What influences patients' reports of three aspects of hospital services?

OBJECTIVES: Market forces make it essential to know what policies and actions influence patients' reports of hospital services. No studies have examined the role of patient characteristics, labor quality and staff characteristics, nonlabor resources, managerial practices, and employee attitudes within a single investigation. METHODS: The authors collected, simultaneously, data about labor, management and service processes, nonlabor resources, and employee attitudes on 117 nonintensive medical-surgical inpatient units in 17 hospitals selected from a pool of 69 institutions within a metropolitan area by a stratified random sample. Of the 2,595 patients who agreed to participate, 2,051 (79%) completed telephone interviews regarding their experiences with physical care, education, and pain management services within 26 days of hospital discharge. RESULTS: A significant amount of variation in patients' service reports was explained (adjusted R2 = 0.41 physical care, 0.35 pain management, 0.44 education). Although the predictors varied for each service report, patient characteristics, especially those related to personal resources, had a large explanatory role. A labor assignment pattern that could explain why earlier studies found labor quality and staff characteristics to have only a weak role in the prediction of patients' service reports was noted. CONCLUSIONS: The results related to patient characteristics may indicate opportunities to improve care by confronting service design strategies that erroneously rely on a homogeneous patient population. Measurement challenges identified by this study must be addressed to determine the role of labor quantity and staff characteristics.     

Dynamics of ion beam modification of polymer films

Thin polymer films were irradiated in a high vacuum environment with energetic (～2 MeV) ions. The emitted molecular species were studied with a quadrupole mass spectrometer during bombardment. The emitted species are predominantly small molecules. The efficiency of emission depends strongly upon the electronic energy loss of the incident ions in the film and, hence, upon the velocity and atomic number of the incident ion. The emission efficiency of all species decreases with increasing damage in the film. By pulsing the ion beam, the time dependence of irradiation induced emission of molecular species from the films has been studied. Emission delays of hundreds of milliseconds are observed in some cases. These delays are found to depend upon the emitted species as well as the host film and seem to be associated with diffusion of the species in the films.     

Open Questions in Cold Atmospheric Plasma Treatment in Head and Neck Cancer: A Systematic Review

Over the past decade, we witnessed a promising application of cold atmospheric plasma (CAP) in cancer therapy. The aim of this systematic review was to provide an exhaustive state of the art of CAP employed for the treatment of head and neck cancer (HNC), a tumor whose late diagnosis, local recurrence, distant metastases, and treatment failure are the main causes of patients’ death. Specifically, the characteristics and settings of the CAP devices and the in vitro and in vivo treatment protocols were summarized to meet the urgent need for standardization. Its molecular mechanisms of action, as well as the successes and pitfalls of current CAP applications in HNC, were discussed. Finally, the interesting emerging preclinical hypotheses that warrant further clinical investigation have risen. A total of 24 studies were included. Most studies used a plasma jet device (54.2%). Argon resulted as the mostly employed working gas (33.32%). Direct and indirect plasma application was reported in 87.5% and 20.8% of studies, respectively. In vitro investigations were 79.17%, most of them concerned with direct treatment (78.94%). Only eight (33.32%) in vivo studies were found; three were conducted in mice, and five on human beings. CAP showed pro-apoptotic effects more efficiently in tumor cells than in normal cells by altering redox balance in a way that oxidative distress leads to cell death. In preclinical studies, it exhibited efficacy and tolerability. Results from this systematic review pointed out the current limitations of translational application of CAP in the urge of standardization of the current protocols while highlighting promising effects as supporting treatment in HNC.     

A Rapid and Eco-Friendly Method for Determination of Hydrolysable Tannins and Its Application to Honey Samples

This paper describes the development of a rapid and clean method for the determination of hydrolysable tannins in honey samples, focusing on an easy and green sample pretreatment and low generation of waste. The proposed method is based on the reaction between KIO₃ and hydrolysable tannin compounds in acetate buffer medium (pH 4.75), with formation of a colored product measured at 525 nm. The analytical conditions were optimized using experimental design (central composite design). The linear range obtained was 40.0–740 mg L^?1 (r?=?0.998), and the detection (LOD) and quantification (LOQ) limits were 12.2 and 40.8 mg L^?1, respectively. Acetate buffer was used to ensure formation of the colored product obtained by reaction between the chromogenic reagent and the analyte. The method showed good results when applied to honey samples, with recoveries in the range of 78.3–96.1 %, and the use of diffuse reflectance spectroscopy coupled with spot test analysis provided low reagent consumption and minimized waste generation. The results obtained with the proposed method were confirmed by a spectrophotometric method.     

Topical safety and vasoconstrictive assay-based bioequivalence of a new reformulated mometasone cream

Objectives: A new improved mometasone furoate (Elocon?) cream with an emulsification system that produces a stable emulsion has been developed. In order to register the product in various markets, it was essential to ensure the cream was topically well tolerated and that it was bioequivalent to the reference product.

Methods: Phase I clinical studies were performed to assess the local safety and tolerability upon multiple dosing of this new cream as well as to assess the single-dose bioequivalence relative to the marketed product. Bioequivalence was assessed using a vasoconstrictive assay (VCA) after a dose-duration pilot study was completed with the marketed Elocon cream.

Key findings: The new mometasone cream and its vehicle were nonirritating in healthy subjects during 21-day patch application (MCII <0.025). The positive control was moderately irritating in the same study. The pivotal VCA study enrolled 162 subjects with 105 detectors included in the analysis of bioequivalence. In the 105 detectors, the ratio (×100%) of AUEC values at ED₅₀ for test vs. standard (90% CI) was 112.91% (105.55, 120.87), within the bioequivalence criteria of (80, 125).

Conclusions: These studies supported the registration of reformulated mometasone cream in various markets.     

The membrane-cytoplasm interface of integrin alpha subunits is critical for receptor latency

Localization of integrin receptors to focal contact sites occurs upon ligand binding. This activity is latent, since unoccupied integrin receptors do not localize to focal contacts. Deletion analysis has revealed that the alpha cytoplasmic domains is required for the maintenance of integrin receptor latency. Our current hypothesis for the mechanism of integrin post-ligand binding events is that there is a change in relationship of alpha and beta cytoplasmic domains, which overcomes receptor latency. One possible mechanism for such a change would involve the amino acid residues at the membrane-cytoplasm interface. To test this hypothesis, we have produced point mutations in the human integrin alpha 1 subunit. These mutations had no effect on the adhesion via alpha 1 beta 1 to its ligand, collagen IV. However, receptor latency is lost in one of these mutants, leading to constitutive focal contact localization. This effect did not occur in receptors with an exchange of intracellular domains, suggesting that the mechanism of loss of latency involves a relative motion of the integrin chains. These results suggest a model in which post-ligand binding events in integrin receptors are associated with changes in the position of the alpha and beta cytoplasmic domains.     

Analog network testability measurement: a symbolic formulationapproach

A symbolic formulation approach is applied to the problem of computing testability features of analog linear networks. The program, SAPTES, obtained by following this approach is presented. The program can be a very useful tool for designers and researchers in the field of linear analog circuits. SAPTES, which is written in LISP and runs on MS-DOS personal computers, is able to compute the testability of linear circuits of rather high complexity (composed of tens of components and nodes). Computational times range from a few tens of seconds to some tens of minutes on medium speed computers. The program is easily transportable to workstations or a mainframe, and, for the mainframe, program performance will considerably increase     

Integrin receptor signaling: the propagation of an alpha-helix model

Improper assessment and treatment of asthma attacks have been identified as causes of increased morbidity and mortality: several pneumological societies have therefore created and published guidelines for facilitating decision making and for preventing unnecessary failures of therapy. The objective of this study was to examine emergency department compliance with such guidelines in our hospital, comparing the performance of pneumologists and other specialists. We reviewed the records of 117 patients treated for acute asthma attacks in 1994 (87 women and 30 men, mean age 46 years); 37 patients were treated by pneumologists and 80 by other specialists. The two physician groups differed significantly with respect to initial assessment of severity, particularly in the recording of vital signs (p < 0.05) and in the examination of some signs such as the use of accessory musculature (38% versus 10%, for pneumologists and other specialists, respectively) or the presence of cyanosis (81% versus 55%). Other factors associated with risk of death were noted only occasionally. Peak flow meters were used with only 5 patients, all examined by pneumologists; on the other hand, arterial blood samples for gasometric measurements were taken from 97%, although only 24% met the criteria stipulated in the guidelines. Treatment evaluated against the guidelines was incorrect in 24%, with no significant differences between pneumologists and other specialists. We conclude that: 1) the emergency clinical assessment and treatment of patients presenting with acute asthma attack is inadequate for a large proportion of patients, as the recommendations of consensual guidelines are habitually ignored, and 2) although there are differences in the management of these patients by pneumologists and other emergency room specialists, the former do not generally do a better job of following the guidelines.     

Automated selection of test frequencies for fault diagnosis in analog electronic circuits

This paper suggests three novel methods for selecting the frequencies of sinusoidal test signals to be used in fault diagnosis of analog electronic circuits. The first and second methods are based on a sensitivity analysis and show to be particularly effective in linear circuits where a priori information and designer experience can be exploited. Conversely, the third method selects the input frequencies to be used for diagnostic purposes without requiring any hypothesis about the circuit or testing design background. As such, the method is particularly appealing in complex -possibly nonlinear - circuits where the designer experience is of little value and an effective "blind" approach saves both designer and testing time. The suggested frequency selection methods are then contrasted to each other against performance and computational complexity.