A set of X-ray test objects for image quality control in digital subtraction fluorography. II: Application and interpretation of results

In the previous article we introduced a set of test objects for quality control of digital subtraction fluorography (DSF) systems. These test objects have been evaluated using several commercial DSF systems in their clinical environment. In this second article we present test images and results obtained during these trails and explain how the test objects can be used to analyse the imaging performance of DSF systems.     

Implications of the California Nurse Staffing Mandate for Other States

Objectives. To determine whether nurse staffing in California hospitals, where state‐mandated minimum nurse‐to‐patient ratios are in effect, differs from two states without legislation and whether those differences are associated with nurse and patient outcomes. Data Sources. Primary survey data from 22,336 hospital staff nurses in California, Pennsylvania, and New Jersey in 2006 and state hospital discharge databases. Study Design. Nurse workloads are compared across the three states and we examine how nurse and patient outcomes, including patient mortality and failure‐to‐rescue, are affected by the differences in nurse workloads across the hospitals in these states. Principal Findings. California hospital nurses cared for one less patient on average than nurses in the other states and two fewer patients on medical and surgical units. Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California‐mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care. Conclusions. Hospital nurse staffing ratios mandated in California are associated with lower mortality and nurse outcomes predictive of better nurse retention in California and in other states where they occur.     

Mucus clearance from peripheral and central airways of asymptomatic cigarette smokers

Insoluble radioaerosol particles have been used to monitor mucus clearance from peripheral, intermediate and inner lung zones. Nine asymptomatic cigarette smokers and nine healthy non-smokers who closely matched them for age, height and lung function were each tested twice under differing radioaerosol inhalation conditions ('high' and 'low' flow rate inhalation), so that clearance differences between smokers and non-smokers should not be masked by apparent clearance differences merely resulting from differing aerosol deposition patterns. Peripheral zone clearance in the smokers was closely similar to that in the non-smokers and was affected very little by changing from 'low' to 'high' flow rate inhalation. Inner zone clearance (calculated by a method which makes allowance for material cleared into the inner zone from more distal airways) was significantly slower in smokers than in nonsmokers for both inhalation conditions. In fact, inner zone clearance in the smokers after 'high' flow inhalation (favouring central aerosol deposition) was slower (p congruent to 0.05) than in the non-smokers after 'low' inhalation (favouring relatively peripheral deposition).     

Comparison of risk factors for cervical cancer in different populations

The incidence of cervical cancer has been found to vary between populations. Risk factors of cervical cancer include early age at first marriage, multiple marriages and antibodies to herpes simplex virus type 2 (HSV-2). The interrelatedness of these risk factors was examined by comparing data collected from 428 cancer cases and 947 control women selected from 6 populations having standardized cervical cancer incidence rates varying from 9.3 to 85.1 per 100,000. Logistic regression analysis revealed that multiple marriages, early age at first marriage or pregnancy and HSV-2 antibodies were all associated with significant risk when all 3 factors were entered into the model. Cervical cancer incidence rates were best predicted by the occurrence of HSV-2 antibodies among control women. To further assess the relation between cervical cancer rates and HSV-2 antibody, 2,306 additional sera representing an 0.8% random sample of females over 9 years of age residing in the Republic of Panama were assayed for antibodies to the virus, and the occurrence of antibodies was correlated with invasive cervical cancer rates specific to each Province. Data from both the random sample and the other study populations yielded a linear relation between the occurrence of HSV-2 antibodies and the incidence of cervical cancer. An exception was found for women living in Herrera Province, Republic of Panama, who had a higher cancer rate than predicted by HSV-2 antibody occurrence. The data suggested that infection with HSV-2 is a co-variable of venereal factors, although a role for the virus in the genesis of a certain proportion of cervical cancers is not excluded.     

Intracellular myocardial pH measured in vivo with sustained and reperfused coronary occlusion

Intracellular pH provides an important measure of the adequacy of local tissue perfusion. The purpose of this study was to measure regional intracellular myocardial pH (impH) in the ischemic zone in vivo during experimental canine coronary occlusion, with and without coronary reperfusion. Twenty adult dogs were studied. Ten dogs underwent permanent ligation of the proximal anterior left descending coronary artery (group L), five dogs had coronary reperfusion after 1 hour of total coronary occlusion (group R), and five dogs did not undergo ligation and served as controls (group C). Intracellular myocardial pH was measured by 31phosphorus nuclear magnetic resonance spectroscopy at baseline and then at 15-minute intervals for 6 hours after coronary occlusion (or after sham occlusion in group C). Baseline impH did not differ among groups (group C, 7.22 +/- 0.12 mean +/- standard error of mean; group L, 7.17 +/- 0.07; group R, 7.22 +/- 0.09). During hour 1 of total occlusion, the impH of both groups L (6.58 +/- 0.05) and R (6.55 +/- 0.08) was significantly reduced as compared with the impH of group C (7.3 +/- 0.12; p less than 0.05). At 0 to 1, 1 to 3, and 3 to 5 hours of reperfusion, the impH of group R (7.34 +/- 0.08, 7.27 +/- 0.07, and 7.29 +/- 0.06, respectively for these times) did not differ from group C (7.26 +/- 0.11, 7.21 +/- 0.07, and 7.25 +/- 0.10). At these same times, the impH of group L (6.47 +/- 0.05, 6.57 +/- 0.04, and 6.75 +/- 0.04) was significantly reduced as compared with both groups R and C (p less than 0.05). Thus a severe, persistent regional intracellular myocardial acidosis occurs in the ischemic zone with coronary occlusion but is rapidly corrected by reperfusion within 1 hour.     

Porcine fatty acid synthase: cloning of a complementary DNA, tissue distribution of its mRNA and suppression of expression by somatotropin and dietary protein

A cDNA for porcine fatty acid synthase was isolated and used to examine the tissue distribution of fatty acid synthase mRNA within the pig and to determine the impact of recombinant porcine somatotropin (rpSt) and the level of dietary protein on fatty acid synthase mRNA abundance in pig liver and adipose tissue. A 1.5-kb cDNA representing the thioesterase domain of porcine fatty acid synthase was isolated from a lambda gt 11 liver cDNA library. Northern analysis with total RNA extracted from adipose tissue, liver, heart, lung, kidney and intestine revealed a single major fatty acid synthase mRNA species of 8-9 kb. The amount of fatty acid synthase mRNA in hepatic tissue was 25% of the amount in adipose tissue, which suggests that the liver may be a significant site of fatty acid synthesis in the pig. Fatty acid synthase mRNA abundance was significantly reduced in the adipose tissue (P less than 0.01) and the liver (P less than 0.1) by chronic daily administration (60 micrograms/kg) of rpSt. In addition, increasing the amount of dietary protein decreased (P less than 0.1) the abundance of fatty acid synthase mRNA in adipose tissue but had no effect on liver fatty acid synthase expression. In contrast, the abundance of adipose fatty acid binding protein mRNA was unaffected by rpSt or dietary protein. These data indicate that the reduction in the level of fatty acid synthase mRNA is a factor in the pSt-mediated suppression of fatty acid synthesis in porcine adipose tissue.     

Temporary sequential atrioventricular pacing in myocardial infarction

The loss of atrial contraction can seriously impair cardiac output when complete heart block follows myocardial infarction. We describe two cases in which temporary sequential atrioventricular pacing was lifesaving. The pacemaker used was a previously explanted internal pacemaker. By avoiding the need for an expensive dedicated temporary pacemaker this technique may be more widely applied.     

Estrogen effects on 5-HT1A receptors in hippocampal membranes from ovariectomized rats: functional and binding studies

Chronic treatment (4 days) of ovariectomized rats with estrogen produced a two-fold shift to the left (with no change in the maximal percent inhibition) in the concentration response curve for the inhibition of adenylyl cyclase activity by 5-HT, but did not alter curves for R-PIA (adenosine A1 agonist) or Gpp(NH)p (to activate Gi). Furthermore, estrogen treatment had no effect on the number or affinity of 5-HT1A binding sites labeled with [3H]8-OH-DPAT. These data, when considered with the results of previous studies, suggest that estrogen treatment may selectively enhance 5-HT1A-mediated responses in rat hippocampus.     

Evaluation of speech outcomes following treatment of oral and oropharyngeal cancers

Oral and oropharyngeal cancers are amongst the commonest cancers worldwide and present a major health problem. Owing to their critical anatomical location and complex physiologic functions, the treatment of oral and oropharyngeal cancers often affects important functions, including speech. The importance of speech in a patient’s life can not be overemphasized, as its loss is often associated with severe functional and psychosocial problems and a poor quality of life. A thorough understanding of the speech problems that are faced by these patients and their timely management is the key to providing a better functional quality of life, which must be one of the major goals of modern oncologic practice. This review summarises key methods of evaluation and outcome of speech functions in the literature on oral and oropharyngeal cancer published between January 2000 and December 2008. Speech has been generally overlooked and poorly investigated in this group of patients. This review is an attempt to fill this gap by conducting the first speech-specific review for oral and oropharyngeal cancer patients. We have proposed guidelines for better understanding and management of speech problems faced by these patients in their day-to-day life.