A review of telemedicine and asthma

The literature contains a number of reports of early work involving telemedicine and chronic disease; however, there are comparatively few studies in asthma. Most of the telemedicine studies in asthma have investigated the use of remote monitoring of patients in the home, e.g. transmitting spirometry data via a telephone modem to a central server. The primary objective of these studies was to improve management. A secondary benefit was that patient adherence to prescribed treatment is also likely to be improved. Early results are encouraging; home monitoring in a randomized controlled trial in Japan significantly reduced the number of emergency room visits by patients with poorly controlled asthma. Other studies have described the cost-benefits of a specialist asthma nurse who can manage patients by telephone contact, as well as deliver asthma education. Many web-based systems are available for the general public or healthcare professionals to improve education in asthma, although their quality is highly variable. The work on telemedicine in asthma clearly shows that the technique holds promise in a number of areas. Unfortunately - as in telemedicine generally - most of the literature in patients with asthma refers to pilot trials and feasibility studies, with short-term outcomes. Large-scale, formal research trials are required to establish the cost effectiveness of telemedicine in asthma.

Hemochromatosis and alcoholic liver disease

The close association of excessive alcohol consumption and clinical expression of hemochromatosis has been of widespread interest for many years. In most populations of northern European extraction, more than 90% of patients with overt hemochromatosis are homozygous for the C282Y mutation in the HFE gene. Nevertheless, the strong association of heavy alcohol intake with the clinical expression of hemochromatosis remains. We (individually or in association with colleagues from our laboratories) have performed three relevant studies in which this association was explored. In the first, performed in 1975 before the cloning of the HFE gene, the frequency of clinical symptoms and signs was compared in patients with classical hemochromatosis who consumed 100 g or more of alcohol per day versus in nondrinkers or moderate drinkers who consumed less than 100 g of alcohol per day. The results showed no difference between the two groups except for features of complications of alcoholism in the first group, especially jaundice, peripheral neuritis, and hepatic failure. Twenty-five percent of those with heavy alcohol consumption showed histologic features of alcoholic liver disease (including cirrhosis) together with heavy iron overload. It was concluded that these patients had the genetic disease complicated by alcoholic liver disease. In the second study (2002), 206 subjects with classical HFE-associated hemochromatosis in whom liver biopsy had been performed were evaluated to quantify the contribution of excess alcohol consumption to the development of cirrhosis in hemochromatosis. Cirrhosis was approximately nine times more likely to develop in subjects with hemochromatosis who consumed more than 60 g of alcohol per day than in those who drank less than this amount. In the third study (2002), 371 C282Y-homozygous relatives of patients with HFE-associated hemochromatosis were assessed. Eleven subjects had cirrhosis on liver biopsy and four of these drank 60 g or more of alcohol per day. The reason why heavy alcohol consumption accentuates the clinical expression of hemochromatosis is unclear. Increased dietary iron or increased iron absorption is unlikely. The most likely explanation would seem to be the added co-factor effect of iron and alcohol, both of which cause oxidative stress, hepatic stellate cell activation, and hepatic fibrogenesis. In addition, the cumulative effects of other forms of liver injury may result when iron and alcohol are present concurrently. Clearly, the addition of dietary iron in subjects homozygous for hemochromatosis would be unwise. (C) 2003 Elsevier Inc. All rights reserved.

Electronic structure methods applied to gas-carbon reactions

A review is given on the fundamental studies of gas-carbon reactions using electronic structure methods in the last several decades. The three types of electronic structure methods including semi-empirical, ab initio and density functional theory, methods are briefly introduced first, followed by the studies on carbon reactions with hydrogen and oxygen-containing gases (non-catalysed and catalysed). The problems yet to solve and possible promising directions are discussed. (C) 2002 Elsevier Science Ltd. All rights reserved.

A single-centre experience of post-renal transplant lymphoproliferative disorder

Post-transplant lymphoproliferative disorder (PTLD) complicates 1 to 10% of all transplantations. Previous clinicopathological studies of PTLD have been limited by small numbers, short follow-up times, outdated data, heterogeneity of pooled solid-organ transplant results, and selective inclusion of early-onset disease. We therefore undertake here a retrospective analysis and identify all cases of PTLD that complicated renal transplantation at the Princess Alexandra Hospital between 30 June 1969 and 31 May 2001. Tumour samples were subsequently retrieved for pathological review and for Epstein-Barr virus-encoded RNA in situ hybridisation (EBER-ISH). Of 2,030 renal transplantation patients, 29 (1.4%) developed PTLD after a median period of 0.5 years (range 0.1 to 23.3 years). PTLD patients were more likely to have received cyclosporine (76% versus 62%, P

Refined method of potential enhancement in the equilibria characterization of activated carbon. Comparison with GCMC and DFT

In this paper, we present a technique for equilibria characterization of activated carbon having slit-shaped pores. This method was first developed by Do (Do, D. D. A new method for the characterisation of micro-mesoporous materials. Presented at the International Symposium on New Trends in Colloid and Interface Science, September 24-26, 1998 Chiba, Japan) and applied by his group and other groups for characterization of pore size distribution (PSD) as well as adsorption equilibria determination of a wide range of hydrocarbons. It is refined in this paper and compared with the grand canonical Monte Carlo (GCMG) simulation and density functional theory (DFT). The refined theory results in a good agreement between the pore filling pressure versus pore width and those obtained by GCMG and DFT. Furthermore, our local isotherms are qualitatively in good agreement with those obtained by the GCMC simulations. The main advantage of this method is that it is about 4 orders of magnitude faster than the GCMC simulations, making it suitable for optimization studies and design purposes. Finally, we apply our method and the GCMG in the derivation of the PSD of a commercial activated carbon. It was found that the PSD derived from our method is comparable to that derived from the GCMG simulations.

Factors affecting N2 fixation by the cyanobacterium Trichodesmium sp. GBRTRLI101

Various factors affecting N-2 fixation of a cultured strain of Trichodesmium sp. (GBRTRLI101) from the Great Barrier Reef Lagoon were investigated. The diurnal pattern of N2 fixation demonstrated that it was primarily light-induced although fixation continued to occur for at least 1 h in the dark in samples that had been actively fixing N-2. N-2 fixation was dependent on the light intensity and stimulated more by white light when compared with blue, green, yellow and red light whereas rates of N-2 fixation decreased most under red light. Inorganic phosphorous concentrations in the lower range of treatments up to 1.2 muM significantly stimulated N-2 fixation and further additions promoted little or no increase in N-2 fixation. Organic phosphorous (Na-glycerophosphate) also stimulated N-2 fixation rates. Added combined nitrogen (NH4+, NO3-, urea) of 10 muM did not inhibit N-2 fixation in short-term studies (first generation), however it was depressed in the long-term studies (fifth generation). (C) 2003 Federation of European Microbiological Societies. Published by Elsevier Science B.V. All rights reserved.

Robust multivariable control of complex biological processes

This paper addresses advanced control of a biological nutrient removal (BNR) activated sludge process. Based on a previously validated distributed parameter model of the BNR activated sludge process, we present robust multivariable controller designs for the process, involving loop shaping of plant model, robust stability and performance analyses. Results from three design case studies showed that a multivariable controller with stability margins of 0.163, 0.492 and 1.062 measured by the normalised coprime factor, multiplicative and additive uncertainties respectively give the best results for meeting performance robustness specifications. The controller robustly stabilises effluent nutrients in the presence of uncertainties with the behaviour of phosphorus accumulating organisms as well as to effectively attenuate major disturbances introduced as step changes. This study also shows that, performance of the multivariable robust controller is superior to multi-loops SISO PI controllers for regulating the BNR activated sludge process in terms of robust stability and performance and controlling the process using inlet feed flowrate is infeasible. (C) 2003 Elsevier Ltd. All rights reserved.

A dynamic mathematical model for sequential leach bed anaerobic digestion of organic fraction of municipal solid waste

A mathematical model that describes the operation of a sequential leach bed process for anaerobic digestion of organic fraction of municipal solid waste (MSW) is developed and validated. This model assumes that ultimate mineralisation of the organic component of the waste occurs in three steps, namely solubilisation of particulate matter, fermentation to volatile organic acids (modelled as acetic acid) along with liberation of carbon dioxide and hydrogen, and methanogenesis from acetate and hydrogen. The model incorporates the ionic equilibrium equations arising due to dissolution of carbon dioxide, generation of alkalinity from breakdown of solids and dissociation of acetic acid. Rather than a charge balance, a mass balance on the hydronium and hydroxide ions is used to calculate pH. The flow of liquid through the bed is modelled as occurring through two zones-a permeable zone with high flushing rates and the other more stagnant. Some of the kinetic parameters for the biological processes were obtained from batch MSW digestion experiments. The parameters for flow model were obtained from residence time distribution studies conducted using tritium as a tracer. The model was validated using data from leach bed digestion experiments in which a leachate volume equal to 10% of the fresh waste bed volume was sequenced. The model was then tested, without altering any kinetic or flow parameters, by varying volume of leachate that is sequenced between the beds. Simulations for sequencing/recirculating 5 and 30% of the bed volume are presented and compared with experimental results. (C) 2002 Elsevier Science B.V. All rights reserved.

The treatment of domestic wastewater using small-scale vermicompost filter beds

The aim of this study is to quantity the effect of filter bed depth and solid waste inputs on the performance of small-scale vermicompost filter beds that treat the soluble contaminants within domestic wastewater. The study also aims to identify environmental conditions within the filters by quantifying the oxygen content and pH of wastewater held within it. Vermicompost is being utilised within commercially available on-site domestic waste treatment systems however, there are few reported studies that have examined this medium for the purpose of wastewater treatment. Three replicate small-scale reactors were designed to enable wastewater sampling at five reactor depths in 10-cm intervals. The surface of each reactor received household solid organic waste and 1301 m(-2) per day of raw domestic wastewater. The solid waste at the filter bed surface leached oxygen demand into the wastewater flowing through it. The oxygen demand was subsequently removed in lower reactor sections. Both nitrification and denitrification occurred in the bed. The extent of denitrification was a function of BOD leached from the solid waste. The environmental conditions measured within the bed were found to be suitable for earthworms living within them. The study identified factors that will affect the performance and application of the vermicompost filtration technology. (C) 2004 Elsevier B.V. All rights reserved.

Designing biostable polyurethane elastomers for biomedical implants

The chemical structure, synthesis, morphology, and properties of polyurethane elastomers are briefly discussed. The current understanding of the effect of chemical structure and the associated morphology on the stability of polyurethanes in the biological environments is reviewed. The degradation of conventional polyurethanes appears as surface or deep cracking, stiffening, and deterioration of mechanical properties, such as flex-fatigue resistance. Polyester and poly( tetramethylene oxide) based polyurethanes degrade by hydrolytic and oxidative degradation of ester and ether functional groups, respectively. The recent approaches to develop polyurethanes with improved long-term biostability are based on developing novel polyether, hydrocarbon, polycarbonate, and siloxane macrodiols to replace degradation-prone polyester and polyether macrodiols in polyurethane formulations. The new approaches are discussed with respect to synthesis, properties and biostability based on reported in vivo studies. Among the newly developed materials, siloxane-based polyurethanes have exhibited excellent biostability and are expected to find many applications in biomedical implants.

Drawing a line in the Taiwan Strait: 'strategic ambiguity' and its discontents

The Bush administration's continuing emphasis on US military deterrence of the PRC on behalf of Taiwan threatens to undermine the posture of 'strategic ambiguity' that the United States has proclaimed since 1979. This article argues for the retention of 'strategic ambiguity' and traces the origins of revisionist sentiment towards this effective conflict avoidance mechanism to reactions within the US foreign policy community to the 1995-96 Taiwan Strait crisis. Case studies of this crisis and its predecessors in 1954-55 and 1958 demonstrate that US military deterrence was not a decisive factor in their resolution. US and PRC initiatives and responses in the 1950s crises introduced the essential elements of 'strategic ambiguity' into the triangular relationship between themselves and Taiwan. In particular, they established a precedent for the United States and the PRC in circumscribing the issue of Taiwan so as to achieve a political accommodation.

Valerian does not appear to reduce symptoms for patients with chronic insomnia in general practice using a series of randomised n-of-I trials

Objectives: To investigate the effectiveness of valerian for the management of chronic insomnia in general practice. Design: Valerian versus placebo in a series of n-of-1 trials, in Queensland, Australia. Results: Of 42 enrolled patients, 24 (57%) had sufficient data for inclusion into the n-of-1 analysis. Response to valerian was fair for 23 (96%) participants evaluating their 'energy level in the previous day' but poor or modest for all 24 (100%) participants' response to 'total sleep time' and for 23 (96%) participants' response to 'number of night awakenings' and 'morning refreshment'. As a group, the proportion of treatment successes ranged from 0.35 (95% CI 0.23, 0.47) to 0.55 (95% CI 0.43, 0.67) for the six elicited outcome sleep variables. There was no significant difference in the number (P = 0.06), distribution (P = 1.00) or severity (P = 0.46) of side effects between valerian and placebo treatments. Conclusions: Valerian was not shown to be appreciably better than placebo in promoting sleep or sleep-related factors for any individual patient or for all patients as a group. (C) 2003 Elsevier Ltd. All rights reserved.