Office space planning and design for medical practices: Part 3, Implementation,design, and construction

The decision to build anew or remodel/add-on to your existing facility can be a tough one. Once that decision is reached, the implementation of design and construction presents many difficult hurdles on the road to achieving a functional office space in a cost effective manner. This article will continue to explore just how a practice goes about that implementation process.     

Detailed analysis of allelic variation in the ABCA4 gene in age-related maculopathy

PURPOSE. Age-related maculopathy (ARM) is one of the most common causes of blindness in older adults worldwide. Sequence variants in a gene coding for a retina-specific ATP-binding cassette (ABCA4) transporter protein, which is responsible for a phenotypically similar Mendelian form of retinal disease, were proposed to increase the risk of ARM. To examine the potential relationship of ABCA4 sequence variation and ARM risk in an independent data set, a clinically well-characterized population of 165 multiplex patients with ARM from 70 families, 33 unaffected relatives, and 59 unrelated control subjects with confirmed absence of ARM was screened for variants in any of the 50 exons and exon-intron boundaries of this gene. METHODS. A combination of denaturing high-performance liquid chromatography (DHPLC) and bidirectional sequencing was used to detect ABCA4 sequence variants. The data set was analyzed with both case-control and family-based association analysis methods. RESULTS. No evidence was found of significantly different allele frequencies of ABCA4 sequence variants in patients compared with control subjects, and no evidence for association or cosegregation with disease in family-based analyses. CONCLUSIONS. This study confirmed the very high degree of ABCA4 sequence polymorphism in the general population, which makes the detection of potential disease-associated alleles particularly challenging. While this study does not definitively exclude ABCA4 from contributing to a small or moderate fraction of ARM, it adds to the body of evidence suggesting that ABCA4 is not a major susceptibility gene for this disorder.     

Mercury effects on predator avoidance behavior of a forage fish,golden shiner (Notemigonus crysoleucas)

Mercury contamination of fish is widespread in North America and has resulted in the establishment of fish consumption advisories to protect human health. However, the effects of mercury exposure to fish have seldom been investigated. We examined the effects of dietary mercury exposure at environmental levels in a common forage species, golden shiner (Notemigonus crysoleucas). Fish were fed either an unaltered diet (12 ng/g wet wt methylmercury [MeHg] as Hg), a low-Hg diet (455 ng/g Hg), or a high-Hg diet (959 ng/g Hg). After 90 d mean fish whole-body total Hg concentrations were 41, 230, and 518 ng/g wet wt, respectively, which were within the range of concentrations found in this species in northern U.S. lakes. There were no mortalities or differences in growth rate among groups. Groups of fish from each treatment were exposed to a model avian predator and their behavioral response videotaped for analysis. Brain acetylcholinesterase (AChE) activity was determined in fish after behavioral testing. Fish fed the high-Hg diet had significantly greater shoal vertical dispersal following predator exposure, took longer to return to pre-exposure activity level, and had greater shoal area after return to pre-exposure activity than did the other treatments, all of which would increase vulnerability of the fish to predation. There were no differences in brain AChE among treatments. We conclude that mercury exposure at levels currently occurring in northern United States lakes alters fish predator-avoidance behavior in a manner that may increase vulnerability to predation. This finding has significant implications for food chain transfer of Hg and Hg exposure of fish predators.     

The use of Section 136 of the Mental Health Act 1983 in a family of rural English police forces

Section 136 of the Mental Health Act 1983 is used by police officers to detain persons who they feel might be suffering with mental disorder until a formal Mental Health Act assessment can be undertaken. Previous studies have shown that the outcomes of these assessments result in remarkably different rates of subsequent hospital admissions. Within a rural setting it has also been shown that the rate of use of Section 136 varies considerably. This study examines the use of Section 136 within a family of eight police forces that have been matched to ensure that they cover similar populations. The results show that there are considerable variations in the use of Section 136, with the Devon and Cornwall region using the section over two and a half times the mean for the group. Possible reasons for this discrepancy are discussed.     

Least possible fixation of fractures of the proximal humerus

The purpose of this study was to assess the clinical outcome of an unreported technique of the least possible fixation for valgus-impacted fractures. Using an open technique without any sharp deep soft tissue dissection, the split between the tuberosities is opened to allow elevation of the impacted humeral head fragment. The tuberosities are reduced and repaired with absorbable sutures between the rotator cuff insertions. No bone grafting, Kirschner wire or other fixation device was used. For 11 patients, with an average age of 55 years, who were operated between 1989 and 1998, the mean follow-up period was 69 months. The patients were assessed radiologically and clinically using the Constant-Murley score. As a percentage of the normal side, the Constant-Murley scores ranged from 55 to 100% (mean 86%); there were eight patients with scores >80%, two patients with scores between 70 and 79% and one patient with score <70%. One patient (9%) showed avascular necrosis (AVN). This fixation allows preservation of the soft tissues in an open approach and avoids the dangers of other fixation methods. There is a low risk of AVN and it allows a good functional result.     

Adenoma multiplicity in irradiated Apc(Min) mice is modified by chromosome 16 segments from BALB/c

Ionizing radiation (IR) is a well-characterized carcinogen in humans and mice. The BALB/c mouse strain is unusually sensitive to IR-induced tissue damage and cancer development in a range of organs, suggestive of a partial defect in DNA damage response. This has been confirmed by finding BALB/c-specific functional polymorphism in Prkdc, a gene on mouse chromosome 16 that encodes the catalytic subunit of DNA-dependent protein kinase. Prkdc(BALB) has been associated with increased susceptibility to IR-induced mammary and lymphatic neoplasia. Here, we provide evidence that chromosome 16 segments from BALB/c interact with Apc(Min) (multiple intestinal neoplasia) and specifically enhance IR-induced adenoma development in the upper part of the small intestine.     

Whole blood mercury concentrations in sub-fertile men in Hong Kong

We aimed to investigate the association between whole blood mercury concentrations and semen quality in sub-fertile men. Fifty-nine male partners of infertile couples attending the Assisted Reproduction Unit of the Chinese University of Hong Kong between 1997 and 1998 were recruited into our study. Blood was taken from each subject for whole blood mercury concentration and hormone profile. Semen samples were obtained for computer assisted semen analysis using the Hobson sperm tracker. The semen parameters and hormone profile were compared between subjects with normal and those with elevated mercury concentrations. Twenty-one subjects (35.6%) had a whole blood mercury concentration higher than the normal range (0-50 nmol/l). All parameters of the semen analysis including the concentration of sperm, percentage of morphologically normal sperm, percentage of motile sperm, curvilinear velocity, straight-line velocity, average path velocity, and amplitude of lateral head displacement, were reduced in those with elevated blood mercury concentrations, although the difference was not statistically significant. We failed to demonstrate a statistically significant effect on the measurement of semen quality, but other adverse effects cannot be excluded. From a public heath perspective, these findings confirm that mercury toxicity is a potentially serious problem affecting the local community.     

Shear bond strength of four filled dentin bonding systems

This study compared the shear bond strength of four filled dentin bonding agents (Prime & Bond NT, One Coat Bond, OptiBond Solo, PermaQuik1) to a conventional unfilled Dentin Bonding agent (3M Scotchbond Multipurpose Plus). A column of composite resin (Herculite XRV Restorative Resin) was bonded to human dentin using the five dentin-bonding systems following the manufacturers' directions. The specimens were thermocycled 1000 cycles from 6 to 60 degrees C. Each specimen was tested on an MTS machine in shear-to-failure. The data were subjected to One-Factor ANOVA and Newman-Kuels post-hoc tests. Statistical analysis revealed that One Coat Bond had significantly greater shear bond strength than all other materials tested.     

Providing continuity of care for patients transferred from ICU

Patients requiring treatments previously only undertaken in critical care units are now being nursed in other ward areas. A study was carried out to determine the difficulties that are faced by ward nurses caring for this highly dependent patient group. Staff and patient stress were problems experienced and there was a call for closer liaison between ICU and ward staff.