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This study assessed the effect of tissue storage duration and accuracy of the metabolic inhibitor tissue homogenate (MITH) method on intracellular pH (pHi) values of tissues of white sturgeon Acipenser transmontanus during hypercarbia. No effect of storage in liquid nitrogen of up to 30 days was observed and MITH appears appropriate for measurement of pH in fish exposed to up to 10% CO2 (10000 Pa pCO2). [ABSTRACT FROM AUTHOR]

Baker DW, Matey V, Huynh KT, Wilson JM, Morgan JO, Brauner CI. Complete intracellular pH protection during extracellular pH depression is associated with hypercarbia tolerance in white sturgeon, Acipenser transmontanus. Am J Physiol Regul integr Comp Physiol 296: R1868-R1880, 2009. First published April 1, 2009; doi: 10.11 52/ajpregu.90767.2008.-Sturgeons are among the most CO[sub2] tolerant of fishes investigated to date. However, the basis of this exceptional CO[sub2] tolerance is unknown. Here, white sturgeon, Acipenser transmontanus, were exposed to elevated CO[sub2] to investigate the mechanisms associated with short-term hypercarbia tolerance. During exposure to 1.5 kPa PCO[sub2], transient blood pH [extracellular pH (pHe)] depression was compensated within 24 h and associated with net plasma HCO[sub3][sup-] accumulation and equimolar C1 loss, and changes in gill morphology, such as a decrease in apical surface area of mitochondrial-rich cells. These findings indicate that pHe recovery at this level of hypercarbia is accomplished in a manner similar to most freshwater teleost species studied to date, although branchial mechanisms involved may differ. White sturgeon exposed to more severe hypercarbia (3 and 6 kPa PCO[sub2]) for 48 h exhibited incomplete pH compensation in blood and red blood cells. Despite pHe depression, intracellular pH (pHi) of white muscle, heart, brain, and liver did not decrease during a transient (6 h of 1.5 kPa P[subCO[sub2]]) or prolonged (48 h at 3 and 6 kPa P[subCO[sub2]]) blood acidosis. This pHi protection was not due to high intrinsic buffering in tissues. Such tight active cellular regulation of pHi in the absence of pHe compensation represents a unique pattern for non-air-breathing fishes, and we hypothesize that it is the basis for the exceptional CO[sub2] tolerance of white sturgeon and, likely, other CO[sub2] tolerant fishes. Further research to elucidate the specific mechanisms responsible for this tremendous pH regulatory capacity in tissues of white sturgeon is warranted. [ABSTRACT FROM AUTHOR]

In vivoexperiments were conducted to examine the haematology of juveniles from two relic bony fishes, Atlantic sturgeonAcipenser oxyrhinchusand shortnose sturgeonAcipenser brevirostrum. Oxygen transport characteristics(haematocrit, haemoglobin and mean erythrocytic haemoglobin concentration), ionic composition(Na+, Cl−, K+ and osmolality), metabolite concentration(lactate, cortisol and glucose) and protein content in blood were measured or calculated at rest and during recovery from forced activity. Under resting conditions, plasma osmolality and concentrations of Na+, Cl−, lactate, cortisol and total protein were significantly different between Atlantic and shortnose sturgeon. All other resting variables were not different between species. Following forced activity, plasma lactate levels were significantly higher in both species than at rest. Plasma cortisol levels in both species were only significantly higher 1 h following forced activity compared to resting values. Plasma lactate levels were significantly higher in Atlantic sturgeon than in shortnose sturgeon, but these levels returned to resting levels by 1 h in both species. Cortisol increases were greater in shortnose sturgeon than in Atlantic sturgeon. In general, oxygen transport characteristics, blood glucose, plasma protein and plasma osmolality were not altered by forced activity in either sturgeon species. Overall, both species had reduced responses( i.e. the magnitude of changes in measured variables) to forced activity compared with teleosts. [ABSTRACT FROM AUTHOR]

Objective: To assess the association of physician gender with patient ratings of physician care.Design: Interviewer-administered survey and follow-up interviews 1 week after emergency department (ED) visit.Setting: Public hospital ED.Patients/participants: English- and Spanish-speaking adults presenting for care of nonemergent problems; of 852 patients interviewed in the ED who were eligible for follow-up, 727 (85%) completed a second interview.Measurements and Main Results: We conducted separate ordered logistic regressions for women and men to determine the unique association of physician gender with patient ratings of 5 interpersonal aspects of care, their trust of the physician, and their overall ratings of the physician, controlling for patient age, health status, language and interpreter status, literacy level, and expected satisfaction. Female patients trusted female physicians more (P =.003) than male physicians and rated female physicians more positively on the amount of time spent (P =.01), on concern shown (P =.04), and overall (P =.03). Differences in ratings by female patients of male and female physicians in terms of friendliness (P =.13), respect shown (P =.74), and the extent to which the physician made them feel comfortable (P =.10) did not differ significantly. Male patients rated male and female physicians similarly on all dimensions of care (overall, P =.74; friendliness, P =.75; time spent, P =.30; concern shown, P =.62; making them feel comfortable, P =.75; respect shown, P =.13; trust, P =.92).Conclusions: Having a female physician was positively associated with women's satisfaction, but physician gender was not associated with men's satisfaction. Further studies are needed to identify reasons for physician gender differences in interpersonal care delivered to women. [ABSTRACT FROM AUTHOR]

Objective: To determine whether patients who encountered language barriers during an emergency department visit were less likely to be referred for a follow-up appointment and less likely to complete a recommended appointment.Design: Cohort study.Setting: Public hospital emergency department.Participants: English- and Spanish-speaking patients (N = 714) presenting with nonemergent medical problems.Measurements and Main Results: Patients were interviewed to determine sociodemographic information, health status, whether an interpreter was used, and whether an interpreter should have been used. The dependent variables were referral for a follow-up appointment after the emergency department visit and appointment compliance, as determined by chart review and the hospital information system. The proportion of patients who received a follow-up appointment was 83% for those without language barriers, 75% for those who communicated through an interpreter, and 76% for those who said an interpreter should have been used but was not (P =. 05). In multivariate analysis, the adjusted odds ratio for not receiving a follow-up appointment was 1.92 (95% confidence interval [CI], 1.11 to 3.33) for patients who had an interpreter and 1.79 (95% CI, 1.00 to 3.23) for patients who said an interpreter should have been used (compared with patients without language barriers). Appointment compliance rates were similar for patients who communicated through an interpreter, those who said an interpreter should have been used but was not, and those without language barriers (60%, 54%, and 64%, respectively; P =.78).Conclusions: Language barriers may decrease the likelihood that a patient is given a follow-up appointment after an emergency department visit. However, patients who experienced language barriers were equally likely to comply with follow-up appointments. [ABSTRACT FROM AUTHOR]

To assess racial differences in the use of oral anticoagulant therapy for patients with heart failure, we conducted a cohort study of 30 hospitals in northeast Ohio. For 12,911 Medicare enrollees consecutively admitted in 1992 through 1994 with heart failure, crude and adjusted odds of being on oral anticoagulation were determined. The crude and adjusted odds of being African Americans on oral anticoagulant therapy relative to whites were 0.57 (95% confidence interval 0.47-0.69) and 0.55 (95% confidence interval 0. 45-0.67), respectively. African-Americans with heart failure were much less likely than whites to receive oral anticoagulant therapy, even after adjusting for other variables associated with anticoagulant use. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between patient literacy and hospitalization.Design: Prospective cohort study.Setting: Urban public hospital.Patients: A total of 979 emergency department patients who participated in the Literacy in Health Care study and had completed an intake interview and literacy testing with the Test of Functional Health Literacy in Adults were eligible for this study. Of these, 958 (97.8%) had an electronic medical record available for 1994 and 1995.Measurements and Main Results: Hospital admissions to Grady Memorial Hospital during 1994 and 1995 were determined by the hospital information system. We used multivariate logistic regression to determine the independent association between inadequate functional health literacy and hospital admission. Patients with inadequate literacy were twice as likely as patients with adequate literacy to be hospitalized during 1994 and 1995 (31. 5% vs 14.9%, p <.001). After adjusting for age, gender, race, self-reported health, socioeconomic status, and health insurance, patients with inadequate literacy were more likely to be hospitalized than patients with adequate literacy (adjusted odds ratio [OR] 1.69; 95% confidence interval [CI] 1.13, 2.53). The association between inadequate literacy and hospital admission was strongest among patients who had been hospitalized in the year before study entry (OR 3.15; 95% CI 1.45, 6.85).Conclusions: In this study population, patients with inadequate functional health literacy had an increased risk of hospital admission. [ABSTRACT FROM AUTHOR]

Objective: This article reviews the role of counseling, education, dietary modifications, and exercise for patients with heart failure due to left ventricular systolic dysfunction.Data Source: We reviewed studies published in English between 1966 and 1993 and referenced in MEDLINE or EMBASE. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific areas of interest. Where data were lacking, we relied on opinions of panel members and peer reviewers. STUDY SELECTION AND DATA SYNTHESIS: Studies were reviewed to determine whether patients had heart failure due to systolic dysfunction (left ventricular ejection fraction, < 0.35 to 0.40) and whether clinical outcomes were reported. Studies that reported only intermediate outcomes (eg, hemodynamics) were not reviewed.Conclusion: Counseling and education can improve patient outcomes and decrease unnecessary hospitalizations. Patients with mild to moderate heart failure should be restricted to 3 g/d of sodium initially. Those who are unresponsive to this dosage or who have more severe disease should be advised to consume 2 g/d or less. Patients should be strongly advised to drink no more than 30 mL/d of alcohol or, preferably, to abstain completely. Exercise training is safe and can improve exercise duration and symptoms. Adherence to the treatment plan should be stressed and monitored at each visit. Clinicians should inform patients of the seriousness of their disease and their prognosis, but they should emphasize that patients can continue to remain active and enjoy a reasonable quality of life. [ABSTRACT FROM AUTHOR]

Objective: To describe primary care clinic use and emergency department (ED) use for a cohort of public hospital patients seen in the ED, identify predictors of frequent ED use, and ascertain the clinical diagnoses of those with high rates of ED use.Design: Cohort observational study.Setting: A public hospital in Atlanta, Georgia.Patients: Random sample of 351 adults initially surveyed in the ED in May 1992 and followed for 2 years.Measurements and Main Results: Of the 351 patients from the initial survey, 319 (91%) had at least one ambulatory visit in the public hospital system during the following 2 years and one third of the cohort was hospitalized. The median number of subsequent ED visits was 2 (mean 6.4), while the median number of visits to a primary care appointment clinic was O (mean 1.1) with only 90 (26%) of the patients having any primary care clinic visits. The 58 patients (16.6%) who had more than 10 subsequent ED visits accounted for 65.6% of all subsequent ED visits. Overall, patients received 55% of their subsequent ambulatory care in the ED, with only 7.5% in a primary care clinic. In multivariate regression, only access to a telephone (odds ratio [OR] 0.48; 95% confidence interval [CI] 0.39, 0.60), hospital admission (OR 5.90; 95% CI 4.01, 8.76), and primary care visits (OR 1.68; 95% CI 1.34, 2.12) were associated with higher ED visit rates. Regular source of care, insurance coverage, and health status were not associated with ED use. From clinical record review, 74.1% of those with high rates of use had multiple chronic medical conditions, or a chronic medical condition complicated by a psychiatric diagnosis, or substance abuse.Conclusions: All subgroups of patients in this study relied heavily on the ED for ambulatory care, and high ED use was positively correlated with appointment clinic visits and inpatient hospitalization rates, suggesting that high resource utilization was related to a higher burden of illness among those patients. The prevalence of chronic medical conditions and substance abuse among these most frequent emergency department users points to a need for comprehensive primary care. Multidisciplinary case management strategies to identify frequent ED users and facilitate their use of alternative care sites will be particularly important as managed care strategies are applied to indigent populations who have traditionally received care in public hospital EDs. [ABSTRACT FROM AUTHOR]

Objective: To develop a valid, reliable instrument to measure the functional health literacy of patients.Design: The Test of Functional Health Literacy in Adults (TOFHLA) was developed using actual hospital materials. The TOFHLA consists of a 50-item reading comprehension and 17-item numerical ability test, taking up to 22 minutes to administer. The TOFHLA, the Wide Range Achievement Test--Revised (WRAT-R), and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered for comparison. A Spanish version was also developed (TOFHLA-S).Setting: Outpatient settings in two public teaching hospitals.Patients: 256 English- and 249 Spanish-speaking patients were approached. 78% of the English- and 82% of the Spanish-speaking patients gave informed consent, completed a demographic survey, and took the TOFHLA or TOFHLA-S.Results: The TOFHLA showed good correlation with the WRAT-R and the REALM (correlation coefficients 0.74 and 0.84, respectively). Only 52% of the English speakers completed more than 80% of the questions correctly. 15% of the patients could not read and interpret a prescription bottle with instructions to take one pill by mouth four times daily, 37% did not understand instructions to take a medication on an empty stomach, and 48% could not determine whether they were eligible for free care.Conclusions: The TOFHLA is a valid, reliable indicator of patient ability to read health-related materials. Data suggest that a high proportion of patients cannot perform basic reading tasks. Additional work is needed to determine the prevalence of functional health illiteracy and its effect on the health care experience. [ABSTRACT FROM AUTHOR]

The phase diagram of lead-free piezoelectric KxNa1-xNbO3 has been studied, with particular focus on the proposed morphotropic phase boundaries, by powder and single crystal x-ray diffraction. The tilt system and cation displacement has been mapped out as a function of temperature and composition, highlighting changes in the oxygen octahedra at x=0.2 and x=0.4 at room temperature. The orthorhombic to monoclinic boundary at x=0.5 has been investigated, with a subtle change in the structure observed. The conclusion is that KxNa1-xNbO3 does not display a morphotropic phase boundary comparable with that in lead zirconate titanate, and that the most significant structural change as a function of composition occurs at x=0.2 because of the change of the tilt system. [ABSTRACT FROM AUTHOR]

The phase diagram of lead-free piezoelectric KxNa1-xNbO3 has been studied, with particular focus on the proposed morphotropic phase boundaries, by powder and single crystal x-ray diffraction. The tilt system and cation displacement has been mapped out as a function of temperature and composition, highlighting changes in the oxygen octahedra at x=0.2 and x=0.4 at room temperature. The orthorhombic to monoclinic boundary at x=0.5 has been investigated, with a subtle change in the structure observed. The conclusion is that KxNa1-xNbO3 does not display a morphotropic phase boundary comparable with that in lead zirconate titanate, and that the most significant structural change as a function of composition occurs at x=0.2 because of the change of the tilt system. [ABSTRACT FROM AUTHOR]