A High Energy X-ray Diffraction Study of Amorphous Indomethacin.

Amorphous pharmaceuticals often possess a wide range of molecular conformations and bonding arrangements. The x-ray pair distribution function (PDF) method is a powerful technique for the characterization of variations in both intra-molecular and inter-molecular packing arrangements. Here, the x-ray PDF of amorphous Indomethacin is shown to be particularly sensitive to the preferred orientations of the chlorobenzyl ring found in isomers in the crystalline state. In some cases, the chlorobenzyl ring has no preferred torsional angle in the amorphous form, while in others evidence of distinct isomer orientations are observed. Amorphous samples with no preferred torsion angles of the chlorobenzyl ring are found to favor enhanced inter-molecular hydrogen bonding, and this is reflected in the intensity of the first sharp diffraction peak. These significant variations in structure rule out amorphous Indomethacin as a possible standard for x-ray PDF measurements. At high humidity, time resolved PDF's for >40 h reveal water molecules forming hydrogen bonds with Indomethacin molecules. A simple linear hydrogen bond model indicates that water molecules in the wet amorphous form have similar hydrogen bond strengths to those found between Indomethacin dimers or chains in the dry amorphous form.

Implementation of a medical intensive care unit acute-care nurse practitioner service.

Demands for critical care services are increasing, but the supply of qualified physicians is not. Moreover, there are mounting national expectations for continuous on-site, senior providers and for adherence to quality and safety practices. In teaching institutions, manpower shortages are exacerbated by shrinking trainee duty hours, and there is a growing desire to recoup the revenue lost when a non-credentialed provider delivers a service. Increasingly, hospitalists and acute-care nurse practitioners (ACNPs) are meeting these needs. This article describes the development of an ACNP service in a university hospital medical intensive care unit (ICU) designed to improve the range and quality of services and faculty staffing when the ICU expanded from 22 to 34 beds without adding physicians. Eight ACNPs were hired and, over 9 months, received didactic, procedural, simulation center, and supervised patient care training. Progressive workload and graded responsibility were used to transition to a 24-hour, in-house, resident-independent, attending-supervised service, which now admits just under half of all patients (3.4 ± 1.3 patients/day), cares for approximately one-fourth of the unit's critically ill patients (6.0 ± 1.4 patients/day), and responds to medical rapid response team calls daily (1.5 ± 1.7 calls/day). Over the first 5 months of operation, work output in all categories continued to increase, with ACNPs documenting an average of 11.1 ± 2.7 activities per day (all data mean ± standard deviation). Acute-care nurse practitioners also provide 40% of the daily resident core lectures and a monthly staff nurse conference. Insufficient data exist at this time, however, to report accurate billing or collection results. Specific areas discussed within this article include service structure, hiring and training, implementation, scheduling, supervision, problems encountered, productivity, monitoring, and future plans.

Risk-based cost modelling of oral rabies vaccine interventions for raccoon rabies.

Distribution of oral rabies vaccine (ORV) is an effective but costly strategy to control raccoon rabies. Because of high costs, ORV for raccoon rabies in the U.S. has been limited primarily to epizootic areas, leaving extensive raccoon rabies regions without any ORV intervention. Several cost scenarios for ORV application in raccoon rabies enzootic and epizootic regions were modelled in New York State to obtain estimated costs of ORV baits per scenario and potential savings compared with a uniform ORV baiting strategy. These cost scenarios modelled at the census tract, level the application of ORV baits at different densities according to levels of risk defined by the observed number of raccoon rabies cases per km2 and the expected number of cases per km2 estimated with a Poisson regression model. Bait purchase costs were lower using the modelled cost scenarios than a uniform baiting strategy, for both the NYS enzootic region and the Long Island epizootic zone. The proportion of savings for the NYS enzootic region was 29.57%, and the proportion of savings for the Long Island epizootic zone was 38.9%. Use of these cost scenarios to determine bait distribution by rabies risk level should be considered to maximize efficacy and reduce costs of ORV interventions.

Distribution effects on 1H double-quantum MAS NMR spectra.

The effect of a distribution in the (1)H-(1)H dipolar coupling on (1)H double-quantum (DQ) magic angle spinning (MAS) nuclear magnetic resonance (NMR) spinning sideband patterns is considered. In disordered or amorphous materials a distribution in the magnitude of the (1)H-(1)H dipolar coupling is a realistic possibility. Simulations of the (1)H DQ MAS NMR spinning sideband spectra were performed with the two-spin approximation. These simulations reveal that a dipolar coupling distribution can greatly affect the DQ spectral shape and behavior of the DQ build-up. The spectral line shapes are quantified by measurement of the relative intensities of the DQ sidebands. These variations in the (1)H DQ NMR spectra are evaluated as a function of the width of the dipolar coupling distribution. As an example, the experimental DQ spinning sideband spectrum for a hydrated polyoxoniobate containing 15 H(2)O molecules per hexaniobate cluster, are better simulated with a distribution of dipolar couplings opposed to a single coupling constant.

West Nile virus infection in mosquitoes, birds, horses, and humans, Staten Island, New York, 2000.

West Nile (WN) virus transmission in the United States during 2000 was most intense on Staten Island, New York, where 10 neurologic illnesses among humans and 2 among horses occurred. WN virus was isolated from Aedes vexans, Culex pipiens, Cx. salinarius, Ochlerotatus triseriatus, and Psorophora ferox, and WN viral RNA was detected in Anopheles punctipennis. An elevated weekly minimum infection rate (MIR) for Cx. pipiens and increased dead bird density were present for 2 weeks before the first human illness occurred. Increasing mosquito MIRs and dead bird densities in an area may be indicators of an increasing risk for human infections. A transmission model is proposed involving Cx. pipiens and Cx. restuans as the primary enzootic and epizootic vectors among birds, Cx. salinarius as the primary bridge vector for humans, and Aedes/Ochlerotatus spp. as bridge vectors for equine infection.

Dead crow densities and human cases of West Nile virus, New York State, 2000.

In 2000, Staten Island, New York, reported 10 human West Nile virus cases and high densities of dead crows. Surrounding counties with <2 human cases had moderate dead crow densities, and upstate counties with no human cases had low dead crow densities. Monitoring such densities may be helpful because this factor may be determined without the delays associated with specimen collection and testing.

Risk factors for lyme disease in Chester County, Pennsylvania.

OBJECTIVE: To identify factors associated with increased or decreased risk of infection for Lyme disease in Chester County, Pennyslvania. METHODS: The authors designed an unmatched case-control study involving 294 incident cases reported to the Chester County Health Department in 1998 and 449 controls selected by random digit dialing. All case and control participants were interviewed by telephone. RESULTS: Age is a risk factor for Lyme disease for groups aged 10-19 years old and 50 years or older. Sex was not a risk factor. Incidence of Lyme disease in a rural setting was three times the incidence in an urban setting. Increased risk also was associated with living in single family homes, homes with yards or attached land, woods on the land, signs of tick hosts seen on the land, and homes within 100 feet of woodland. Gardening for more than four hours per week was also a risk factor, but most other outdoor activities were not. Twice as many participants took protective measures against tick bites before outdoor employment than those who merely ventured into the yard or land associated with the home. Only checking for ticks during outdoor activity and the use of repellents prior to outdoor activities outside the yard were unequivocally associated with a reduced risk of Lyme disease. CONCLUSIONS: It is important to increase public awareness about the risk of acquiring Lyme disease from ticks in the immediate environment of the home.

Serologic evidence for West Nile virus infection in birds in Staten Island, New York, after an outbreak in 2000.

After an outbreak of West Nile virus (WNV) infections in people, horses, and wildlife in Staten Island, NY, during the summer of 2000, we surveyed the bird population of the island for evidence of infection. Neutralizing antibodies were detected in 59 of 257 (23.0%) resident birds and none of 96 transient (migrating) birds sampled in early October. Species with the greatest seroprevalence were northern cardinal (Cardinalis cardinalis) (69.2%) and rock dove (Columba livia) (54.5%). House sparrows (Passer domesticus) and chickens (Gallus gallus) had lower than expected seroprevalences, 8.6% and 5.5%, respectively. The geographic distribution of seropositivity suggested focal transmission at several locations on the island. The concentration of seropositive birds among resident bird populations on Staten Island supports the concept that many birds survive WNV infection and that some of these play an important role in the WNV-bird-mosquito transmission cycle.

Publishing a nursing textbook: collaborating through "seamless technology".

Electronic communication can enhance long-distance networking and scholarly activity and make long-distance collaboration through technology a reality. Technology presents a new world of opportunity for improving writing skills, nurturing collegiality, and maximizing efficiency in the successful completion of collaborative projects. The concept of "seamless technology" introduced by the authors provides a guide to assist partners involved in collaborative projects to manage technology for a successful, rewarding experience. Basic questions regarding technology that need to be answered on the front end of a long-distance project are suggested in this article. In addition, the steps taken by the authors to co-author and co-edit a nursing textbook and accompanying instructor's manual by using electronic communication and other sources of technology are outlined. The authors address ways that long-distance collaboration required them to maximize their communication and planning skills, thereby increasing productivity and reducing costs. The challenges and rewards of working together exclusively through technology are discussed, and finally, implications for professional nursing are addressed.

Derivation and pilot assessment of a health promotion program for Mandarin-speaking Chinese older adults.

As the percentage of older adults of diverse ethnicities increases in the United States, the call for culturally sensitive health care service strategies that target the special needs of older people grows. The present report describes methods used to adapt a health care program so that it would better meet the needs of a group of well, older Mandarin-speaking Chinese residents of Los Angeles. The specific qualitative research procedures that we used to adapt the treatment program are described, along with the particular adaptations that emerged. Additionally, outcomes from a randomized pilot experiment are presented that are consistent with the notion that the adapted program was effective in reducing health-related declines among older Mandarin-speaking men and women. The overall outcome of this project is in agreement with other reports in the health care literature that address the importance of providing culturally sensitive health care service for elders.

Psychometric properties of a Chinese translation of the SF-36 health survey questionnaire in the Well Elderly Study.

OBJECTIVES: To evaluate the psychometric properties of a Chinese translation of the 36-item Short Form Health Survey (SF-36) in the Well Elderly Study--a randomized clinical trial designed to evaluate the effectiveness of preventive occupational therapy services specifically tailored for multiethnic, independent-living, older adults. METHODS: Translation and back-translation procedures were used to obtain appropriate meanings for the SF-36 survey questions and to ensure face, functional, and conceptual equivalence. RESULTS: Statistical analyses demonstrated satisfactory reliability and validity, with the results generally similar to those reported for older Anglo adults. DISCUSSION: As the percentage of older adults of diverse ethnicity increases, the need for health care research and service strategies that can effectively include multiple ethnicities becomes paramount. The results of this study suggest that a Chinese-translated SF-36 can be used to assess multiple dimensions of health in a Mandarin-speaking population of older adults.

Hemispheric asymmetries in vigilance and cerebral arousal mechanisms in younger and older adults.

Younger and older adults responded to an asterisk presented to either the left or right visual field, with delay interval between onset of a fixation cross and onset of the asterisk varied. At delay intervals longer than 3 s, reaction time was faster when the same visual field was stimulated on 2 successive trials than when different visual fields were stimulated. This prefield effect was larger in the left visual field (right hemisphere), consistent with hypotheses of hemispheric asymmetry for arousal and vigilance. For older adults, these results were obtained only when participants responded with the left hand, suggesting that some aspects of hemispheric asymmetry for attention-related processing or the efficiency of interhemispheric transfer may change in an age-related fashion.

The Cloutterbuck Minimum Data Matrix: a teaching mechanism for the new millennium.

The demands of the United States' rapidly changing health care system and society signal the need to design and implement health professions programs which prepare students for practice within a health care paradigm that will be very different from the one existing today and for work with an increasingly diverse and independent consumer population. The Cloutterbuck Minimum Data Matrix (CMDM) is a teaching mechanism designed to generate a comprehensive base of consumer information prerequisite to the indepth level of critical analysis and synthesis needed to produce quality health care outcomes in the 21st century. The CMDM assumes an interdisciplinary perspective and educates students to recognize and incorporate consumer diversity into strategies for care.

Multitask analysis of cerebral hemisphere specialization in monozygotic twins discordant for handedness.

This study constitutes a multitask appraisal of cerebral hemisphere specialization with 13 monozygotic (MZ) twin pairs discordant for handedness. Tasks included dichotic listening, finger tapping with concurrent loads, two tachistoscopic visual half-field tests, and a free-vision face test. Overall, MZ twins showed similar performance asymmetries on most tasks. Different asymmetries, however, were observed on the finger tapping with anagram load and visual half-field with chair stimuli. In these instances, asymmetries for left- and right-handed MZ twins were more similar to patterns reported in the literature for left- and right-handed singletons, respectively, than for opposite-handed co-twins.

Evaluation of bovine viral diarrhea virus control using a mathematical model of infection dynamics.

A mathematical model for infection with bovine viral diarrhea virus (BVDV) was created comprising a series of coupled differential equations. The model architecture is a development of the traditional model framework using susceptible, infectious and removed animals (the SIR model). The model predicts 1.2% persistent infection (within the range of field estimates) and is fairly insensitive to alterations of structure or parameter values. This model allows us to draw important conclusions regarding the control of BVD, particularly with respect to the importance of persistently infected (PI) animals in maintaining BVD as an endemic entity in the herd. Herds without PI animals are likely to experience episodic reproductive losses at intervals of two to three years, unlike herds with PI animals which will not see such marked episodic manifestations of infection. Instead, these herds will experience an initial peak of disease which will settle to low-level chronic reproductive losses. The model indicates that vaccine coverage for herd immunity (to avoid episodic manifestations of disease) need be only 57% without PI animals, although 97% coverage is required when PI animals are present. Analysis of model behavior suggests a program of detection and removal of PI animals may enhance the effectiveness of a vaccine program provided these animals are in the herd for 10 days or less. The best results would be seen with PI animals in the herd for 5 or fewer days.

Occupational therapy for independent-living older adults. A randomized controlled trial.

CONTEXT: Preventive health programs may mitigate against the health risks of older adulthood. OBJECTIVE: To evaluate the effectiveness of preventive occupational therapy (OT) services specifically tailored for multiethnic, independent-living older adults. Design.-A randomized controlled trial. SETTING: Two government subsidized apartment complexes for independent-living older adults. SUBJECTS: A total of 361 culturally diverse volunteers aged 60 years or older. INTERVENTION: An OT group, a social activity control group, and a nontreatment control group. The period of treatment was 9 months. MAIN OUTCOME MEASURES: A battery of self-administered questionnaires designed to measure physical and social function, self-rated health, life satisfaction, and depressive symptoms. RESULTS: Benefit attributable to OT treatment was found for the quality of interaction scale on the Functional Status Questionnaire (P=.03), Life Satisfaction Index-Z (P=.03), Medical Outcomes Study Health Perception Survey (P=.05), and for 7 of 8 scales on the RAND 36-Item Health Status Survey, Short Form: bodily pain (P=.03), physical functioning (P=.008), role limitations attributable to health problems (P=.02), vitality (P=.004), social functioning (P=.05), role limitations attributable to emotional problems (P=.05), and general mental health (P=.02). CONCLUSIONS: Significant benefits for the OT preventive treatment group were found across various health, function, and quality-of-life domains. Because the control groups tended to decline over the study interval, our results suggest that preventive health programs based on OT may mitigate against the health risks of older adulthood.

Canadian beef quality audit.

A study was conducted in 4 Canadian processing plants in 1995-96 to determine the prevalence of quality defects in Canadian cattle. One percent of the annual number of cattle processed in Canada were evaluated on the processing floor and 0.1% were graded in the cooler. Brands were observed on 37% and multiple brands on 6% of the cattle. Forty percent of the cattle had horns, 20% of which were scurs, 33% were stubs, 10% were tipped, and 37% were full length. Tag (mud and manure on the hide) was observed on 34% of the cattle. Bruises were found on 78% of the carcasses, 81% of which were minor in severity. Fifteen percent of the bruises were located on the round, 29% on the loin, 40% on the rib, 16% on the chuck, and 0.02% on the brisket. Grubs were observed in 0.02% of the steers, and injection sites were observed in 1.3% of whole hanging carcasses. Seventy percent of the livers were passed for human food and 14% for pet food; 16% were condemned. Approximately 71% of the liver condemnations were due to liver abscesses. Four percent of the heads, 6% of the tongues, and 0.2% of whole carcasses were condemned. The pregnancy rate in female cattle was approximately 6.7%. The average hot carcass weight was 357 kg (s = 40) in steers, 325 kg (s = 41) in heifers, 305 kg (s = 53) in cows, 388 kg (s = 62) in virgin bulls and 340 kg (s = 39) in mature bulls. The average ribeye area in all cattle was 84 cm2 (s = 12); range 29 cm2 to 128 cm2. Grade fat was highly variable and averaged 9 mm (s = 4) for steers and heifers, 6 mm (s = 6) for cows, 5 mm (s = 1) for virgin bulls, and 4 mm (s = 0.5) for mature bulls. The average lean meat yield was 59.7% in cattle (s = 3.4); range 39% to 67%. One percent of the carcasses were devoid of marbling, 1% were dark cutters, and 0.05% of the steer carcasses were staggy. Six percent of the carcasses had poor conformation, 3.7% were underfinished, and 0.7% were overfinished. Yellow fat was observed in 4% of the carcasses; 10% of carcasses were aged. Based on January 1996 prices, the economic analysis showed that the Canadian beef industry lost $70.52 per head or $189.6 million annually from quality nonconformities. Methods identified to reduce these nonconformities included improvements in management, animal identification, handling, genetic selection, marketing, grading, and information transfer.

Lateralized dual task interference in left-handers: initial value differences do not affect the outcome.

The study was conducted to clarify factors involved in dual-task finger-tapping interference. Left-handers, as assessed by hand-writing preference and left-hand baseline tapping advantage, tapped both alone and while solving anagrams. Even though the left-hand baseline tapping advantage was experimentally removed on some (adjusted) trials, greater left- than right-hand tapping interference was observed during concurrent task performance. This result coupled with previous findings for right-handed subjects [Kee and Cherry, Neuropsychologia, Vol. 28, pp. 313-316, 1990] indicates that lateralized interference effects are not merely due to initial baseline tapping differences as proposed by Willis and Goodwin [Neuropsychologia, Vol. 25, pp. 719-724, 1987].

Age differences and similarities in patterns of cerebral hemispheric asymmetry.

Younger (M age = 20.4 years) and older (M age = 70.7 years) adults participated in 3 visual half-field experiments. These were designed to examine specific aspects of hemispheric asymmetry: (a) hemispheric dominance for phonetic-linguistic processing (as measured by identification of non-word trigrams), (b) hemispheric differences in trigram processing strategy, (c) characteristic perceptual biases thought to reflect hemispheric arousal asymmetries, and (d) hemispheric dominance for processing emotions shown on faces. Patterns of left-right asymmetries were comparable for older and younger participants, and intercorrelations among the various measures of asymmetry were similar for both groups. In view of the present results, it seems unlikely that changes in hemispheric asymmetry contribute significantly to age-related changes in cognitive functioning.