A rapid urease test for presumptive identification of Cryptococcus neoformans

Extra-contractual referrals (ECRs) can be a cause of considerable anxiety to purchasing authorities, mainly because of their potential to generate unexpected expenditure. But ECRs can also be used as a tool for monitoring the demand for, and quality of, clinical services. ECRs were studied in the Darlington Health Authority district using a variety of methods including inter-disciplinary meetings, a series of interviews with local GPs, and a questionnaire to general practitioners on 230 consecutive ECRs. The methods and results of the questionnaire study are presented. The commonest reasons for making ECRs included the mistaken belief that a contract existed with the ECR provider, patient dissatisfaction with the local provider, and referral to benefit from shorter waiting lists. ECRs for bone-mass densitometry, orthopaedics, and ear nose and throat services were over-represented. Questionnaire results were validated by comparison with an interview study of all GPs in the district. We conclude that trends in ECRs can be monitored as a convenient "early warning system' to alert purchasing authorities to changes in demand or perceived problems with local provider units. ECR data must be interpreted in the context of further local background information from sources such as GPs and public health physicians. In the case of Darlington, scrutiny of ECRs has led to changes in services and contracts.     

Factors causing stress in patients in intensive care units

Intensive care units have been considered stress generating areas. Knowing the causes why this happens will allow us to take specific measures to prevent or minimize it. This study has been performed with the aim to identify stress raising factors, as they are perceived by intensive care patients. The study has been performed in 49 patients most of whom were being attended in postoperatory control. The valuation of the degree of stress was performed using the "Scale of Environmental Stressors in Intensive Care" by Ballard in 1981, modified and adapted to our environment, with a result of 43 items distributed in six groups; Immobilization, Isolation, Deprivation of sleep, Time-spacial disorientation, Sensorial deprivation and overestimulation, and depersonalization and loss of autocontrol. The level of stress perceived by patients was low. The factors considered as most stressing were those related to physical aspects; presence of tubes in nose and mouth, impossibility to sleep and presence of noise, whereas those less stressing referred to Nursing attention. We conclude that patients perceive ICU as a little stressing place in spite of the excessive noise, remark the presence of invasive tubes and the difficulty to sleep as the most stressing factors, and in the same way, express a high degree of satisfaction about the attention received.     

Innovative techniques in pediatric liver transplantation: reduced-, split- and living-donor related liver transplantation

BACKGROUND: Biological systems that show threshold phenomena are candidates for stochastic resonance as a mechanism to explain what appears to be biovariability. Stochastic resonance is the amplification of weak signals by "noise." OBJECTIVE: This review discusses the areas of contact dermatitis in which threshold events have been documented. The purpose is to point out the mechanism by which stochastic resonance may affect patch test results. METHODS: A literature review technique was used. RESULTS: The recent finding of a neurological influence on contract dermatitis provides a mechanism for stochastic resonance to affect patch test results. CONCLUSION: Stochastic resonance is likely to affect patch test results when more than one patch test result is positive.     

The lactulose breath hydrogen test and small intestinal bacterial overgrowth

OBJECTIVES: To i) document the sensitivity and specificity of a combined scintigraphic/lactulose breath hydrogen test for small intestinal bacterial overgrowth and ii) investigate the validity of currently accepted definitions of an abnormal lactulose breath hydrogen test based on "double peaks" in breath hydrogen concentrations. METHODS: Twenty-eight subjects were investigated with culture of proximal small intestinal aspirate and a 10-g lactulose breath hydrogen test combined with scintigraphy. Gastroduodenal pH, the presence or absence of gastric bacterial overgrowth, and the in vitro capability of overgrowth flora to ferment lactulose were determined. RESULTS: Sensitivity (16.7%) and specificity (70.0%) of the lactulose breath hydrogen test alone for small intestinal bacterial overgrowth were poor. Combination with scintigraphy resulted in 100% specificity, because double peaks in serial breath hydrogen concentrations may occur as a result of lactulose fermentation by cecal bacteria. Sensitivity increased to 38.9% with scintigraphy, because a single rise in breath hydrogen concentrations, commencing before the test meal reaches the cecum, may occur in this disorder. Sensitivity remained suboptimal irrespective of the definition of small intestinal bacterial overgrowth used, the nature of the overgrowth flora, favorable luminal pH, the presence of concurrent gastric bacterial overgrowth, or the in vitro ability of the overgrowth flora to ferment lactulose. CONCLUSIONS: Definitions of an abnormal lactulose breath hydrogen test based on the occurrence of double peaks in breath hydrogen concentrations are inappropriate. Not even the addition of scintigraphy renders this test a clinically useful alternative to culture of aspirate for diagnosing small intestinal bacterial overgrowth.     

Visualising Errors in Animal Pedigree Genotype Data

Genetic analysis of a breeding animal population involves determining the inheritance pattern of genotypes for multiple genetic markers across the individuals in the population pedigree structure. However, experimental pedigree genotype data invariably contains errors in both the pedigree structure and in the associated individual genotypes, introducing inconsistencies into the dataset, rendering them useless for further analysis. The resolution of these errors requires consideration of genotype inheritance patterns in the context of the pedigree structure. Existing pedigree visualisations are typically more suited to human pedigrees and are less suitable for large complex animal pedigrees which may exhibit cross generational inbreeding. Similarly, table‐based viewers of genotype marker data can highlight where errors become apparent but lack the functionality and interactive visual feedback to allow users to locate the origin of errors within the pedigree. In this paper, we detail a design study steered by biologists who work with pedigree data, and describe successive iterations through approaches and prototypes for viewing genotyping errors in the context of a displayed pedigree. We describe how each approach performs with real pedigree genotype data and why eventually we deemed them unsuitable. Finally, a novel prototype visualisation for pedigrees, which we term the ‘sandwich view’, is detailed and we demonstrate how the approach effectively communicates errors in the pedigree context, supporting the biologist in the error identification task.     

Shallow circuits and concise formulae for multiple addition and multiplication

A theory is developed for the construction of carry-save networks with minimal delay, using a given collection of carry-save adders each of which may receive inputs and produce outputs using several different representation standards.The construction of some new carry-save adders is described. Using these carry-save adders optimally, as prescribed by the above theory, we get {, , }-circuits of depth 3.48 log₂ n and {, , }-circuits of depth 4.95 log₂ n for the carry-save addition ofn numbers of arbitrary length. As a consequence we get multiplication circuits of the same depth. These circuits put out two numbers whose sum is the result of the multiplication. If a single output number is required then the depth of the multiplication circuits increases respectively to 4.48 log₂ n and 5.95 log₂ n.We also get {, , }-formulae of sizeO (n ^3.13) and {, }-formulae of sizeO (n ^4.57) for all the output bits of a carry-save addition ofn numbers. As a consequence we get formulae of the same size for the majority function and many other symmetric Boolean functions.     

Infant feeding practices in St. Vincent and factors which affect them

A survey was conducted in the summer of 1975 in 2 towns in St. Vincent--Layou and Georgetown--in the effort to obtain information regarding infant feeding practices and some of the factors which may influence them. Mothers of children from 1-2 years of age were interviewed in their homes. Complete data sets were obtained on 192 of the 216 eligible children in the 2 towns. For most children the period of exclusive breastfeeding (no other milk product given) was very short. About 1/2 of the children had received milk by 2 weeks of age, and 75% by 1 month. This was followed by a much longer period of "mixed" feeding--both breast and bottle--until breastfeeding was stopped at a median age of 6.8 months. Many types of milk were used for infant feeding. For 73% of the infants, infant formula was the 1st type of milk given. This was commonly replaced by a "heavier" full cream powdered milk at a few months of age. Prelacteal feeds were very common, predominantly glucose water. "Tonics," often consisting of vitamin preparations, were another common supplement during the early months of life. Among solid foods, arrowroot, "custard," and commercial infant cereals were the first to be introduced. Relatively inexpensive locally bagged staple foods and milk powders were available in both towns, but most mothers relied heavily on packaged brand name products for infant feeding even though the cost was 2-10 times higher. It was not possible to pinpoint the exact causes for the high levels of bottle feeding, nor for the possible recent decline in breastfeeding, but several important factors were identified. Part of the problem appeared to be due to poor health and nutritional status of the mothers. In addition, in several cases the mothers reported that they had wanted to continue breastfeeding but had received no support from health professionals, and in a few instances had been ordered to stop for seemingly trivial medical reasons.     

Relaxation of the distribution function branch imbalance Q * in Sn and Sn-In alloys

We have used double tunnel junctions M₁-S₂-N₃ to measure the detector junction (S₂-N₃) voltage at zero detector current V _d(0) vs. generator junction (M₁-S₂) current I _g for samples cooled by helium exchange gas. We find terms both symmetric V _d ^S(0; I _g ²) and asymmetric V _d ^A(0; I _g) in I _g. The term V _d ^S is attributed to a thermoelectric voltage generated in the sample; V _d ^A is produced by Q ^*, the distribution function branch imbalance, in S₂. We have analyzed Q ^* relaxation in these samples and have compared the results with those obtained earlier by Paterson. For Sn and Sn : In alloys we find % MathType!MTEF!2!1!+-% feaafiart1ev1aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn% hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr% 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9% vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x% fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaeqiXdq3aaS% baaSqaaGqaaiaa-ffacaWFQaaabeaakiabg2da9Gqaciaa+fdacaGF% UaGaa4xmaiaa+flacaGFWaGaa4Nlaiaa+jdacaGFxdGaa4xmaiaa+b% dadaahaaWcbeqaaiaa+1cacaGFXaGaa4hmaaaakiabfs5aejaacIca% caGFWaGaaiykaiaac+cacqqHuoarcaGGOaGaa8hvaiaacMcaaaa!4C83!\[\tau _{Q*} = 1.1 \pm 0.2 \times 10^{ - 10} \Delta (0)/\Delta (T)\] sec for T - T _c; the data at all temperatures have been compared with the calculations by Chang. The attempt to measure % MathType!MTEF!2!1!+-% feaafiart1ev1aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn% hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr% 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9% vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x% fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaeqiXdq3aaS% baaSqaaGqaaiaa-ffacaWFQaaabeaaaaa!3964!\[\tau _{Q*} \] in Pb near T _c is discussed and data are presented for V _d ^S for Pb.Supported by grants from the Research Corporation and the National Science Foundation (DMR 74-23661).     

Critical currents of SNS junctions with Cu:Mn and Cu:Ni barriers

Critical supercurrent densities j _c have been measured for Pb-Cu₉₁Ni₉-Pb and Pb-Cu_99.8Mn_0.2-Pb junctions over the temperature range 1.3<T<4.2K. Diffraction patterns for the junctions indicate highly uniform current densities in the non-self-field-limited regime. The data for the Cu:Ni barriers provide some indication of a spin-flip depairing temperature% MathType!MTEF!2!1!+-% feaafeart1ev1aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn% hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr% 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9% vqaqpepm0xbba9pwe9Q8fs0-qqaqpepae9pg0FirpepeKkFr0xfr-x% fr-xHapdbiqaaeGaciGaaiaabeqaamaabaabaaGcbaGaeqySdeMaey% ypa0JaeS4dHGMaai4laiaaikdacqaHapaCcaWGRbWaaSbaaSqaaiaa% dkeadaahaaadbeqaaiabes8a0naaBaaabaGaam4CaaqabaaaaaWcbe% aakiabgIKi7kaaiodacaqGGaacbaGaa83saaaa!4613!\[\alpha = \hbar /2\pi k_{B^{\tau _s } } \approx 3{\rm{ }}K\]and the data for Cu:Mn provide some indication of an 15 K; the measured supercurrent densities, however, are only approximately represented by the derived expression % MathType!MTEF!2!1!+-% feaafeart1ev1aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn% hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr% 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9% vqaqpepm0xbba9pwe9Q8fs0-qqaqpepae9pg0FirpepeKkFr0xfr-x% fr-xHapdbiqaaeGaciGaaiaabeqaamaabaabaaGcbaacbaGaa8NAam% aaBaaaleaacaWFdbaabeaakiaacIcacaWFubGaaiykaiabg2da9iaa% -jeaieGacaGFLbGaa4hEaiaa+bhacaGF7bGaeyOeI0Iaeq4SdCMaai% ikaiaa-rfacqGHRaWkcqaHXoqycaGGPaGaai4laiaa-rfadaWgaaWc% baGaa83qaaqabaGcdaahaaWcbeqaaiaaigdacaGGVaGaaGOmaaaaki% aac2faaaa!4CEE!\[j_C (T) = Bexp\{ - \gamma (T + \alpha )/T_C ^{1/2} ]\]. The data for Cu:Mn fit the empirically determined % MathType!MTEF!2!1!+-% feaafeart1ev1aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn% hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr% 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9% vqaqpepm0xbba9pwe9Q8fs0-qqaqpepae9pg0FirpepeKkFr0xfr-x% fr-xHapdbiqaaeGaciGaaiaabeqaamaabaabaaGcbaacbaGaa8NAam% aaBaaaleaacaWFJbaabeaakiaacIcacaWFubGaaiykaiabg2da9iaa% dQgacaGGOaGaaGimaiaacMcaieGacaGFLbGaa4hEaiaa+bhacaGGBb% GaeyOeI0IaeqOSdiMaaiikaiaa-rfacaGGVaGaa8hvamaaBaaaleaa% caWGJbaabeaakiaacMcadaahaaWcbeqaaiaaiodacaGGVaGaaGOmaa% aakiaac2faaaa!4CD0!\[j_c (T) = j(0)exp[ - \beta (T/T_c )^{3/2} ]\]much better; there is, however, no apparent theoretical basis for this expression. The measured junction resistances are 50% higher than the values implied by the measured resistivity of the barrier material for both the Cu:Ni and the Cu:Mn; this excess resistance is presumably contributed by the two S-N interfaces.Work supported by the Atomic Energy Commission and by NSF Grant DMR 74-23661.