The effect of physician staffing model on patient outcomes in a medical progressive care unit.

PURPOSE: Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. MATERIALS AND METHODS: We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. RESULTS: A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. CONCLUSIONS: We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care.

Influence of Incorporated Pt-Fe2O3 Core-Shell Nanoparticles on the Resistive Switching Characteristics of ZnO Thin Film.

The resistance-switching characteristics of metal oxides have attracted great interest for the non-volatile memory applications such as resistive random access memory. A basic resistive random access memory device has a metal/insulator/metal structure, and its memory effect is achieved by applying voltage to change the resistance of the insulating layer. One of the promising candidates for explaining the resistance-switching mechanism is the formation and rupture of nanoscale conductive filaments. However, this model has an issue that needs to be addressed: the wide distribution of switching voltage due to randomly formed filaments. Therefore, some researchers have reported a decrease in switching voltage distribution and an increase in switching stability by incorporating nanoparticles into the insulating layer. In this study, we investigated influence of incorporated Pt-Fe2O3 core-shell nanoparticles on the resistive switching characteristics of ZnO thin films. Devices were fabricated on SiO2 wafers. A 100-nm-thick Cr layer was used as the bottom electrode. A 50-nm-thick ZnO layer was deposited using the sputtering method, and Pt-Fe2O3 nanoparticles were deposited on it by the dip coating method. A 50-nm-thick ZnO layer was then deposited again. A top Cr electrode (size: 100 µm x 100 µm) was deposited using a shadow mask and sputtering system. All the devices showed bipolar resistance-switching behavior that is observed in Cr/ZnO/Cr structures. However, the on/off voltage was dramatically lowered by incorporating nanoparticles into the insulating layer when compared with that of the devices without nanoparticles. In addition, the switching stability of the devices was improved upon the incorporation of nanoparticles. On the basis of these results, we can conclude that Pt-Fe2O3 nanoparticles may be used to enhance the resistance switching properties of ZnO thin films by incorporating them into the films.

Resistive switching characteristics of the Cr/ZnO/Cr structure.

Resistive random access memory (ReRAM) with conductor-dielectric-conductor structures has attracted extensive attention for next generation nonvolatile memory devices. The resistive switching effect has been observed in various materials, such as metal oxides and chalcogenide oxides. From our findings, we advocate the resistive switching characteristics of zinc oxide thin film, due to its simple composition and ease of manipulation. In this study, we investigated the current-voltage (I-V) characteristics of the Cr/ZnO/Cr capacitor structure. The Cr electrode and ZnO thin film were deposited by radio frequency magnetron sputtering at room temperature. The top electrode layers were patterned by 100 microm x 100 microm. The fabricated devices of the Cr/ZnO/Cr structures exhibited bipolar switching behavior. In addition, using the Cr-coated AFM tip replaced with the top electrode enabled us to map the local current image and measure the current flow at each point. This gave us more information to verify the resistive switching mechanism of ZnO thin film.

Influence of stereopsis and abnormal binocular vision on ocular and systemic discomfort while watching 3D television.

PURPOSE: To evaluate the degree of three-dimensional (3D) perception and ocular and systemic discomfort in patients with abnormal binocular vision (ABV), and their relationship to stereoacuity while watching a 3D television (TV). METHODS: Patients with strabismus, amblyopia, or anisometropia older than 9 years were recruited for the ABV group (98 subjects). Normal volunteers were enrolled in the control group (32 subjects). Best-corrected visual acuity, refractive errors, angle of strabismus, and stereoacuity were measured. After watching 3D TV for 20 min, a survey was conducted to evaluate the degree of 3D perception, and ocular and systemic discomfort while watching 3D TV. RESULTS: One hundred and thirty subjects were enrolled in this study. The ABV group included 49 patients with strabismus, 22 with amblyopia, and 27 with anisometropia. The ABV group showed worse stereoacuity at near and distant fixation (P<0.001). Ocular and systemic discomfort was, however, not different between the two groups. Fifty-three subjects in the ABV group and all subjects in the control group showed good stereopsis (60 s of arc or better at near), and they reported more dizziness, headache, eye fatigue, and pain (P<0.05) than the other 45 subjects with decreased stereopsis. The subjects with good stereopsis in the ABV group felt more eye fatigue than those in the control group (P=0.031). The subjects with decreased stereopsis showed more difficulty with 3D perception (P<0.001). CONCLUSIONS: The subjects with abnormal stereopsis showed decreased 3D perception while watching 3D TV. However, ocular and systemic discomfort was more closely related to better stereopsis.

Hypermethylation of CpG island loci and hypomethylation of LINE-1 and Alu repeats in prostate adenocarcinoma and their relationship to clinicopathological features.

Promoter CpG island hypermethylation is an important carcinogenic event in prostate adenocarcinoma. Regardless of tissue type, human cancers have in common both focal CpG island hypermethylation and global genomic hypomethylation. The present study evaluated CpG island loci hypermethylation and LINE-1 and Alu repeat hypomethylation in prostate adenocarcinoma, analysed the relationship between them, and correlated these findings with clinicopathological features. We examined 179 cases of prostate adenocarcinoma and 30 cases of benign prostate hypertrophy for the methylation status of 22 CpG island loci and the methylation levels of LINE-1 and Alu repeats using methylation-specific polymerase chain reaction and combined bisulphite restriction analysis, respectively. The following 16 CpG island loci were found to display cancer-related hypermethylation: RASSF1A, GSTP1, RARB, TNFRSF10C, APC, BCL2, MDR1, ASC, TIG1, RBP1, COX2, THBS1, TNFRSF10D, CD44, p16, and RUNX3. Except for the last four CpG island loci, hypermethylation of each of the remaining 12 CpG island loci displayed a close association with one or more of the prognostic parameters (ie preoperative serum prostate specific antigen level, Gleason score sum, and clinical stage). Prostate adenocarcinoma with hypermethylation of each of ASC, COX2, RARB, TNFRSF10C, MDR1, TIG1, RBP1, NEUROG1, RASSF1A, and GSTP1 showed a significantly lower methylation level of Alu or LINE-1 than prostate adenocarcinoma without hypermethylation. In addition, hypomethylation of Alu or LINE-1 was closely associated with one or more of the above prognostic parameters. These data suggest that in tumour progression a close relationship exists between CpG island hypermethylation and the hypomethylation of repetitive elements, and that CpG island hypermethylation and DNA hypomethylation contribute to cancer progression.

Fission yeast hrp1, a chromodomain ATPase, is required for proper chromosome segregation and its overexpression interferes with chromatin condensation.

Hrp1 of Schizosaccharomyces pombe is a member of the CHD protein family, characterized by a chromodomain, a Myb-like telobox-related DNA-binding domain and a SNF2-related helicase/ATPase domain. CHD proteins are thought to be required for modification of the chromatin structure in transcription, but the exact roles of CHD proteins are not known. Here we examine the sub-cellular localization and biochemical activity of Hrp1 and the phenotypes of hrp1 Delta and Hrp1-overexpressing strains. Fluorescence microscopy revealed that Hrp1 protein is targeted to the nucleus. We found that Hrp1 exhibited DNA-dependent ATPase activity, stimulated by both single- and double-stranded DNA. Overexpression of Hrp1 caused slow cell growth accompanied by defective chromosome condensation in anaphase resulting in a 'cut' (celluntimelytorn) phenotype and chromosome loss. The hrp1 Delta mutation also caused abnormal anaphase and mini-chromosome loss phenotypes. Electron micrographs demonstrated that aberrantly shaped nucleoli appeared in Hrp1-overexpressing cells. Therefore, these results suggest that Hrp1 may play a role in mitotic chromosome segregation and maintenance of chromatin structure by utilizing the energy from ATP hydrolysis.

Isolation and characterization of hrp1+, a new member of the SNF2/SWI2 gene family from the fission yeast Schizosaccharomyces pombe.

The SNF2/SWI2 ATPase/helicase family comprises proteins from a variety of species, which serve a number of functions, such as transcriptional regulation, maintenance of chromosome stability during mitosis, and various types of DNA repair. Several proteins with unknown functions are also included in this family. The number of genes that belong to this family is rapidly expanding, which makes it easier to analyze the common biological functions of the family members. This study was designed to clone the SNF2/SWI2 helicase-related genes from the fission yeast Schizosaccharomyces pombe in the hope that this would help to elucidate the common functions of the proteins in this family. The hrp1+ (helicase-related gene from S. pombe) gene was initially cloned by PCR amplification using degenerate primers based on conserved SNF2 motifs within the ERCC6 gene, which encodes a protein involved in DNA excision repair. The hrp1+ ORF codes for an 1373-amino acid polypeptide with a molecular mass of 159 kDa. Like other SNF2/SWI2 family proteins, the deduced amino acid sequence of Hrp1 contains DNA-dependent ATPase/7 helicase domains, as well as a chromodomain and a DNA-binding domain. This configuration is similar to that of mCHD1 (mouse chromo-ATPase/helicase-DNA-binding protein 1), suggesting that Hrp1 is a S. pombe homolog of mCHD1, which is thought to function in altering the chromatin structure to facilitate gene expression. Northern blot analysis showed that the hrp1+ gene produces a 4.6-kb transcript, which reaches its maximal level just before the cells enter the exponential growth phase, and then decreases gradually. DNA-damaging agents, such as MMS, MNNG and UV, decrease the rate of transcription of hrp1+. Deletion of the hrp1+ gene resulted in accelerated cell growth. On the other hand, overexpression of Hrp1 caused a reduction in growth rate. These results indicate that hrp1+ may act as a negative regulator of cellular growth.

Identification of the DNA damage-responsive elements of the rhp51+ gene, a recA and RAD51 homolog from the fission yeast Schizosaccharomyces pombe.

The Schizosaccharomyces pombe rhp51+ gene encodes a recombinational repair protein that shares significant sequence identities with the bacterial RecA and the Saccharomyces cerevisiae RAD51 protein. Levels of rhp51+ mRNA increase following several types of DNA damage or inhibition of DNA synthesis. An rhp51::ura4 fusion gene was used to identify the cis-acting promoter elements involved in regulating rhp51+ expression in response to DNA damage. Two elements, designated DRE1 and DRE2 (for damage-responsive element), match a decamer consensus URS (upstream repressing sequence) found in the promoters of many other DNA repair and metabolism genes from S. cerevisiae. However, our results show that DRE1 and DRE2 each function as a UAS (upstream activating sequence) rather than a URS and are also required for DNA-damage inducibility of the gene. A 20-bp fragment located downstream of both DRE1 and DRE2 is responsible for URS function. The DRE1 and DRE2 elements cross-competed for binding to two proteins of 45 and 59 kDa. DNase I footprint analysis suggests that DRE1 and DRE2 bind to the same DNA-binding proteins. These results suggest that the DRE-binding proteins may play an important role in the DNA-damage inducibility of rhp51+ expression.

Evidences for possible involvement of Rhp51 protein in mitotic events including chromosome segregation.

To understand the role of the Rhp51 protein in Schizosaccharomyces pombe, we examined the phenotypes of the null mutant for the rhp51+ gene. Unlike Saccharomyces cerevisiae rad51 mutants, S. pombe rhp51 mutants (rhp51delta cells) displayed slow growth and heterogeneity in cell size, indicating perturbation of the cell cycle. Furthermore, many aberrant nuclear structures found in 4',6'-diamidino-2-phenylindole (DAPI)-stained rhp51delta cells and the caffeine hypersensitivity of the mutant cells suggested an involvement of the Rhp51 protein in normal chromosome segregation. These data suggested that the Rhp51 proteins were required for normal cell growth as well as a DNA repair pathway. Moreover, rhp51delta mutants showed a considerable sensitivity to ultraviolet (UV) light-irradiation as well as methyl methanesulfonate (MMS) treatment, indicating that the Rhp51 proteins are involved in both the active excision mechanism of UV-induced DNA damage and recombinational repair in S. pombe. Taken together, we suggest that the role(s) of the Rhp51 protein in S. pombe may be different from those of Rad51 in S. cerevisiae.