Quality of care of patients hospitalized with acute coronary syndromes

Background: Measurement and improvement of quality of care is a priority issue in health care. Patients hospitalized with acute coronary syndromes (ACS) constitute a high-risk population whose care, if shown to be suboptimal on the basis of available research evidence, may benefit from quality improvement interventions. Aim: To evaluate the quality of in-hospital care for patients with ACS, using explicit quality indicators. Methods: Retrospective case note review was undertaken of 397 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between 1 October 2000 and 17 April 2001. The main out-come measures were 12 process-of-care quality indicators, calculated as either: (i) the proportion of all patients who received specific interventions or (ii) the proportion of ideal patients who received -specific interventions (i.e. patients with clear indi-cations and lacking contraindications). Results: Quality indicators with values above 80% included: (i) patient selection for thrombolysis (100%) and discharge prescription of beta-blockers (84%), (ii) antiplatelet agents (94%) and (iii) lipid-lowering agents (82%). Indicators with values between 50% and 80% included: (i) timely per-formance of electrocardiogram (ECG) on admission (61%), (ii) early coronary angiography (75%), (iii) measurement of serum lipids (71%) and (iv) discharge prescription of angiotensin-converting-enzyme (ACE) inhibitors (73%). Indicators with values <50% included: (i) timely administration of thrombolysis (35%), (ii) non-invasive risk assessment (23%) and (ii) formal in-hospital and post-hospital cardiac rehabilitation (47% and 7%, respectively). Conclusion: There were delays in performing ECG and administering thrombolysis to patients who presented to emergency departments with ACS. Improvement is warranted in use of non-invasive procedures for identifying high-risk patients who may benefit from coronary revascularization as well as use of serum lipid measurements, ACE inhibitors and cardiac rehabilitation.

Perception or synthesized voice quality in connected speech by Cantonese speakers

Perceptual voice analysis is a subjective process. However, despite reports of varying degrees of intrajudge and interjudge reliability, it is widely used in clinical voice evaluation. One of the ways to improve the reliability of this procedure is to provide judges with signals as external standards so that comparison can be made in relation to these anchor signals. The present study used a Klatt speech synthesizer to create a set of speech signals with varying degree of three different voice qualities based on a Cantonese sentence. The primary objective of the study was to determine whether different abnormal voice qualities could be synthesized using the built-in synthesis parameters using a perceptual study. The second objective was to determine the relationship between acoustic characteristics of the synthesized signals and perceptual judgment. Twenty Cantonese-speaking speech pathologists with at least three years of clinical experience in perceptual voice evaluation were asked to undertake two tasks. The first was to decide whether the voice quality of the synthesized signals was normal or not. The second was to decide whether the abnormal signals should be described as rough, breathy, or vocal fry. The results showed that signals generated with a small degree of aspiration noise were perceived as breathiness while signals with a small degree of flutter or double pulsing were perceived as roughness. When the flutter or double pulsing increased further, tremor and vocal fry, rather than roughness, were perceived. Furthermore, the amount of aspiration noise, flutter, or double pulsing required for male voice stimuli was different from that required for the female voice stimuli with a similar level of perceptual breathiness and roughness. These findings showed that changes in perceived vocal quality could be achieved by systematic modifications of synthesis parameters. This opens up the possibility of using synthesized voice signals as external standards or anchors to improve the reliability of clinical perceptual voice evaluation. (C) 2002 Acoustical Society of America.

The microbiological quality of beef tripe using different processing techniques

The microbiological quality of routinely processed tripe and rumen pillars were compared with those derived after emptying the rumen (paunch) without using water (dry dumping) and after deliberately bursting the paunches before processing. Prior to packing the mean:log(10) aerobic plate counts (APC) for the routinely processed tripe and rumen pillars were 3.55+/-1.08 and 3.28+/-0.87/g respectively. The corresponding mean log(10) total coliform counts (TCC) were 1.27+/-1.28 and 2.08+/-0.87. The mean log(10) APC counts on tripe and rumen pillars after dry-dumping were 3.06+/-0.60 and 3.90+/-0.75/g, respectively. The corresponding mean log(10) TCC were 1.03+/-0.60/g and 2.75+/-1.14/g respectively. After deliberately bursting the paunches, before processing, the mean log(10) APC counts on tripe and rumen pillars were 3.55+/-0.83/g and 3.50+/-0.59/g and the mean log(10) TCC were 1.54+/-0.95/g and 2.66+/-0.82/g respectively. In all cases the prevalence of Salmonella and Campylobacter spp. was less than 3%. The results indicate that both tripe and rumen pillars can be produced after dry dumping without compromising the quality of tripe and rumen pillars. Similarly, incidentally burst paunches that become contaminated with ingesta on the serosal surface can be processed without compromising product quality. Crown Copyright (C) 2002 Published by Elsevier Science Ltd. All rights reserved.

The effect of water, brine and ethanol flotation on the quality and shelf life of macadamia kernels 2. Kernel pieces

Raw macadamia kernel pieces were immersed in water (specific gravity 1.00 g/cm(3)), brine (SG 1.02 g/cm(3)) or ethanol solution (SG 0.97 g/cm(3)) for 30 or 60 s, then re-dried to below 1.5% moisture (wet basis) and stored under vacuum for 0, 4 and 12 months. Flotation in water had no effect on the quality or shelf life of the kernel pieces over 12 months storage, as measured by sensory evaluation of the kernels and chemical analysis of the kernel oil. Immersion in a salt solution caused unacceptable changes in quality during storage, increasing as storage time increased. Flotation in dilute ethanol also caused unacceptable quality changes during storage. Therefore, only flotation of macadamia kernel pieces in water can be recommended for commercial operations. Microbiological concerns with such a process still need to be addressed.

Tree yield and fruit minerals concentrations influence 'Hass' avocado fruit quality

To investigate the variation in quality of 'Hass' avocado fruit within an orchard, fruit were harvested at commercial maturity from 15 'Hass' trees of similar appearance, growing in three adjacent rows on the same soil type, and receiving similar management. Fruit were harvested at commercial maturity, and either ripened at 22 degreesC or stored at 2 or 7 degreesC for 3 or 5 weeks and then ripened. Significant positive correlations (based, on the mean for each datum tree) were noted between fruit flesh calcium (Ca) and magnesium (Mg) concentrations and the (Ca + Mg)/potassium ratio, and the number of days for the fruit to reach the eating ripe stage (DTR). Negative correlations were also observed between these minerals and anthracnose and mesocarp discolouration (MD) severity. Negative correlations were observed between fruit potassium (K) and phosphorus (P) concentrations and DTR. Fruit from trees with high fruit yield were generally smaller, with lower anthracnose and MD severity, ripened more slowly, and had higher flesh Ca concentrations. It is likely that cultural practices that maintain moderate to high fruit yield and reduce variation in yield will improve avocado fruit quality and reduce variability in quality. Since the main differences between adjacent trees in this trial were the seedling rootstocks of unknown origin, it is suggested that rootstocks can have a significant impact on avocado yield and fruit quality. (C) 2002 Elsevier Science B.V. All rights reserved.

Second primary oesophageal cancer following radiation for breast cancer

The management of 12 women who presented with a second primary oesophageal cancer following radiotherapy for breast cancer was reviewed. It was concluded that nine cases fitted the classical description of a radiation-induced malignancy. Most cases were successfully managed with combined modality therapy in spite of their previous radiotherapy. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

The effect of water, brine and ethanol flotation on the quality and shelf life of macadamia kernels - 1. Whole kernels

Whole macadamia kernels were immersed in water (specific gravity 1.00 g/cm(3)), brine (SG 1.02 g/cm(3)) and ethanol solution (SG 0.97 g/cm(3)) for 30 or 60 s, re-dried to 1.0-1.5% moisture (wet basis) and stored under vacuum for 0, 4 and 12 months. Immersion in water had no effect on the quality or shelf life of kernels, as measured by sensory evaluation and analysis of the kernel oil. Immersion in brine and ethanol solutions changed the flavour of kernels, but had no effect on shelf life or kernel oil stability over 12 months storage. Water flotation to separate kernels based on differences in oil content is therefore feasible, but microbiological concerns need to be investigated.

Randomized comparison of the quality of realtime fetal ultrasound images transmitted by ISDN and by IP videoconferencing

We compared the quality of realtime fetal ultrasound images transmitted using ISDN and IP networks. Four experienced obstetric ultrasound specialists viewed standard recordings in a randomized trial and rated the appearance of 30 fetal anatomical landmarks, each on a seven-point scale. A total of 12 evaluations were performed for various combinations of bandwidths (128, 384 or 768 kbit/s) and networks (ISDN or IF). The intraobserver coefficient of variation was 2.9%, 5.0%, 12.7% and 14.7% for the four observers. The mean overall ratings by each of the four observers were 4.6, 4.8, 5.0 and 5.3, respectively (a rating of 4 indicated satisfactory visualization and 7 indicated as good as the original recording). Analysis of variance showed that there were no significant interobserver variations nor significant differences in the mean scores for the different types of videoconferencing machines used. The most significant variable affecting the mean score was the bandwidth used. For ISDN, the mean score was 3.7 at 128 kbit/s, which was significantly worse than the mean score of 4.9 at 384 kbit/s, which was in turn significantly worse than the mean score of 5.9 at 768 kbit/s. The mean score for transmission using IP was about 0.5 points lower than that using ISDN across all the different bandwidths, but the differences were not significant. It appears that IP transmission in a private (non-shared) network is an acceptable alternative to ISDN for fetal tele-ultrasound and one deserving further study.

Was there a second adaptive radiation of giant tortoises in the Indian Ocean? Using mitochondrial DNA to investigate speciation and biogeography of Aldabrachelys (Reptilia, Testudinidae)

A radiation of five species of giant tortoises (Cylindraspis ) existed in the southwest Indian Ocean, on the Mascarene islands, and another (of Aldabrachelys ) has been postulated on small islands north of Madagascar, from where at least eight nominal species have been named and up to five have been recently recognized. Of 37 specimens of Madagascan and small-island Aldabrachelys investigated by us, 23 yielded significant portions of a 428-base-pair (bp) fragment of mitochondrial (cytochrome b and tRNA-Glu), including type material of seven nominal species (A. arnoldi, A. dussumieri, A. hololissa, A. daudinii, A. sumierei, A. ponderosa and A. gouffei ). These and nearly all the remaining specimens, including 15 additional captive individuals sequenced previously, show little variation. Thirty-three exhibit no differences and the remainder diverge by only 1-4 bp (0.23-0.93%). This contrasts with more widely accepted tortoise species which show much greater inter- and intraspecific differences. The non-Madagascan material examined may therefore only represent a single species and all specimens may come from Aldabra where the common haplotype is known to occur. The present study provides no evidence against the Madagascan origin for Aldabra tortoises suggested by a previous molecular phylogenetic analysis, the direction of marine currents and phylogeography of other reptiles in the area. Ancient mitochondrial DNA from the extinct subfossil A. grandidieri of Madagascar differs at 25 sites (5.8%) from all other Aldabrachelys samples examined here.

Quantitative trait loci for agronomic and seed quality traits in an F-2 and F-4 : 6 soybean population

Molecular breeding is becoming more practical as better technology emerges. The use of molecular markers in plant breeding for indirect selection of important traits can favorably impact breeding efficiency. The purpose of this research is to identify quantitative trait loci (QTL) on molecular linkage groups (MLG) which are associated with seed protein concentration, seed oil concentration, seed size, plant height, lodging, and maturity, in a population from a cross between the soybean cultivars 'Essex' and 'Williams.' DNA was extracted from F-2 generation soybean leaves and amplified via polymerase chain reaction (PCR) using simple sequence repeat (SSR) markers. Markers that were polymorphic between the parents were analyzed against phenotypic trait data from the F-2 and F-4:6 generation. For the F-2 population, significant additive QTL were Satt540 (MLG M, maturity, r(2)=0.11; height, r(2)=0.04, seed size, r(2)=0.061, Satt373 (MLG L, seed size, r(2)=0.04; height, r(2)=0.14), Satt50 (MLG A1, maturity r(2)=0.07), Satt14 (MLG D2, oil, r(2)=0.05), and Satt251 (protein r(2)=0.03, oil, r(2)=0.04). Significant dominant QTL for the F-2 population were Satt540 (MLG M, height, r(2)=0.04; seed size, r(2)=0.06) and Satt14 (MLG D2, oil, r(2)=0.05). In the F-4:6 generation significant additive QTL were Satt239 (MLG I, height, r(2)=0.02 at Knoxville, TN and r(2)=0.03 at Springfield, TN), Satt14 (MLG D2, seed size, r(2)=0.14 at Knoxville, TN), Satt373 (MLG L, protein, r(2)=0.04 at Knoxville, TN) and Satt251 (MLG B I, lodging r(2)=0.04 at Springfield, TN). Averaged over both environments in the F-4:6 generation, significant additive QTL were identified as Satt251 (MLG B 1, protein, r(2)=0.03), and Satt239 (MLG 1, height, r(2)=0.03). The results found in this study indicate that selections based solely on these QTL would produce limited gains (based on low r(2) values). Few QTL were detected to be stable across environments. Further research to identify stable QTL over environments is needed to make marker-assisted approaches more widely adopted by soybean breeders.