Reframing Future Risks of Extreme Heat in the United States.

The goal of this study is to reframe the analysis and discussion of extreme heat projections to improve communication of future extreme heat risks in the United States. We combine existing data from 31 of the Coupled Model Intercomparison Project Phase 5 models to examine future exposure to extreme heat for global average temperatures of 1.5, 2, 3, and 4 °C above a preindustrial baseline. We find that throughout the United States, historically rare extreme heat events become increasingly common in the future as global temperatures rise and that the depiction of exposure depends in large part on whether extreme heat is defined by absolute or relative metrics. For example, for a 4 °C global temperature rise, parts of the country may never see summertime temperatures in excess of 100 °F, but virtually all of the country is projected to experience more than 4 weeks per summer with temperatures exceeding their historical summertime maximum. All of the extreme temperature metrics we explored become more severe with increasing global average temperatures. However, a moderate climate scenario delays the impacts projected for a 3 °C world by almost a generation relative to the higher scenario and prevents the most extreme impacts projected for a 4 °C world.

Inhibitory effect of Mercurascan on lymphocytes.

Human lymphocytes treated in vitro with Mercurascan (MSC) have a reduced capacity to form E rosettes and to respond to phytohemagglutinin. MSC was also found to reduce the capacity of mouse lymphocytes to activate the regional lymph nodes of allogeneic recipients and release the lymph node-activating factor.

Influence of protein intake and renal function on plasma amino acids in patients with renal impairment and after kidney transplantation.

A group of 17 patients with chronic renal impairment and a group of 11 patients surviving for 3--7 years after kidney transplantation were examined. In all patients plasma amino acids were analyzed. The ratio of essential/nonessential amino acids, the valine/glycine ratio and Whitehead's quotient are influenced above all by the dietary protein intake. Raised citrulline and 3-methylhistidine values were not influenced by the protein intake, while they correlate with indicators of renal function. Changes detected after kidney transplantation are analogous.

Function of the autotransplanted pancreatic segment in the dog.

Autotransplantation of the left lobe of the pancreas to the neck vessels was performed in 13 dogs. The technique employed made it possible to examine pancreatic secretion and arteriovenous difference in enzymes immediately after transplantation. Following functional examination the pancreatic duct was ligated. From 4 to 20 postoperative days the graft was intact only in 3 dogs. Severe autolysis of the graft and/or of the surrounding tissue developed in ten dogs 4 to 6 days after transplantation. Stimulation with secretin elicited immediate secretion response of the graft, the volume of secretion and output of amylase corresponding to normal values. A statistically significant arteriovenous difference was found both for amylase and LDH before and after secretin. Stimulation of exocrine secretion of the graft elicited a marked increase of enzyme concentration in the arterial and particularly in the venous blood of the graft. Cellular damage with subsequent leakage of enzymes into extracellular fluid plays a significant role in the pathogenesis of autolysis of the graft and surrounding tissues.

A comparison of methods for the measurement of hemodialysis access recirculation and access blood flow rate.

The ability to accurately measure access recirculation (AR) is of importance because its presence indicates access dysfunction and may explain why a prescribed Kt/V (urea) has not been delivered. The ability to measure access flow (Qa) allows access monitoring and the detection of impending access dysfunction. AR can be measured by indicator dilution or conductivity tracer techniques. Qa calculation is simple if AR can be detected. The previous techniques are used while the patient's blood lines are reversed to induce AR, and the Krivitski equation gives: Qa = Qb [1-r/r] where Qb = dialyzer blood flow and r = proportion of AR induced. Three methods for AR and Qa measurements were directly compared: 1) ultrasound dilution (Transonics Hemodialysis Monitor, Transonics Systems Incorporated) (TRANS); 2) hematocrit dilution (Crit-Line Monitor, In-Line Diagnostics) (CRIT); and 3) differential conductivity (Hemodynamic Monitor, GAMBRO Healthcare Incorporated) (HDM). Patients were cannulated in a standard fashion and dialysis commenced with lines in normal configuration. A HDM test was performed and, if AR = zero, the lines were reversed to induce AR. HDM, TRANS, and CRIT tests for AR were next done in rapid succession for direct comparison. Each test was repeated three times in succession, the device in random order, to assess test repeatability. Qb was taken from the 1) dialysis machine pump, and 2) directly from TRANS and Qa calculated, using 1) and 2) AR results. In comparison to TRANS, AR results were virtually identical for HDM (TRANS AR = 1.04 HDM-AR + 0.02, r = 0.98, p = 0.0000), and good for CRIT (CRIT-AR = 0.84 TRANS-AR - 0.2, r = 0.81, p = 0.001), but CRIT underestimated the values. Repeatability was assessed by normalizing (%) the SD of repeated measurements; values were 7.5% (HDM), 9.1 % (TRANS), and 17.4% (CRIT). Qa value comparisons were similar (minimal r = 0.83) regardless of Qb source, but CRIT overestimated the value; repeatability data showed 10.6% (HDM), 13.0% (TRANS), and 25.2% (CRIT) (n ranged from 15-64). In summary, TRANS and HDM appear equal as far as accuracy and repeatability of measurements; CRIT results correlated well, but tended to underestimate AR and overestimate Qa, and was less reproducible.

Immunogenic capacity of mouse alloantigens from ischaemic liver.

Immunogenic versus tolerogenic capacity of mouse alloantigens from ischaemic liver was tested in two different congenic strain combinations (H-2 compatible, non-H-2 incompatible). The recipients of test skin allografts were pretreated with tissue homogenate or particulate fraction and the survival pattern of the skin allografts was used as the criterion of the induced status. The results showed a difference in the immunogenicity of antigenic extracts from normal (healthy) and ischaemic liver. Following a single dose, alloantigens from ischaemic liver had an increased immunogenicity (which could be reduced through perfusion) as compared to control (extracts from healthy liver). Following three larger doses of ischaemic liver extracts, the effect was tolerogenic. Possible mechanism of the altered immunogenicity of alloantigens due to ischaemization of the liver tissue and the effect of perfusion are discussed.

Effect of mercurascan and tetracycline on ischaemia-altered immunogenicity of liver extract alloantigens in mice.

The action of Mercurascan and Tetracycline on ischaemic liver in mice was investigated. The effect was reflected in different immunogenicity (in allotrasplantation reaction) of liver extracts 1 mg. membrane fraction) derived from treated and normal organs in the donor--recipient strain combination B10--B10.LP. In the recipients treated with a single administration of extract from ischaemic liver the survival time of skin grafts was shortened as compared to the untreated control group and the control group given normal liver extract. Immunogenicity of the liver extracts from Mercurascan- or Tetracycline-treated mice was diminished.

Different efficiency of mercurascan in allograft survival prolongation in male and female mice.

The efficiency of mercurascan on prolongation of skin allograft survival was found to depend on the sex of experimental animals. Long-term treatment of the recipients by MSC in the mouse strain combination B10--B10.LP (donor X recipient, difference in non-H-2 loci) was more efficient in females than in males. The immunosuppressive effect of MSC was weak. MSC had no effect on the survival time of skin or heart allografts in a strain combination with limited H-2 differences [B10.D2--M(504)]. The effect of MSC on the cell membrane was followed in vitro by measurement of the rate of H-2 antigen redistribution on lymphoid cells of animals treated in vivo by MSC. The rate of redistribution on lymphoid cells from MSC-treated females was decreased; no effect was observed in the case of cells from treated males.

Transplantation models using the regional lymph node.

Several transplantation models, using the regional lymph node, to study the transplantation reaction in strictly defined and simple conditions were devised. Lymphoid cells were transplanted to inbred rats and mice at the sites drained by one regional lymph node; the experimental design was chosen so as to permit theoretically a one-way reaction, either the host-versus-graft (HVG) or the graft-versus-host (GVH) reaction. The changes in the lymph nodes draining the site of cell injection (weight increase, histology, lymphocyte activation) were very similar in both transplantation reactions. They were ascribed to a humoral mediator released upon the contact of lymphoid cells from two genetically different individuals. The direct demonstration of a mediator which is capable of activating the regional lymph node in vivo introduces some new aspects into the process of sensitization after transplantation.

[Academician Vilém Laufberger and the Czechoslovak Academy of Sciences]. / Akademik Vilém Laufberger a CSAV.

Academician Vilém Laufberger participated in a significant way in the work of the Czechoslovak Academy of Sciences. He was one of its founders as a member of the preparatory commission for its establishment, an important official in its presidium, founder and director of one of its institutes and a permanent long-term critical observer and commentator of its activities. He greatly appreciated the steep rise of biomedical research at the beginnings of the Academy as a worthy development of the traditions of world reknown physiologists J. E. Purkyne and I. P. Pavlov. He evaluated favourably also its subsequent development. At the very beginning he drew attention to some shortcomings which during subsequent development influenced the activities of the Academy in an adverse way. Their elimination is a task for the present time.

Staff participation in administrative decision-making.

Victoria Hospital Corporation in London has adopted a collaborative management model that involves the participation of medical, union and non-union staff in the administrative decision-making process within predetermined parameters. Reactions have been favourable from all sides--positive feedback from the groups involved and minimal negative public response to the sensitive decisions made concerning downsizing. Early indicators suggest increasing further the participation of union and non-union staff in decision-making on multiple levels, but with clearly defined "boundaries of responsibility."

[Changes in the pancreas after obliteration of the pancreatic ducts in a dog with Hydron]. / Zmeny pankreatu po obliteraci pankreatických vývodu u psa Hydronem.

The development of pancreatic changes was studied after obliteration of pancreatic ducts by means af 2-hydroxyethylmethacrylate. The drug was injected into the main pancreatic duct of 15 dogs that were put to death successively and examined by histology. Necrosis of pancreatic duct epithelium was found in 4 days after the polymer administration in addition to focal periductal necrosis of acinar tissue and interstitial oedema with fibroblast activation. Later, a rapid development of fibrosis occurred which ensue in an extinction of exocrine tissue after 2 months. Pancreas consisted then but of connective tissue and cumulated Langerhans' islets with positive beta-granulations. Pancreatic ducts obliteration is a reliable method for selective inhibition of exocrine activity.

Framing the work: development of a renal nursing professional practice model.

In 1997, a nursing care model task group was formed to develop a framework to guide the development of the nursing care delivery system in a newly merged hospital corporation. A collective group of experienced and motivated nurses in the renal program met to develop an integrated renal nursing professional practice model. In addition it was recognized that a city-wide model involving the two acute care renal centres would be advantageous. The challenge was to clearly articulate the professional roles and relationships of nurses and nurse practitioner/clinical nurse specialists in a constantly changing environment. This process provided the opportunity to identify key trends influencing renal care and possibilities for changing practice. Networking across the corporations was enhanced, partnerships were formed, and a sense of value for the work that was being undertaken developed. The group's endeavours resulted in an integrated nursing professional practice model that emphasizes accountability and continuity and places value on therapeutic relationships. Another strength of the model is the acknowledgement of the collaborative nature of the multidisciplinary team. After two years of development, the model was implemented. A city-wide Renal Nursing Professional Practice Council has been established in order to provide leadership in evaluating the model. This will include assessing the success of implementation, impact on patient/family care, and collaborative rewards experienced by staff. Future planning will address the potential need for a multidisciplinary focus within the practice council.