A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices.

BACKGROUND: To study etiologies of anemia using an extensive laboratory analysis in general practices. METHOD: An extensive laboratory analysis was performed in blood of newly diagnosed anemia patients aged ≥50 years from the general population in the city of Dordrecht area, the Netherlands. Eight laboratory-orientated etiologies of anemia were defined. Patients were assigned one or more of these etiologies on the basis of their test results. RESULTS: Blood of 4152 patients (median age 75 years; 49% male) was analyzed. The anemia etiology was unclear in 20%; a single etiology was established in 59%; and multiple etiologies in 22% of the patients. The most common etiologies were anemia of chronic disease (ACD) (54.5%), iron deficiency anemia (IDA) (19.1%) and renal anemia (13.8%). The most common single etiologies were IDA (82%) and ACD (68%), while the multiple etiologies most commonly included folic acid deficiency (94%) and suspected bone marrow disease (88%). Older age was associated with a lower incidence of IDA and a higher incidence of renal anemia. Mild anemia was more often associated with ACD and uncertain anemia, while severe anemia was mainly seen in patients with IDA. CONCLUSION: Extensive laboratory analysis in anemic patients from the general population helped clarify the etiology of anemia and revealed many various combinations of etiologies in a significant proportion of patients. Age, sex and the severity of anemia are predictive of the underlying etiology.

Membrane-aerated biofilm reactor for the removal of 1,2-dichloroethane by Pseudomonas sp. strain DCA1.

A membrane-aerated biofilm reactor (MBR) with a biofilm of Pseudomonas sp. strain DCA1 was studied for the removal of 1,2-dichloroethane (DCA) from water. A hydrophobic membrane was used to create a barrier between the liquid and the gas phase. Inoculation of the MBR with cells of strain DCA1 grown in a continuous culture resulted in the formation of a stable and active DCA-degrading biofilm on the membrane. The maximum removal rate of the MBR was reached at a DCA concentration of approximately 80 micro M. Simulation of the DCA fluxes into the biofilm showed that the MBR performance at lower concentrations was limited by the DCA diffusion rate rather than by kinetic constraints of strain DCA1. Aerobic biodegradation of DCA present in anoxic water could be achieved by supplying oxygen solely from the gas phase to the biofilm grown on the liquid side of the membrane. As a result, direct aeration of the water, which leads to undesired coagulation of iron oxides, could be avoided.

A comparison of the recognition distance of several types of pedestrial signals with low-vision pedestrians.

Although approximately 80-85% of the legally blind population has some residual vision, little research has examined the relative conspicuity of various types of visual pedestrian signals currently used by cities with this group of pedestrians. This research compared the relative conspicuity of an incandescent WALK sign, a white LED WALK sign, a blue LED WALK sign, and white and blue LED WALK signs that included an animated "eyes" display with legally blind participants who had some vision. All WALK signals were equated for brightness with the use of a N.I.S.T.-certified illuminance meter. Participants had to discriminate whether the test stimulus was a blue/white WALK sign or a blue/white DON'T WALK sign. Test stimuli were presented in randomized blocks of trials, and recognition distances were determined by having participants approach the test stimuli until they could identify them. Results indicated that there were no significant differences between the incandescent and LED signals without the animated eyes or between the blue and white LED signals. However, Tukey's method showed a significant contrast between the signals with the animated eyes display and signals without this display (F=149.88, P value<0.0001). Participants could identify the Walk signal 62% further away when it also contained the animated "eyes" display. These results show that the addition of an animated "eyes" display to the WALK sign significantly improves recognition distance for a large segment of persons with visual impairment.

Increasing motorist compliance and caution at stop signs.

This study evaluated strategies to improve motorist compliance and caution at three stop-sign-controlled intersections with a history of motor vehicle crashes. The primary intervention was a light-emitting diode (LED) sign that featured animated eyes scanning left and right to prompt drivers to look left and right for approaching traffic. Data were scored from videotape on the percentage of drivers coming to a complete stop and the percentage of drivers looking right before entering the intersection. Observational data were collected on the percentage of right-angle conflicts (defined as braking suddenly or swerving from the path to avoid an intersection crash). The introduction of the LED sign according to a multiple baseline across the three intersections was associated with an increase in the percentage of vehicles coming to a complete stop at all three intersections and a small increase in the percentage of drivers looking right before entering the intersections. Conflicts between vehicles on the major and minor road were also reduced following the introduction of the animated eyes prompt.

Thermophilic sulphate and sulphite reduction in lab-scale gas-lift reactors using H(2) and CO(2) as energy and carbon source.

Feasibility of thermophilic (55 degrees C) sulphate and sulphite reduction with H(2) and CO(2) gas-mixtures was studied in gas-lift reactors, which contained pumice particles as carrier material. Particular attention was paid to biomass retention and the competition between hydrogenotrophic sulphate-reducers and other hydrogenotrophic thermophiles. A model medium with defined mineral nutrients was used.The results of the experiments clearly demonstrate that sulphate conversion rates up to 7.5 g SO(4) (2-)/L per day can be achieved. With sulphite, a reduction rate of 3.7 g S/L per day was obtained, which equals a sulphate conversion rate of 11.1 g SO(4) (2-)/L per day. Under the applied conditions, a strong competition for hydrogen between hydrogenotrophic sulphate-reducers, tentatively designated as Desulfotomaculum sp., and hydrogenotrophic methanogens was observed. The outcome of the competition could not be predicted. Growth of the mixed culture was totally inhibited at an H(2)S concentration of 250 mg/L. Poor attachment of sulphate-reducing bacteria was observed in all experiments. The biomass concentration did not exceed 1.2 g/L, despite the presence of 50 g/L of pumice. The reason for this phenomenon remains to be understood. (c) 1997 John Wiley & Sons, Inc. Biotechnol Bioeng 55: 807-814, 1997.

The use of feedback signs to increase observed daytime seat belt use in two cities in North Carolina.

Well publicized enforcement programs in North Carolina have raised seat belt use to about 80%. In an effort to find techniques to raise belt use further, signs providing feedback to drivers on belt use rates were introduced in two communities, Asheboro (population 18,000) and Greensboro (population 183,000). Feedback signs remind motorists about belt use and imply a constant and vigorous enforcement presence. The signs were prominently posted by the roadside at high volume locations; belt use information was changed weekly based on observational surveys. Observed daytime driver belt use in Asheboro increased from an average of 75% before the signs to 89% after the signs were established. At urban sites in Greensboro, driver belt use increased from 80% to 86%. Right front passenger belt use increased significantly in Asheboro but not in Greensboro. There were no changes in belt use at two interstate exit sites in Greensboro. Reasons for the differential success rates may relate to differences in initial belt use rates, community size, amount of publicity, and numbers of encounters with the signs. It is clear, however, that feedback signs can be an important supplement to belt use enforcement programs.

A comparison of the characteristics of self-stimulatory behaviors in "normal" children and children with developmental delays.

We examined the occurrence and characteristics of self-stimulatory behaviors in 10 nonhandicapped children and 5 children with developmental delays. Each child with a developmental delay was matched with two normal comparison children, one for chronological age and the other for mental age. The subjects were videotaped in four everyday settings. It was found that few differences existed between the children with developmental delays and their age-matched pairs in the percentage of time they engaged in self-stimulatory behavior, the variety of self-stimulatory behavior, how fast or slowly a behavior was preformed, or the degree of perseveration of each of the behaviors. However, the children with developmental delays and their mental age matches displayed higher levels of obvious and gross motor behavior than the chronological age matches, and the children with developmental delays were more likely to be visually oriented towards their behavior than their age-matched pairs. A measure of judged bizarreness of various self-stimulatory behaviors indicated that obvious gross motor behaviors received the highest bizarreness ratings.

Biological sulfate reduction using synthesis gas as energy and carbon source.

Biological sulfate reduction was studied in laboratory-scale gas-lift reactors. Synthesis gas (gas mixtures of H(2)/CO/CO(2)) was used as energy and carbon source. The required biomass retention was obtained by aggregation and immobilization on pumice particles. Special attention was paid to the effect of CO addition on the sulfate conversion rate, aggregation, and aggregate composition.Addition of 5% CO negatively affected the overall sulfate conversion rate; i.e., it dropped from 12-14 to 6-8 g SO(2-) (4)/L day. However, a further increase of CO to 10 and 20% did not further deteriorate the process. With external biomass recycling the sulfate conversion rate could be improved to 10 g SO(2-) (4)/L day. Therefore biomass retention clearly could be regarded as the rate-limiting step. Furthermore, CO affected the aggregate shape and diameter. Scanning electron microscopy (SEM) photographs showed that rough aggregates pregrown on H(2)/CO(2) changed into smooth aggregates upon addition of CO. Addition of CO also changed the aggregate Sauter mean diameter (d(32)) from 1.7 mm at 5% CO to 2.1 mm at 20% CO. After addition of CO, a layered biomass structure developed. Acetobacterium sp. were mainly located at the outside of the aggregates, whereas Desulfovibrio sp. were located inside the aggregates.

Topical active H1-antihistamines and their effect on nasal airway resistance.

The introduction of a topically active H1-antihistamine nasal spray Azelastine, has given an extra dimension in the management of allergic rhinitis. The drug acts rapidly and avoids the systemic adverse effects of antihistimines. An objective prospective study was performed to detect the effect of Azelastine nasal spray on nasal airway resistance. Twelve healthy adult volunteers with no rhinological problems were included in the study. Nasal cavities were sprayed with 280 micrograms (two puffs) of Azelastine nasal spray and the nasal airway resistance was measured with anterior rhinomanometry at intervals of 30 minutes for up to two hours. Our study has shown a statistically significant increase in the total nasal airway resistance following the use of Azelastine nasal spray in the absence of a subjective change in nasal airway resistance. There are substances when inhaled which can cause subjective improvement in nasal airway patency without changing the measured nasal airway resistance. However this medication gives no subjective change in nasal airway patency in spite of increasing nasal airway resistance.

The effects of low alcohol beverages on alcohol consumption and impairment.

We examined the effects of providing drinks with half the alcohol level on alcohol consumption and blood alcohol concentration (BAC) of 4 patrons of a private club. Alcohol consumption was measured by observers and level of impairment was determined from breath samples obtained by digitalized ALERT (Alcohol Level Evaluation Road Tester) breath testing devices. An alternating treatments design was employed to compare the sessions during which people drank mixed drinks with their usual alcohol concentration with sessions during which they drank mixed drinks with half the alcohol concentration that cost half as much as the regular drinks. All 4 participants consumed less alcohol during sessions when they received drinks with the lower alcohol content. BAC was also less on all but two sessions during the low alcohol condition.

Biological sulphate reduction using gas-lift reactors fed with hydrogen and carbon dioxide as energy and carbon source.

Feasibility and engineering aspects of biological sulphate reduction in gas-lift reactors were studied. Hydrogen and carbon dioxide were used as energy and carbon source. Attention was paid to biofilm formation, sulphide toxicity, sulphate conversion rate optimization, and gas-liquid mass transfer limitations. Sulphate-reducing bacteria formed stable biofilms on pumice particles. Biofilm formation was not observed when basalt particles were used. However, use of basalt particles led to the formation of granules of sulphate-reducing biomass. The sulphate-reducing bacteria, grown on pumice, easily adapted to free H(2)S concentrations up to 450 mg/L. Biofilm growth rate then equilibrated biomass loss rate. These high free H(2)S concentrations caused reversible inhibition rather than acute toxicity. When free H(2)S concentrations were kept below 450 mg/L, a maximum sulphate conversion rate of 30 g SO(4) (2-)/L x d could be achieved after only 10 days of operation. Gas-to-liquid hydrogen mass transfer capacity of the reactor determined the maximum sulphate conversion rate.

Late effects of locally delivered mitomycin C on formation of neointima and on vasomotor response to acetylcholine.

BACKGROUND: Balloon angioplasty damages endothelial cells and stimulates smooth muscle cell proliferation. The effects of local cytotoxic drug therapy on formation of neointima and late endothelial function are not known. This study was designed to determine whether direct infusion of mitomycin C via a microporous balloon catheter could significantly reduce formation of neointima after angioplasty. Furthermore, we investigated whether endothelial cell function is normal 7 weeks after the initial microporous angioplasty procedure. METHODS: In 34 New Zealand white rabbits, bilateral external iliac arteries underwent balloon angioplasty, followed by either high-dose (0.66 mg/kg) or low-dose (0.025 mg/kg) mitomycin C in one iliac artery and saline infusion in the contralateral artery, and a control group was given saline in both vessels. Formation of neointima was measured in the iliac arteries after 7 weeks by morphometry. Before sacrifice of 17 'angioplasty' rabbits and three undamaged rabbits, graded doses of acetylcholine and isosorbide dinitrate were infused in the distal aorta, and the iliac artery diameter was measured by computerized quantitative angiography. RESULTS: No significant differences in the absolute area of the intima or the intima: media ratio were demonstrated between control arteries and arteries that were directly infused with either high-dose or low-dose mitomycin. However, within the high-dose group, the mitomycin-treated vessel had a significantly lesser extent of formation of intimal hyperplasia (0.17 +/- 0.03 versus 0.27 +/- 0.03 mm2, P < 0.03) and lower intima: media area ratio (0.60 +/- 0.31 versus 1.09 +/- 0.42, P < 0.03) than the contralateral saline-treated vessel. Significant increases in mean luminal iliac artery diameter [0.18 mm (10.5%) at 1 min and 0.23 mm (13%) at 3 min, P < 0.05)] from baseline values following acetylcholine were observed in previously damaged iliac arteries. This vasodilatory response was not different from that in undamaged arteries. CONCLUSIONS: Local delivery of mitomycin C had no favorable effect on the inhibition of intimal hyperplasia compared with control saline-treated arteries. Normal endothelial function, determined on the basis of dilatory response to acetylcholine, can be demonstrated 7 weeks after balloon angioplasty injury.

Operant extinction in the treatment of severe maladaptive behavior: adapting research to practice.

Operant extinction involves termination of reinforcement for a previously reinforced response. As a clinical intervention for severe maladaptive behavior operant extinction is often repudiated because of intensity of side effects, length of treatment time required, and implementation difficulties. This article discusses both theoretical and practical aspects of extinction, including components of the extinction process and the importance of functional assessment to its effective use. Potential strategies for increasing the effectiveness of extinction while diminishing intrusiveness are recommended. Based on recent research innovations, a technology is emerging for effective use of operant extinction in the treatment of severe maladaptive behavior.

High cell density cultivation of Pseudomonas oleovorans: growth and production of poly (3-hydroxyalkanoates) in two-liquid phase batch and fed-batch systems.

Pseudomonas oleovorans is able to accumulate poly(3-hydroxyalkanoates) (PHAs) under conditions of excess n-alkanes, which serve as sole energy and carbon source, and limitation of an essential nutrient such as ammonium. In this study we aimed at an efficient production of these PHAs by growing P. oleovorans to high cell densities in fed-batch cultures.To examine the efficiency of our reactor system, P. oleovorans was first grown in batch cultures using n-octane as growth substrate and ammonia water for pH regulation to prevent ammonium limiting conditions. When cell growth ceased due to oxygen limiting conditions, a maximum cell density of 27 g .L(-1) dry weight was obtained. When the growth temperature was decreased from the optimal temperature of 30 degrees -18 degrees C, cell growth continued to a final cell density of 35 g . L(-1) due to a lower oxygen demand of the cells at this lower incubation temperature.To quantify mass transfer rates in our reactor system, the volumetric oxygen transfer coefficient (k(L)a) was determined during growth of P. oleovorans on n-octane. Since the stirrer speed and airflow were increased during growth of the organism, the k(L)a also increased, reaching a constant value of 0.49 s(-1) at maximum airflow and stirrer speed of 2 L . min(-1) and 2500 rpm, respectively. This k(L)a value suggests that oxygen transfer is very efficient in our stirred tank reactor.Using these conditions of high oxygen transfer rates, PHA production by P. oleovorans in fed-batch cultures was studied. The cells were first grown batchwise to a density of 6 g . L(-1), after which a nutrient feed, consisting of (NH(4))(2)SO(4) and MgSO(4), was started. The limiting nutrient ammonium was added at a constant rate of 0.23 g NH(4) (+) per hour, and when after 38 h the feed was stopped, a biomass concentration of 37.1 g . L(-1) was obtained. The Cellular PHA content was 33% (w/w), which is equal to a final PHA yield of 12.1 g . L(-1) and an overall PHA productivity of 0.25 g PHA produced per liter medium per hour.

The failure of feedback on alcohol impairment to reduce impaired driving.

We examined the effects of rules to govern drinking, individual feedback on blood alcohol concentration (BAC), and public posting of group data on impaired driving on the incidence of impaired driving. Level of impairment was determined from breath samples taken from tavern patrons. Following baseline, an intervention package consisting of (a) cards to guide patrons in pacing their drinking to stay under the legal limit, (b) individual feedback on BAC, and (c) posted group feedback on the percentage of patrons driving while impaired the preceding week was introduced in two taverns. Results indicated that the intervention package did not reduce the percentage of impaired drivers departing either tavern. The addition of a brief intensive police enforcement program directed at impaired driving produced a short-term reduction in impaired driving.

The use of wrist weights to reduce self-injury maintained by sensory reinforcement.

The participant in this study was a boy with a long history of self-injurious face slapping. Following a functional analysis indicating that face slapping was maintained by sensory consequences, the participant was given soft wrist weights to wear for progressively longer periods. Data on the frequency of face slapping were collected 5 min before the weights were put on, while the weights were on, and 5 min after the weights were removed. At all other times a protective helmet was placed on the participant's head for 30 min contingent on face slaps. When weights were worn for 30 min each day, face slapping decreased during 5-min observation periods before and after wearing the weights. The use of protective headgear was eliminated by the end of the study. Face slapping did not occur during a follow-up check conducted 5 months after completion of the study.

The influence of signs prompting motorists to yield before marked crosswalks on motor vehicle-pedestrian conflicts at crosswalks with flashing amber.

The purpose of this experiment was to evaluate the effects of signs reading "STOP HERE FOR PEDESTRIANS" alone and in conjunction with advance stop lines on pedestrian safety at multilane crosswalks with pedestrian-activated amber flashing lights. Motorist and pedestrian behaviors measured throughout this experiment included the occurrence of various types of motor vehicle-pedestrian conflicts; the distance that motorists stopped before the crosswalk when yielding to pedestrians; and the percentage of motorists yielding to pedestrians. The introduction of the sign alone 50 feet (15.15 m) before the crosswalk increased the distance before the crosswalk that motorists yielded to pedestrians and reduced the percentage of motor vehicle-pedestrian conflicts whether the flashing light was activated or not. The addition of the advance stop line was associated with further improvements in both measures.

Increasing generalized social interactions in psychotic and mentally retarded residents through peer-mediated therapy.

This study investigated whether withdrawn adults living in a residential center for psychotic and mentally handicapped persons could serve as peer therapists to increase the social interaction of other withdrawn residents. Two pairs of residents served as participants. Treatments were introduced and evaluated within a multiple baseline with reversal design. After baseline, the peer therapist was instructed to increase the social interactions of a target peer through engagement in social interactions. The results demonstrated that the peer therapist increased the social interactions of target peers. However, these increases did not generalize to other residents until the introduction of a multiple peer therapist condition. The percentage of time the peer therapists interacted with other nontarget residents also increased throughout the study. These results were maintained during a 4-month follow-up condition.

High-conductance anion channels in embryonic chick osteogenic cells.

Patch-clamp measurements done on excised membrane patches obtained from 1-5 day cultured embryonic chick osteoblasts, osteocytes, and periosteal fibroblasts revealed the existence of a high-conductance anion channel: 371 +/- 63 pS when measured under symmetrical 158 mM Cl- conditions. The channel frequently displayed subconductance levels. The ion selectivity of the channel expressed as the (an)ion to chloride permeability ratio was as follows: Cl- (1.0) greater than methylsulfate- (0.71) greater than gluconate- (0.25) greater than glutamate- (0.17) greater than Na+ = K+ (0.10). In addition, the channel had a significant permeability for inorganic phosphate ions. The channel was found in about 1% of the cell-attached patches, which indicates that the channel is under the control of as yet unknown intracellular factors. Once activated by patch excision, the channel was voltage dependent and active at potentials close to 0 mV. At potentials outside the range of +/- 10 mV channel activity decreased. This process proceeded faster at increasing membrane potentials of either polarity. Returning to potentials close to 0 mV caused reopening of the channels within seconds if the preceding voltage step led to complete closure of the channels. Channel activity did not depend noticeably on intracellular and extracellular CA2+ ions. The channel is not unique to (chick) osteogenic cells but has been demonstrated in excised patches obtained from excitable and other nonexcitable cells. Although its presence in a wide variety of cell types suggests that the channel plays a general role in as yet unknown cell physiologic processes, the channel may also have specific functions in osteogenic cells, for example providing a pathway for phosphate ions during mineralization.

The use of a brief movement restriction procedure to eliminate severe inappropriate behavior.

The effect of a brief movement restriction (BMR) procedure on the maladaptive behavior of two severely mentally retarded persons was evaluated using a multiple baseline research design. Following a functional analysis of the maladaptive behaviors, baseline data were collected on the frequency of smearing in a six year old boy and the frequency of aggression-destruction and stereotypic behavior in a 24 year old man. Following the baseline period a treatment package that included reinforcement for alternative behavior and BMR were first introduced for feces smearing. After feces smearing had shown a reduction with the first client the treatment package was introduced for aggression and destruction with the second client. After aggression and destruction had been reduced, the treatment package was added for stereotypy. The treatment package completely eliminated each of the target behaviors and they remained absent during a long follow-up period.