Silicon detector dark matter results from the final exposure of CDMS II.

We report results of a search for weakly interacting massive particles (WIMPS) with the silicon detectors of the CDMS II experiment. This blind analysis of 140.2 kg day of data taken between July 2007 and September 2008 revealed three WIMP-candidate events with a surface-event background estimate of 0.41(-0.08)(+0.20)(stat)(-0.24)(+0.28)(syst). Other known backgrounds from neutrons and 206Pb are limited to <0.13 and <0.08 events at the 90% confidence level, respectively. The exposure of this analysis is equivalent to 23.4 kg day for a recoil energy range of 7-100 keV for a WIMP of mass 10 GeV/c2. The probability that the known backgrounds would produce three or more events in the signal region is 5.4%. A profile likelihood ratio test of the three events that includes the measured recoil energies gives a 0.19% probability for the known-background-only hypothesis when tested against the alternative WIMP+background hypothesis. The highest likelihood occurs for a WIMP mass of 8.6 GeV/c2 and WIMP-nucleon cross section of 1.9×10(-41) cm2.

Utility of UB-92 data for monitoring emergency department performance improvement.

The Universal Billing Code of 1992 (UB-92) is a standard database used by hospitals to generate itemized charges for patient visits. This study examined the use of UB-92 information to monitor emergency department performance improvement projects. UB-92 data were used to determine whether urine tests had been ordered for emergency department patients. A population of patients at low risk for requiring a urine culture was defined as discharged female patients between 16 and 60 years of age undergoing a urinalysis as part of their emergency department treatment during a 10-month period. Based on UB-92 data, only a total of 2,138 patients were identified who met the study's low-risk criteria. Recommendations for the optimum use of these tests were presented to the emergency physicians as part of departmental performance improvement activities. Additional logistical problems associated with the procedure for ordering this test were identified and corrected as part of this project. After an additional 5-month period, a second analysis of the entire 15 months of UB-92 data was performed. Prior to physician notification, 41.6% of low-risk patients underwent both a urinalysis and a urine culture and sensitivity in the emergency department. In the 5-month follow-up period, the percentage of patients undergoing both tests decreased 18% to only 23%.

Acceptance of family member presence during pediatric resuscitations in the emergency department: effects of personal experience.

OBJECTIVE: Opinions remain polarized on allowing family member presence during pediatric resuscitations (FMP). Reluctance to adopt FMP may stem from preconceived notions on this practice. This study evaluates the effect of prior experience with FMP and on its acceptance by emergency department personnel (EDP). METHODS: EDP from three different EDs were surveyed concerning FMP. Study facilities included an urban teaching community ED with routine FMP (R-ED), a suburban community ED with occasional FMP (O-ED) and an urban university pediatric ED with virtually no FMP (N-ED) during pediatric resuscitations. Survey information included hospital of practice, position in ED, years in practice, opinions on FMP and personal experience with FMP for five clinical scenarios: laceration repair (LAC), intravenous access (IV), lumbar puncture (LP), endotracheal intubation (ETI), cardiopulmonary resuscitation (CPR), and critical resuscitation (CR). Statistical analysis was through chi square and regression analysis. RESULTS: Eighty-five emergency department personnel participated in the survey, 57 (67%) nurses, 22 (25%) physicians, 4 technicians (5%), and 2 nurses aids (2%). There was a significant correlation between a favorable opinion concerning family member presence during LP, ETI, CPR and CR and the type of Emergency Department in which the individual practiced (P<0.002). Regression analysis demonstrated a similar relation between personal experience with LAC, IV, ETI, CR, and CPR and a favorable opinion on FMP during that activity (P<0.03). CONCLUSION: Opinions on FMP are strongly influenced by experience with this practice. Emergency department personnel with prior exposure to family member presence during resuscitations favor this activity. Biases by EDP lacking experience with FMP may limit its introduction into unfamiliar institutions.

Acute cardiogenic pulmonary edema. What's the latest in emergency treatment?

With the methods available today, most patients who arrive at the emergency department with acute cardiogenic pulmonary edema can be treated quickly and effectively. Modern pharmacologic therapy is based on directly counteracting the physiologic abnormalities that cause pulmonary edema. Agents that are useful in reducing LV preload and afterload and in managing hypotension are nitroglycerin, ACE inhibitors, vasodilators, vasopressors, and bipyrines. Noninvasive pressure support ventilation helps patients with pulmonary edema by decreasing the work of breathing, enhancing oxygen and carbon dioxide exchange, and increasing cardiac output. Use of BiPAP systems in emergency departments has averted endotracheal intubation in about 90% of patients with pulmonary edema who are experiencing acute respiratory failure.

Family member presence during pediatric emergency department procedures.

OBJECTIVE: Exclusion of family members (FM) during pediatric procedures in the emergency department (ED) is an accepted practice. This study questions the validity of such a practice. SUBJECTS: FM of ED pediatric patients undergoing procedures and ED staff performing procedures. SITES: ED of a tertiary care university-affiliated community hospital and the pediatric ED of a university hospital. METHODS: Post-procedure surveys were obtained from FM remaining with their child during an ED procedure and from the ED personnel performing the procedures. FM activity during the procedure was also recorded. RESULTS: Ninety-six children (average age 20 months) underwent a total of 127 procedures. ED procedures included: vascular access 91, lumbar puncture 23, urethral catheterization 9, nasogastric tube placement 1, rapid sequence intubation 1, fluid resuscitation from shock 1, and removal of foreign body from eye 1. Three children were critically ill during performance of procedures. ED staff answered 98 surveys concerning the performance of the 127 procedures. FM ACTIVITIES INCLUDED: Stood at bedside 35 (31%), soothed child 21 (19%), and helped restrain child 55 (55%). In 55 (57%) cases the FM was the only adult present with the ED staff member performing the procedure(s). FM MEMBER OPINIONS OF PRESENCE DURING PROCEDURES WERE: Good idea 101 (91%), bad idea 6 (5%), and did not care 4 (4%). ED staff opinions were: good idea 92 (93%), bad idea 2 (2%), and did not care 4 (5%). FM presence made four (5%) members of the ED staff nervous. CONCLUSION: FM presence during ED procedures is a practice favored by both parents and ED staff at our institutions. This practice should not be limited to minimally invasive procedures in stable patients but should be considered for procedures such as lumbar punctures and intubations even in critically ill patients.

Transmission of Mycobacterium tuberculosis to recipients of single lung transplants from the same donor.

Recipients of organ transplants are at increased risk for infection both because of immunosuppression and because of the transfer of microbes through the donor organs. We report two cases of M. tuberculosis disease in recipients of single lung transplants who shared a common donor. Both recipients developed pulmonary tuberculosis, one having fever and pulmonary infiltrates and the other having subclinical disease with M. tuberculosis organisms being recovered from bronchoalveolar lavage. Restriction fragment length polymorphism analysis on both isolates of M. tuberculosis revealed a common source. The donor of both lungs had a normal chest radiograph and no known prior history of M. tuberculosis infection of disease. These cases are the first report of two single lung recipients developing pulmonary tuberculosis from a common donor.

Laboratory contamination of Mycobacterium tuberculosis cultures.

The purpose of this study was to investigate possible laboratory contamination of Mycobacterium tuberculosis cultures which resulted in the misdiagnosis of tuberculosis. We have investigated three cases in which a patient's culture was positive for M. tuberculosis but there was not a high clinical suspicion for disease. In each instance, another patient with clinically obvious pulmonary tuberculosis had specimens cultured concurrently within the same clinical laboratory. The isolates from both the obvious cases of tuberculosis and the suspect cases were obtained through the State of Alabama TB Laboratory, but these isolates originated at a commercial laboratory, a community hospital laboratory, and at a university hospital. MTB isolates were fingerprinted by probing for the insertion sequence IS6110. With each of the three pairs of isolates (case and suspicious case), identical IS6110 banding patterns were found suggesting identical MTB strains. Because the patients were geographically separated, it is strongly suspected that laboratory contamination of M. tuberculosis cultures resulted in the three suspect cases being diagnosed with tuberculosis. These findings indicate that positive M. tuberculosis cultures resulting from laboratory contamination can occur.

Bi-level positive airway pressure support system use in acute congestive heart failure: preliminary case series.

OBJECTIVE: To describe the use of a noninvasive bi-level positive airway pressure (PAP) support system for ED patients with acute congestive heart failure (CHF). METHODS: Retrospective case series analysis of ED patients presenting with acute CHF in imminent need of endotracheal intubation (ETI) managed with a bi-level PAP system. The bi-level PAP system was applied at the discretion of the treating emergency physician. Management of the bi-level PAP system, including setting of inspiratory PAP (IPAP) and expiratory PAP (EPAP), weaning, adjunct pharmacologic therapy, and failure of bi-level PAP support, was determined by the treating physician. RESULTS: Only two (9%) of 22 patient presentations necessitated ETI. The mean duration of bi-level PAP therapy was 7.9 hours. The mean maximum IPAP and EPAP settings were 10.8 and 5.8 cm H2O, respectively. Mean intensive care unit length of stay (LOS) was 2.4 days, with a median LOS of only 1 day. There were three deaths in the series; none were attributed to the bi-level PAP system. No technical difficulty with the bi-level PAP system was noted. CONCLUSION: Noninvasive pressure support ventilation with a bi-level PAP support system may avert ETI in acute CHF patients. This device can be effectively used by ED personnel.

Comparison of expression of a humanized monoclonal antibody in mouse NSO myeloma cells and Chinese hamster ovary cells.

We report a detailed comparison of two commonly used stable, amplifiable mammalian expression systems (Chinese Hamster Ovary cells/dihydrofolate reductase and Mouse NSO myeloma/glutamine synthetase) used to express a humanized IgG1 monoclonal antibody. We compare copy number and steady state mRNA levels of both the selectable marker and heavy chain of the antibody throughout the selection and amplification process. In both cell lines, copy number and steady state levels of heavy chain and selectable marker increased during selection and were further increased during amplification. As expected, an increase in steady state mRNA levels of heavy chain correlated with an increase in expression of antibody whilst an increase in the steady state levels of mRNA of the selectable marker correlated with increased resistance to the selective agent. In NSO and CHO cells producing equivalent amounts of antibody, the copy number of the antibody genes and selectable marker was significantly higher in the CHO cells than in the NSO cells. However, the steady state mRNA levels of the heavy chain of the antibody were virtually identical. Rates of protein secretion in the two cell lines were also compared and found to be very similar. When the antibody purified from both systems was compared in a number of functional assays they behaved identically.

Resident management of emergency department patients: is closer attending supervision needed?

STUDY OBJECTIVE: To determine the extent of supervision necessary for emergency medicine residents practicing in the emergency department. SETTING: ED of a university-affiliated tertiary care facility with an annual census of 32,000 visits. STUDY POPULATION: All ED patients presenting during study hours during a four-month period. DESIGN: A prospective study was conducted of changes made by emergency medicine attendings in the management of ED patients seen initially by second-year emergency medicine residents. Second-year emergency medicine residents presented all patients seen by them to a specified emergency medicine attending, who also interviewed and examined these patients. Initial patient care was designed by the resident and modified by the emergency medicine attending. Attending modification was recorded by the emergency medicine attending in the study log. Modifications of the residents' proposed care were designated as major (change resulted in an alteration in patient disposition, detection of unsuspected pathology, or marked revision of intended treatment); minor (change resulted in lesser modification of patient management); or no change. RESULTS: Four hundred eight patient encounters were included in the study. Sixteen patients (4%) had major modifications of their care, 134 (33%) had minor modifications, and 258 (63%) had no change. CONCLUSION: Supervision is required for all patients managed by second-year emergency medicine residents, regardless of complaints. This evaluation should include a direct patient interview and examination by the emergency medicine attending and should not be limited to a case discussion or ED record cosignature.

Regulation of de novo phosphatidylcholine biosynthesis during renal growth.

Potential regulatory steps of de novo renal cortical synthesis of phosphatidylcholine (PC) were investigated during renal growth in rats. Twenty-four hours following unilateral nephrectomy, cortical PC content was increased in the remaining kidney when compared with sham-operated controls, 3.47 +/- 0.07 and 2.79 +/- 0.14 mumol/mg DNA, respectively (P less than 0.02). No alterations occurred in the cortical PC precursor pools of choline, phosphocholine, cytidine diphosphocholine, or diacylglycerol. At 15 min after the injection of 32P, the incorporation of isotope into the PC pool was increased in the contralateral kidney when compared with sham-operated controls. The calculated maximal velocities of choline kinase and cholinephosphotransferase were increased subsequent to unilateral nephrectomy, supporting a regulatory role for these enzymes in PC biosynthesis during renal growth.

Renotrophic factors in urine.

Our previous observations of increased renal protein synthesis in rats subjected to the constant intravenous reinfusion of half their urine output has suggested that the circulatory retention of renotrophic factors in urine is capable of stimulating renal growth. In the present studies, using this same model of "half-urine-reinfusion," which is designed to produce a selective halving of renal excretory function, we have demonstrated significant increases in total DNA content and the incorporation of tritiated thymidine in renal DNA. In addition, a bioassay method was developed in which an assay rat, given an intravenous infusion of urine from another rat, exhibited increases in the incorporation of thymidine into renal DNA and the incorporation of radiolabelled choline into renal phospholipid. This renotrophic activity in the urine was only minimally decreased by heating to 100 degrees C for 30 min and was confined to ultrafiltration fractions retained on a membrane with a nominal 10,000-dalton solute rejection. Removal of one kidney from the rats from which the urine was obtained led to only a modest and transient reduction in the excretion of renotrophic activity, suggesting that the urinary renotrophic factors are of circulatory, not renal, origin. Isolated renal cortical fragments incubated with an ultrafiltration retentate of urine displayed a dose-dependent increase in choline incorporation into phospholipid, suggesting a direct action of the factors on kidney tissue. Finally, no evidence of stimulation of either DNA or phospholipid synthesis could be seen in hepatic tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Uptake and intracellular distribution of ferritin in the rat distal convoluted tubule.

The purpose of this study was to determine the uptake and intracellular distribution of anionic ferritin (AF) and cationic ferritin (CF) in the distal convoluted tubule (DCT) of the rat kidney. Male Sprague-Dawley rats were prepared for micropuncture, and individual distal tubules were perfused with 5 or 10 mg/ml of AF or 0.1 or 0.5 mg/ml of CF in isotonic saline for either 30 sec or 3 min. The tubules were fixed by perfusion with 6.25% glutaraldehyde either immediately or at different time intervals after exposure to ferritin. Electron microscopy of tubules fixed immediately after perfusion showed no binding of AF to the apical cell membrane, and only traces of AF were observed in small apical structures. In contrast, CF was extensively bound to the apical cell membrane and located in apical vesicles and tubules, and in multivesicular bodies. Occasionally, CF was observed in Golgi vesicles and cisternae. Sixty min after perfusion with ferritin, traces of AF were present in multivesicular bodies and lysosome-like structures. Thirty and 60 min after perfusion, large concentrations of CF were located in multivesicular bodies and lysosome-like bodies. This study reveals that in the DCT, CF is bound to the apical cell membrane and taken up into the tubule cells, whereas only traces of AF are taken up, indicating that the charge of a protein molecule may determine whether or not the protein is reabsorbed by the DCT. The demonstration of CF in the Golgi complex is compatible with the existence of membrane recycling in cells of the DCT.