Reducing unnecessary Medicare hospital admissions for chest pain in Arizona and Florida.

Purpose/objectives: Each year in the United States, more than 4.4 million patients with chest pain (DRG 143) present to emergency departments. Many of these admissions do not have documented justification to support an acute inpatient admission.

Poverty reduction in Africa.

Poverty in Africa has been rising for the last quarter-century, while it has been falling in the rest of the developing world. Africa's distinctive problem is that its economies have not been growing. This article attempts to synthesize a range of recent research to account for this failure of the growth process.

Advances in the treatment of intracapsular hip fractures in the elderly.

A review of recent advances in the treatment of intracapsular hip fractures in the elderly patient is offered to provide some guidelines on choosing the appropriate treatment for a given patient. Alternatives discussed include open reduction and internal fixation versus arthroplasty; unipolar versus bipolar hemiarthroplasty versus total hip arthroplasty; cemented versus cementlless prostheses; and a surgical approach. These recommendations are based upon a review of the substantial literature on the subject and the author's own experience.

Building a behemoth.

The Large Hadron Collider makes extensive use of existing CERN infrastructure but is in many respects an unprecedented undertaking. It is a proton-proton collider; therefore, it requires two separate accelerator rings with magnetic fields of opposite polarity to guide the two beams in opposite directions around its 27-km circumference. In addition, the extraordinary energies and collision rates that it has been designed to attain pose huge challenges for controlling the beam and protecting the accelerator.

The hidden risk of deep vein thrombosis--the need for risk factor assessment: case reviews.

Deep vein thrombosis (DVT) is a very serious, potentially fatal, and very preventable medical condition. It is important for all patients admitted to the hospital to be screened for the risk of developing a DVT. This could be easily accomplished by performing a risk factor assessment-screening tool on all patients.

Structural analysis of anaerobic granules in a phase separated reactor by electron microscopy.

This paper discusses the microbial community structure of anaerobic granules and the effect of phase separation in anaerobic reactor on the characteristics of granules. Electron micrographs revealed that the core of anaerobic granular sludge consists predominantly of Methanosaeta-like cells, a key microorganism in granulation process. Granules in the methanogenic dominant zone of the reactor were stable and densely packed with smooth regular surface.

The performance of a phase separated granular bed bioreactor treating brewery wastewater.

This study presents the performance characteristics of a plug flow phase separated anaerobic granular bed baffled reactor (GRABBR) fed with brewery wastewater at various operating conditions. The reactor achieved chemical oxygen demand (COD) removal of 93-96% with high methane production when operated at organic loading rates (OLRs) of 2.16-13.

Assessment of morphology for anaerobic-granular particles.

This study shows that a proper assessment of granule morphology is fundamental before applying any mathematical derivation or empirical formula based on the shape factor of anaerobic-granular particles to determine granular characteristics. The granular images and size distribution of samples observed in this study revealed two different dimensions along two axes, which characterize these particles as ellipsoids. In the literature, theoretical-settling velocities and particle-size distribution of anaerobic granules have been calculated by assuming granules as spherical-shaped and using the numerical correlation between the size and settling velocity.

The impact of psoriasis guidelines on appropriateness of referral from primary to secondary care: a randomized controlled trial.

Background: Most patients with psoriasis have limited disease which can be managed effectively in primary care. There is a marked variation in the frequency of referrals between practices reflecting, in part, inadequate training of general practitioners (GPs) in the management of psoriasis.

Objectives: To assess the effectiveness of guidelines and training sessions on the management of psoriasis in reducing inappropriate referrals from primary care.

Studies on the total synthesis of lactonamycin: construction of model ABCD ring systems.

Model studies on the synthesis of the tetracyclic ABCD ring system of lactonamycin (1) are described. The key step involved the double Michael addition reaction of alcohol 8 to propynoate esters to produce the BCD units 13 and 14 of the target 1. Alternatively, double Michael addition of alcohol 8 to di-tert-butyl acetylenedcarboxylate gave the corresponding BCD ring systems 36 and 37.

Development and validation of an HPLC method for the determination of spironolactone and its metabolites in paediatric plasma samples.

An HPLC method has been developed and validated for the determination of spironolactone, 7 alpha-thiomethylspirolactone and canrenone in paediatric plasma samples. The method utilises 200 microl of plasma and sample preparation involves protein precipitation followed by Solid Phase Extraction (SPE). Determination of standard curves of peak height ratio (PHR) against concentration was performed by weighted least squares linear regression using a weighting factor of 1/concentration2.

Carbon and nitrogen removal in a granular bed baffled reactor.

The application of an anaerobic five compartment granular bed baffled reactor (GRABBR) was investigated with brewery wastewater for combined carbon and nitrate removal, with a separate downstream nitrification unit for converting ammonia to nitrate. The GRABBR was operated at an organic loading rate of 3.57 kg chemical oxygen demand (COD) m(-3) d(-1) and ammoniacal nitrogen (NH4-N) loading rate of 0.

Discovery and pharmacological characterization of a novel rodent-active CCR2 antagonist, INCB3344.

This report describes the characterization of INCB3344, a novel, potent and selective small molecule antagonist of the mouse CCR2 receptor. The lack of rodent cross-reactivity inherent in the small molecule CCR2 antagonists discovered to date has precluded pharmacological studies of antagonists of this receptor and its therapeutic relevance. In vitro, INCB3344 inhibits the binding of CCL2 to mouse monocytes with nanomolar potency (IC(50) = 10 nM) and displays dose-dependent inhibition of CCL2-mediated functional responses such as ERK phosphorylation and chemotaxis with similar potency.

A case management protocol: reducing unnecessary Medicare admissions in Florida.

The Florida Medicare quality improvement organization implemented a case management project with 20 acute care hospitals to reduce unnecessary Medicare admissions. The project called for hospitals to implement a protocol to assign patients to observation or inpatient admission status. Results of the project showed a 67% reduction in the denial rate for the participating facilities.

Enhanced para-xylene selectivity in the toluene alkylation reaction at ultralow contact time.

Dramatic improvements in the para-xylene selectivity of the toluene alkylation reaction can be effected by operating the catalytic reaction at ultralow contact time. Unexpectedly, the rate of alkylation is sustained, while unwanted side reactions are suppressed. By demonstrating that contact time directly influences the fate of para-xylene, which is known to form and diffuse preferentially within the zeolite catalyst, we conclude that external mass transfer is a key parameter in controlling selectivity.

Intravenous indometacin in preterm infants with symptomatic patent ductus arteriosus. A population pharmacokinetic study.

Aims: To characterize the population pharmacokinetics of indometacin in preterm infants with symptomatic patent ductus arteriosus and to investigate the influence of various factors on the response to treatment.

Methods: Data were collected from 35 infants (gestational age 25-34 weeks; postnatal age 1-77 days) in neonatal units in Belfast and Copenhagen. Infants received an initial course of up to three doses of intravenous indometacin (0.

Diastereotopic analysis of mesoridazine besylate (Serentil).

NMR studies were conducted with the aim of determining the diastereoisomeric ratio of a commercially supplied sample of mesoridazine (MES) and to compare the results with a freshly synthesised sample of MES. The results indicated that the commercially supplied MES consisted almost entirely of one diastereoisomeric pair, which was in agreement with previous findings reported by Eap et al. The synthesised sample of MES was analysed by NMR in two stages: 1) as the initial product isolated as the free base from the direct synthesis, and 2) as the free base isolated from the crystallised besylate salt of the synthetic product.

Liquid chromatographic determination including simultaneous "on-cartridge" separation of ranitidine cisapride drug combinations from paediatric plasma samples using an automated solid-phase extraction procedure.

HPLC methodology was investigated for the simultaneous determination of cisapride and ranitidine in small volume paediatric plasma samples. Such a simultaneous determination proved difficult due to the small sample volumes, the low concentrations of the drugs and the different log P values of the two compounds. The two drugs and their respective internal standards were separated "on-cartridge" using HLB Solid Phase Extraction cartridges and the samples quantified by individual HPLC methodologies.

Active-site coating for molecular discrimination in heterogeneous catalysis.

A coherent layer of zeolite A has been applied to a SiO2-supported Pt-Fe oxidation catalyst, using total surface charge-reversal. The zeolite has tracked the metals into the pore structure of the support, covering the active sites. The zeolite channel size is large enough to allow access of CO and O2 to the active sites, and to allow CO2 to emerge, but it excludes larger molecules.

The small bovine amelogenin LRAP fails to rescue the amelogenin null phenotype.

Amelogenins are the most abundant secreted proteins in developing dental enamel. These evolutionarily-conserved proteins have important roles in enamel mineral formation, as mutations within the amelogenin gene coding region lead to defects in enamel thickness or mineral structure. Because of extensive alternative splicing of the primary RNA transcript and proteolytic processing of the secreted proteins, it has been difficult to assign functions to individual amelogenins.

Induction of endogenous genes by peroxisome proliferator activated receptor alpha ligands in a human kidney cell line and in vivo.

The peroxisome proliferator activated receptor alpha (PPARalpha) plays a key role in regulating fatty acid metabolism by regulating expression of genes involved in fatty acid oxidation. To identify endogenous transcripts that could be used as surrogate markers for on-target activity of PPARalpha agonists, we employed a global profiling approach using DNA microarrays. The HK-2 cell line derived from proximal tubules of the human kidney, showed induction of several genes, including pyruvate dehydrogenase kinase 4 (PDK-4) and adipocyte differentiation related protein (ADRP) by PPARalpha ligands.

Randomized, double-blind, placebo-controlled trial of autologous blood therapy for atopic dermatitis.

Background: Autologous blood therapy (ABT) is used for treating atopic dermatitis (AD) in some European countries and is promoted on internet sites for this condition. However, there is little evidence from rigorous clinical trials to suggest that it is effective.

Objectives: To test the effectiveness of ABT for the symptomatic treatment of patients with AD.

Microemulsions are highly effective anti-biofilm agents.

Aims: The demonstration of the antibiofilm effects of pharmaceutical microemulsions.

Methods And Results: Microemulsions were prepared as physically stable oil/water systems. Previous work by this group has shown that microemulsions are highly effective antimembrane agents that result in rapid losses of viability in planktonic populations of Pseudomonas aeruginosa and Staphylococcus aureus.

Two-dimensional molecular electronics circuits.

Addressing an array of bistable [2]rotaxanes through a two-dimensional crossbar arrangement provides the device element of a current-driven molecular electronic circuit. The development of the [2]rotaxane switches through an iterative, evolutionary process is described. The arrangement reported here allows both memory and logic functions to use the same elements.