Randomised trial of educational visits to enhance use of systematic reviews in 25 obstetric units

OBJECTIVE: To evaluate the effectiveness of an educational visit to help obstetricians and midwives select and use evidence from a Cochrane database containing 600 systematic reviews. DESIGN: Randomised single blind controlled trial with obstetric units allocated to an educational visit or control group. SETTING: 25 of the 26 district general obstetric units in two former NHS regions. SUBJECTS: The senior obstetrician and midwife from each intervention unit participated in educational visits. Clinical practices of all staff were assessed in 4508 pregnancies. INTERVENTION: Single informal educational visit by a respected obstetrician including discussion of evidence based obstetrics, guidance on implementation, and donation of Cochrane database and other materials. MAIN OUTCOME MEASURES: Rates of perineal suturing with polyglycolic acid, ventouse delivery, prophylactic antibiotics in caesarean section, and steroids in preterm delivery, before and 9 months after visits, and concordance of guidelines with review evidence for same marker practices before and after visits. RESULTS: Rates varied greatly, but the overall baseline mean of 43% (986/2312) increased to 54% (1189/2196) 9 months later. Rates of ventouse delivery increased significantly in intervention units but not in control units; there was no difference between the two types of units in uptake of other practices. Pooling rates from all 25 units, use of antibiotics in caesarean section and use of polyglycolic acid sutures increased significantly over the period, but use of steroids in preterm delivery was unchanged. Labour ward guidelines seldom agreed with evidence at baseline; this hardly improved after visits. Educational visits cost pound860 each (at 1995 prices). CONCLUSIONS: There was considerable uptake of evidence into practice in both control and intervention units between 1994 and 1995. Our educational visits added little to this, despite the informal setting, targeting of senior staff from two disciplines, and donation of educational materials. Further work is needed to define cost effective methods to enhance the uptake of evidence from systematic reviews and to clarify leadership and roles of senior obstetric staff in implementing the evidence.     

Ethical and practical issues involved in behavioral pharmacology research that administers drugs of abuse to human volunteers

Researchers carrying out non-therapeutic research that involves the administration of drugs of abuse to human volunteers can be faced with many ethical and practical questions. The history of this type of research is relatively brief, with little in the way of published information relevant to carrying out behavioral pharmacological research with human participants. The aim of this article is to raise issues that occur in most studies of this type and to provide solutions that we have found acceptable and which have been approved by a variety of institutions and regulatory agencies. Clearly, there are other approaches that would work equally as well, and we are not attempting to provide 'the' answer to many of the issues raised. We believe that raising these issues and providing our perspectives is important for stimulating others to discuss them and for all of us to strive, where possible, to reach a consensus concerning ethical practices and to become aware of gaps and pitfalls. The topics discussed range from the nuts and bolts of acquiring and keeping track of drugs, to selecting research participants and designing ethical studies that protect our volunteers while still collecting scientifically useful data.     

Directions for improving manual fire suppression using a physically based computer simulation

The Swedish Fire Research Board and the U.S. Federal Emergency Management Agency are sponsoring a project to further the understanding of the basic mechanisms involved, as well as to support the development of standards for and to seek ways of improving the performance of portable fire suppression systems used by fire departments.This paper describes a physically based computer model developed to simulate one aspect of the problem: the manual suppression of postflashover fires. This includes: (1) an overview of the physical basis behind the model; (2) a comparison of model predictions with available experimental data, and (3) an analysis of fire suppression effectiveness using the model.The analysis concludes that, when direct access and extinguishment of the burning fuel is not possible, improved fire control occurs with water sprays having a Rosin-Rammler distribution of droplet sizes with volume-median-drop diameters in the 0.15 to 0.35 mm range. This agrees with available experimental data. It is also shown that fire fighting venting and standoff distance requirements may lead to more severe fires requiring more water for control; although venting and water spray induced air/gas flow also serve to channel hot steam and gases away from the fire fighter adding to his safety. The analysis also shows that allowing higher gas and surface temperatures at fire control through improved fire fighter protective clothing and equipment design reduces water flow rate requirements. Additional experimental work is recommended before all these conclusions are considered definitive. Reference: L. M. Pietrzak and G. A. Johanson, Directions for Improving Manual Fire Suppression Using a Physically Based Computer Simulation,Fire Technology, Vol. 22, No. 3, August, 1986, p. 184.     

Interactive Workspaces

We are rapidly entering a world in which people equip themselves with a small constellation of mobile devices and pass through environments rich in embedded technology. However, we are still a long way from harnessing the power of this technology in a way that seamlessly and invisibly assists users in their day-to-day activities. Bringing pervasive computing to maturity requires innovations in systems integration and human-computer interaction (HCI). To investigate these challenges, Stanford University's Interactive Workspaces project (http://iwork.stanford.edu/) is exploring team-based collaboration in technology-augmented environments. These workspaces are designed to allow groups of five to ten people to work together using computing and interaction devices on many scales.     

Intravenous cocaine discrimination in humans.

Ten cocaine-dependent participants were trained to discriminate between intravenous saline and 20 mg/70 kg cocaine. During the first session, saline and cocaine injections were alternated twice, with each separated by 1 hr. The injections were identified by letter codes. During the next 3 sessions, 12 trials were conducted, with saline and cocaine administered 6 times each in pseudorandom order. Thirty minutes following each injection, participants were asked to identify the injection by letter code. Seven of the 10 learned the discrimination (at least 10 trials correct). To evaluate sensitivity, the investigators tested participants with different doses of cocaine in test sessions. In the next phase, methamphetamine (5 and 10 mg/70 kg) and pentobarbital (50 and 100 mg/70 kg) were given intravenously during test sessions to determine whether the discrimination exhibited pharmacological class selectivity. During the evaluation of sensitivity and selectivity, training sessions were interspersed. As dose of cocaine increased, the number of participants identifying the test dose as cocaine increased, demonstrating sensitivity. The higher doses of methamphetamine and pentobarbital substituted for cocaine. The physiological and subjective effects of cocaine and methamphetamine were stimulant-like and dose related. Pentobarbital produced no physiological changes but increased Visual Analog Scale ratings of Sedation, Good Drug Effect, and High. This failure to demonstrate pharmacological selectivity may be related to participants' learning a drug-vs.-no-drug discrimination, and thus it may be necessary to alter training procedures in future studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of vancomycin-resistant Enterococcus faecium infections with an investigational streptogramin antibiotic (quinupristin/dalfopristin): a report of fifteen cases

OBJECTIVE: Previous studies of surgical treatment for acromegaly have used varied criteria for 'cure', but elevated GH levels are considered to be associated with continuing disease activity. We wished to analyse the results of transsphenoidal pituitary surgery for acromegaly and assess the longer-term outcome for patients not offered further treatment when post-operative levels of GH < 5 mU/l were achieved. DESIGN: We studied a retrospective group of patients who underwent transsphenoidal surgery for acromegaly at St Bartholomew's Hospital between 1985 and 1993. PATIENTS: One hundred consecutive patients (53 male, mean age 46 years, range 18-68 years) undergoing transsphenoidal surgery for acromegaly were assessed. The patients were followed for a mean of 3.8 years (range 0.5-8 years) after operation. MEASUREMENTS: GH levels are represented as a mean value from a four-point day curve taken at 0830, 1300, 1700 and 1900 h. ACTH reserve was assessed basally and, if this was normal, with the insulin tolerance or glucagon tests. TSH, T4, PRL, LH, FSH, testosterone or oestradiol and plasma and urine osmolality were also measured. RESULTS: Post-operatively, 42% of patients achieved a mean GH level of < 5 mU/l. The success of surgery was related to the preoperative GH level; 65% of the patients with preoperative GH levels < 20 mU/l but only 18% of the patients with GH levels > 100 mU/l achieved post-operative GH values < 5 mU/l. In addition, tumour size influenced the outcome of surgery with 61% of patients with a microadenoma but only 23% of patients with a macroadenoma achieving post-operative GH levels of < 5 mU/l. Of the 42 patients considered in remission post-operatively (mean GH < 5 mU/l), 32 were available for long-term follow-up and were not offered any further treatment: only one of these has shown evidence of mild biochemical recurrence after a mean follow-up of 3.8 years (range 0.5-8). There were no peri-operative deaths. Two patients required surgical repair for CSF leaks and there were eight documented cases of meningitis. Permanent diabetes insipidus was noted in eight patients post-operatively. New anterior pituitary deficiency occurred in 21% of patients following surgery; 73% had unaltered pituitary function and in 6% recovery of partial hypopituitarism was noted. CONCLUSIONS: The stated outcome of surgery depends on the criteria adopted. Safe GH levels (mean levels < 5 mU/l) can be achieved in 42% of an unselected series of patients with acromegaly and if the tumour is a microadenoma this figure rises to 61%. Based on the current evidence it is safe not to offer further treatment to those patients in whom post-operative GH < 5 mU/l are achieved.     

137Cs in the fungal compartment of Swedish forest soils

The (137)Cs activities in soil profiles and in the mycelia of four ectomycorrhizal fungi were studied in a Swedish forest in an attempt to understand the mechanisms governing the transfer and retention of (137)Cs in forest soil. The biomass of four species of fungi was determined and estimated to be 16 g m(-2) in a peat soil and 47-189 g m(-2) in non-peat soil to the depth of 10 cm. The vertical distribution was rather homogeneous for two species (Tylospora spp. and Piloderma fallax) and very superficial for Hydnellum peckii. Most of the (137)Cs activity in mycelium of non-peat soils was found in the upper 5 cm. Transfer factors were quite high even for those species producing resupinate sporocarps. In the peat soil only approximately 0.3% of the total (137)Cs inventory in soil was found in the fungal mycelium. The corresponding values for non-peat soil were 1.3, 1.8 and 1.9%.     

Integrating information appliances into an interactive workspace

The authors present a robust, infrastructure-centric, and platform-independent approach to integrating information appliances into the iRoom, an interactive workspace. The Interactive Workspaces Project at Stanford explores new possibilities for people to work together in technology-rich spaces with computing and interaction devices on many different scales. It includes faculty and students from the areas of graphics, human-computer interaction (HCI), networking, ubiquitous computing, and databases, and draws on previous work in all those areas. We design and experiment with multidevice, multiuser environments based on a new architecture that makes it easy to create and add new display and input devices, to move work of all kinds from one computing device to another, and to support and facilitate group interactions. In the same way that today's standard operating systems make it feasible to write single-workstation software that uses multiple devices and networked resources, we are constructing a higher level operating system for the world of ubiquitous computing. We combine research on infrastructure (ways of flexibly configuring and connecting devices, processes, and communication links) with research on HCI (ways of interacting with heterogeneous changing collections of devices with multiple modalities)     

Non-positive autoimmune responses against CYP2E1 in refrigeration mechanics exposed to halogenated hydrocarbons

The aim of the study was to determine if occupational exposure to hydrofluorocarbons (HFC) and hydrochlorofluorocarbons (HCFC) generates autoimmune responses against CYP2E1. HFCs and HCFCs have replaced the chlorofluorocarbons (CFC) in e.g. refrigeration installations and air-conditioning systems. During the substitution period, refrigeration mechanics reported symptoms like asthma, influenza-like reactions, and joint troubles. These symptoms resemble those of chronic inflammatory diseases with an autoimmune component. Since exposure to structurally similar chemicals, e.g. halothane, has previously been associated with autoimmune responses and diseases, autoimmunity among the refrigeration mechanics might hypothetically explain the reported inflammatory symptoms. Serum from 44 Swedish men, occupationally exposed to halogenated hydrocarbons, was screened for antibodies against CYP2E1 with enzyme-linked immunosorbent assay. Thirty of the workers had asthma, joint problems or influenza-like symptoms whereas 14 of them had no such symptoms. They were all selected from a cohort of 280 refrigeration mechanics. Unexposed, healthy, Swedish men (n=35) constituted control group. The study was approved by the Ethics Committee at Karolinska Institutet. No increase in autoantibodies against CYP2E1 was detected among the occupationally exposed workers as compared to the unexposed controls. Further, there was no difference in antibody titer between the exposed workers with symptoms and the exposed, asymtomatic workers or the unexposed controls. The present study does not completely exclude a connection between exposure and effect but makes the relation less likely at these exposure levels.