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We assessed the appropriateness of surgical antibiotic prophylaxis in 6 teaching hospitals in Shiraz, Iran, using the American Society of Health-System Pharmacists guideline as a reference. We reviewed the medical records of 1,000 patients who underwent 1 of 9 different surgical procedures (1 procedure per patient). The proportion of procedures in which there was compliance with all guideline recommendations was 0.3%. The most common mistakes were overuse and misuse of antibiotics.

Purposes of this investigation were to examine differences in smoke exposure and smoking topography across three smoking conditions: usual number of cigarettes, restricted (50%) and increased (167%) simulating restricted and unrestricted cigarette availability. A repeated-measures counterbalanced design with a sample of 25 women (13 African Americans; 12 Caucasians) was implemented with a 6-day inpatient protocol conducted in the General Clinical Research Center (GCRC). There were significantly larger percentage increases in carbon monoxide (CO) postcigarette in the restricted condition compared to usual and increased condition. Women with baseline cotinine/cigarette ratios >20 ng/ml/cigarette, considered efficient smokers, had significantly higher CO increases postcigarette at baseline than participants with lower cotinine/cigarette ratios, yet increased this exposure further during the restricted condition. Efficient smokers had significantly higher nicotine boost in the restricted condition compared to less efficient smokers. Differences by ethnicity were also noted with significantly higher CO percentage increases pre- to postcigarette in African Americans across all conditions, compared to Caucasians. Levels of smoke exposure postcigarette in persons who reduce cigarettes per day in response to restricted cigarette availability may be substantial.

Activating transcription factor 3 (ATF3) is a member of the CREB/ATF family of transcription factors. Previously, we demonstrated that the expression of the ATF3 gene is induced by many stress signals. In this report, we demonstrate that expression of ATF3 is induced by cardiac ischemia coupled with reperfusion (ischemia-reperfusion) in both cultured cells and an animal model. Transgenic mice expressing ATF3 under the control of the alpha-myosin heavy chain promoter have atrial enlargement, and atrial and ventricular hypertrophy. Microscopic examination showed myocyte degeneration and fibrosis. Functionally, the transgenic heart has reduced contractility and aberrant conduction. Interestingly, expression of sorcin, a gene whose product inhibits the release of calcium from sarcoplasmic reticulum, is increased in these transgenic hearts. Taken together, our results indicate that expression of ATF3, a stress-inducible gene, in the heart leads to altered gene expression and impaired cardiac function.

A two-dimensional, biomechanical computer model was developed, using the software package Working Model(TM), to simulate the postural control of seated individuals. Both able-bodied and spinal cord-injured subjects were represented. The model incorporated active control of the upper body through full-state feedback. Specifically, a linear quadratic regulator scheme was implemented in the model. Nonlinearities were included in the torque computations to mimic physiological constraints and disability. Interactions between the subject and the wheelchair were also included in the model. Simulation results were compared with those obtained from experiments in which the subjects had attempted to remain stable during the application of significant disturbance moments, similar to those experienced during braking in a vehicle. While subjects exhibited more complex control schemes, the model was able to simulate overall stability. Therefore, it is believed that the model could prove beneficial to future research examining the effects of various restraints on stability.

Study Design: A study of the impact of spinal cord injury (SCI) on seated balance was conducted by comparing the results obtained from experiments with able-bodied and SCI subjects., Objectives: The purpose of this preliminary study was to examine the lateral postural stability of seated individuals with SCI in a dynamic environment., Setting: Experiments were conducted at the Cleveland Clinic Foundation in Cleveland, Ohio., Methods: Controlled perturbations were applied to each subject, seated in a wheelchair, through the use of a servo-controlled tilt platform. The platform was rotated so as to create disturbances similar in nature to those experienced in the frontal plane during left turns in a vehicle. Four quadriplegic, four paraplegic, and five able-bodied subjects participated in this study. Kinematic information and center of pressure (COP) movement were recorded., Results: None of the spinal cord-injured subjects was able to maintain his stability when exposed to the stronger perturbations, while all of the able-bodied subjects stayed upright for all of the trials. On an individual basis, injury level was not always indicative of balance. However, regression results suggest a correlation between ability to perform static leaning and dynamic balance (P<0.001)., Conclusions: SCI subjects lost stability under dynamic conditions even though they were stable in the static situation. Initial results also raise some questions about where and when external support may be needed. Information of this nature could help to guide the design of new lateral supports with improved client acceptance.

One hundred six patients treated consecutively with total knee arthroplasty were evaluated to determine whether preoperative comorbidity (as measured by patient class, knee score, short form, anesthesia severity assessment, and number of medical comorbidities) correlated with perioperative and postoperative outcomes, including length of stay, total (and specific) hospital charges, and validated outcome scores. The length of stay for total knee arthroplasty was longer in patients who had lower preoperative knee scores and for patients with greater medical and musculoskeletal morbidity. Greater total hospital costs were associated with Class C patients and patients with poor anesthesia morbidity ratings. Patients who were debilitated medically and had four or more risk factors had decreased postoperative outcome scores. Preoperative medical and musculoskeletal morbidity influence the results of total knee arthroplasty. These findings may be useful to surgeons for optimizing resource utilization and outcomes in patients undergoing total knee arthroplasty. These data must be accounted for when contrasting total knee arthroplasty results between different surgeons and institutions.

The symptoms and physical findings of reflux laryngopharyngitis are characteristic, but the mucosal alterations evident in the larynx are not exclusive to reflux. When conventional reflux management produces an equivocal response, other etiologic factors such as mycotic laryngitis, need consideration. The differential diagnosis of dysphonia in an immunocompromised patient always includes mycotic infections, but mycotic laryngitis can also occur in the immunocompetent host. Laryngeal candidiasis can produce physical findings, such as erythema and leukoplakia, that are similar to reflux laryngopharyngitis. Predisposing factors include previous radiation therapy, antibiotic therapy, corticosteroids, and any alteration in the mucosal barrier. Diagnosis is established by mucosal biopsy with special staining of the tissue to identify the characteristic hyphae. Treatment of mycoses can be difficult and long-term therapy is often required.

This study was performed to determine preoperative criteria for identifying patients at risk for delirium after major head and neck cancer surgery. The authors prospectively evaluated 138 consecutive patients undergoing head and neck cancer surgery lasting more than 2 hours at the Arthur G. James Cancer Hospital and Research Institute, Ohio State University, Columbus, from July 1993 through May 1994. Postoperative delirium developed in 24 of 138 patients (17%; 95% confidence interval 11% to 24%). The strongest univariate predictors of delirium were living alone (P = .005), the American Society of Anesthesiologists class (P = .003), and the preoperative white blood cell count (P < .0001). A predictive model for delirium using five criteria--age of 70 or more years, alcohol abuse, poor cognitive status, poor functional status, and markedly abnormal serum sodium, potassium, or glucose level--stratified the patients into three cohorts with an increasing risk of postoperative delirium (i.e., 9%, 19%, and 25%).

Nongovernmental organizations (NGOs) have played a major role in the diffusion of biomedical engineering training to developing nations. This paper reviews the roles and unique attributes of NGOs in biomedical engineering training programs. The activities of one leading NGO in this field, Project HOPE, are discussed with examples drawn from around the world. Future challenges to biomedical engineering in the developing world, and the potential of NGOs to provide a response to these needs, are considered.

Patients from the Comprehensive Cancer Center of the Arthur G. James Cancer Hospital and Research Institute, Ohio State University, Columbus, who were undergoing major head and neck oncologic surgery were prospectively studied to determine predictors of postoperative medical complications and wound infection. Of 119 patients studied, 28 (24%) had at least one postoperative medical complication. The strongest predictors of medical complication were poor functional capacity as assessed by the Specific Activity Scale questionnaire and alcohol abuse. Thirteen patients (11%) developed wound infections. The strongest predictors of wound infection were an elevated preoperative platelet count and prolonged surgery. Wound infection was the strongest correlate of prolonged hospital stay. These findings suggest that the Specific Activity Scale questionnaire identifies patients at risk for medical complication, that alcohol abuse should be managed aggressively, and that thrombocytosis identifies patients at risk for wound infection.

Study Objective: To investigate wound infection in nonvenomous snakebite., Design: Prospective clinical series., Setting: Massachusetts Poison Control System., Participants: Seventy-two consecutive children and adults with nonenvenomated snakebite wounds., Interventions: Patients were examined and advised that there was no published clinical evidence that prophylactic antibiotics were beneficial for nonenvenomated snakebites. They were re-examined five to ten days after the bite., Main Results: Four patients used prophylactic antibiotics; 68 did not. There were no wound infections. Plain radiographs revealed a snake tooth fragment in the persistently tender wound of one patient bitten by his pet python., Conclusion: Despite reports that pathogenic bacteria can be isolated from snakes' mouths, nonenvenomated snakebites in Massachusetts usually do not require prophylactic antibiotic therapy. Radiography is occasionally indicated for persistently tender wounds inflicted by large snakes.

Objective: To evaluate the status of men and women faculty in academic general internal medicine, including their professional training, faculty responsibilities, research performance, academic rank, and compensation, to determine whether systematic differences exist by gender., Design/setting: The authors analyzed responses to a 55-part questionnaire sent to all full-time general internal medicine faculty at the major teaching hospitals in the United States. Unadjusted means were generated for men versus women faculty in demographics, training background, hours of work, professional time allocations, institutional support, professional self-assessment, research performance, academic rank, and compensation. Means were recalculated after adjusting for other variables using multivariate methods., Results: The authors found no significant difference in the frequency of fellowship training between men and women faculty. Women and men perform similar professional activities, but even after multivariate adjustment, women devote less time to research and perceive less research skill and institutional support for their research, but have similar numbers of grants, abstracts, and publications in refereed journals and have similar academic ranks. Women faculty, however, receive lower compensation than do men faculty, even after adjustment., Conclusion: While the characteristics of men and women faculty are quite similar, including those defining their academic productivity, important differences exist in research time, perceived institutional support, and compensation. These differences cannot be explained by such obvious factors as age differentials, academic rank, or hours of work per week.

In 1949, Hellems, Haynes, and Dexter proposed that the pressure in a catheter wedged so as to occlude a pulmonary artery was an "estimate" of the pressure in the pulmonary capillaries. Their report led to the designation of this pulmonary artery wedge pressure as the pulmonary "capillary" wedge pressure. In fact, the pulmonary artery wedge pressure is a distorted measure of the pressure in the pulmonary veins. Usually this pressure differs only slightly from the capillary pressure, and the misconception fostered by the inaccurate name is inconsequential; however, sometimes this misconception leads to errors in diagnosis. This report briefly reviews the early history of pulmonary vascular catheterization, offers an explanation of pulmonary artery wedge pressure, and discusses a disease in which pulmonary artery wedge pressure is normal, even though capillary pressure is elevated.

The psychophysical responses of human subjects to vibratory tactile stimulation of the skin were investigated experimentally. The parameters of the waveform important to the minimization of power consumed by the tactile array of electromechanical vibrators and the maximization of the skin sensitivity to the stimulus were explored to develop optimum stimulation. Parameters investigated included the amplitude, frequency, and duty cycle of the current waveform used to drive the vibrators as well as the number of pulses per stimulating burst and the recovery time between bursts. Graphical techniques were used to determine the optimal combination of the parameters which gave a stimulus that excited the skin to above tactile threshold while maintaining at a relative minimum the power required for the stimulus. The optimal stimulation waveform contains a burst of 10 rectangular pulses of 4% duty cycle separated by a period of nonstimulation of 2 s. Such a waveform can elicit a sensitivity of 29.4 mA-1 consuming only 55 microW of power.

The association of poliovirus metabolism with the cytoskeleton was investigated. Infected cells were extracted by using the nonionic detergent Triton X-100 in the physiological cytoskeleton buffer. The skeletal framework obtained was examined by transmission electron microscopy of resinless sections. The fibers of the framework were grossly distorted in infected cells. No virions or procapsids were seen but many virus-specific spheroidal bodies were associated with the framework. They had a diameter of 40 to 70 nm, were characterized by a dense core and a translucent periphery, and occurred in strings, often near the remnants of flattened vesicles. These spheres may correspond to virus-synthesizing bodies. The metabolism of poliovirus RNA was shown to be associated with the skeletal framework by pulse-labeling cells with [3H]uridine and measuring the RNA retained on the framework. 20S double-stranded RNA, a form of poliovirus RNA found only in the replication complex, was attached to the skeleton throughout a 60-min pulse-label. 35S single-stranded viral RNA, a form found in virions, in polyribosomes, and in the replication complex, appeared first on the framework but after a few minutes was also found in the soluble cytoplasmic phase, encapsidated in virions. In contrast to viral RNA, viral proteins exhibited a varied association with the skeletal framework. Viral proteins were pulse-labeled with [35S]methionine and chased with unlabeled methionine. Although all of the virus-specific proteins were found, to some extent, in the skeletal fraction, the derivatives of P2 (P2-X and P2-5) and a derivative of P3 (P3-2) showed a preferential association with the skeletal framework. Virions and procapsids, on the other hand, were not associated with the cytoskeleton; both they and their component proteins (P1-VP0, P1-VP1, P1-VP2, and P1-VP3) were found dominantly in the soluble cytoplasmic phase. The pathway of poliovirus assembly can be inferred from the above data. It is different from that found previously for the enveloped vesicular stomatitis virus and may be representative of encapsidated cytoplasmic virus assembly.

The purpose of this study was to discover the cause and magnitude of changes in the body-surface potentials occurring when: (1) fluids of various conductivity were added to the pericardial sac, or (2) the volume of the blood within chambers of the heart was either increased or decreased. Fluids added to the pericardium were physiological saline, whole-blood, and mineral oil. Magnitudes of body-surface potentials were compared to the predictions based on a mathematical eccentric spheres model of the heart and torso developed previously by Rudy and Plonsey. Data demonstrated conclusively that there is a nonlinear relationship between the body-surface potentials and the conductivity of the pericardial layer. This relationship is one in which the body-surface potentials of the anterior chest were found to decrease when conductivity of the pericardial layer was either increased or decreased. These changes in body-surface potentials were caused solely by alterations in the conductivity and volume of the fluid effusate. It was demonstrated that these changes were not caused by any "stretching" or "compression" of the cardiac tissue caused by the altered fluid volumes in and around the heart. Findings were accurately predicted by the eccentric spheres model, thereby confirming the model's usefulness as a predictive instrument. The model provides an explanation for the nonlinear relationship that was exhibited by the data.

Dimethylhydrazine (DMH) induces adenocarcinomas of the colon and rectum in rodents; this animal cancer model system is thought to closely resemble human colorectal cancer. An extract of soybeans containing the Bowman-Birk protease inhibitor added to the diet of DMH-treated mice resulted in a significant suppression of adenomatous tumors of the colonic mucosa. Non-treated mice maintained on the same diet for most of their natural life-span (1.5 years) showed no observable health problems.