Risk factors for a medically inappropriate admission to a Department of Internal Medicine

OBJECTIVE: To identify patient- and admission-related risk factors for a medically inappropriate admission to a department of internal medicine. METHODS: Cross-sectional study of a systematic sample of 500 admissions to the department of internal medicine of an urban teaching hospital. The appropriateness of each admission and reasons for inappropriate admissions were assessed using the Appropriateness Evaluation Protocol. Risk factors included the time (day of week and holidays) and manner (through emergency department or direct admission) of admission, patient age and sex, health status of patient and spouse, living arrangements, formal home care services, and informal support from family or friends. RESULTS: Overall, 76 (15.2%) hospital admissions were rated as medically inappropriate by the Appropriateness Evaluation Protocol. In multivariate analysis, the likelihood of an inappropriate admission was increased by better physical functioning of the patient (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.1 [for 1 SD in Physical Functioning scores]), lower mental health status of the patient's spouse (OR, 2.6; 95% CI, 1.3-5.6), receipt of informal help from family or friends (OR, 3.3; 95% CI, 1.5-7.2), and hospitalization by one's physician (OR, 3.6; 95% CI, 1.7-7.5). Receiving formal adult home care was not associated with inappropriateness of hospitalization. CONCLUSIONS: Inappropriate admissions to internal medicine wards are determined by a mix of factors, including the patient's health and social environment. In addition, the private practitioners' discretionary ability to hospitalize their patients directly may also favor medically inappropriate admissions.     

The ability of the rat to metabolize myristoyl-methionine: an acylamino acid with potentially useful antibacterial properties

Two experiments with Sprague Dawley rats tested their ability to hydrolyse myristoyl-methionine (M-M) into myristic acid and L-methionine (M). In the first experiment, lasting for 3 days. male rats were orally administered [9,10-3H]myristoyl-L-[35S]methionine. The recovery of radioactivity was approximately 90% for both isotopes; 19% of the administered 3H was recovered in the urine and 16% in the faeces, while the recovered 35S activity was 13 and 12%, respectively. The balance of the radioactivity was found among the tissues, organs and blood. In the second experiment, male and female rats received soybean-based diets which were supplemented with either 0.305% M-M or 0.2% M (both diets contained equal amounts of M) for periods up to 4 weeks. The growth rate of the rats receiving the 0.305% M-M diets was slightly slower than that for the rats on the 0.2% M diet, but the difference was not statistically significant (P > 0.05). The M-M rats had a transitory decrease in feed consumption, suggesting that palatability may have contributed to the growth difference and that a somewhat greater amount of M-M was necessary for the rat to attain the same growth rate as that produced by 0.2% M. When the amount of dietary M-M was increased to 3.05% M-M, a greater reduction in feed consumption and body weight gain was observed. This latter diet was an initial attempt to study the potential toxicity of M-M. None of the haematological, clinical chemistry or organ weight data suggested that M-M was overtly toxic per se, but longer-term feeding studies are needed to evaluate the potential toxicity of M-M more fully.     

Kinetic analysis of the coding properties of O6-methylguanine in DNA: the crucial role of the conformation of the phosphodiester bond

Production by N-nitroso compounds of O6-alkylguanine (O6-alkylG) in DNA directs the misincorporation of thymine during DNA replication, leading to G:C to A:T transition mutations, despite the fact that DNA containing O6-alkylG:T base pairs is less stable than that containing O6-alkylG:C pairs. We have examined the kinetics of incorporation by Klenow fragment (KF) of Escherichia coli DNA polymerase I of thymine (T) and of cytosine (C) opposite O6-MeG in the template DNA strand. Both T and C were incorporated opposite O6-MeG much slower than nucleotides forming regular A:T or G:C base pairs. Using various concentrations of dTTP, dCTP, or their phosphorothioate (Sp)-dNTP alpha S analogues, or a mixture of dTTP and dCTP, the progress of incorporation of a single nucleotide in a single catalytic cycle of a preformed KF-DNA complex was measured (pre-steady-state kinetics). The results were consistent with the kinetic scheme (Kuchta, R. D., Benkovic, P., & Benkovic, S. J. (1988) Biochemistry 27, 6716-6725): (1) binding of dNTP to polymerase-DNA; (2) conformational change in polymerase; (3) formation of phosphodiester between the dNTP and the 3'-OH of the primer; (4) conformational change of polymerase; (5) release of pyrophosphate. The results were analyzed mathematically to identify the steps at which the rate constants differ significantly between the incorporation of T and C. The only significant difference was the 5-fold difference in the rates of formation of the phosphodiester bond (for dTTP, kforward = 3.9 s-1 and kback = 1.9 s-1; for dCTP, kforward = 0.7 s-1 and kback = 0.9 s-1). These pre-steady-state progress curves were biphasic with a rapid initial burst followed by an apparently steady-state rise. Deconvolution of these curves gave direct evidence for the importance of the conformational change after polymerization by showing that the curves represented the sum of the rapid accumulation of the product of step 3 followed by the slow conversion of that to the product of step 5 (because of the rapidity of the release of pyrophosphate there was no significant accumulation of the product of step 4). The equilibrium constants for each step suggest that the greatest change in the Gibbs free energy occurs at the conformational change after polymerization and that while the formation of the phosphodiester bond to T is slightly exothermic, that to C is slightly endothermic.(ABSTRACT TRUNCATED AT 400 WORDS)     

A broad line n.m.r. study of oriented poly(vinylidene fluoride)

Broadline nuclear magnetic resonance measurements have been carried out for the proton resonance in oriented poly(vinylidene fluoride). The spectra in general show two component lines with distinctly different line widths. The broad component shows a high degree of molecular orientation and can be satisfactorily assigned to the crystalline regions of the polymer. The narrow component corresponds to an oriented non crystalline phase which is sufficiently constrained to allow motion about the chain axis only. An appreciable decrease in the value of the rigid mass fraction was observed in both of the samples over the temperature range examined. Our calculations indicate that this could play an important role in the temperature dependence of the pyroelectric response of this material.     

Uncooled DBR laser directly Modulated at 3.125 gb/s as athermal transmitter for low-cost WDM systems

An uncooled three-section tunable distributed Bragg reflector laser is demonstrated as an athermal transmitter for low-cost uncooled wavelength-division-multiplexing (WDM) systems with tight channel spacing. A /spl plusmn/0.02-nm thermal wavelength drift is achieved under continuous-wave operation up to 70/spl deg/C. Dynamic sidemode suppression ratio of greater than 35 dB is consistently obtained under 3.125-Gb/s direct modulation over a 20/spl deg/C-70/spl deg/C temperature range, with wavelength variation of as low as /spl plusmn/0.2 nm. This indicates that more than an order of magnitude reduction in coarse WDM channel spacing is possible using this source.     

Contamination of facial memory through exposure to misleading composite pictures.

In Exp I, 46 male and 51 female undergraduates witnessed a filmed incident and later described the target. Results show that Ss who observed a composite containing misleading information (either incorrect hair or an added moustache) were significantly more likely to misreport hairstyle and the presence of a moustache than those who did not. In Exp II, 210 17–65 yr old Ss observed a filmed incident and were tested for their recall and recognition of the target either immediately or after delays of 2 or 7 days. Significant bias, consistent with the content of the misleading composite, was present for both cued recall and choice of mug shot in a photo spread. The effect did not increase over delay but was greater when the composite was seen just prior to recall than immediately after the incident. Implications concerning interference with the memory of the witness who produced the composite and for other witnesses exposed to the misleading composite are discussed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Development of Color Categories in Two Languages: A Longitudinal Study.

This study unites investigations into the linguistic relativity of color categories with research on children's category acquisition. Naming, comprehension, and memory for colors were tracked in 2 populations over a 3-year period. Children from a seminomadic equatorial African culture, whose language contains 5 color terms, were compared with a group of English children. Despite differences in visual environment, language, and education, they showed similar patterns of term acquisition. Both groups acquired color vocabulary slowly and with great individual variation. Those knowing no color terms made recognition errors based on perceptual distance, and the influence of naming on memory increased with age. An initial perceptually driven color continuum appears to be progressively organized into sets appropriate to each culture and language. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A site selection model for high technology manufacturing firms in the United States

This article offers a quantitative model for site selection by high technology manufacturing firms. In the past, site selection studies have usually been qualitative in nature, and very subjective. This is an attempt to introduce a more objective quantitative approach. The site selection factors most important to high technology manufacturing firms were identified, ranked and weighted based on a US Joint Economic Committe survey of such firms. The eight most important factors were: the availability of technical and professional workers, labor costs, tax climate, academic institutions, cost of living, transportation for people, and access to markets. Demographic data on these factors were collected and analyzed for 32 developing high technology areas in the United States. By using the quantitative model, a score was developed for each area, allowing them to be ranked as R & D manufacturing environments. This model should prove a useful tool for both regional planners and high-tech companies seeking to relocate.     

Crystal structure of tyrosine hydroxylase at 2.3 A and its implications for inherited neurodegenerative diseases

Tyrosine hydroxylase (TyrOH) catalyzes the conversion of tyrosine to L-DOPA, the rate-limiting step in the biosynthesis of the catecholamines dopamine, adrenaline, and noradrenaline. TyrOH is highly homologous in terms of both protein sequence and catalytic mechanism to phenylalanine hydroxylase (PheOH) and tryptophan hydroxylase (TrpOH). The crystal structure of the catalytic and tetramerization domains of TyrOH reveals a novel alpha-helical basket holding the catalytic iron and a 40 A long anti-parallel coiled coil which forms the core of the tetramer. The catalytic iron is located 10 A below the enzyme surface in a 17 A deep active site pocket and is coordinated by the conserved residues His 331, His 336 and Glu 376. The structure provides a rationale for the effect of point mutations in TyrOH that cause L-DOPA responsive parkinsonism and Segawa's syndrome. The location of 112 different point mutations in PheOH that lead to phenylketonuria (PKU) are predicted based on the TyrOH structure.