Predicting bat colony survival under controls targeting multiple transmission routes of white-nose syndrome.

White-nose syndrome (WNS) is a lethal infection of bats caused by the psychrophilic fungus Pseudogymnoascus destructans (Pd). Since the first cases of WNS were documented in 2006, it is estimated that as many as 5.5million bats have succumbed in the United States-one of the fastest mammalian die-offs due to disease ever observed, and the first known sustained epizootic of bats. WNS is contagious between bats, and mounting evidence suggests that a persistent environmental reservoir of Pd plays a significant role in transmission as well. It is unclear, however, the relative contributions of bat-to-bat and environment-to-bat transmission to disease propagation within a colony. We analyze a mathematical model to investigate the consequences of both avenues of transmission on colony survival in addition to the efficacy of disease control strategies. Our model shows that selection of the most effective control strategies is highly dependent on the primary route of WNS transmission. Under all scenarios, however, generalized culling is ineffective and while targeted culling of infected bats may be effective under idealized conditions, it primarily has negative consequences. Thus, understanding the significance of environment-to-bat transmission is paramount to designing effective management plans.

Fuzzy modeling to predict chicken egg hatchability in commercial hatchery.

Experimental studies have shown that hatching rate depends, among other factors, on the main physical characteristics of the eggs. The physical parameters used in our work were egg weight, eggshell thickness, egg sphericity, and yolk per albumen ratio. The relationships of these parameters in the incubation process were modeled by Fuzzy logic. The rules of the Fuzzy modeling were based on the analysis of the physical characteristics of the hatching eggs and the respective hatching rate using a commercial hatchery by applying a trapezoidal membership function into the modeling process. The implementations were performed in software. Aiming to compare the Fuzzy with a statistical modeling, the same data obtained in the commercial hatchery were analyzed using multiple linear regression. The estimated parameters of multiple linear regressions were based on a backward selection procedure. The results showed that the determination coefficient and the mean square error were higher using the Fuzzy method when compared with the statistical modeling. Furthermore, the predicted hatchability rates by Fuzzy Logic agreed with hatching rates obtained in the commercial hatchery.

Physical therapists' notes and outcomes of physical therapy. A case of insufficient evidence.

This article addresses the problem of documenting the outcomes of physical therapy. This is a timely issue because new approaches to reimbursing health-care costs will favor those providers and professions able to demonstrate sufficient benefits to patients to justify prospective cost reimbursement. To assess the adequacy of existing outcome data, we conducted detailed longitudinal audits of 63 geriatric patients' medical records. For nearly half of these patients, the records contained insufficient data to document any improvement in physical functioning. The number of treatments administered correlated with functional improvements documented, but diagnostic related group classifications and patient demographics did not. We found practicing physical therapists overestimated the amount of outcome data recorded and documented some areas of physical functioning more frequently than others. A wider scope for functional assessment and greater standardization in record keeping are advocated. We discuss implications for clinical practice and research and offer a new instrument for quantifying outcomes.

Mingling decision making metaphors.

Organizational decisions provide conceptual playing fields wherein scientists adhering to rival theories based on different metaphors skirmish in-decisively. Organizational decisions, however, are also empirical arenas wherein practitioners espousing discordant theories-in-use reconcile their differences pragmatically. Practitioners' decision-making metaphors encountered while studying capital budgeting suggest how disjoint perspectives are assimilated and shifts from instrumental to symbolic actions are triggered. Implications for decision theories are discussed, and potential benefits of incorporating practitioners' knowledge into organizational science are considered.

Organizational strategy, structure, and process.

Organizational adaptation is a topic that has received only limited and fragmented theoretical treatment. Any attempt to examine organizational adaptation is difficult, since the process is highly complex and changeable. The proposed theoretical framework deals with alternative ways in which organizations define their product-market domains (strategy) and construct mechanisms (structures and processes) to pursue these strategies. The framework is based on interpretation of existing literature and continuing studies in four industries (college textbook publishing, electronics, food processing, and health care).

Adapting to environmental jolts.

This paper examines organizational adaptations to an environmental jolt--a sudden and unprecedented event (in this case, a doctors' strike)-- that created a natural experiment within a group of hospitals. Although adaptations were diverse and appeared anomalous, they are elucidated by considering the hospitals' antecedent strategies, structures, ideologies, and stockpiles of slack resources. Assessments of the primacy of the antecedents suggest that ideological and strategic variables are better predictors of adaptations to jolts than are structural variables or measures of organizational slack. Although abrupt changes in environments are commonly thought to jeopardize organizations, environmental jolts are found to be ambiguous events that offer propitious opportunities for organizational learning, administrative drama, and introducing unrelated changes.

Hospital capital budgeting: fusion of rationality, politics and ceremony.

Budgetary requests for medical capital equipment give rise to streams of rational, political and ceremonial decision making. As they cascade through hospitals, these processes influence the deployment of organizational assets and the viability of organizational cultures.

Reacting to surprises: hospital strategy, structure and ideology.

A physicians' strike in San Francisco caused a severe environmental jolt to hospitals in the area. A look at the responses of three of those hospitals reveals striking differences among them regarding their market strategies, administrative structures and ideologies. An analysis of these differences can help administrators prepare for and cope with unpleasant surprises.

Prehospital emergency rapid sequence induction of anaesthesia.

OBJECTIVE: To determine the number of and reasons for rapid sequence inductions done by accident and emergency (A&E) doctors out of hospital as part of the activities of the MEDIC 1 Flying Squad. "Rapid sequence induction" was defined as any attempted endotracheal intubation accompanied by use of drugs to assist intubation and ventilation, including opiates, benzodiazepines, intravenous and topical anaesthetics, and neuromuscular blocking drugs. METHODS: Retrospective study of all MEDIC 1 and A&E records over the period 1 February 1993 to 28 February 1996 (37 months). The anaesthetic technique used, drugs used, complications, difficulties, reasons for induction out of hospital, and grade of doctor performing the technique were determined. RESULTS: Various anaesthetic techniques were used to secure the airway definitively by endotracheal intubation. Several difficulties were encountered in the prehospital setting, all of which were dealt with successfully. CONCLUSIONS: The lack of complications related to rapid sequence induction in prehospital care suggests that this technique is safe when done by A&E doctors on appropriate patients.

Jumping from the Westgate Bridge, Melbourne.

OBJECTIVE: To describe characteristics of people who jumped from the Westgate Bridge (identifying risk factors for attempted suicide) and to determine why people may survive such a jump. DESIGN AND SETTING: A retrospective case review (coroners' reports and hospital records) of all people known to have jumped from the Westgate Bridge between 1991 and 1998. RESULTS: We identified 62 people who jumped from the Westgate Bridge over the study period. Seven survived. Forty-one (74%) of those who jumped were male. The average age was 33.8 years (range, 15-58 years). Forty-four (71%) had known mental illness (23 schizophrenia, 21 depression). Thirty-nine (63%) landed in water, falling from a height of 58.5 m. Nineteen (31%) fell onto land and in four cases (6%) the landing site was not determined. All survivors landed in water. Six people died from drowning after the fall, and in eight more deaths drowning was a major or contributing factor. All jumps resulted from suicidal intent, and 12 people (19%) had positive toxicology screens for alcohol or other non-prescription drugs at postmortem. CONCLUSIONS: Each year the Westgate Bridge is the scene of about eight suicide attempts by jumping (particularly by men with active psychiatric illness). Some deaths by drowning could be prevented by early detection and rapid emergency service response. The erection of an effective safety barrier would probably prevent more deaths.

Tobacco plants carrying a tms locus of Ti-plasmid origin and the Hl-1 allele are tumor prone.

The autonomous growth of plant tumor cells is believed to result from their persistent loss of the requirement for growth hormones such as auxin and cytokinin. The partially dominant gene Habituated leaf-1 (Hl-1) regulates the requirement of cultures tissues of Havana 425 tobacco (Nicotiana tabacum L.) for cytokinins. The Hl-1 allele can partially restore the tumor phenotype in tobacco cells transformed with a Agrobacterium tumefaciens Ti plasmid defective in the isopentenyl transferase locus, which encodes a key enzyme in cytokinin biosynthesis and is required for neoplastic growth. To investigate the oncogenic function of Hl-1, we transformed wild-type (hl-1/hl-1) and Hl-1/Hl-1 tobacco plants with the tms locus derived from the limited-host-range Ti plasmid pTiAg162. This locus encodes enzymes for biosynthesis of the auxin indole-3-acetic acid. Grafting tests and measurements of the hormone requirement of cultured explants show that wound-induced overgrowths arising in tms transformed Hl-1 plants are tumorous. While some wound-induced overgrowths also formed in hl-1/hl-1 transformants, these showed slight hormone-autotrophic growth and weak tumorigenicity in grafting tests. In addition, Hl-1/Hl-1 tms/tms plants, but not hl-1/hl-1 tms/tms plants, spontaneously developed rooty teratomatous overgrowths, showed flowering abnormalities, and formed calli at the base of the stem in young seedlings. Thus, Hl-1 tms plants exhibit a tumor-prone phenotype, and in this regard closely resemble tumor-prone hybrids that arise in certain interspecific crosses of Nicotiana species. Our results show that the interaction of just two genetic elements-the mutant Hl-1 allele of the tobacco host with tms genes of Ti plasmid origin-are sufficient for a tumor-prone phenotype.

A tobacco homologue of the Ri-plasmid orf13 gene causes cell proliferation in carrot root discs.

The tobacco genome contains genes, called cellular rol (c-rol) genes, that are very similar in sequence to genes present in the T-DNA of the Agrobacterium rhizogenes Ri-plasmid. We have cloned two homologues (torf13-1 and torf13-2) of the Ri-plasmid orf13 gene from Nicotiana tabacum L. cv. Havana 425. The clone torf13-1 has a 594-bp open reading frame (ORF) which is similar in sequence (77-82% for DNA and 67-77% for the deduced amino acid sequence) to orf13 genes of the agropine, mikimopine, and mannopine Ri-plasmids and the N. glauca homologue Ngorf13. Southern analyses showed that there are at least two torf13 genes derived from the N. tomentosiformis ancestor of tobacco, strongly suggesting that torf13 resulted from an ancient transfer between ancestors of modern A. rhizogenes and tobacco. Steady-state expression of torf13 mRNA is high in sepals, petals, shoot tips and in younger leaves, but considerably lower in stem tissues, lower leaves and roots. Treatment of cultured leaf discs for 5-20 days on medium containing auxin (10.7 microM alpha-naphthaleneacetic acid) and cytokinin (1.4 microM kinetin) resulted in a marked down-regulation of torf13 mRNA accumulation. Therefore, torf13 is transcriptionally active in normal tobacco tissues and the steady-state mRNA level is regulated. Inoculation of carrot-root discs with A. tumefaciens strains carrying the mannopine Ri-plasmid orf13 and torf13-1 regulated by the strong cauliflower mosaic virus 35S RNA promoter induced the formation of dense green callus on the disc surface. These findings indicate that at least one function of the orf13 ORF is conserved in the tobacco homologue, and provide direct evidence that a c-rol gene can influence cell proliferation.

Horizontal gene transfer: regulated expression of a tobacco homologue of the Agrobacterium rhizogenes rolC gene.

A tobacco homologue (trolC) of the rolC gene of the Agrobacterium rhizogenes Ri-plasmid was cloned and sequenced from Nicotiana tabacum L. cv. Havana 425. The coding region of trolC is similar in sequence (69-87% for DNA and 54-89% for the deduced amino acid sequence) to rolC genes of the agropine, mannopine, and mikimopine strains of Ri-plasmids and the N. glauca rolC homologue. Southern analyses showed that trolC is encoded by a small gene family derived from the tomentosiformis ancestor of tobacco. This suggests that trolC resulted from an ancient transfer of DNA between A. rhizogenes and a progenitor of modern tobacco. Transcripts of trolC were detected in three morphologically distinct cultivars of tobacco. trolC mRNA accumulated in young leaves and shoot tips, but not in lower leaves and roots of mature plants. Accumulation of trolC mRNA in cultured leaf tissues was strongly down-regulated by auxin and induced by cytokinin. These results are of particular interest because they suggest that a gene of bacterial origin introduced during evolution can have a function in a modern plant.

Intra-articular lignocaine versus Entonox for reduction of acute anterior shoulder dislocation.

We assessed, in a prospective randomised trial, the relative analgesic effects of Entonox and intra-articular lignocaine (IAL) in patients with acute anterior dislocation of the shoulder. A statistically significant reduction in pain scores was achieved with IAL (7.9 vs 5.2, P < 0.05), but the effect with Entonox was greater (7.8 vs 2.9, P < 0.001). We conclude that Entonox provides better analgesia than IAL in patients with acute anterior shoulder dislocation.

Intracellular transport and processing of a tobacco vacuolar ß-1,3-glucanase.

The class I ß-1,3-glucanases are basic, vacuolar enzymes implicated in the defense of plants against pathogen infection. The tobacco (Nicotiana tabacum L.) enzyme is synthesized as a preproprotein with an N-terminal signal peptide for targeting to the lumen of the endoplasmic reticulum and an N-glycosylated C-terminal extension which is lost during protein maturation. The transport and processing of ß-1,3-glucanase in cellsuspension cultures of the tobacco cultivar Havana 425 was investigated by pulse-chase labelling and cell fractionation. We verified that mature ß-1,3-glucanase is localized in the vacuole of the suspension-cultured cells. Comparison of the time course of processing in homogenates, the soluble fraction, and membrane fractions indicates that proglucanase is transported from the endoplasmic reticulum via the Golgi compartment to the vacuole. Processing to the mature form occurs in the vacuole. Treatment of cells with tunicamycin, which inhibits N-glycosylation, and digestion of the (35)S-labelled processing intermediates with endoglycosidase H indicate that ß-1,3-glucanase has a single N-glycan attached to the C-terminal extension. Glycosylation is not required for proteolytic processing or correct targeting to the vacuole.

Out-of-hospital cardiac arrest.

Out-of-hospital cardiac arrest (OHCA), with its high fatality rate, is a significant public health issue. The aetiology of OHCA is reviewed, and management strategies are discussed, including the "chain of survival", the Utstein method of data collection, and recent developments in advanced cardiac life support emphasising defibrillation.

Automatic external defibrillators: changing the way we manage ventricular fibrillation.

OBJECTIVE: To discuss recent developments in automatic defibrillation and to review the evidence that first-responders equipped with automatic external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest. DATA SOURCES: MEDLINE search from 1966 to 1999 (articles in English only) and examination of bibliographies. STUDY SELECTION: Published studies of out-of-hospital cardiac arrest and first-responders equipped with AEDs. Studies had to have a control group and to report survival to hospital discharge from ventricular fibrillation (VF). DATA EXTRACTION: Six studies met the selection criteria (two prospective randomised trials, two prospective controlled trials, and one cohort study and one retrospective study, both with historical controls). DATA SYNTHESIS: A random effects meta-analysis of odds ratios for survival from VF. CONCLUSIONS: Meta-analysis suggests that equipping first-responders with AEDs increases the probability of survival to hospital discharge after out-of-hospital cardiac arrest (odds ratio, 1.74; 95% CI, 1.27-2.38; P < 0.001). However, most of the studies lacked sufficient power to draw definitive conclusions. Until the impact of wide deployment of AEDs is fully understood, first-responder defibrillation in Australia should only occur as part of coordinated multicentre research studies.

Is the public equipped to act in out of hospital cardiac emergencies?

STUDY OBJECTIVE: This study aimed to determine whether the people in Australia are informed about and prepared to intervene in a cardiac emergency. METHODS: A cross sectional telephone survey, which contained sections regarding participant demographics, cardiopulmonary resuscitation (CPR) training, knowledge of CPR, and the emergency contact number and potential barriers to performing chest compressions and mouth to mouth. RESULTS: A total of 1489 people completed the questionnaire. Only 11% of the population had recently (<12 months) trained in CPR. When presented with a cardiac arrest scenario most participants stated that they would telephone 000. Significantly more respondents believed that they would give mouth to mouth to a family member compared with a stranger. A bleeding victim and fear of not having the skills were the most common barriers that reduced the participants perceived willingness to perform chest compressions and mouth to mouth. CONCLUSION: This study suggests that a low percentage of the public is currently trained in CPR and also that they are unprepared to act in a cardiac emergency.

Asystolic cardiac arrest in Melbourne, Australia.

OBJECTIVE: To study the outcome of victims of out-of-hospital cardiac arrest presenting to the Metropolitan Ambulance Service in asystole, in Melbourne, Australia. METHODS: A retrospective case-note review of all patients presenting to the Metropolitan Ambulance Service in asystole for 1997 was performed. Metropolitan Ambulance Service case notes and hospital records were examined to determine the presenting rhythm and the patients' outcome. RESULTS: In a 12-month period, 778 patients met the entry criteria. Age mean was 67 years, 36% female, 64% male. Metropolitan Ambulance Service response time to scene time was a mean of 9.76 min. Resuscitation was commenced on 37% of patients. There was one survivor (0.12%). CONCLUSION: Adult victims of out-of-hospital cardiac arrest presenting as asystole should not receive treatment.