Selection of Postacute Stroke Rehabilitation Facilities: A Survey of Discharge Planners From the Northeast Cerebrovascular Consortium (NECC) Region.

The process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.

Accidentes en trabajadores ganaderos en Santa Fe, Argentina

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Intracellular fate of bioresponsive poly(amidoamine)s in vitro and in vivo

Linear poly(amidoamine)s (PAAs) have been designed to exhibit minimal non-specific toxicity, display pH-dependent membrane lysis and deliver genes and toxins in vitro. The aim of this study was to measure PAA cellular uptake using ISA1-OG (and as a reference ISA23-OG) in B16F10 cells in vitro and, by subcellular fractionation, quantitate intracellular trafficking of (125)I-labelled ISA1-tyr in liver cells after intravenous (i.v.) administration to rats. The effect of time after administration (0.5-3h) and ISA1 dose (0.04-100mg/kg) on trafficking, and vesicle permeabilisation (N-acetyl-b-D-glucosaminidase (NAG) release from an isolated vesicular fraction) were also studied. ISA1-OG displayed approximately 60-fold greater B16F10 cell uptake than ISA23-OG. Passage of ISA1 along the liver cell endocytic pathway caused a transient decrease in vesicle buoyant density (also visible by TEM). Increasing ISA1 dose from 10mg/kg to 100mg/kg increased both radioactivity and NAG levels in the cytosolic fraction (5-10 fold) at 1h. Moreover, internalised ISA1 provoked NAG release from an isolated vesicular fraction in a dose-dependent manner. These results provide direct evidence, for the first time, of PAA permeabilisation of endocytic vesicular membranes in vivo, and they have important implications for potential efficacy/toxicity of such polymeric vectors.

Kinetic studies of the effect of varnish on water loss by glass-ionomer cements

OBJECTIVES: This paper reports a study of the water loss behaviour of two commercial glass-ionomer cements coated with varnishes. METHODS: For each cement (Fuji IX Fast or Chemflex), specimens (6mmdiameterx2mm depth) were prepared and cured for 10min at 37 degrees C. They were exposed to a desiccating environment over H(2)SO(4) either uncoated or coated with the appropriate varnish (Fuji Varnish, a solvent-based lacquer, or Fuji Coat, a light-cured varnish). Four specimens were prepared for each material. They were weighed at hourly intervals for 6h, daily for up to 5 days, then weekly thereafter until equilibration. RESULTS: Unlike the uncoated specimens, water loss from varnished cements was not Fickian, but followed the form: mass loss=A/t+B, where t is time, A and B are constants specific to each cement/varnish combination. A varied from 1.22 to 1.30 (mean 1.26, standard deviation 0.04), whereas B varied from 1.54 to 2.09 (mean -1.83, standard deviation 0.29). At equilibrium, varnished specimens lost much less water than unvarnished ones (p>0.01) but there was no significant difference between the solvent-based and the light-cured varnishes. SIGNIFICANCE: Varnishes protect immature glass-ionomer cements from drying out by altering the mechanism of water loss. This slows the rate of drying but does not necessarily change the total amount of water retained. It confirms that, in clinical use, glass-ionomer restoratives should be varnished to allow them to mature satisfactorily.

Coccolithophore species as indicators of surface oceanographic conditions in the vicinity of Azores islands

During summer 2008 and spring 2009, surface oceanographic surveys were carried out around three islands of the Azores archipelago (Terceira, Sao Miguel and Santa Maria) to assess the phytoplankton distribution and associated physico-chemical processes. The Azores archipelago is a major feature in the biogeochemical North Atlantic Subtropical Gyre (NAST) province although its influence on the productivity of the surrounding ocean is poorly known. Surface phytoplankton was studied by microscopy and HPLC (High Precision Liquid Chromatography). The mean values for biomass proxy Chlorophyll a (Chla) ranged from 0.04 to 0.55 mu g L-1 (Chla maximum = 0.86 mu g L-1) and coccolithophores were the most abundant group, followed by small flagellates, Cyanobacteria, diatoms and dinoflagellates being the least abundant group. The distribution of phytoplankton and coccolithophore species in particular presented seasonal differences and was consistent with the nearshore influence of warm subtropical waters from the south Azores current and colder subpolar waters from the north. The satellite-derived circulation patterns showed southward cold water intrusions off Terceira and northward warm water intrusions off Santa Maria. The warmer waters signal was confirmed by the subtropical coccolithophore assemblage, being Discosphaera tubifera a constant presence under these conditions. The regions of enhanced biomass, either resulting from northern cooler waters or from island induced processes, were characterized by the presence of Emiliania huxleyi. Diatoms and dinoflagellates indicated coastal and regional processes of nutrient enrichment and areas of physical stability, respectively.

Indications of a negative impact of herring on recruitment of Norway pout

The Norway pout (Trisopterus esmarkii) stock in the North Sea has experienced poor recruitment recently. Herring (Clupea harengus) has been suggested to be a major predator on fish larvae in the North Sea. We investigated possible interactions between herring and Norway pout using a simple statistical analysis and a modified stock - recruit relationship. There was a significant negative relationship (linear regression, r = 20.44, p < 0.05) between total herring biomass and recruitment of Norway pout. The spawning stock of Norway pout is typically dominated by 2-year-olds, and there was a strong negative relationship (linear regression, r = 20.79, p < 0.01) between herring biomass and Norway pout spawning-stock biomass (SSB) 2 years later. A Beverton-Holt model fitted to stock recruit data of Norway pout produced a rather poor correlation (r(2) = 0.04). However, when only the Norway pout SSB not overlapping with herring is considered, the fit between the model and the stock - recruit data improves (r(2) = 0.31). The analyses indicate a negative impact by herring on recruitment of Norway pout, the most plausible cause for this being herring predation on Norway pout larvae, but field studies are needed to verify such predation.

Influence of climate change and trophic coupling across four trophic levels in the Celtic Sea

Climate change has had profound effects upon marine ecosystems, impacting across all trophic levels from plankton to apex predators. Determining the impacts of climate change on marine ecosystems requires understanding the direct effects on all trophic levels as well as indirect effects mediated by trophic coupling. The aim of this study was to investigate the effects of climate change on the pelagic food web in the Celtic Sea, a productive shelf region in the Northeast Atlantic. Using long-term data, we examined possible direct and indirect ‘bottom-up’ climate effects across four trophic levels: phytoplankton, zooplankton, mid-trophic level fish and seabirds. During the period 1986–2007, although there was no temporal trend in the North Atlantic Oscillation index (NAO), the decadal mean Sea Surface Temperature (SST) in the Celtic Sea increased by 0.66±0.02°C. Despite this, there was only a weak signal of climate change in the Celtic Sea food web. Changes in plankton community structure were found, however this was not related to SST or NAO. A negative relationship occurred between herring abundance (0- and 1-group) and spring SST (0-group: p = 0.02, slope = −0.305±0.125; 1-group: p = 0.04, slope = −0.410±0.193). Seabird demographics showed complex species–specific responses. There was evidence of direct effects of spring NAO (on black-legged kittiwake population growth rate: p = 0.03, slope = 0.0314±0.014) as well as indirect bottom-up effects of lagged spring SST (on razorbill breeding success: p = 0.01, slope = −0.144±0.05). Negative relationships between breeding success and population growth rate of razorbills and common guillemots may be explained by interactions between mid-trophic level fish. Our findings show that the impacts of climate change on the Celtic Sea ecosystem is not as marked as in nearby regions (e.g. the North Sea), emphasizing the need for more research at regional scales.

Zooplankton response to a warmer northern Wadden Sea

Weekly measurements of mesozooplankton (>76 mu m) and hydrographic parameters have been carried out since 1984 in the List Tidal Basin (northern Wadden Sea). Monthly water temperature significantly increased by 0.04 degrees C year. The largest increase by 3 degrees C in 22 years occurred in September, implying, an extension of the warm summer period. Mean annual copepod abundance and length of copepod season correlated significantly with mean temperature from January to May. Except for an increasing Acartia sp. abundance during spring (April-May), no longterm trends in copepod abundance were observed. The percentage of carnivorous zooplankton increased significantly since 1984 mainly due to a sudden increase in the cyclopoid copepod Oithona similis in 1997. We expect that global warming will lead to a longer copepod season and higher copepod abundances in the northern Wadden Sea.

The influence of phytoplankton productivity, temperature and environmental stability on the control of copepod diversity in the North East Atlantic

The patterns of copepod species richness (S) and their relationship with phytoplankton productivity, temperature and environmental stability were investigated at climatological, seasonal and year-to-year time scales as well as scales along latitudinal and oceanic–neritic gradients using monthly time series of the Continuous Plankton Recorder (CPR) Survey collected in the North East Atlantic between 1958 and 2006. Time series analyses confirmed previously described geographic patterns. Equatorward and towards neritic environments, the climatological average of S increases and the variance explained by the seasonal cycle decreases. The bi-modal character of seasonality increases equatorward and the timing of the seasonal cycle takes place progressive earlier equatorward and towards neritic environments. In the long-term, the climatological average of S decreased significantly (p < 0.001) between 1958 and 2006 in the Bay of Biscay and North Iberian shelf at a rate of ca. 0.04 year−1, and increased at the same rate between 1991 and 2006 in the northernmost oceanic location. The climatological averages of S correlate positively with those of the index of seasonality of phytoplankton productivity (ratio between the minimum and maximum monthly values of surface chlorophyll) and sea surface temperature, and negatively with those of the proxy for environmental stability (monthly frequency of occurrence of daily averaged wind speed exceeding 10 m s−1). The seasonal cycles of S and phytoplankton productivity (surface chlorophyll as proxy) exhibit similar features in terms of shape, timing and explained variance, but the relationship between the climatological averages of both variables is non-significant. From year-to-year, the annual averages of S correlate negatively with those of phytoplankton productivity and positively with those of sea surface temperature along the latitudinal gradient, and negatively with those of environmental stability along the oceanic–neritic gradient. The annual anomalies of S (i.e. factoring out geographic variation) show a unimodal relationship with those of sea surface temperature and environmental stability, with S peaking at intermediate values of the anomalies of these variables. The results evidence the role of seasonality of phytoplankton productivity on the control of copepod species richness at seasonal and climatological scales, giving support to the species richness–productivity hypothesis. Although sea surface temperature (SST) is indeed a good predictor of richness along the latitudinal gradient, it is unable to predict the increase of richness form oceanic to neritic environments, thus lessening the generality of the species richness–energy hypothesis. Meteo-hydrographic disturbances (i.e. SST and wind speed anomalies as proxies), presumably through its role on mixed layer depth dynamics and turbulence and hence productivity, maximise local diversity when occurring at intermediate frequency and or intensity, thus providing support to the intermediate disturbance hypothesis on the control of copepod diversity.

An estimate of the global emissions of methyl bromide from automobile exhausts

An estimate of the annual global methyl bromide (CH3Br) emissions from automobile exhausts has been determined by extrapolating the results of a field study conducted in the United Kingdom (UK). A strong linear correlation was observed between the CH3Br and carbon monoxide (CO) concentrations of roadside air in three cities. This correlation and knowledge of the UK CO emissions was used to estimate the source strength of CH3Br from automobile exhausts in the UK (0.04 ktonnes yr−1). Further extrapolations lead to a value of 1.5 ktonnes yr−1 (with an upper limit of 3.0 ktonnes yr−1) of CH3Br released globally to the atmosphere from automobile exhausts.

The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: A quasi-experimental study

Background:
Internationally, nurse-directed protocolised-weaning has been evaluated by measuring its impact on patient outcomes. The impact on nurses’ views and perceptions has been largely ignored.

Aim:
To determine the change in intensive care nurses’ perceptions, satisfaction, knowledge and attitudes following the introduction of nurse-directed weaning. Additionally, views were obtained on how useful protocolised-weaning was to practice.

Methods:
The sample comprised nurses working in general intensive care units in three university-affiliated hospitals. Nurse-directed protocolised-weaning was implemented in one unit (intervention group); two ICUs continued with usual doctor-led practice (control group). Nurses’ perceptions, satisfaction, knowledge and attitudes were measured by self-completed questionnaires before (Phase I) and after the implementation of nurse-directed weaning (Phase II) in all units.

Results:
Response rates were 79% (n=140n=140) for Phase 1 and 62% (n=132n=132) for Phase II. Regression-based analyses showed that changes from Phase I to Phase II were not significantly different between the intervention and control groups. Sixty-nine nurses responded to both Phase I and II questionnaires. In the intervention group, these nurses scored their mean perceived level of knowledge higher in Phase II (6.39 vs 7.17, p=0.01p=0.01). In the control group, role perception (4.41 vs 4.22, p=0.01p=0.01) was lower and, perceived knowledge (6.03 vs 6.63, p=0.04p=0.04), awareness of weaning plans (6.09 vs 7.06, p=0.01p=0.01) and satisfaction with communication (5.28 vs 6.19, p=0.01p=0.01) were higher in Phase II. The intervention group found protocolised weaning useful in their practice (75%): this was scored significantly higher by junior and senior nurses than middle grade nurses (p=0.02p=0.02).

Conclusion

We conclude that nurse-directed protocolised-weaning had no effect on nurses’ views and perceptions due to the high level of satisfaction which encouraged nurses’ participation in weaning throughout. Control group changes are attributed to a ‘reactive effect’ from being study participants. Weaning protocols provide a uniform method of weaning practice and are particularly beneficial in providing safe guidance for junior staff.

CCD photometry of distant comets II

R band CCD photometric observations of short period Jupiter family comets in the heliocentric region of 2.11 AU less than or equal to R-h less than or equal to 5.63 AU were performed using the 4.2 m William Herschel Telescope on La Palma in December 1998. 22 comets were targeted, including the comet- asteroid transition object 49P/Arend-Rigaux. Out of a total of ten detected comets. six were seen to display substantial outgassing (48P, 65P, 74P, 103Pt 128P, and 139P), with the remaining four comets (7P. 9P, 22P. and 49P) being stellar in appearance. Nuclear radius measurements and relative dust production rates in terms of Af rho were measured for these comets, along with upper limits for the remaining twelve undetected comets (6P, 44P, 51P, 54P, 57P: 63P, 71P, 73P, 79P, 86P, 87P, and 100P). The inactive comets had nuclear radii in the range 1.8 km less than or equal to r(N) less than or equal to 4.4 km, while upper limits for the active and undetected comets (assuming they all lay within the held of view) were between 0.6 km and 12.7 km, for an assumed albedo of 0.04. Even if one applies the previously measured maximum axis ratio of 2.6:1 and the minimum measured albedo of 0.02 to the undetected comets. their projected semi-major axes are all constrained to below 8 km. For the active comets, photometric profiles of their dust comae were measured and are consistent with those of steady state coma models.

The Galactic metallicity gradient

We have previously published intermediate to hi,oh resolution spectroscopic observations of approximately 80 early B-type main-sequence stars situated in 19 Galactic open clusters/associations with Galactocentric distances distributed over 6 less than or equal to R-g less than or equal to 18 kpc. This current study collates and re-analyses these equivalent- width datasets using LTE and non-LTE model atmosphere techniques, in order to determine the stellar atmospheric parameters and abundance estimates for C, N, O, Mg, Al and Si. The latter should be representative of the present-day Galactic interstellar medium. Our extensive observational dataset permits the identification of sub-samples of stars with similar atmospheric parameters and of homogeneous subsets of lines. As such, this investigation represents the most extensive and systematic study of its kind to date. We conclude that the distribution of light elements (CI O, Mg & Si) in the Galactic disk can be represented by a linear, radial gradient of -0.07 +/- 0.01 dex kpc(-1) Our results for nitrogen and oxygen viz. (-0.09 +/- 0.01 dex kpc(-1) and -0.067 +/- 0.008 dex kpc(-1)) are in excellent agreement with that found from the study of HII regions. We have also examined our datasets for evidence of an abrupt discontinuity in the metallicity of the Galactic disk near a Galactocentric distance of 10 kpc (see Twarog et al. 1997). However, there is no evidence to suggest that our data would be better fitted with a two-zone model. Moreover, we observe a N/O gradient of -0.04 +/- 0.02 dex kpc(-1) which is consistent with that found for other spiral galaxies (Vila- Costas gr Edmunds 1993).

The present-day chemical composition of the LMC

High-resolution observations of five OB-type main-sequence stars in the Large Magellanic Cloud (LMC) have been obtained with the UCL echelle spectrograph on the 3.9-m Anglo-Australian Telescope. These spectra have been analysed using LTE model- atmosphere techniques, to derive stellar atmospheric parameters and chemical compositions. As these stars are located within the hydrogen burning main-sequence band, their surface abundances should reflect those of the present-day interstellar medium. Detailed line-by-line differential analyses have been undertaken relative to Galactic comparison stars. We conclude that there exists a general metal deficiency of - 0.31 +/- 0.04 dex within the LMC, and find no significant abundance variations between cluster and field stars. There is also tentative evidence to suggest a lower oxygen to iron abundance ratio, and an over-deficiency of magnesium relative to the other alpha-elements. These are discussed in terms of previous abundance analyses and models of discontinuous (or bursting) star formation within the LMC. Finally, there is some evidence to suggest a greater chemical enrichment of material within the H. region LH104.

Effects of n-3 long chain polyunsaturated fatty acids on depressed mood: Systematic review of published trials.

Background: Greater dietary intakes of n–3 long-chain polyunsaturated fatty acids (n–3 PUFAs) may be beneficial for depressed mood. Objective: This study aimed to systematically review all published randomized controlled trials investigating the effects of n–3 PUFAs on depressed mood. Design: Eight medical and health databases were searched over all years of records until June 2006 for trials that exposed participants to n–3 PUFAs or fish, measured depressed mood, were conducted on human participants, and included a comparison group. Results: Eighteen randomized controlled trials were identified; 12 were included in a meta-analysis. The pooled standardized difference in mean outcome (fixed-effects model) was 0.13 SDs (95% CI: 0.01, 0.25) in those receiving n–3 PUFAs compared with placebo, with strong evidence of heterogeneity (I2 = 79%, P <0.001). The presence of funnel plot asymmetry suggested that publication bias was the likely source of heterogeneity. Sensitivity analyses that excluded one large trial increased the effect size estimates but did not reduce heterogeneity. Metaregression provided some evidence that the effect was stronger in trials involving populations with major depression—the difference in the effect size estimates was 0.73 (95% CI: 0.05, 1.41; P = 0.04), but there was still considerable heterogeneity when trials that involved populations with major depression were pooled separately (I2 = 72%, P <0.001). Conclusions: Trial evidence that examines the effects of n–3 PUFAs on depressed mood is limited and is difficult to summarize and evaluate because of considerable heterogeneity. The evidence available provides little support for the use of n–3 PUFAs to improve depressed mood. Larger trials with adequate power to detect clinically important benefits are required.