Factors associated and knowledge on road traffic accidents, rules among private university students in Chengalpattu district, Tamil Nadu, India - A cross-sectional study.

BACKGROUND: Road traffic accidents (RTAs) are an emerging public health issue of global concern causing 1.35 million deaths per year. They are the leading cause of death among 5-29 years who contribute to the future and current productive population of the country. The outcome of mortality and permanent disability are public health concerns. We determined the factors associated with RTAs among medical undergraduates and assessed their knowledge of road traffic rules. MATERIALS AND METHODS: This study had 500 medical undergraduates from a tertiary hospital located in Chengalpattu district, Tamil Nadu. Data were collected using questions from "Road safety question bank" issued by Ministry of Road Transport and Highways, Government of India, sent as Google forms to students. Descriptive statistics were used and multivariate analysis was performed to identify risk factors associated with RTAs. RESULTS: The mean age of the students was 21.4 (standard deviation = 1.7) years. About 30.4% of students suffered from RTAs in the past 2 years. Practice of drunken driving and mobile phone usage showed significant association with RTA occurrence (P < 0.001). Multiple logistic regression revealed that students crossing speed limits and jumping signals had 3.19 and 2.04 times more risk of sustaining RTAs. Seventy-five percent of students had good knowledge on road traffic rules. CONCLUSION: Nearly half the subjects have suffered RTA in the past 2 years. Students who over speed, jumped signals and used mobile phones while driving sustained more RTAs. Overall, road traffic rules knowledge was satisfactory. Students need education on risky driving behaviors and aftermath of crashes.

The changing pattern of primary glomerulonephritis in Singapore and other countries over the past 3 decades.

This review of 2,586 renal biopsies over the past 3 decades in Singapore documents the changing pattern of glomerulonephritis (GN) from that of a third world country to that of a developed nation. In the 1st decade, mesangial proliferative glomerulonephritis was the most common form of primary GN, just as it was in the surrounding Asian countries. In the 2nd decade, the prevalence of mesangial proliferative GN decreased with a rise in membranous, GN which is also seen in China and Thailand. In the 3rd decade, there was a dramatic increase in focal sclerosing glomerulosclerosis. This increase reflects aging and obesity in keeping with more developed countries like Australia, India, Thailand and the United States of America. IgA nephritis remains the most common GN. Apart from the geographical influence, other socioeconomic factors play a significant role in the evolution of the renal biopsy pattern. Mesangial proliferative GN remains prevalent in many Asian countries, but in Singapore the prevalence is decreasing just as it is in Japan, Korea and Malaysia. Worldwide, the prevalence of focal sclerosing glomerulosclerosis continues to increase in many countries.

Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia.

INTRODUCTION: The emergency treatment of supraventricular tachycardia (SVT) has, over the last two decades, changed from verapamil to adenosine primarily owing to documented hypotensive episodes occurring with rapid bolus infusions of the calcium channel blocker. Slow infusions of calcium channel blockers have not previously demonstrated hypotension to any significant degree. The aim of this study was to compare the efficacy and safety of bolus intravenous adenosine and slow infusion of the calcium channel blockers verapamil and diltiazem in the emergency treatment of spontaneous SVT. METHODS: A prospective randomized controlled trial with one group receiving bolus intravenous adenosine 6 mg followed, if conversion was not achieved, by adenosine 12 mg; and the other group receiving a slow infusion of either verapamil at a rate of 1mg per minute up to a maximum dose of 20mg, or diltiazem at a rate of 2.5mg per minute up to a maximum dose of 50mg. These infusions would be stopped at time of conversion of the SVT or when the whole dose was administered. Heart rate and blood pressure was continuously monitored during drug infusion and for up to 2h post-conversion. RESULTS: A total of 206 patients with spontaneous SVT were analysed. Of these, 102 were administered calcium channel blockers (verapamil=48, diltiazem=54) and 104 were given adenosine. The conversion rates for the calcium channel blockers (98%) were statistically higher than the adenosine group (86.5%), p=0.002, RR 1.13, 95% CI 1.04-1.23. The initial mean change in blood pressure post-conversion in the calcium channel blocker group was -13.0/-8.1 mmHg (verapamil) and -7.0/-9.4 mmHg (diltiazem) and 2.6/-1.7 mmHg for adenosine. Only one patient in the calcium channel group (0.98%) (95% CI 0.025-5.3) developed hypotension, and none in the adenosine group. CONCLUSION: Slow infusion of calcium channel blockers is an alternative to adenosine in the emergency treatment of stable patients with SVT. Calcium channel blockers are safe and affordable for healthcare systems where the availability of adenosine is limited.

The CHASE domain: a predicted ligand-binding module in plant cytokinin receptors and other eukaryotic and bacterial receptors.

A novel, 200-230 amino acid extracellular domain was identified in the plant cytokinin receptor Cre1, in the receptor-histidine kinase DhkA and the adenylyl cyclase Acg from the slime mold Dictyostelium discoideum, and in a variety of other receptor-like proteins from bacteria and eukaryotes. The domain is predicted to bind diverse low molecular weight ligands, such as the cytokinin-like adenine derivatives or peptides, and mediate signal transduction through the respective receptors.

Comparison of chest compression only and standard cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Singapore.

OBJECTIVE: Chest compression only cardiopulmonary resuscitation (CC-CPR) without ventilation has been proposed as an alternative to standard cardiopulmonary resuscitation (CPR) for bystanders. However, there has been controversy regarding the relative effectiveness of both of these techniques. We aim to compare the outcomes of cardiac arrest patients in the cardiac arrest and resuscitation epidemiology study who either received CC-CPR, standard CPR or no bystander CPR. METHODS: This prospective cohort study involved all out-of-hospital cardiac arrest (OHCA) patients attended to by emergency medical service (EMS) providers in a large urban centre. The data analyses were conducted secondarily on these collected data. The technique of bystander CPR was reported by paramedics who arrived at the scene. RESULTS: From 1 October 2001 to 14 October 2004, 2428 patients were enrolled into the study. Of these, 255 were EMS-witnessed arrests and were excluded. 1695 cases did not receive any bystander CPR, 287 had standard CPR and 154 CC-CPR. Patient characteristics were similar in both the standard and CC-CPR groups except for a higher incidence of residential arrests and previous heart disease sufferers in the CC-CPR group. Patients who received standard CPR (odds ratio (OR) 5.4, 95% confidence interval (CI) 2.1-14.0) or CC-CPR (OR 5.0, 95% CI 1.5-16.4) were more likely to survive to discharge than those who had no bystander CPR. There was no significant difference in survival to discharge between those who received CC-CPR and standard CPR (OR 0.9, 95% CI 0.3-3.1). CONCLUSION: We found that patients were more likely to survive with any form of bystander CPR than without. This emphasises the importance of chest compressions for OHCA patients, whether with or without ventilation.

An observational study describing the geographic-time distribution of cardiac arrests in Singapore: what is the utility of geographic information systems for planning public access defibrillation? (PADS Phase I).

INTRODUCTION: Public access defibrillation (PAD) has shown potential to increase cardiac arrest survival rates. OBJECTIVES: To describe the geographic epidemiology of prehospital cardiac arrest in Singapore using geographic information systems (GIS) technology and assess the potential for deployment of a PAD program. METHODS: We conducted an observational prospective study looking at the geographic location of pre-hospital cardiac arrests in Singapore. Included were all patients with out-of-hospital cardiac arrest (OHCA) presented to emergency departments. Patient characteristics, cardiac arrest circumstances, emergency medical service (EMS) response and outcomes were recorded according to the Utstein style. Location of cardiac arrests was spot-mapped using GIS. RESULTS: From 1 October 2001 to 14 October 2004, 2428 patients were enrolled into the study. Mean age for arrests was 60.6 years with 68.0% male. 67.8% of arrests occurred in residences, with 54.5% bystander witnessed and another 10.5% EMS witnessed. Mean EMS response time was 9.6 min with 21.7% receiving prehospital defibrillation. Cardiac arrest occurrence was highest in the suburban town centers in the Eastern and Southern part of the country. We also identified communities with the highest arrest rates. About twice as many arrests occurred during the day (07:00-18:59 h) compared to night (19:00-06:59 h). The categories with the highest frequencies of occurrence included residential areas, in vehicles, healthcare facilities, along roads, shopping areas and offices/industrial areas. CONCLUSION: We found a definite geographical distribution pattern of cardiac arrest. This study demonstrates the utility of GIS with a national cardiac arrest database and has implications for implementing a PAD program, targeted CPR training, AED placement and ambulance deployment.

A computer-aided MFCC-based HMM system for automatic auscultation.

Auscultation, the act of listening to the sounds of internal organs, is a valuable medical diagnostic tool. Auscultation methods provide the information about a vast variety of internal body sounds originated by various organs such as heart, lungs, bowel, vascular disorders, etc. In this study, a cardiac sound registration system has been designed incorporating functions such as heart signals segmentation, classification and characterization for automated identification and ease of interpretation by the users. Considering a synergy with the domain of speech analysis, the authors introduced Mel-frequency cepstral coefficient (MFCC) to extract representative features and develop hidden Markov model (HMM) for signal classification. This system was applied to 1381 data sets of real and simulated, normal and abnormal domains. Classification rates for normal and abnormal heart sounds were found to be 95.7% for continuous murmurs, 96.25% for systolic murmurs and 90% for diastolic murmurs by a probabilistic comparison approach. This implies a high potential for the system as a diagnostic aid for primary health-care sectors.

Renal Artery Diameter Is a Surrogate Marker for Kidney Volume in Living Kidney Donors.

Donor kidney volume (KV) is an increasingly important parameter evaluated before living kidney donation; however, KV measurements on computed tomographic (CT) scanning requires a manually intensive process of manual or semiautomatic segmentation of kidneys with interobserver variation. Renal artery diameter (RAD) is an easier marker to measure, and this study aims to investigate the relationship between donor RAD and KV. METHODS: A retrospective review of 77 patients who underwent living donor nephrectomy was conducted. Bilateral KVs were measured based on contrast-enhanced CT scan imaging, and renal artery maximum diameter was measured by direct visualization on the arterial phase of transverse CT sections. RESULTS: On regression analysis, there was a significant association between the right and left RADs and their ipsilateral KVs with a regression coefficient of 7.9 (95% CI, 1.3-14.5; P = .02) and 9.8 (95% CI, 3.3-16.3; P = .004), respectively. Mean total RAD correlated with total KV with a regression coefficient of 9.3 (95% CI, 3.8-14.7; P = .001) and weakly correlated with estimated glomerular filtration rate with a Pearson coefficient of .10. CONCLUSIONS: This study demonstrates that renal artery size is positively associated with KV and may be used as an easily measured surrogate marker for kidney size with its attended implications in living donor transplantation.

Regulatory potential, phyletic distribution and evolution of ancient, intracellular small-molecule-binding domains.

Central cellular functions such as metabolism, solute transport and signal transduction are regulated, in part, via binding of small molecules by specialized domains. Using sensitive methods for sequence profile analysis and protein structure comparison, we exhaustively surveyed the protein sets from completely sequenced genomes for all occurrences of 21 intracellular small-molecule-binding domains (SMBDs) that are represented in at least two of the three major divisions of life (bacteria, archaea and eukaryotes). These included previously characterized domains such as PAS, GAF, ACT and ferredoxins, as well as three newly predicted SMBDs, namely the 4-vinyl reductase (4VR) domain, the NIFX domain and the 3-histidines (3H) domain. Although there are only a limited number of different superfamilies of these ancient SMBDs, they are present in numerous distinct proteins combined with various enzymatic, transport and signal-transducing domains. Most of the SMBDs show considerable evolutionary mobility and are involved in the generation of many lineage-specific domain architectures. Frequent re-invention of analogous architectures involving functionally related, but not homologous, domains was detected, such as, fusion of different SMBDs to several types of DNA-binding domains to form diverse transcription regulators in prokaryotes and eukaryotes. This is suggestive of similar selective forces affecting the diverse SMBDs and resulting in the formation of multidomain proteins that fit a limited number of functional stereotypes. Using the "guilt by association approach", the identification of SMBDs allowed prediction of functions and mode of regulation for a variety of previously uncharacterized proteins.

Results of the first five years of the prehospital automatic external defibrillation project in Singapore in the "Utstein style".

In 1994, all emergency medical services (EMS) ambulance officers in Singapore were trained to perform pre-hospital defibrillation with semi-automated external defibrillators (AED). All non-traumatic cardiac arrest patients over 10 years old were included, excluding those who were obviously dead and children below 36 kg. The data were collected by the ambulance officers according to the Utstein guidelines. From 1 February 1994 to 31 January 1999; resuscitation was attempted in 968 non-trauma cardiac arrests. Fifteen percent of the cases were of non-cardiac origin. The overall survival rate was 40/968 (4.1%, 95% CI 2.9-5.6%). Of 968 patients, 22/136 (16.2%, 95% CI 10.4-23.5%), 18/622 (2.9%, 95% CI 1.7-4.5%) and 0/210 (0%, 95% CI 0-1.7%) survived in the EMS witnessed, bystander witnessed and un-witnessed groups, respectively (P < 0.001). Within the EMS witnessed group, those with an initial rhythm of VF/VT had a higher survival rate (30.6%) than those without VF/VT (4.1%). P < 0.001, OR = 10.3, 95% CI 2.9-36.9. Similarly, the VF/VT survival rate in the bystander witnessed group (4.5%) was higher than the non-VF/VT (1.0%) (P = 0.011, OR = 4.4, 95% CI 1.3-15.4). The survival rate of patients with bystander witnessed VF/VT arrest who received bystander CPR was 9.4% compared to 1.0% in those who did not (P = 0.037, OR = 4.4, 95% CI 1.01-20.1). Our survival rate of bystander witnessed VF/VT arrest is comparable to large metropolitan cities in the USA. The determinants of survival include EMS witnessed arrest and VF/VT arrest. Increased quantity and quality of bystander CPR rate may improve the outcome in bystander witnessed cardiac arrest.

The SHS2 module is a common structural theme in functionally diverse protein groups, like Rpb7p, FtsA, GyrI, and MTH1598/TM1083 superfamilies.

Using structural comparisons, we identified a novel domain with a simple fold in the bacterial cell division ATPase FtsA, the archaeo-eukaryotic RNA polymerase subunit Rpb7p, the GyrI superfamily, and the uncharacterized MTH1598/Tm1083-like proteins. The fold contains a core of 3 strands, forming a curved sheet, and a single helix in a strand-helix-strand-strand (SHS2) configuration. The SHS2 domain may exist either in single or duplicate copies within the same polypeptide. The single-copy versions of the domain in FtsA and Rbp7p are most closely related, and appear to mediate protein-protein interactions by means of strand 1, and the loop between strand 2 and strand 3 of the domain. We predict that the interactions between FtsA and its functional partners in bacterial cell division are likely to be similar to the interactions of Rbp7p in the archaeo-eukaryotic RNA polymerase complex. The dimeric versions typified by the GyrI superfamily appear to have been adapted for small-molecule binding. Sequence profiles searches helped us to identify several new versions of the GyrI superfamily, including a family of secreted forms that is found only in animals and the bacterial pathogen Leptospira. Through sequence-structure comparisons, we predict the positions that are likely to be important for ligand specificity in the GyrI superfamily. In the MTH1598/Tm1083-like proteins, a SHS2 domain is inserted into the loop between strand 1 and helix 1 of another SHS2 domain. This has resulted in a structure that has convergent similarities with the Hsp33 and green fluorescent protein folds. The sequence conservation pattern and its phyletic profile suggest that it might function as an enzyme in some conserved aspect of nucleic acid metabolism. Thus, the SHS2 domain is an example of a simple module that has been adapted to perform an entire spectrum of functions ranging from protein-protein interactions to small-molecule recognition and catalysis.

Synthesis and selective class III antiarrhythmic activity of novel N-heteroaralkyl-substituted 1-(aryloxy)-2-propanolamine and related propylamine derivatives.

The synthesis and biological evaluation of a series of novel 1-(aryloxy)-2-propanolamines and several related deshydroxy analogues are described. Compounds 4-29 were prepared and investigated for their class III electrophysiological activity in isolated canine Purkinje fibers and in anesthetized open-chest dogs. None of these compounds showed any class I activity. On the basis of the in vitro data, structure-activity relationships for the series are discussed. Two compounds, N-[4-[2-hydroxy-3-[methyl(2-quinolinylmethyl)amino] propoxy]phenyl]methanesulfonamide (12,WAY-123,223) and N-[2-[[methyl[3-[4-[(methylsulfonyl)amino]phenoxy]propyl] amino]methyl]-6-quinolinyl]-methanesulfonamide (24, WAY-125,971) were identified and characterized as potent and specific class III antiarrhythmic agents in vitro and in vivo. Compound 12 was found to be orally bioavailable, to produce large increases of ventricular fibrillation threshold (VFT), and, in some instances, to restore sinus rhythm from ventricular fibrillation in anesthetized open-chest dogs at a dose of 5 mg/kg (iv). The enantiomers of 12 (i.e., 13 and 14) were synthesized and were found to exhibit similar electrophysiological effects in the Purkinje fiber screen. Compound 24, a propylamine analogue with potency and efficacy comparable to those of UK-68798 (2) and E-4031 (3), was studied in voltage-clamp experiments (isolated cat myocytes) and was found to be a potent and specific blocker of the delayed rectifier potassium current (IK).

TRAM, a predicted RNA-binding domain, common to tRNA uracil methylation and adenine thiolation enzymes.

A previously undetected conserved domain is identified in two distinct classes of tRNA-modifying enzymes, namely uridine methylases of the TRM2 family and enzymes of the MiaB family that are involved in 2-methylthioadenine formation. This domain, for which the acronym TRAM is proposed after TRM2 and MiaB, is predicted to bind tRNA and deliver the RNA-modifying enzymatic domains to their targets. In addition to the two families of RNA-modifying enzymes, the TRAM domain is present in several other proteins associated with the translation machinery and in a family of small, uncharacterized archaeal proteins that are predicted to have a role in the regulation of tRNA modification or translation. Secondary structure prediction indicates that the TRAM domain adopts a simple beta-barrel fold. In addition, sequence analysis of the MiaB family enzymes showed that they share the predicted catalytic site with biotin and lipoate synthases and probably employ the same mechanism for sulfur insertion into their respective substrate.

Slow-infusion of calcium channel blockers in the emergency management of supraventricular tachycardia.

OBJECTIVE: To compare the efficacy of verapamil and diltiazem as slow infusions in terminating spontaneous supraventricular tachycardia (SVT) in the emergency department (ED). METHOD: Patients of at least 10 years of age who presented to our ED with regular narrow complex tachycardia not converted with a vagal manoeuvre with an ECG diagnosis of SVT were included. Those who were haemodynamically unstable were excluded. Patients were randomized to undergo either verapamil infusion at a rate of 1 mg/min to a maximum of 20 mg or diltiazem infusion at a rate of 2.5 mg/min to a maximum of 50 mg. RESULTS: Eighty-one patients were randomized to receive verapamil infusion and 80 were randomized to receive the diltiazem infusion. There is no difference in success rate between verapamil (98.8%) and diltiazem (96.3%) infusion. The dose of medication required to convert 25,50 and 75% of SVTs were 4.0,5.0 and 8.0 mg for the verapamil infusion and 10.0,12.5 and 17.5 mg for the diltiazem infusion. There was one complication in each group. CONCLUSION: Calcium channel blockers infusions were safe and efficacious in terminating spontaneous SVT. There was no difference between the success rates of verapamil and diltiazem infusions.

Calcium channel blockers as first line treatment for broad complex tachycardia with right bundle branch block: ingenuity or folly?

OBJECTIVE: To study the response of regular broad-complex tachycardia (BCT) demonstrating right bundle branch block (RBBB) to treatment in the Emergency department (ED). METHODS: Retrospective chart review of management of patients with BCT, RBBB without a history of ischaemic heart disease. A diagnosis of ventricular tachycardia (VT) was made if the ECG showed features such as atrioventricular dissociation, capture or fusion beats or if VT was demonstrated during electrophysiological studies (EPS). RESULTS: A total of 25 patients were eligible. Nineteen patients were given intravenous (IV) calcium channel blockers (either verapamil or diltiazem), as first line treatment. Of these, 18 converted to sinus rhythm and the other one patient subsequently converted with amiodarone. The remaining six patients were given IV adenosine (n=3), lignocaine (n=2) or amiodarone (n=1) as first line treatment but none of them were converted. Of these, four of them converted with IV calcium channel blockers eventually. Of the other two patients, who were both given lignocaine initially, one deteriorated haemodynamically with the use of verapamil and required synchronised cardioversion to convert. The other patient did not respond to amiodarone and synchronised cardioversion but was subsequently converted with verapamil. The difference between the success rate of calcium channel blockers and other anti-arrhythmics is statistically significant (P<0.01 by Fischer's exact method). Fourteen cases had diagnoses of VT, including the two patients given lignocaine. Five cases were found to have supraventricular tachycardia with aberrant conduction. Six cases did not have confirmed diagnoses. CONCLUSION: In patients presenting with BCT and RBBB but without underlying ischaemic heart disease, there is evidence to suggest that calcium channel blockers could effectively be used as the treatment of choice.

Mass cardiopulmonary resuscitation 99--survey results of a multi-organisational effort in public education in cardiopulmonary resuscitation.

Mass cardiopulmonary resuscitation (CPR) 99 in Singapore was a large-scale multi-organisational effort to increase awareness and impart basic cardiac life support skills to the lay public. Mass CPR demonstrations followed by small group manikin practice with instructor guidance was conducted simultaneously in three centres, four times a day. The exercise enlisted 15 community organisations and received the support of 19 other organisations. Three hundred and ninety-eight manikins and 500 instructors ('I's) were mobilised to teach an audience of 6000 participants ('P's). Two surveys, for 'I's and 'P's were conducted with respondent rates of 65.8% and 50%, respectively. 73.6% of the P-respondents ('P-R's) indicated that they attended the event to increase their knowledge. 66.9% were willing to attend a more comprehensive CPR course. Concerns and perceptions in performing bystander CPR were assessed.

Comparison of Treatment of Supraventricular Tachycardia by Valsalva Maneuver and Carotid Sinus Massage.

STUDY OBJECTIVE: To compare the efficacy of the Valsalva maneuver with that of carotid sinus massage (CSM) in terminating paroxysmal supraventricular tachycardia (SVT) in the ED. METHODS: This prospective, randomized case study was performed in the ED of a tertiary care institution. Patients were at least 10 years of age with regular narrow complex tachycardia and had an ECG diagnosis of SVT. Patients with regular narrow complex tachycardia were randomly assigned to undergo either the Valsalva maneuver or CSM. If the tachycardia was not terminated by the method chosen by randomization, then the alternative method of vagal maneuver was used. If the tachycardia was not converted by both methods of vagal stimulation, patients would undergo either synchronized electrical cardioversion or a pharmacologic method of conversion at the discretion of the treating physician, depending on the patient's hemodynamic status. RESULTS: One hundred forty-eight instances of SVT were studied. Sixty-two patients underwent Valsalva maneuver first with conversion in 12 (success rate of 19.4%). Eighty-six underwent CSM first with conversion in 9 (success rate 10.5%). Carotid sinus massage was used in the 50 cases of SVT in which conversion was not achieved with the Valsalva maneuver. Conversion occurred in 7 cases (success rate 14.0%). For the 77 cases of SVT in which initial CSM did not achieve conversion, conversion occurred in 13 with the Valsalva maneuver (success rate 16.9%). The Valsalva maneuver and CSM achieved conversion in a total of 41 instances of SVT (success rate 27.7%). CONCLUSION: Vagal maneuvers are efficacious in terminating about one quarter of spontaneous SVT cases. There is no detectable difference in efficacy between the Valsalva maneuver and CSM. [Lim SH, Anantharaman V, Teo WS, Goh PP, Tan ATH: Comparison of treatment of supraventricular tachycardia by Valsalva maneuver and carotid sinus massage. Ann Emerg Med January 1998;31:30-35.].

Effects of Nucleoside Analogs on Native and Site-Directed Mutants of HTLV Type 1 Reverse Transcriptase.

A bacterial assay was developed for testing HTLV-1 reverse transcriptase sensitivity to common nucleoside analog inhibitors in an Escherichia coli strain characterized by a temperature sensitive PolI/RecA deletion phenotype. This genetic complementation assay exploits the ability of HTLV-1 reverse transcriptase to functionally replace these missing activities at nonpermissive temperatures. The four inhibitors tested, dideoxyinosine, dideoxyadenosine, deoxythymidine, and didehydrodeoxythymidine are well-known inhibitors of HIV reverse transcriptase. All except dideoxyadenosine showed a strong activity against HTLV-1 reverse transcriptase with IC(50); in the nanomolar range. Sequence alignments were used to identify amino acid residues in HTLV-1 reverse transcriptase, which correspond to those identified as important for drug-resistance in HIV reverse transcriptase. Mutations of some of these HTLV-1 residues altered the IC(50) for the inhibitors as expected, which suggests that these amino acids have a function in HTLV-1 reverse transcriptase similar to that of their homologs in HIV reverse transcriptase. Copyright 2000 Academic Press.

Hospital and emergency ambulance link: using IT to enhance emergency pre-hospital care.

Emergency ambulances traditionally inform receiving hospitals of impending arrival of patients only in instances of load and go situations, which on average constitute less than 5% of ambulance runs. Information transmitted is usually sparse. For all other runs, information is made available only on arrival at the emergency department (ED). There have also been numerous limitations associated with voice transmissions.A comprehensive electronic ambulance case record was created as a pilot project in Singapore between three emergency ambulances and the busiest ED there. All information captured by the ambulance crew, including vital signs information and ECGs was entered or downloaded onto a ruggardised PC in the ambulance and this complete ambulance record was transmitted to the ED. Transmission was wireless via the public mobile data network. A 3-month analysis of this pilot run revealed the following. (1) It was possible to capture a complete ambulance case record electronically at a mean time of 94 s vs 7 min 7 s for the traditional written record. (2) Air transmission time for data was approximately 4 s unless ECG wave forms were also transmitted resulting in transmission times frequently exceeding 60 s. (3) At least 68% of data was transmissible in 75% of Hospital & Emergency Ambulance Link (HEAL) ambulances as opposed to only 25% in less than 5% of non-HEAL ambulances. (4) Paramedics' time in the ED decreased from 15 to 8 min as a result of HEAL. (5) The waiting time for critical care patients to be seen at the ED decreased from 35 to 17 min if brought by HEAL ambulances.(6) The HEAL system was able to effectively prompt paramedics in carrying out critical aspects of treatment in close to 100% of instances. (7) The pilot HEAL system was able to demonstrate a limited amount of automated audit of specific aspects of ambulance runs. Having demonstrated the feasibility of the HEAL system, it is a matter of time before enhanced features such as electronic data collection at patient site, voice activated data entry, transmission of data from site, automated ambulance audits and an enhanced level of professional care in the ambulances become common-place reality.

Emergency department organisation for disasters: a review of emergency department disaster plans in public hospitals of Singapore.

Disaster management plans of emergency departments (EDs) in four major public hospitals were reviewed. A comparison was made between these plans, and they were analyzed to gain an understanding of the differing objectives and doctrines behind the practices. These were summarized into five major management concepts, which are considered to be critical to the success of a disaster plan: 1) staff mobilization systems (cascading vs batch mobilization); 2) staff deployment systems; 3) team organization (surgeons vs residents); 4) area management (the role of the area manager); 5) casualty volume management (accommodation vs expansion vs extension concepts). The concepts derived should serve as a useful guide to the development of an ED disaster plan and potentially influence how new ED facilities could be planned.