Redefining the purpose of patient classification

One hospital's nursing staff used a structured process to challenge the purpose and function of the patient classification system. The result was internal development of a more effective system with significant cost savings.     

A survey of hospital diet. Connection between the nutritive value found by analysis and by calculation

The primary aim of this study is to determine the nutritional quality of the food prepared in a selected Danish hospital. Samples consisted of four double portions of the hospital's standard daily ration from two randomly chosen weeks. The amounts of fatty acid, protein, ash, total dry material, and vitamin C were measured. The amount of carbohydrate, energy, and percentage of available energy were calculated. The total energy level was measured to eight MJ per day. The measured percentage of available energy given as protein (17%) and the vitamin C levels (14 mg/MJ) have fulfilled the recommendations. The percentage of energy given as carbohydrates (38%) is below and the percentage of energy given as fat (45%) is above the recommended levels (50% and 32%). There is a direct correlation between the average calculated and the average measured values when all of the meals are analysed as an entity, but the correlation is weak for individual meals.     

Production and determination of specificity of monoclonal IgG anti-mouse-blastocyst antibodies

Five monoclonal anti-mouse-blastocyst IgG antibodies were raised by intrasplenic immunization of three mice with adhesive-stage mouse blastocysts. Each mouse received a total of 60-70 blastocysts which were either nitrocellulose-immobilized or living but irradiated. Tests for pre-implantation stage-specificity showed that the antibodies differed in specificity. None were specific for surface epitopes. One antibody recognized epitopes only on blastocysts. Other antibodies were able to discriminate between unfertilized and fertilized oocytes, uncompacted and compacted morulae, or delayed and adhesive blastocysts. By applying reduced SDS-PAGE and Western blotting to blastocysts the blastocyst-specific antibody was seen to be bound to a peptide of M(r) 34.     

Population based study of prevalence of islet cell autoantibodies in monozygotic and dizygotic Danish twin pairs with insulin dependent diabetes mellitus

OBJECTIVE: To study the comparative importance of environment and genes in the development of islet cell autoimmunity associated with insulin dependent diabetes mellitus. DESIGN: Population based study of diabetic twins. SETTING: Danish population. SUBJECTS: 18 monozygotic and 36 dizygotic twin pairs with one or both partners having insulin dependent diabetes. MAIN OUTCOME MEASURES: Presence of islet cell antibodies, insulin autoantibodies, and autoantibodies to glutamic acid decarboxylase (GAD65) in serum samples from twin pairs 10 years (range 0-30 years) and 9.5 years (2-30 years) after onset of disease. RESULTS: In those with diabetes the prevalence of islet cell antibodies, insulin autoantibodies, and autoantibodies to glutamic acid decarboxylase in the 26 monozygotic twins was 38%, 85%, and 92%, respectively, and in the dizygotic twins was 57%, 70%, and 57%, respectively. In those without diabetes the proportions were 20%, 50%, and 40% in the 10 monozygotic twins and 26%, 49%, and 40% in the 35 dizygotic twins. CONCLUSION: There is no difference between the prevalence of islet cell autoantibodies in dizygotic and monozygotic twins without diabetes, suggesting that islet cell autoimmunity is environmentally rather than genetically determined. Furthermore, the prevalence of islet cell antibodies was higher in the non-diabetic twins than in other first degree relatives of patients with insulin dependent diabetes. This implies that the prenatal or early postnatal period during which twins are exposed to the same environment, in contrast with that experienced by first degree relatives, is of aetiological importance.     

Morphology of step-wise S–N curves depending on work-hardened layer and humidity in a high-strength steel

The present paper describes the effects of work‐hardened layer and humidity on the fatigue response of high strength steel, JIS SNCM439 (AISI4340). Tests were conducted in laboratory air and in dry air using cantilever‐type rotating bending fatigue testing machines. The dew point of dry air was ?60 °C. Specimens with two different surface conditions were prepared, i.e., buff‐finished and electro‐polished specimens. In the buff‐finished specimens, a stepwise S–N curve was seen in both environments, but the transition stress below which subsurface crack initiation occurred shifted to a higher stress level in dry air than in laboratory air. In the electro‐polished specimens, stepwise S–N curve was not observed in laboratory air, but seen in dry air. At stress levels where cracks initiated at the surface, the fatigue lives of the electro‐polished specimens were shorter than those of the buff‐finished specimens. At stress levels where subsurface cracks initiated, the fatigue lives of both specimens were the same, irrespective of surface finishing condition and humidity.     

Necrosis of myometrial choriocarcinoma with fulminating sepsis complicating chemotherapy for trophoblastic tumor

OBJECTIVE: In normal pregnancy and pregnancies complicated by preeclampsia it has been demonstrated that there is increased activation of platelets and the clotting and fibrinolytic system. We measured plasma levels of thrombopoietin, a major regulator of platelet production in these conditions. STUDY DESIGN: We compared the thrombopoietin plasma levels of healthy term pregnant patients (n = 21) with those of healthy nonpregnant controls (n = 17), as well as patients with severe preeclampsia (n = 8) and the hemolysis, elevated liver enzymes, low platelets syndrome (n = 6). RESULTS: Thrombopoietin levels in normal pregnant patients and pregnancies complicated by the hemolysis, elevated liver enzymes, low platelets syndrome were statistically significantly higher than thrombopoietin levels in nonpregnant controls. Data were analyzed with the Kruskal-Wallis one-way analysis of variance by ranks. CONCLUSIONS: This study is the first to report thrombopoietin levels in pregnancy. Thrombopoietin levels are significantly greater in pregnant patients and in pregnancies complicated by the hemolysis, elevated liver enzymes, low platelets syndrome compared with nonpregnant controls.     

Predicting premorbid neuropsychological functioning following pediatric traumatic brain injury

This study examined the prediction of premorbid neuropsychological functioning using data from an ongoing prospective study of traumatic brain injuries (TBI) in children ages 6 to 12 years. Prediction equations were derived based on 80 children with orthopedic injuries (OI), who served as a comparison group for the children with TBI. Collectively, parent ratings of premorbid school performance, maternal ethnicity, family socioeconomic status, and children's word recognition skill predicted from 13% to 45% of the variance in three measures of neuropsychological functioning. The regression equations were used to compute predicted scores among 109 children with TBI. Actual scores fell significantly below predicted scores among children with TBI, and the magnitude of the deficits was correlated with injury severity. Premorbid neuropsychological functioning can be predicted in children with TBI, but with less precision than would be desirable for clinical purposes.