Stress and coping in a week-long disabled submarine exercise

BACKGROUND: Emotional stress could impair cognitive performance and decision-making in the initial period within a disabled submarine (SUBSUNK). The aim of the present study was to explore stress reactions over time in submarine crewmembers exposed to a simulated SUBSUNK trial. METHODS: There were 18 Norwegian sailors who were confined within the front section of a conventional diesel-electric submarine for 6 d 18 h complying with emergency SUBSUNK procedures. Self-reported measures of habitual coping and personality hardiness were completed before the simulation, and measures of emotional stress symptoms and quality of life were assessed daily during the exercise and at 2 wk after the exercise. RESULTS: A repeated measures analysis of variance showed that emotional stress symptoms declined [F (6,14) = 2.76, p < 0.05], while quality of life improved over time [F (6,14) = 4.00, p < 0.01] from the first day compared with subsequent days of the experiment. Personality hardiness was negatively associated with emotional stress (r = -0.52) and lower quality of life (r = -0.47), while avoidant coping was positively associated with lower quality of life (r = 0.53) in the first 24 h of the SUBSUNK situation (all p < 0.05). CONCLUSIONS: These findings suggest that the level of emotional stress was highest in the first 24-h period, and that the level of distress was related to scores on personality hardiness and personality traits. These data have possible implications for selection and healthcare of personnel, and also suggest that crews will benefit from external help especially in the first 24 h of emergency response techniques.     

Repair of ventral hernias in morbidly obese patients undergoing laparoscopic gastric bypass should not be deferred

Background: There is no consensus regarding the optimal treatment of ventral hernias in patients who present for weight loss surgery. Methods: Medical records of consecutive morbidly obese patients who underwent laparoscopic Roux-en-Y (LRYGB) gastric bypass with a secondary diagnosis of ventral hernia were reviewed. Only patients who were beyond 6 months of follow-up were included. Results: The study population was 85 patients. There were three groups of patients according to the method of repair: primary repair (59), small intestine submucosa (SIS) (12), and deferred treatment (14). Average follow-up was 26 months. There was a 22% recurrence in the primary repair group. There were no recurrences in the SIS group. Five of the patients in the deferred treatment group (37.5%) presented with small bowel obstruction due to incarceration. Conclusion: Biomaterial mesh (SIS) repair of ventral hernias concomitant with LRYGB resulted in the most favorable outcome albeit having short follow-up. Concomitant primary repair is associated with a high rate of recurrence. All incarcerated ventral hernias should be repaired concomitant with LRYGB, as deferment may result in small bowel obstruction. Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Los Angeles, CA, USA, 10–15 March 2003     

Update on National Asthma Education and Prevention Program pediatric asthma treatment recommendations

The National Asthma Education and Prevention Program (NAEPP) published an update on selected topics from the 1997 Guidelines for the Diagnosis and Management of Asthma and provided new evidence-based recommendations for asthma treatment. Selected topics on the long-term management of asthma in children addressed the efficacy of inhaled corticosteroids (ICSs) compared with other asthma medications (i.e., as-needed beta(2)-adrenergic agonists and other controllers) in mild and moderate persistent asthma and the safety of long-term ICS use. The effects of early intervention with ICSs on asthma progression also were evaluated. An important new aspect of the treatment update entails the recommendation of ICSs as the controller medication of choice for all severities of persistent asthma in children. Additionally, on the basis of studies in adults, the Expert Panel suggested that long-acting beta(2)-adrenergic agonists are now the preferred adjunct to ICSs in children with moderate or severe persistent asthma. Based on long-term data in children, ICS therapy was deemed safe in terms of growth, bone mineral density, ocular effects, and hypothalamic pituitary adrenal axis function. Although members of the NAEPP Expert Panel determined that the effects of early intervention with ICSs on decline in lung function have not been adequately studied, they found that the effects on asthma control were substantial.     

Designing institutions and incentives in hospitals: an organization economics methodology

Recent seminal developments in organization economics, namely the decision rights approach, offer an opportunity to shed new light on an old question, the design of effective institutions. Drawing on conclusions about how and why firm organizational boundaries change, the decision rights approach is used in this article as an analytical lens to develop a new method for assessing institutional and incentive design in restructured hospitals. The article explains the decision rights approach and shows how the Decision Rights Framework developed from it, is a way of mapping of incentive structures to allow a comparative assessment of institutional design, an understudied area, as most work on hospitals has focused on assessing equity versus efficiency tradeoffs. The new method is illustrated drawing on one example from a case study of an innovative self-corporatized hospital in Lebanon that was at the vanguard of hospital restructuring legislation, adopted for system-wide reforms. A country with a strong private sector tradition, Lebanon was fertile territory for analyzing how high-powered incentive schemes emerge from a public sector setting, in a manner similar to the evolution of a firm in reaction to market forces. Among the findings revealed by the approach is that key to "good" design is the identification of requisite incentives and the matching up of incentives with goals through decision rights allocations. The appropriate organizational form is then a logical result.     

Three-dimensional versus two-dimensional ultrasound measurement of follicular volume: are they comparable?

To compare the accuracy of three-dimensional (3-D) versus two-dimensional (2-D) ultrasonography (U/S) in the measurement of follicular volume and identification of cumulus oophorus complex, thirty women were selected. Women who undergoing ovarian stimulation for in-vitro fertilization and embryo transfer (IVF-ET) using the long protocol of GnRH agonist were scanned by 2-D and 3-D ultrasonography before follicular aspiration. The volume of aspirated follicular fluid was compared with corresponding volume measured by 3-D and 2-D ultrasonography. It was found that, the high accuracy of 3-D U/S measurement of follicular volume is demonstrated clearly by limits of agreement which were within 1 ml of the true volume. While, the 2-D U/S produced limits of agreement those were up to 3.5 ml above or 2.5 ml below the true volume. Also, 3-D U/S could identify cumulus oophorus complex in 86% of cases. From this study, it was concluded that 3-D U/S system is more accurate than 2-D U/S in the measurement of the true follicular volume. Also, 3-D U/S is superior to 2-D U/S for identification of cumulus oophorus complex.     

Mifepristone pretreatment overcomes resistance of prostate cancer cells to tumor necrosis factor alpha-related apoptosis-inducing ligand (TRAIL)

Examination of the effects of TRAIL (tumor necrosis factor alpha-related apoptosis-inducing ligand) showed higher apoptotic response in LNCaP C4-2, whereas LNCaP were resistant. However, treatment of LNCaP with Mifepristone, an antiprogestin, before TRAIL induced significant apoptosis, similar to the levels observed in LNCaP C4-2. Experiments to determine the reasons for altered response of the cell lines showed no significant differences in death/decoy receptors and caspase-8 activity. However, treatment induced increased truncation of Bid and activation of caspases -9, -7, and -3 in LNCaP C4-2. Time course experiments showed that caspase-8 was activated before the involvement of mitochondrial pathway, and caspase-9 was responsible for activation of caspases -7 and -3. Use of specific caspase inhibitors demonstrated the presence of a short-loop feedback activation of Bid. Published reports suggested that increased phosphorylation of Akt was responsible for resistance of LNCaP to TRAIL. However, no significant differences were noticed in the levels of phosphorylated Akt in TRAIL-resistant LNCaP and TRAIL-sensitive LNCaP C4-2. On the basis of our results, it is suggested that the differences in response of the two cell lines to TRAIL is at the mitochondrial level.     

LC determination of dinitrosopiperazine in simulated gastric juice

A simple and specific reversed phase HPLC method for the determination of dinitrosopiperazine in simulated gastric juice using UV detection was reported. The chromatographic resolution of the analyte and the internal standard isosorbide dinitrate was performed without extraction from the gastric juice on a reversed phase ODS column. Isocratic elution was carried out with methanol–0.02 M sodium dihydrogen phosphate (60:40 v/v, pH 3.0) at a flow rate of 1.0 ml min⁻¹ with UV detection at 238 nm. The calibration graph was linear over the concentration range 0.072–2.88 μg ml⁻¹ of dinitrosopiperazine with minimum detectability (S/N=2) of 0.01 μg ml⁻¹ (8×10⁻⁸ M). Inter-day and intra-day precisions calculated as% RSD were in the range 0.32–0.38% and 0.19–0.25% respectively. Inter-day and intra-day accuracies calculated as% error were in the range 0.18–0.21 and 0.08–0.11% respectively. The proposed method was successfully applied to the study of the possible in–vivo production of DNPZ under the standard nitrosation conditions recommended by WHO.     

Kidney transplantation unraveling Wolfram syndrome: a case report

BACKGROUND: In Wolfram syndrome insulin-dependent diabetes is associated with a multisystem neurodegenerative disorder. There are no prior reports of kidney transplantation in patients with Wolfram syndrome. METHODS: Kidney transplantation was undertaken in a child with dysplastic kidneys, sensorineural hearing impairment and bilateral optic atrophy-a combination of features insufficient to define Wolfram syndrome. RESULTS: After the procedure diabetes mellitus, diabetes insipidus and urinary bladder dysfunction emerged, thereby revealing Wolfram syndrome. CONCLUSIONS: We discuss the etiology of our patient's postoperative events, and conclude that kidney transplantation may expose dormant manifestations-or aggravate existing manifestations-of Wolfram syndrome.     

Late acute rejection: Incidence,risk factors,and effect on graft survival and function

Long‐term graft survival and function has not kept pace with short‐term success in kidney transplant (Tx) recipients. LAR ≥6 months post‐Tx may contribute to lack of improvement; risk factors for LAR are not well known. Of 64 Tx recipients followed over six yr, 23 (35.9%) had LAR (LAR group) and 41 had no LAR (no LAR group). Of all variables, significant risk factors for LAR included DGF, (43.4% LAR vs. 14.6% in no LAR group, p = 0.0096); de novo DSA (65.2% vs. 26.8%, p = 0.003); mean COV% of TAC (41.8% vs. 34.6%, p = 0.03); and non‐adherence (34.8% vs. 7.3%, p = 0.0043). DGF and DSA remained statistically significant (p = 0.002 and 0.003, respectively); COV% TAC had borderline significance (p = 0.057), and non‐adherence was not significant on multivariate regression analysis. Patients with LAR had inferior graft survival and function, whereas graft function was stable in the no LAR group over a mean follow‐up of 31.2 months. Patients with de novo DSA and DGF should be considered at risk of LAR; an early diagnosis and treatment of LAR may improve graft survival and function.