Genetic variation in GABRβ1 and the risk for developing alcohol dependence.

Associations between the γ-aminobutyric acid type-A receptors (GABAA) and alcohol dependence risk have been reported, although the receptor subunit driving the association is unclear. Recent work in mice has highlighted a possible role for variants in the Gabr β1 subunit (Gabrβ1) in alcohol dependence risk, although this gene does not contain any common nonsynonymous variants in humans. However, the GABAA receptor is a heteropentamer so multiple potential variants within the gene complex could generate the alcohol dependence phenotype.

Continually improving governance.

What can governance do to ensure the continual improvement of organizational performance? This article explores this question, with particular emphasis on two central considerations. First, what constitutes good governance? Second, what are the sources of and opportunities for leveraging performance available to governance? We argue that focusing on strategy, evaluating performance, and developing the means to learn are the key venues available to governance for leveraging its own and organizational performance.

Total quality management in a hospital.

The adaptation of the management philosophy and tools of total quality management (TQM) to the modern American hospital, its staff, and physicians is a major challenge facing health care today. The TQM "bandwagon" is one that hospitals both want to--and are required to--jump on, insofar as TQM is now part of the revised Joint Commission standards [Ed note: The standards encourage hospitals to adopt TQM, continuous quality improvement, or a similar approach to improve performance]. TQM holds out the promise of improving clinical quality while simultaneously reducing the "cost of poor quality.

University of California/Davis Interdepartmental Conference on gram-negative septicemia.

Gram-negative septicemia remains one of the most serious forms of hospital-acquired infection. The most consistently virulent component of the gram-negative lipopolysaccharide (endotoxin) appears to be lipid A. Elucidation of the structure-function relationships of lipid A and the biochemical configurations required for endotoxicity makes possible the design of lipopolysaccharide antagonists and/or the production of poly- or monoclonal antibodies that may abrogate the biologic effects of endotoxin.

Bacteremia due to Mycobacterium tuberculosis in patients with human immunodeficiency virus infection. A report of 9 cases and a review of the literature.

Mycobacterium tuberculosis bacteremia is being reported more frequently in patients with human immunodeficiency virus, type 1 (HIV-1) infection. We report 9 patients with bacteremia due to M. tuberculosis and HIV infection who were identified over a 36-month period.

Determination of (210)Pb, (210)Bi and (210)Po in natural waters and other materials by electrochemical separation.

An improved method for determination of (210)Pb, (210)Bi and (210)Po in both natural waters and solid materials has been developed. Polonium-210 is spontaneously plated onto a silver disc from dilute hydrochloric acid medium. Bismuth-210 is then electro-deposited onto a platinum gauze cathode directly from the same solution, with a graphite rod as anode.

Randomized clinical trial of aztreonam and aminoglycoside antibiotics in the treatment of serious infections caused by gram-negative bacilli.

Aztreonam was compared with aminoglycoside antibiotics (tobramycin and amikacin) in a randomized, prospective, clinical trial in serious infections caused by gram-negative bacilli (GNB). A total of 43 evaluable patients with 47 infected sites were treated with aztreonam, and 41 evaluable patients were treated with aminoglycosides for 43 infections. Of patients treated with aztreonam, 17 were bacteremic, as were 12 of those treated with aminoglycosides.

Immunization with rough mutants of Salmonella minnesota: initial studies in human subjects.

Vaccines prepared from unheated and boiled, acetone-precipitated Salmonella minnesota R595 (Re chemotype mutant) were administered subcutaneously to 122 healthy volunteers. Titers of antibody to Re lipopolysaccharide, the basal core structure of endotoxin, as measured by indirect hemagglutination, rose in a dose-responsive fashion after immunization. Febrile reactions, usually mild, occurred after 7% of injections with the highest doses (2.

Immunization with rough mutants of Salmonella minnesota: protective activity of IgM and IgG antibody to the R595 (Re chemotype) mutant.

We evaluated the immunoglobulin class responsible for the protective activity in serum obtained from humans and rabbits after immunization with the R595 (Re chemotype) mutant of Salmonella minnesota. Whole serum obtained before immunization and the IgG and IgM fractions failed to protect mice against lethal challenge with viable Klebsiella pneumoniae or Morganella morganii or with Salmonella typhi lipopolysaccharide (LPS). The protective activity of postimmunization serum resided solely in IgM antibody, whereas IgG antibody exhibited no protective activity.

Endotoxin-associated protein: interleukin-1-like activity on serum amyloid A synthesis and T-lymphocyte activation.

Bacterial endotoxins or lipopolysaccharides (LPS) elicit a variety of biologic activities in intact animals and various in vitro systems. LPS from most gram-negative bacteria have appeared to have similar biologic activities regardless of the species of origin or method of preparation of the LPS. More recent studies have suggested differences in the effects of protein-rich as opposed to protein-free LPS in inducing mitogenesis of lymphocytes from endotoxin-resistant C3H/HeJ mice.

Endotoxin-associated protein: a potent stimulus for human granulocytopoietic activity which may be accessory cell independent.

Proteins coextracted with endotoxin, termed endotoxin-associated protein (EAP), have been shown to exert interleukin 1-like activities. The present studies demonstrate that EAP also exerts potent granulopoietic colony-stimulating activity (CSA) on human peripheral blood and bone marrow progenitor cells, comparable to that seen with various types of conditioned media. The CSA observed with EAP appeared to be heat (100 degrees C, 30 min) and trypsin resistant and partially pronase resistant.

Nosocomial infection and fatality in medical and surgical intensive care unit patients.

We prospectively studied 526 patients admitted to the medical intensive care unit (MICU) and 799 patients admitted to the surgical intensive care unit (SICU) at a municipal hospital over a 20-month period. Rates of nosocomial infection were higher in the SICU patients (31% vs 24%). The SICU patients had more urinary tract infections, bacteremias, and wound infections, and the MICU patients were older, had higher acute physiology scores on admission and were more often admitted with shock or coma.

Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization.

Gram-negative nosocomial pneumonia may result from retrograde colonization of the pharynx from the stomach, and this may be more likely when the gastric pH is relatively high. We studied the rate of nosocomial pneumonia among 130 patients given mechanical ventilation in an intensive care unit who were receiving as prophylaxis for stress ulcer either sucralfate (n = 61), which does not raise gastric pH, or conventional treatment with antacids, histamine type 2 (H2) blockers, or both (n = 69). At the time of randomization to treatment, the two groups were similar in age, underlying diseases, and severity of acute illness.

Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex.

Sixty-four episodes of bacterial infection were identified over a 44-month period in 16 of 28 patients with the acquired immune deficiency syndrome (AIDS) and 14 of 31 patients with AIDS-related complex. Nineteen of the 30 infected patients were parenteral drug abusers, 10 were from Caribbean Islands and had no identified risk factor, and one was a homosexual male. Fourteen patients had 21 episodes of community-acquired pneumonia: Streptococcus pneumoniae (10), Haemophilus influenzae (three), other Haemophilus species (three), group B beta-hemolytic streptococci (one), Staphylococcus aureus (one), Branhamella catarrhalis (one), Legionella pneumophila (one), and Mycoplasma pneumoniae (one).

M proteins of group G streptococci isolated from bacteremic human infections.

We studied seven strains of group G streptococci isolated from clinically severe bacteremic infections in six intravenous drug abusers. These group G strains multiplied luxuriantly in fresh human blood. On electron microscopy, they exhibited surface fibrillae similar to those observed in M-protein-rich group A streptococci, but they were not serologically M typable with a battery of 39 M antisera.

Selective pressures and lipopolysaccharide subunits as determinants of resistance of clinical isolates of gram-negative bacilli to human serum.

Differences in molecular composition of lipopolysaccharides (LPS) between serum-sensitive (S) clinical isolates of Escherichia coli and serum-resistant (R) clones derived by serial passage in serum were demonstrated to determine sensitivity or resistance to killing by normal human serum (NHS). LPS from R clones had a greater proportion of higher-molecular-weight, more highly O-antigen-substituted subunits than LPS from their serum S parents. Utilization of a liposomal model with inserted LPS simulating bacterial cell walls established LPS as the site of serum bactericidal action.

Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation.

We studied risk factors for nosocomial pneumonia and fatality in 233 intensive care unit patients requiring continuous mechanical ventilation. Ventilator-associated pneumonia was diagnosed in 49 (21%) of the 233 patients. Of the 8 risk factors univariately associated with the development of pneumonia, only the presence of an intracranial pressure monitor (p less than 0.

Methicillin-resistant Staphylococcus aureus bacteremia linked to intravenous drug abusers using a "shooting gallery".

Over a 15-month period, seven intravenous drug abusers had 10 admissions because of bacteremia due to methicillin-resistant Staphylococcus aureus. Seven episodes of probable bacterial endocarditis occurred in four patients; one patient had septic thrombophlebitis and two had soft tissue infections. All seven patients patronized a local "shooting gallery" where paraphernalia were provided and drugs were often administered by a "street doctor.