Fourier transform microwave and millimeter-wave spectroscopy of bromoiodomethane, CH2BrI.

Bromoiodomethane, CH2BrI, is a molecule of natural origin emitted in significant amount into the marine boundary layer. It can easily be decomposed by solar radiation, releasing Br and I atoms in the troposphere, which in turn impacts the atmospheric chemistry. Spectroscopy is an invaluable tool to monitor species present in the atmosphere. Since no high-resolution spectroscopic studies are available for this dihalomethane, we have investigated the rotational spectra of the two bromine isotopologues of CH2BrI in its vibrational ground state in the microwave and millimeter-wave regions. Transitions of b-type have been recorded by Fourier transform microwave spectroscopy below 25 GHz while both a- and b-type spectral lines have been measured below 230 GHz. Observed transitions correspond to energy levels with J ≤ 132 and Ka ≤ 14. Molecular constants including those describing the nuclear quadrupole coupling tensors for (79)Br, (81)Br, and (127)I were accurately determined from the least-squares analysis of a total of 1873 distinct transition frequencies (of which 943 belong to the CH2(79)BrI isotopologue). An experimental (r0) structure of the title species has been derived from the two sets of rotational constants.

The complete iodine and nitrogen nuclear electric quadrupole coupling tensors for fluoroiodoacetonitrile determined by chirped pulse Fourier transform microwave spectroscopy.

Molecular pulsed jet, chirped-pulse Fourier transform microwave spectroscopy has been used to record 499 transitions for the title molecule. Measurements have been made in the 8-16 GHz regions. Vibrational and electronic ground state rotational constants A, B, and C have been obtained, together with centrifugal distortion terms. The complete iodine and nitrogen nuclear quadrupole coupling tensors have been determined for the first time. Quantum chemical calculations have been performed to aid with analyses and, in particular, to aid in determining the signs of the off-diagonal components of the nuclear quadrupole coupling tensors. An experimentally determined relative electronegativity scale for several polyhalomethyl groups is proposed.

Use of beta blockers and the risk of death in hospitalised patients with acute exacerbations of COPD.

BACKGROUND: Cardiovascular disease is a major cause of death in patients with chronic obstructive pulmonary disease (COPD) and predicts hospitalisation for acute exacerbation, in-hospital death and post-discharge mortality. Although beta blockers improve cardiovascular outcomes, patients with COPD often do not receive them owing to concerns about possible adverse pulmonary effects. There are no published data about beta blocker use among inpatients with COPD exacerbations. A study was undertaken to identify factors associated with beta blocker use in this setting and to determine whether their use is associated with decreased in-hospital mortality. METHODS: Administrative data from the University of Alabama Hospital were reviewed and patients admitted between October 1999 and September 2006 with an acute exacerbation of COPD as a primary diagnosis or as a secondary diagnosis with a primary diagnosis of acute respiratory failure were identified. Demographic data, co-morbidities and medication use were recorded and subjects receiving beta blockers were compared with those who did not. Multivariate regression analysis was performed to determine predictors of in-hospital death after controlling for known covariates and the propensity to receive beta blockers. RESULTS: 825 patients met the inclusion criteria. In-hospital mortality was 5.2%. Those receiving beta blockers (n = 142) were older and more frequently had cardiovascular disease than those who did not. In multivariate analysis adjusting for potential confounders including the propensity score, beta blocker use was associated with reduced mortality (OR = 0.39; 95% CI 0.14 to 0.99). Age, length of stay, number of prior exacerbations, the presence of respiratory failure, congestive heart failure, cerebrovascular disease or liver disease also predicted in-hospital mortality (p<0.05). CONCLUSIONS: The use of beta blockers by inpatients with exacerbations of COPD is well tolerated and may be associated with reduced mortality. The potential protective effect of beta blockers in this population warrants further study.

A randomized trial to improve self-management practices of adults with asthma.

The prevalence and impact of adult asthma are substantial, and poor self-management practices, especially failures to adhere to treatment regimens, appear to be a significant problem. Desirable characteristics of an intervention program to improve self-management were identified through needs assessment and review of existing patient education resources. A comprehensive program was developed that integrated a workbook with one-to-one counseling and adherence-enhancing strategies. A longitudinal 1-year study compared patients receiving this self-management program with "usual care" patients receiving standard asthma pamphlets. Patients were randomly assigned to conditions. Baseline score and asthma severity were statistically controlled. Self-management patients had substantially better adherence than usual care patients, as well as improved functional status, at follow-up. Hospital and emergency department visits decreased in both groups but did not differ between groups.

Asthma self-management: do patient education programs always have an impact?

BACKGROUND: During the past 15 years, programs to improve self-management practices in adults with asthma have reported improvement in functional status and reduction of inappropriate use of health care services. However, these programs usually represent an ideal approach, applying multiple patient education methods. Consequently, when these programs are found to be efficacious, it is important to replicate the programs as well as to evaluate less complex methods that may be more appropriate for nonacademic health care settings. METHODS: We compared the following 3 standardized self-management treatments in a randomized, controlled trial: (1) a replication of the self-management program developed at a university medical center that was previously shown to be efficacious; (2) a modified version of this program including only the core elements; and (3) a usual-care program. Outcome measures included medication and inhaler regimen adherence, asthma symptoms, respiratory illness, functional status, and use of health care resources. RESULTS: All 3 groups improved on measures of respiratory illnesses, use of health care services, and functional status. Patients in both education groups did no better than the usual-care group. CONCLUSIONS: The results are inconsistent with the results of the first asthma self-management study at this institution and with those of efficacy studies of similar programs. Two factors, selection of the patient population and historical changes in asthma treatment, most likely contributed to the lack of impact of the self-management programs. As a result of the improved standards for usual care due to both factors, the opportunity to effect patient outcomes was substantially reduced.

Influence of aphid species and barley yellow dwarf virus on soft red winter wheat yield.

Yield loss in soft red winter wheat, Triticum aestivum L., caused by aphid-transmitted barley yellow dwarf virus (family Luteoviridae, genus Luteovirus, BYDV) was measured over a 2-yr period in central Missouri. Rhopalosiphum padi (L.) was the most common and economically important species, accounting for > 90% of the total aphids. Schizaphis graminum (Rondani), Rhopalosiphum maidis (Fitch), and Sitobion avenae (F.) made up the remainder of the aphids. Aphid numbers peaked at wheat stem elongation in 2003 with 771 R. padi per meter-row. In the 2003-2004 growing season, aphid numbers averaged seven aphids per meter-row in the fall and peaked at 18 aphids per meter-row at jointing. Wheat grain yield was reduced 17 and 13% in 2003 and 2004, respectively. Thousand kernel weights were reduced 10 and 5% in the untreated plots compared with the treated control in 2003 and 2004, respectively. Padi avenae virus was the predominate strain, accounting for 81 and 84% of the symptomatic plots that tested positive for BYDV in 2003 and 2004. Our results indicate that economic thresholds for R. padi are 16 aphids per meter-row in the fall and 164 aphids per meter-row at jointing.

Asthma severity: a factor analytic investigation.

PURPOSE: Reviewers of the asthma research literature have called for improved questionnaires and other measures, particularly for assessing the severity of asthma. To help meet this need, standard multivariate and psychometric techniques were used with data from asthma patients to develop and evaluate a series of scaled questions. Since there is no "gold standard" for assessing asthma severity, we hope this analysis will help improve our ability to more precisely define these important parameters. PATIENTS AND METHODS: Data were collected through interviews and review of clinic records for 199 adult patients with asthma from a university clinic population. For evaluating the severity of asthma, eight scales assessed asthma duration, the incidence of asthma symptoms, the extent to which asthma is an inconvenience to patients, the incidence of respiratory diseases, medication regimens, medication side effects, and health care utilization. Forced expiratory volume in 1 second as a percentage of predicted normal was included as an objective measure of pulmonary function. A physician rating scale assessed the severity of the underlying disease, not the severity of a particular episode, as either (1) mild (infrequent attacks with interim symptomatic treatment), (2) moderate (more frequent attacks with continuous daily treatment), and (3) severe (continuous symptom with continuous multiple drug regimen, including some systemic steroids). RESULTS: In the current analysis of data from adult asthma patients, the scales correlated positively with a physician judgment scale. Factor analysis with an oblique rotation yielded three factors that provided a concise summary of asthma severity. We have named the factors (A) Symptom Intensity, (B) Airflow Impairment, and (C) Management Intensity. CONCLUSION: Asthma severity appears to be multidimensional rather than unidimensional, including at least three components. The physician rating scale, in combination with measures of the three identified factors, could easily be included in other asthma research protocols to provide a standard, brief assessment of asthma severity and might thus promote greater comparability among studies.

Treatment of atypical mycobacterial disease.

The most common disease patterns produced by atypical mycobacteria are pulmonary disease, cervical lymphadenitis, and infection of soft tissue, bones, and joints. The treatment of disease due to atypical mycobacteria can be confusing unless one clearly differentiates the organisms according to clinical characteristics and response to various chemotherapeutic agents. For this reason, we have attempted to simplify the task by proposing a new classification system. The organisms that might be isolated from human material are divided into the following three classes: nonpathogens; those that are easy to treat with standard mycobacterial therapy; and finally, those that are difficult to treat with standard mycobacterial therapy and require other approaches. This new system of classification should help the clinician in dealing with these organisms. Because even the pathogens may sometimes appear as a contaminant in human material, including sputum, one must document that these organisms are associated with disease prior to instituting therapy.

Tuberculosis and alcoholism. A partial solution through detection.

Alcoholism and tuberculosis often coexist, and patients with this combination have the most frequent failures of therapy. Several intriguing alternatives to standard outpatient chemotherapy are now available. The brief MAST interview (a shortened version of the Michigan Alcoholism Screening Test) has been demonstrated to be effective in identifying alcoholism in public health clinics for tuberculosis in New Orleans and Birmingham, Ala., with scores indicating populations of alcoholic patients of 25% and 28%, respectively. The test could be administered without interrupting the routine of the clinic. We believe that the problem of inadequate therapy in the alcoholic patient with tuberculosis is significant and widespread and is not being handled well is most places. Identification of the potential problem patient at first contact will be most helpful in choosing candidates for specialized forms of therapy, including short-term and supervised treatment, begun before failure of therapy ensues.

Medication adherence patterns in chronic obstructive pulmonary disease.

While medical treatment of COPD has advanced, the failure to adhere to regimens for medication poses a significant barrier to effective management. Furthermore, no data are available regarding adherence for patients within the United States. Data from this investigation indicate that 78 outpatients from a medical center in the southeastern region of the United States were prescribed an average of 6.26 medications with both various dosing schedules and different modes of administration. Adherence was poor, with 42 patients (54 percent) underutilizing medications, 39 patients (50 percent) overutilizing medications during periods of respiratory distress, and 24 patients (31 percent) employing ineffective inhaler dosing techniques. Prescription patterns and adherence were not associated with demographic variables; however, adherence was related to classes of medication and situational variables.

Characteristics and correlates of asthma in a university clinic population.

To contribute more comprehensive information about the characteristics of asthma, this article analyzed patients served by the University of Alabama at Birmingham Comprehensive Asthma Program. Their physicians rated one fifth of these patients as having "severe" asthma with the remainder about equally divided between "moderate" and "mild". One in two first received a diagnosis of asthma ten or more years previously. Common comorbidities were hypertension, obesity, rhinitis, bronchitis, sinusitis, and arthritis. One half had visited an emergency room or been hospitalized for asthma in the past year. Inhaled bronchodilators and continuous theophylline were the most commonly prescribed medications. Side effects, especially tachycardia and insomnia, were common and almost exclusively associated with theophylline or corticosteroid therapy. Spirometric assessment showed chronic airflow obstruction in those with more severe asthma. Prevalence of respiratory symptoms, intensity of medication regimen, incidence of side effects, and health care utilization increased as asthma severity increased.

Safety of nicotine polacrilex gum used by 3,094 participants in the Lung Health Study. Lung Health Study Research Group.

STUDY OBJECTIVE: To assess cardiovascular conditions and other side effects associated with the use of nicotine polacrilex (NP), 2 mg. DESIGN: A multicentered randomized control trial of early intervention for the prevention of COPD. SETTING: Ten university medical centers in the United States and Canada. PARTICIPANTS: Adult smoking volunteers with evidence of early COPD; 3,923 in intervention and 1,964 controls. INTERVENTION: Smoking cessation program, including NP. MEASUREMENTS: Data on hospitalizations were collected annually. Data on reported NP side effects were collected at 4-month intervals for intervention participants. RESULTS: The rates of hospitalization for cardiovascular conditions and cardiovascular deaths during the 5 years of the study were not related to use of NP, to dose of NP, or to concomitant use of NP and cigarettes. About 25% of NP users reported at least one side effect, but most were very minor and transient. Side effects associated with discontinuance of NP in 5% or more of users included headache, indigestion, mouth irritation, mouth ulcers, and nausea. There was no evidence that concomitant use of NP and cigarettes was associated with elevated rates of reported side effects. Participants in the smoking cessation intervention who received intensive levels of instruction and monitoring of NP use (initially at 12 meetings during 3 months) appeared to report significantly lower rates of side effects (dizziness, headache, and throat irritation) than control participants, presumed to have less instruction and monitoring. CONCLUSIONS: NP, as used in the Lung Health Study, appears to be safe and unrelated to any cardiovascular illnesses or other serous side effects.

Detection of emphysema with computed tomography. Correlation with pulmonary function tests and chest radiography.

We studied 60 male patients who had concurrent chest films (CXR), computed tomography scans (CT) and pulmonary function tests (PFT) to assess the sensitivity of CT and conventional films in detecting emphysema compared with PFT. We also sought to determine whether emphysema could be diagnosed by CT in patients with normal pulmonary function. Using a method similar to that proposed by Bergin, we scored the severity of emphysema depicted by CT, and using arterial deficiency and bullae as criteria, we estimated the degree of emphysema on CXR. There was a significant inverse correlation between CT scores for emphysema and percentage predicted values of DLco/VA (r = -0.650), FEV1 (r = -0.552), and FVC (r = -0.409), (P less than 0.001). A significant but smaller correlation also was noted with the CXR scores and percentage predicted: DLco/VA (r = -0.564), FEV1 (r = -0.454), and FVC (r = -0.355), (P less than 0.005). When decreased diffusion capacity and airway obstruction were used as functional criteria of emphysema, CT was as sensitive as PFT and more sensitive than CXR in detecting emphysema (96% vs. 68%). There was CT evidence of emphysema in 69% (24/35) of patients who did not have functional findings of emphysema. In 12 pathologic specimens available for review, 11 had emphysema by CT and pathologic examination; one patient had centrilobular emphysema undetected by CT. We conclude that CT is as sensitive as PFT in detecting emphysema and more sensitive than conventional radiography. CT may be more sensitive than PFT in detecting mild emphysema.(ABSTRACT TRUNCATED AT 250 WORDS)

Simple primary tuberculosis in an elderly woman.

The diagnosis of primary tuberculous infection was made in a 78-year-old woman. The chest roentgenographic findings were remarkably similar to those often seen in children and adolescents with primary infection. Like the majority of adults with this entity, the patient was asymptomatic; the diagnosis was suspected epidemiologically and was confirmed by culture of M. tuberculosis from the sputum. As the incidence of new tuberculosis cases declines, the diagnosis of primary tuberculosis in the adult may be made more frequently.

Standardizing contact investigation protocols.

SETTING: The State of Alabama Department of Public Health Division of Tuberculosis Control. OBJECTIVE: To standardize contact investigation protocols and implement an intervention to increase TB field worker adherence to the protocols with the goal of promoting efficiency and effectiveness in contact investigations. DESIGN: A process evaluation of existing data collection and management systems and protocols was performed. Standardized protocols and an intervention to increase TB field worker adherence to the protocols were created and pilot tested. These were then implemented and formative evaluation data were collected. RESULTS: The process evaluation revealed considerable variance among field workers with regard to protocols and definitions of variables related to contact investigations. Protocols were standardized and an intervention targeted at TB field workers was developed. The intervention consisted of a training workshop and the development of a computer-based contact investigation module. This was successfully implemented throughout the state. CONCLUSIONS: To perform effective contact investigations and conduct studies to improve the effectiveness of these investigations, TB control programs must pay careful attention to precisely defining variables and concepts related to the contact investigation. Furthermore, protocols must be standardized and resources devoted to training of TB field workers to ensure adherence to protocols.

How to implement an asthma education program.

Given that poor asthma management leads to such devastating rates of morbidity and mortality in this country, efforts must be made to increase the knowledge, skills, and behaviors of persons with asthma. The suggestions and recommendations provided here represent a blend of academic opinion and practical advice on methods to implement an asthma education program. In developing an asthma education program, consideration must be given to what content should be included, how and by whom that content should be taught, and when education should take place. The identification of a key clinical staff member to take the lead in translating these and other asthma education guidelines will be a critical next step for clinicians committed to developing an effective asthma education program.

Dietitians employed by health care facilities preferred a HACCP system over irradiation or chemical rinses for reducing risk of foodborne disease.

OBJECTIVE: To survey dietitians in health care facilities about the acceptability of alternative meat and poultry processing methods designed to reduce the risk of foodborne disease and their willingness to pay for these processes. SUBJECTS: A geographically representative sample of 600 members of The American Dietetic Association who work in health care facilities. The response rate was 250 completed questionnaires from 592 eligible subjects (42%). DESIGN: A mail survey was used to gather information on the acceptability of a Hazard Analysis and Critical Control Point (HACCP) system, chemical rinses, and irradiation for increasing the safety of food. Discrete choice contingent valuation was used to determine the acceptability at current prices and at 5, 10, and 25 cents per pound above current prices. STATISTICAL ANALYSES: Logistic regression was used to estimate mean willingness to pay (the maximum amount respondents are willing to pay) for each process. A simultaneous equations regression model was used to estimate the effects of other variables on acceptability. RESULTS: Respondents expressed a high level of concern for food safety in health care facilities. The estimated mean willingness to pay was highest for a HACCP system and lowest for chemical rinses. CONCLUSIONS/APPLICATIONS: The successful adoption of alternative methods to increase food safety depends on their acceptance by foodservice professionals. The professionals sampled were most accepting of a HACCP system, somewhat less accepting of irradiation, and least accepting of new chemical rinses. Poultry and beef processors and government agencies concerned with food safety may want to take into account the attitudes of foodservice professionals.

The FEV1/FEV6 predicts lung function decline in adult smokers.

The use of FEV1/FEV6 in place of the traditional FEV1/FVC to detect airways obstruction during spirometry testing performed by primary care providers would reduce time and patient effort. We hypothesized that the FEV1/FEV6, would predict the subsequent decline in FEV1 in adult cigarette smokers who enrolled in the multicenter Lung Health Study. Ten clinical centers in the U.S. and Canada recruited 5887 male and female smokers, aged 35-60 years, with borderline to mild airways obstruction by spirometry. Those who successfully stopped smoking during the 5-yr study (usually as the result of the smoking cessation intervention) were excluded from this analysis. In those continuing to smoke, the relative strength of spirometric predictors of the change in FEV1 during 5 years of follow-up (DFEV1) was determined using a linear regression model. The following covariates were significant independent predictors of DFEV1: the baseline degree of airways obstruction, age, gender, cigarettes per day, years of education, and bronchial hyperresponsiveness. The FEV1/FEV6 was nearly as strong an independent predictor as was the FEV1/FVC (a traditional index of airways obstruction). The degree of airways obstruction, as determined by the FEV1/FEV6 from spirometry, is an independent predictor of subsequent decline in lung function; and therefore, may be used to detect smokers at higher risk of developing COPD.

The deterrent effect of capital punishment during the 1950s.

This investigation examines the deterrence hypothesis of an inverse relationship between state execution rates and homicides. Although this question has received some attention in recent studies, the findings of these investigations are mixed. Cross-sectional analyses of states have typically shown execution and homicide rates to be positively associated, while at least two national time-series studies report support for the deterrence hypothesis. To test whether these divergent findings are result of the two different methodologies employed (cross-sectional vs. time-series), a methodology that combines the strengths of each is used in the present study. For the period 1950 to 1960, we examine cross-sectionally for states the relationship between changes in execution rates and changes in murder rates. This analysis does not find support for the deterrence argument for the certainty of the death penalty when a number of models of the execution rate--murder rate relationship are considered, and when a variety of imprisonment and socio-demographic factors are considered as control variables.

Occult coin perforation of the esophagus.

Only a small number of ingested foreign bodies perforate the esophagus and even a smaller fraction migrate extraluminally with no symptoms. Both of these events are even rarer after coin ingestion. Between 1972 and 1984, three children (16 months to 5 years), who had unabating upper respiratory symptoms, were found to have ingested coins. In only one child could the time interval between ingestion and appearance of symptoms (3 years) be established, and in this child the diagnosis was delayed because of failure to x-ray the chest after an ingestion episode. Surgical evaluation included chest/neck films: tracheal and esophageal shadows were separated by the object and a soft tissue mass; esphagogram: deviation of the esophagus, irregularity of the lumen, and no leak or tracheoesophageal fistula (TEF) and esophagoscopy: mucosa was intact with no direct visualization of the coin. Treatment consisted of exploration: cervical, one; thoracic, two; localization: coin in extraluminal granulomatous soft tissue; removal: without resection of the soft tissue mass or esophagus, and drainage: penrose, one; chest tube, two. There was no morbidity or mortality from 1 to 13 years later. Though generally harmless, ingested coins are capable of penetrating the esophagus. Sporadic literature reports confirm that the clinical findings and operative results are typical of this seemingly intermediate stage between perforation with mediastinitis and perforation with TEF.