Quality improvement in acute stroke: the New York State Stroke Center Designation Project.

Background: Many hospitals lack the infrastructure required to treat patients with acute stroke. The Brain Attack Coalition (BAC) published guidelines for the establishment of primary stroke centers.

Objective: To determine if stroke center designation and selective triage of acute stroke patients improve quality of care.

Intracranial pressure monitoring: modeling cerebrovascular pressure transmission.

Objectives: To examine changes in cerebrovascular pressure transmission derived from arterial blood pressure (ABP) and intracranial pressure (ICP) recordings by autoregressive moving average modeling technique.

Methods: Digitized ICP and ABP recordings were obtained from patients with brain injury. Two groups were defined: Group A with 4 patients who demonstrated plateau waves, and Group B with 4 intracranial hypertensive, hypoperfused patients.

Plateau waves: changes of cerebrovascular pressure transmission.

Objective: To test the validity of the hypothesis that active vasodilatation and vasoconstriction underlie the occurrence of intracranial pressure (ICP) plateau waves by evaluating corresponding changes of cerebrovascular pressure transmission of arterial blood pressure (ABP) to ICP.

Methods: Digitized recordings of ICP and ABP sampled at 30 Hz were obtained from nine patients with traumatic brain injury. For each 16.

Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors.

Background And Purpose: To estimate the prevalence of insomnia symptoms and syndrome in the general population, describe the types of self-help treatments and consultations initiated for insomnia, and examine help-seeking determinants.

Patients And Methods: A randomly selected sample of 2001 French-speaking adults from the province of Quebec (Canada) responded to a telephone survey about sleep, insomnia, and its treatments.

Results: Of the total sample, 25.

Influenza among healthy young children: changes in parental attitudes and predictors of immunization during the 2003 to 2004 influenza season.

Background: In Colorado, the 2003 to 2004 influenza season was unusually early and severe and received substantial media attention.

Objectives: Among parents of healthy young children, to determine how parental knowledge and attitudes regarding influenza infection and immunization changed during the 2003 to 2004 influenza season and to identify factors predictive of influenza immunization.

Methods: The study was conducted in 5 metropolitan Denver pediatric practices.

Interspecific variation in nighttime transpiration and stomatal conductance in a mixed New England deciduous forest.

Transpiration is generally assumed to be insignificant at night when stomata close in response to the lack of photosynthetically active radiation. However, there is increasing evidence that the stomata of some species remain open at night, which would allow for nighttime transpiration if there were a sufficient environmental driving force. We examined nighttime water use in co-occurring species in a mixed deciduous stand at Harvard Forest, MA, using whole-tree and leaf-level measurements.

Metal bridges between the PhoQ sensor domain and the membrane regulate transmembrane signaling.

Bacterial histidine kinases respond to environmental stimuli by transducing a signal from an extracytosolic sensor domain to a cytosolic catalytic domain. Among them, PhoQ promotes bacterial virulence and is tightly repressed by the divalent cations such as calcium and magnesium. We have determined the crystal structure of the PhoQ sensor domain from Salmonella typhimurium in the Ca2+-bound state, which reveals a highly negatively charged surface that is in close proximity to the inner membrane.

Running over rough terrain: guinea fowl maintain dynamic stability despite a large unexpected change in substrate height.

In the natural world, animals must routinely negotiate varied and unpredictable terrain. Yet, we know little about the locomotor strategies used by animals to accomplish this while maintaining dynamic stability. In this paper, we perturb the running of guinea fowl with an unexpected drop in substrate height (DeltaH).

Structural determinants for plant annexin-membrane interactions.

The interactions of two plant annexins, annexin 24(Ca32) from Capsicum annuum and annexin Gh1 from Gossypium hirsutum, with phospholipid membranes have been characterized using liposome-based assays and adsorption to monolayers. These two plant annexins show a preference for phosphatidylserine-containing membranes and display a membrane binding behavior with a half-maximum calcium concentration in the sub-millimolar range. Surprisingly, the two plant annexins also display calcium-independent membrane binding at levels of 10-20% at neutral pH.

Missed opportunities for influenza vaccination in children with chronic medical conditions.

Objectives: To assess the frequency and characteristics of missed opportunities for influenza immunization in children with chronic medical conditions and, among unimmunized children in that group, to explore parent-reported reasons for not vaccinating their child.

Design: Prospective cohort study. Data were obtained from billing and immunization registry databases and telephone interviews of parents.

Effects of a statewide carve out on spending and access to substance abuse treatment in Massachusetts, 1992 to 1996.

Objective: We studied the first four years of the statewide carve out for Medicaid enrollees in Massachusetts to assess its effect on access and spending.

Data Sources/study Design: Using administrative data, we compared the state's fiscal years 1992 (the last year before the carve out) through 1996 (the final year of the state's first carve-out vendor, MHMA). We evaluated the effect on spending by converting expenditures to constant (1996) prices using the medical services component of the Consumer Price Index for Boston and standardizing directly for the changing proportion of Medicaid enrollees who were disabled.

Recognition of antimicrobial peptides by a bacterial sensor kinase.

PhoQ is a membrane bound sensor kinase important for the pathogenesis of a number of Gram-negative bacterial species. PhoQ and its cognate response regulator PhoP constitute a signal-transduction cascade that controls inducible resistance to host antimicrobial peptides. We show that enzymatic activity of Salmonella typhimurium PhoQ is directly activated by antimicrobial peptides.

Incidence of anaphylactoid reactions to isosulfan blue dye during breast carcinoma lymphatic mapping in patients treated with preoperative prophylaxis: results of a surgical prospective clinical practice protocol.

Background: Severe anaphylactoid reactions to isosulfan blue dye requiring resuscitation are reported to occur in 1.1% of patients with breast carcinoma undergoing sentinel lymphadenectomy. In December 2001, the authors began administering a prophylactic regimen before dye injection to determine whether prophylaxis reduced the incidence of life-threatening reactions.

Provider adoption of pneumococcal conjugate vaccine and the impact of vaccine shortages.

Objectives: To 1) determine the factors associated with provider acceptance of pneumococcal conjugate vaccine and 2) describe how providers prioritize pneumococcal conjugate vaccine during shortages.

Design/methods: During April-November 2002, we conducted a mailed survey of rural and urban Colorado practitioners who provided routine pediatric immunizations. Three groups were surveyed: 1) all immunization providers (n = 51) in 2 geographically large rural areas, identified through a regional immunization registry; 2) all providers (n = 61) from private pediatric practices in metropolitan Denver that were actively participating in the same registry; and 3) all family physicians (n = 244) from the same urban areas as the pediatric practices.

Race, managed care, and the quality of substance abuse treatment.

The adoption of managed behavioral health care by state Medicaid agencies has the potential to increase the quality of treatment for racial minorities by promoting access to substance abuse treatment and creating more appropriate utilization patterns. This paper examines three indicators of quality for white, Black, and Hispanic Medicaid clients who received substance abuse treatment in Massachusetts between 1992 and 1996. It evaluates whether a managed behavioral health care carve-out in FY1993 had a positive or negative effect on access, continuity of care, and 30-day re-admissions.

Managed behavioral health care: lessons from Massachusetts.

Since implementing the first statewide carve-out for behavioral health care in 1992, Massachusetts has achieved sustained reductions in cost, increases in access, and improvements in major quality measures. This introduction to a special issue describes the context, linkages with primary care, consumer satisfaction, unmet need, performance incentives (a key component of the success), stakeholder perspectives, and impacts on special populations.

Changes in quality of life for pregnant women in substance user treatment: developing a quality of life index for the addictions.

Unlabelled: Using preference weights from a community sample, items from the Addiction Severity Index (ASI) were converted into a quality of life index (QOLI) and used to compare the cost-effectiveness of five addiction treatment modalities for pregnant women.

Methods: Interviews using the time trade-off methodology were conducted with 143 members of Massachusetts local health planning boards to determine preference weights for different health states resulting from active addiction. A multi-attribute utility formula was used to convert these seven preference weighted scores into a single QOLI.

Case study: the internet as a developmental tool in an adolescent boy with psychosis.

The Internet has become an increasingly important part of teen culture; however, there still remains little in the medical/psychiatric literature pertaining to the impact of the Internet on adolescent development. Despite the potential problems associated with communication online, the Internet offers a variety of positive opportunities for teens. In this report, we present a case study that illustrates the Internet as a helpful tool in a 15-year-old adolescent boy with a history of chronic neurological illness accompanied by refractory psychosis.

Implementation of universal influenza immunization recommendations for healthy young children: results of a randomized, controlled trial with registry-based recall.

Background: An Advisory Committee on Immunization Practices policy of encouraging influenza vaccination for healthy 6- to 23-month-old children was in effect during the 2003-2004 influenza season, which was unusually severe in Colorado. We collaborated with 5 pediatric practices to attempt universal influenza immunization in this age group.

Objectives: The objectives were (1) to assess the maximal influenza immunization rates that could be achieved for healthy young children in private practice settings, (2) to evaluate the efficacy of registry-based reminder/recall for influenza vaccination, and (3) to describe methods used by private practices to implement the recommendations.

Hydrogen bonding on the ice-binding face of a beta-helical antifreeze protein indicated by amide proton NMR chemical shifts.

The dependence of amide proton chemical shifts on temperature is used as an indication of the hydrogen bonding properties in a protein. The amide proton temperature coefficients of the beta-helical antifreeze protein from Tenebrio molitor are examined to determine their hydrogen bonding state in solution. The temperature-dependent chemical shift behavior of the amides in T.

Adverse events associated with the intraoperative injection of isosulfan blue.

Study Objective: To describe the adverse events associated with the intraoperative injection of isosulfan blue in a large group of patients having a wide range of surgical procedures, and to identify risk factors for these events.

Design: Retrospective chart review.

Setting: University-affiliated institution specializing in malignancies

Patients: 1835 patients representing a total of 1852 surgical procedures.

Enhancing the activity of a beta-helical antifreeze protein by the engineered addition of coils.

The effectiveness of natural antifreeze proteins in inhibiting the growth of a seed ice crystal seems to vary with protein size. Here we have made use of the extreme regularity of the beta-helical antifreeze protein from the beetle Tenebrio molitor to explore systematically the relationship between antifreeze activity and the area of the ice-binding site. Each of the 12-amino acid, disulfide-bonded central coils of the beta-helix contains a Thr-Xaa-Thr ice-binding motif.

The regional immunization registry as a public health tool for improving clinical practice and guiding immunization delivery policy.

Objectives: We assessed the distribution of immunization records among 3 health care delivery sectors and the impact of a regional immunization registry on "up to date" rates.

Methods: Immunization registry records in 2 regions were categorized as having originated in private practices, community health centers, or public health clinics. "Up to date" rates were calculated after we sequentially added immunization records from the 3 sectors.

Heme oxygenase inhibition reduces neuronal activation evoked by bicuculline in newborn pigs.

Carbon monoxide (CO) is a product of heme degradation by heme oxygenase (HO) that is highly expressed in the brain. The present study addresses the hypothesis that CO can be involved in brain neuronal function. The effects of the HO inhibitor, tin protoporphyrin (SnPP), on brain electrical activity and pial arteriolar diameter were examined using quantitative electroencephalography (EEG) and cranial window techniques in the bicuculline model of sustained generalized seizures in newborn pigs.

Assessment of cerebrovascular autoregulation: changes of highest modal frequency of cerebrovascular pressure transmission with cerebral perfusion pressure.

Background And Purpose: Development of a method to continuously assess cerebrovascular autoregulation of patients with traumatic brain injury would facilitate therapeutic intervention and thus reduce secondary complications.

Methods: Changes in arterial blood pressure (ABP), intracranial pressure (ICP), cerebral blood flow velocity (CBFV), and pial arteriolar diameter (PAD) induced by acute pressor challenge (norepinephrine; 1 microg/[kg. min]) were evaluated in both uninjured and fluid percussion injured piglets equipped with cranial windows.