Using postoperative cardiac troponin-I (cTi) levels to detect myocardial ischaemia in patients undergoing vascular surgery

Background, Cardiac complications occur commonly in vascular surgery patients. Diagnosis of cardiac complications is difficult because of the inaccuracies associated with traditional cardiac enzyme measurements. CTi, a highly sensitive and specific marker of myocardial injury, may be able to detect cardiac complications with greater ease and accuracy. Methods. The study prospectively examined 100 consecutive patients who underwent major vascular surgery between 6/7/98 and 31/12/98 at the Royal Brisbane Hospital. Daily measurements of cTi, creatine kinase (CK), creatine kinase MB (CKMB), CKMB index, renal function and haemoglobin were taken for three postoperative days. One postoperative electrocardiograph (ECC) was taken. An extensive cardiac history was taken. Intraoperative and postoperative events were recorded. Findings. There were 100 patients, 18 patients (18%) had a cTi elevation. On the basis of classical diagnostic criteria, 15 patients (15%) suffered one or more cardiac complication (either myocardial infarction, congestive cardiac failure, unstable angina or atrial fibrillation), One patient (1%) who had a cTi elevation died. CTI elevation occurred in five patients (5%) who were not diagnosed with cardiac complications based on traditional criteria. Despite not meeting specific diagnostic criteria for cardiac complications, all patients showed signs and symptoms that could be attributed to myocardial ischaemia, Every patient who developed congestive cardiac failure or atrial fibrillation had a cTi elevation. A Chi-square analysis revealed a significant association between cTi elevation and postoperative cardiac complications. Four variables contributed small but significant amounts of unique variance to the prediction of peak cTi on linear regression analysis. These were peak CKMB index, postoperative congestive cardiac failure, postoperative chest pain and postoperative cardiac complications. Conclusions. Routine cTi monitoring of postoperative vascular patients would be an effective and inexpensive way to detect patients with cardiac complications. The relationship between postoperative cTi elevation and significant coronary artery disease remains to be shown, (C) 2001 The international Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.

The plausibility of long-wavelength stress correlation or stress magnitude as a mechanism for precursory seismicity: Results from two simple elastic models

Observations of accelerating seismic activity prior to large earthquakes in natural fault systems have raised hopes for intermediate-term eartquake forecasting. If this phenomena does exist, then what causes it to occur? Recent theoretical work suggests that the accelerating seismic release sequence is a symptom of increasing long-wavelength stress correlation in the fault region. A more traditional explanation, based on Reid's elastic rebound theory, argues that an accelerating sequence of seismic energy release could be a consequence of increasing stress in a fault system whose stress moment release is dominated by large events. Both of these theories are examined using two discrete models of seismicity: a Burridge-Knopoff block-slider model and an elastic continuum based model. Both models display an accelerating release of seismic energy prior to large simulated earthquakes. In both models there is a correlation between the rate of seismic energy release with the total root-mean-squared stress and the level of long-wavelength stress correlation. Furthermore, both models exhibit a systematic increase in the number of large events at high stress and high long-wavelength stress correlation levels. These results suggest that either explanation is plausible for the accelerating moment release in the models examined. A statistical model based on the Burridge-Knopoff block-slider is constructed which indicates that stress alone is sufficient to produce accelerating release of seismic energy with time prior to a large earthquake.

Rapid diagnosis in pediatric infectious diseases: The past, the present and the future

The focus of rapid diagnosis of infectious diseases of children in the last decade has shifted from variations of the conventional laboratory techniques of antigen detection, microscopy and culture to that of molecular diagnosis of infectious agents. Pediatricians will need to be able to interpret the use, limitations and results of molecular diagnostic techniques as they are increasingly integrated into routine clinical microbiology laboratory protocols. PCR is the best known and most successfully implemented diagnostic molecular technology to date. It can detect specific infectious agents and determine their virulence and antimicrobial genotypes with greater speed, sensitivity and specificity than conventional microbiology methods. Inherent technical limitations of PCR are present, although they are reduced in laboratories that follow suitable validation and quality control procedures. Variations of PCR together with advances in nucleic acid amplification technology have broadened its diagnostic capabilities in clinical infectious disease to now rival and even surpass traditional methods in some situations. Automation of all components of PCR is now possible. The completion of the genome sequencing projects for significant microbial pathogens, in combination with PCR and DNA chip technology, will revolutionize the diagnosis and management of infectious diseases.

Emerging concepts in colorectal neoplasia

An understanding of the mechanisms that explain the initiation and early evolution of colorectal cancer should facilitate the development of new approaches to effective prevention and intervention. This review highlights deficiencies in the current model for colorectal neoplasia in which APC mutation is placed at the point of initiation. Other genes implicated in the regulation of apoptosis and DNA repair may underlie the early development of colorectal cancer. Inactivation of these genes may occur not by mutation or loss but through silencing mediated by methylation of the gene's promoter region. hMLH1 and MGMT are examples of DNA repair genes that are silenced by methylation. Loss of expression of hMLH1 and MGMT protein has been demonstrated immunohistochemically in serrated polyps. Multiple lines of evidence point to a serrated pathway of neoplasia that is driven by inhibition of apoptosis and the subsequent inactivation of DNA repair genes by promoter methylation. The earliest lesions in this pathway are aberrant crypt foci (ACF). These may develop Into hyperplastic polyps or transform while still of microscopic size into admixed polyps, serrated adenomas, or traditional adenomas. Cancers developing from these lesions may show high- or low-level microsatellite instability (MSI-H and MSI-L, respectively) or may be microsatellite stable (MSS). The suggested clinical model for this alternative pathway is the condition hyperplastic polyposis. If colorectal cancer is a heterogeneous disease comprising discrete subsets that evolve through different pathways, it is evident that these subsets will need to be studied individually in the future.

The life-history basis of latitudinal diversity gradients: how do species traits vary from the poles to the equator.

1. Latitudinal variation among species in life-history traits is often suggested to contribute to high tropical species richness. However, traditional methods of analysing such variation rarely control for phylogeny and latitudinal range overlap between species, potentially giving misleading results. 2. Using a method of pairwise independent contrasts which overcomes these problems, I tested for latitudinal variation among bird species in a number of traits which have been linked, theoretically or empirically, with both latitude and species richness. 3. This method indicates strong support for Rapoport's Rule and decreasing clutch size towards the equator in both hemispheres, but only partial support for decreasing body size and ecological generalism towards the equator. 4. Indirect measures of sexual selection (sexual dichromatism and size dimorphism) show no variation with latitude; an apparent increase in dichromatism towards the equator is shown to be an artefact of phylogeny. 5. Many of the associations between life history and latitude were not detected by traditional cross-species analyses, highlighting the importance of incorporating phylogeny and overlap in studies of geographical life-history variation. Establishing associations between life-history traits and latitude does not prove, but is a necessary prerequisite for., a link between these traits and latitudinal diversity gradients.

Testing the beneficial acclimation hypothesis

Recent developments in evolutionary physiology have seen many of the long-held assumptions within comparative physiology receive rigorous experimental analysis. Studies of the adaptive significance of physiological acclimation exemplify this new evolutionary approach. The beneficial acclimation hypothesis (BAH) was proposed to describe the assumption that all acclimation changes enhance the physiological performance or fitness of an individual organism. To the surprise of most physiologists, all empirical examinations of the BAH have rejected its generality. However, we suggest that these examinations are neither direct nor complete tests of the functional benefit of acclimation. We consider them to be elegant analyses of the adaptive significance of developmental plasticity, a type of phenotypic plasticity that is very different from the traditional concept of acclimation that is used by comparative physiologists.

Functional assessment tools for paediatric clients with Juvenile Chronic Arthritis: An update and review for occupational therapists

Juvenile chronic arthritis (JCA) is one cause of chronic illness and disability in childhood. Traditional clinical assessment of clients with JCA include objective measures of joint deformity, joint swelling, range of motion, duration of morning stiffness, pain, walking speed, running speed and muscle strength. In many instances, these traditional measures have little or no significance or relevance to paediatric clients and their parents whereas functional skills used in everyday living are more likely to be meaningful. Measures of physical, social, and psychological functioning ensure a comprehensive health assessment. Responsible occupational therapy assessment and management of paediatric clients diagnosed with JCA requires the use of reliable, valid and sensitive measures of function. Several instruments are now available which measure a child's or adolescent's functional abilities. In this paper, JCA and the impact of JCA on functional development are reviewed. As well, seven functional assessment tools designed for use with paediatric clients with JCA which occupational therapists can use in their clinical practice will be appraised. The various characteristics of these tools are discussed in order to assist practitioners and researchers in selecting the functional instrument which best meets their needs.

Patterns of gene expression are altered in the frontal and motor cortices of human alcoholics

Alcoholism is a major health problem in Western countries, yet relatively little is known about the mechanisms by which chronic alcohol abuse causes the pathologic changes associated with the disease. It is likely that chronic alcoholism affects a number of signaling cascades and transcription factors, which in turn result in distinct gene expression patterns. These patterns are difficult to detect by traditional experiments measuring a few mRNAs at a time, but are well suited to microarray analyses. We used cDNA microarrays to analyze expression of approximately 10 000 genes in the frontal and motor cortices of three groups of chronic alcoholic and matched control cases. A functional hierarchy was devised for classification of brain genes and the resulting groups were compared based on differential expression. Comparison of gene expression patterns in these brain regions revealed a selective reprogramming of gene expression in distinct functional groups. The most pronounced differences were found in myelin-related genes and genes involved in protein trafficking. Significant changes in the expression of known alcohol-responsive genes, and genes involved in calcium, cAMP, and thyroid signaling pathways were also identified. These results suggest that multiple pathways may be important for neuropathology and altered neuronal function observed in alcoholism.

The beliefs of nurses who were involved in a whistleblowing event

Background. Nursing codes of ethics bind nurses to the role of patient advocate and compel them to take action when the rights or safety of a patient are jeopardized. Reporting misconduct is known as whistleblowing and studies indicate that there are personal and professional risks involved in blowing the whistle. Aim. The aim of this study was to explore the beliefs of nurses who wrestled with this ethical dilemma. Design. A descriptive survey design was used to examine the beliefs of nurses in Western Australia who reported misconduct (whistleblowers) and of those who did not report misconduct (nonwhistleblowers). Methods. The instrument listed statements from current ethical codes, statements from traditional views on nursing and statements of beliefs related to the participant's whistleblowing experience. Respondents were asked to rate each item on a five-point Likert format which ranged from strongly agree to strongly disagree. Data were analysed using a Pearson's correlation matrix and one-way ANOVA. To further explore the data, a factor analysis was run with varimax rotation. Results. Results indicated that whistleblowers supported the beliefs inherent in patient advocacy, while nonwhistleblowers retained a belief in the traditional role of nursing. Participants who reported misconduct (whistleblowers) supported the belief that nurses were primarily responsible to the patient and should protect a patient from incompetent or unethical people. Participants who did not report misconduct (nonwhistleblowers) supported the belief that nurses are obligated to follow a physician's order at all times and that nurses are equally responsible to the patient, the physician and the employer. Conclusion. These findings indicate that nurses may respond to ethical dilemmas based on different belief systems.

Convergent maternal care strategies in ungulates and macropods

Mammals show extensive interspecific variation in the form of maternal care. Among ungulates, there is a dichotomy between species in which offspring follow the mother (following strategy) versus species in which offspring remain concealed (hiding strategy). Here we reveal that the same dichotomy exists among macropods (kangaroos, wallabies and allies). We test three traditional adaptive explanations and one new life history hypothesis. and find very similar patterns among both ungulates and macropods. The three traditional explanations that we tested were that a ''following'' strategy is associated with (1) open habitat, (2) large mothers, and (3) gregariousness. Our new life-history hypothesis is that a following strategy'' is associated with delayed weaning, and thus with the slow end of the slow-fast mammalian life-history continuum, because offspring devote resources to locomotion rather than rapid growth. Our comparative test strongly supports the habitat structure hypothesis and provides some support for this new delayed weaning hypothesis for both ungulates and macropods. We propose that sedentary young in closed habitats benefit energetically by having milk brought to them. In open habitats, predation pressure will select against hiding. Followers will suffer slower growth to independence. Taken together, therefore, our results provide the first quantitative evidence that macropods and ungulates are convergent with respect to interspecific variation in maternal care strategy. In both clades, differences between species in the form of parental care are due to a similar interaction between habitat, social behavior, and life history.

Interspecific variation in plumage colour among birds: species recognition or light environment?

The traditional explanation for interspecific plumage colour variation in birds is that colour differences between species are adaptations to minimize the risk of hybridization. Under this explanation, colour differences between closely related species of birds represent reproductive character displacement. An alternative explanation is that interspecific variation in plumage colour is an adaptive response to variation in light environments across habitats. Under this explanation, differences in colour between closely related species are a product of selection on signal efficiency. We use a comparative approach to examine these two hypotheses, testing the effects of sympatry and habitat use, respectively, on divergence in male plumage colour. Contrary to the prediction of the Species Isolation Hypothesis, we find no evidence that sympatric pairs of species are consistently more divergent in coloration than are allopatric pairs of species. However, in agreement with the Light Environment Hypothesis, we find significant associations between plumage coloration and habitat use. All of these results remain qualitatively unchanged irrespective of the statistical methodology used to compare reflectance spectra, the body regions used in the analyses, or the exclusion of areas of plumage not used in sexual displays. Our results suggest that, in general, interspecific variation in plumage colour among birds is more strongly influenced by the signalling environment than by the risk of hybridization.

Patterns of change and stability in the gender division of household labour in Australia, 1986-1997

Recent research in Australia and overseas has suggested that we are witnessing a convergence of men's and women's time on domestic labour activities. But there is disagreement about whether this is due to women reducing their time on housework or men increasing their time on housework. This article addresses these issues using national survey data collected in Australia in 1986, 1993 and 1997. The results show some changes in the proportional responsibilities of men and women in the home with men reporting a greater share of traditional indoor activities. But overall both men and women are spending less time on housework. In particular, women's time on housework has declined by six hours per week since 1986. Hence, while the gender gap between men's and women's involvement in the home is getting smaller, it is not the result of men increasing their share of the load, but is due to the large decline in women's time spent on domestic labour. There is also evidence of change in the relationship. between paid and unpaid work for women. Women's hours of,paid labour had a greater impact on their involvement in domestic labour in 1997 compared to a decade earlier. The article concludes that women's increased labour force involvement in combination with changing patterns and styles, of consumption is leading to some changes in the gender-division:of household labour, but not in the direction anticipated by earlier commentators on the domestic division of labour.

Investigation of electrical conductivity as a function of dopant-ion radius in the systems Zr0.75Ce0.08M0.17O1.92 (M=Nd, Sm, Gd, Dy, Ho, Y, Er, Yb, Sc)

Electrical conductivity versus dopant ionic radius studies in zirconia- and ceria-based, solid oxide fuel cell (SOFC) electrolyte systems have shown that oxygen-ion conductivity is highest when the host and dopant ions are similar in size [J. Am. Ceram. Soc. 48 (1965) 286; Solid State Ionics 37 (1989) 67; Solid State Ionics 5 (1981) 547]. Under these conditions, it is thought that the conduction paths within the crystal lattice become less distorted [Solid State Ionics 8 (1983) 201]. In this study, binary ZrO2-M2O3 unit cells were expanded, via the partial substitution of Ce+4 for Zr+4 into the lattice, in an attempt to identify new, ternary, zirconia/ceria-based electrolyte systems with enhanced electrical conductivity. The compositions Zr0.75Ce0.08M0.17O1.92 (M = Nd, Sm, Gd, Dy, Ho, Y, Yb, Sc) were prepared using traditional solid state techniques. Bulk phase characterisation and precise lattice parameter measurements were performed with X-ray diffraction techniques. Four-probe DC conductivity measurements between 400 and 900 degreesC showed that the dopant-ion radius influenced electrical conductivity. The conductivity versus dopant-ion radius trends previously observed in zirconia-based, binary systems are clearly apparent in the ternary systems investigated in this study. The addition of ceria was found to have a negative influence on the electrical conductivity over the temperature range 400-900 degreesC. It is suggested that distortion of the oxygen-ion conduction path by the presence of the larger M+3 and Ce+4 species (relative to Zr+4) is the reason for the decreasing electrical conductivity as a function of increasing dopant size and ceria addition, respectively. (C) 2002 Elsevier Science B.V. All rights reserved.

Benchmarking nitrogen removal suspended-carrier biofilm systems using dynamic simulation

We are witnessing an enormous growth in biological nitrogen removal from wastewater. It presents specific challenges beyond traditional COD (carbon) removal. A possibility for optimised process design is the use of biomass-supporting media. In this paper, attached growth processes (AGP) are evaluated using dynamic simulations. The advantages of these systems that were qualitatively described elsewhere, are validated quantitatively based on a simulation benchmark for activated sludge treatment systems. This simulation benchmark is extended with a biofilm model that allows for fast and accurate simulation of the conversion of different substrates in a biofilm. The economic feasibility of this system is evaluated using the data generated with the benchmark simulations. Capital savings due to volume reduction and reduced sludge production are weighed out against increased aeration costs. In this evaluation, effluent quality is integrated as well.

Transient evoked otoacoustic emissions in children studying in special schools

Objectives: The present study aimed to investigate the feasibility and practicalities or testing children in special school settings using transient evoked otoacoustic emissions (TEOAE) and tympanometry. Children studying in special schools, particularly those with intellectual impairment, may be highly susceptible to hearing pathologies and can be difficult to assess using traditional test batteries. Researchers have recently suggested the possible applicability of TEOAE testing. in lieu of conventional behavioral methods, as a hearing screening device for persons with intellectual impairment. However, to date. few publications have detailed the particulars and results of such testing. Methods: A total of 489 children, with a mean age of 9.6 years, were tested in 15 special schools. Case information was obtained regarding birth history, medical history and type,degree of impairment, for later comparison with screening results. TEOAEs were collected using Quickscreen mode of the ILO292 Otodynamics Analyzer, whilst tympanometry was performed utilizing a Madsen Zodiac 901 Middle Ear Analyzer. Results: In total, 80% of students were able to be tested using TEOAEs. Average test time per ear was 2 min. However, a large proportion (40 of those able to be tested) failed TEOAE testing in at least one ear. No significant effects were found between could-not-test (CNT) cases and case history factors, A significant difference in TEOAE failure rates was found across history of neonatal special care nursery residency and history of parental concern regarding possible hearing impairment. Failure rates were higher for those who indicated positive histories. A total of 74% of subjects could be tested using tympanometry, with 25% of those able to be tested failing in at least one ear. Notably, neither type nor degree of impairment had any significant bearing on CNT or failure rates for tympanometry or TEOAE screening. Conclusions: Findings of the present investigation lend support to the review of hearing screening programs for children in special schools. with TEOAEs presenting as a potential alternative procedure. Further examination of the performance measures of protocols incorporating TEOAEs would now be advantageous. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.