more successful microscopical methods employ delicate aldehyde fixation of biological tissue followed by "sympathetic" processing into an acrylic resin. Processing regimens do not have to be complicated. Simple and cost effective room temperature protocols utilising partial dehydration have been devised and they can be as effective as the more complex low temperature techniques in preserving both ultrastructure and antigenic reactivity. The embedded material can be investigated by either light or electron microscopy. Frozen sections can be cut and immunolabelled but only if the tissue is chemically fixed first, as in resin embedding. Fixation with low concentrations of aldehyde will normally better preserve tissue immunoreactivity but this may be at the expense of good ultrastructure with these protocols. If so, low temperature resin embedding methods or rapid freezing and cryosubstitution can be tried. The choice of processing protocol will determine which acrylic resin to use, as will the preference for subsequent immunolabelling with either colloidal gold or peroxidase/diaminobenzidine (DAB). Both types of labelling system offer advantages to localisation studies and can be used in combination for double or even triple labelling. Silver enhancement of the colloidal gold or DAB allows for improved observation by light microscopy.     

Gastric and biliary excretion of meperidine in man

The role and importance of enterogastric secretion in the disposition and elimination of the weak base, meperidine (pKa 8.63), was studied after intravenous administration (50 mg) of the drug to 6 normal volunteers. Continuous collection of the gastric fluid over a 4-hr period demonstrated the establishment of high gastric fluid/plasma concentration ratios for meperidine (mean about 50, range, 10 to 200). However, the total amount of drug recovered, even after correction for incomplete collection, was only a small percentage of the administered dose. Under basal conditions a mean +/- SE of 1.9 +/- 0.3 mg, equivalent to 3.7% of the administered dose, was found in the total gastric aspirate. Stimulation of gastric secretion by subcutaneous injection of betazole (1.5 mg/kg) increased this recovery to 3.6 +/- 0.3 mg (7.2%) primarily due to the increase in gastric volumen output. Aspiration of the gastric fluid in either the basal or stimulated situation had no observable effect upon the plasma concentration/time profile of meperidine whether assessed by the terminal half-life, t 1/2 beta, or the plasma clearance; control values were 3.8 +/- hr and 1,190 +/- 130 ml/min, respectively. In 2 subjects "bile fluid" was also collected for 2.5 hr and found to contain less than 0.2% of the administered dose. Enterosystemic recycling is therefore of minor importance in the disposition and elimination of meperidine in man.     

The heroin epidemic in San Francisco: estimates of incidence and prevalence

Much attention has recently been focused on the question of the extent of heroin use in America. In a worthwhile effort to call public attention to the problem, many estimates of its size have evidenced a tendency toward exaggeration and aggrandizement. This paper presents methods of estimation of the extent of heroin addiction which, when carefully employed, should effectively correct such distorted estimates. Two general types of estimation are employed, incidence and prevalence. Incidence estimates are concerned with new cases of heroin addiction that occur in a specific population within a given amount of time. These estimates are based upon self-report data from addicts regarding date of first addiction. When corrected for the "lag phase" (that period of time between onset of first addiction and eventual visit to a treatment program), these data permit accurate retrospective charting of incidence trends. Prevalence estimates focus on all known cases of heroin addiction in a specific population within a given amount of time. Three separate types of prevalence estimates from three separate sources are outlined in this article: estimates based on overdose death data, estimates based on crime statistics, and estimates of "unknown" addicts. In outlining these methods, this article describes the fluctuations in heroin addiction in one major American city, San Francisco, California. After analyzing data gathered from a sample of 2,367 addicts contacted over a 3-year period, this study suggests that the incidence of heroin addiction seems to have declined after 1970. Possible factors underlying this apparent decline in heroin addiction are then discussed, including the post-1970 maturation of the "population at risk," the effectiveness of antidrug media messages, the changing drug fashions in the heroin subculture, and the gradual deterioration of the quality and potency of street heroin.     

The limitations and potential of AVHRR GAC data for continental scale fire studies

Global Area Coverage (GAC) data from the Advanced Very High Resolution Radiometer (AVHRR) are available on a daily basis, dating back to July 1981. The AVHRR's 3·55–3·93 μm channel is suitable for detection of terrestrial hot spots, such as bushfires. The long-term archives and global cover make the GAC a potentially valuable data source for large scale fire studies. However, these data are sampled spatially through a combination of line skipping and averaging. This study shows that the sampling affects the sensitivity of GAC for fire detection in relation to ecosystem and season. The GAC are found to provide a reasonable measure of fire activity in grassland and open b'ush savannah, but to perform poorly in the forest margins. Overall at least 79 per cent of fires detected with non-sampled AVHRR data are missed by the GAC. This severely limits the use of GAC data for quantitative fire studies. The GAC does appear to provide a reasonable measure of fire calendar (i.e., variations in fire activity with time) and on a continental scale successfully identifies the main regions of fire activity. The potential of these data for continental scale fire studies is illustrated through the preliminary analysis of 277 GAC mosaics of Africa for the period September 1988 to August 1989.     

PRACTICAL INCONSISTENCY MANAGEMENT FOR CRITICAL-TASKS DECISION-SUPPORT SYSTEMS

Abstract

In this paper, the problem of logical consistency in critical-tasks decision systems is addressed. It is shown how local search techniques can be used to check the (in)consistency of very large propositional knowledge bases (KBs). Using new heuristic findings. we can now implement efficient forms of diagnostic reasoning in the context of very large ICBs modeling deep models of complex devices and including patterns of default reasoning.     

Effects of additional milk replacer feeding on calf health, growth, and selected blood metabolites in calves

The objective of the experiment was to evaluate effects of increased milk replacer feeding on growth, intake, feed efficiency, and health parameters in stressed calves. Holstein bull calves (n = 120; approximately 3 to 8 d of age) were purchased from sale barns and dairy farms and housed in fiberglass hutches. In addition, wood shavings contaminated with coronavirus were mixed with clean shavings and added to each hutch before the start of the experiment. Calves were fed either a fixed amount (454 g/d) of a 20% crude protein (CP), 20% fat milk replacer to weaning at 28 d or a variable amount (454, 681, 908, and 454 g/d on d 0 to 7, 8 to 14, 15 to 31, and 32 to 41, respectively) of a milk replacer containing 28% CP and 17% fat without or with added dietary supplement containing bovine serum. Calves were also fed commercial calf starter and water ad libitum. Plasma IgG concentration in most calves on arrival at the facility was < 10 g/L. Intake, change in body weight, feed efficiency, morbidity and mortality, and selected plasma metabolites were determined. Body weight at 28 d, 56 d, daily body weight gain, intake of milk replacer, fecal scores, days with diarrhea, and days treated with antibiotics were increased with feeding variable amount of milk replacer over the 56-d study. Starter intake from d 1 to 56 was reduced from 919 to 717 g/d in calves fed fixed and variable amounts of milk replacer, respectively. Morbidity, measured as the number of days that calves had diarrhea, was increased by 53% when a variable amount of milk replacer was fed. Calves fed variable milk replacer were treated with antibiotics for 3.1 d compared with 1.9 d for calves fed 454 g of milk replacer/d. Concentrations of plasma glucose, urea N, and insulin-like growth factor-I were increased when calves were fed variable amount of milk replacer. Dietary supplement containing bovine serum had no effect on any parameter measured. There was no effect of milk replacer feeding on concentrations of nonesterified fatty acids, total protein, or growth hormone concentrations. Plasma tumor necrosis factor-α was highest in calves with the highest plasma IgG concentrations on the day of arrival and might be related to the calf's ability to identify pathogens in the environment. Under conditions of this study, calves fed variable amount of milk replacer and exposed to immunological challenge before weaning had greater BW gain, but also increased incidence of diarrhea that required added veterinary treatments.     

Effects of amount of colostrum replacer,amount of milk replacer,and housing cleanliness on health,growth, and intake of Holstein calves to 8 weeks of age

Newborn Holstein bull calves (n = 96) were assigned randomly at birth to receive 150 g (C150) or 450 g (C450) of IgG in the first 24 h of life from a lacteal-based colostrum replacer in 2 trials. Mass of product fed was 500 and 1,500 g, respectively. Replacer was reconstituted with warm water and administered by esophageal feeder at approximately 1, 6, and 12 h of age. Thereafter, calves were fed 2 L of whole milk twice daily at approximately 0700 and 1700 h until transported to the experimental facility at 2 to 3 d of age. Calves fed C450 had greater serum total protein and IgG concentrations at 2 to 3 d of age. Failure of passive transfer of immunity (serum IgG <10 g/L) was detected in 100 and 11% of calves fed C150 and C450, respectively. Calves (n = 48) in trial 1 were assigned randomly within colostrum group to receive 0.68 kg/d of milk replacer (MR) for 42 d, and then 0.34 kg/d for 7 d (moderate MR, MMR) or 1 kg/d of MR for 5 d, 1.36 kg/d for 37 d, and 0.68 kg/d for 7 d (high MR, HMR). Starter and water were available for ad libitum consumption. Calves fed HMR had greater average daily gain, higher average fecal scores, more days with abnormal fecal scores, and more medical days than calves fed MMR. Calves fed HMR also had lower starter intake and tended to have lower gain-to-feed ratio than calves fed MMR. Calves fed C450 and MMR began eating calf starter earlier and ate more starter than other groups from 3 wk. In trial 2, calves (n = 48) were assigned randomly within colostrum group to housing in nursery pens bedded with clean, dry straw (clean bedding) or soiled straw used in previous studies (dirty bedding). Milk replacer was fed at 0.68 kg/d for 39 d, and then 0.34 kg/d for 3 d along with free-choice texturized starter and water. Calves fed C450 had fewer days with abnormal fecal scores and days with medical treatments compared with calves fed C150. Calves housed in dirty bedding tended to grow more slowly and have lower gain-to-feed ratio than calves housed with clean bedding. Temporal changes in serum IgG and total protein varied by treatment. Serum IgG in calves fed C150 varied little from 0 to 4 wk and increased thereafter, whereas IgG in calves fed C450 declined to 4 wk (estimated half-life = 23.9 d) and increased thereafter. Differences in serum IgG concentrations caused by feeding different amounts of colostrum replacer did not markedly affect growth or intake when calves were fed different amounts of milk replacer or when they were housed with clean or dirty bedding.     

Situvis: A sensor data analysis and abstraction tool for pervasive computing systems

Pervasive systems are large-scale systems consisting of many sensors capturing numerous types of information. As this data is highly voluminous and dimensional, data analysis tasks can be extremely cumbersome and time-consuming. Enabling computers to recognise real-world situations is an even more difficult problem, involving not only data analysis, but also consistency checking. Here we present Situvis, an interactive visualisation tool for representing sensor data and creating higher-level abstractions from the data. This paper builds on previous work, Clear et al. (2009) [8] through evolved tool functionality and an evaluation of Situvis. A user-trial consisting of 10 participants shows that Situvis can be used to complete the key tasks in the development process of situation specifications in over 50% less time than an improvised alternative toolset.