Resource implications of inter-facility transport between emergency departments in Hong Kong.

BACKGROUND: The Inter-facility Transport (IFT) service provided by the Emergency Department (ED) is a vital service in Hong Kong. Patients need to be rapidly transported over distances to access appropriate healthcare facilities. METHODS: This study aims 1. to examine the resource utilisation of IFT accompanied by ED staff and 2. to analyse the crude, fixed and variable costs of IFT. A retrospective review was conducted of all IFT from Alice Ho Miu Ling Nethersole Hospital in the New Territories of Hong Kong where ED staff accompanied patients from 1 January 2006 to 31 December 2008. Descriptive analysis was used to evaluate the crude, fixed and variable costs per year for providing an ED-based IFT service. RESULTS: There were 337 transports accompanied by either medical or nursing staff from the ED that accounted for around 2% of all IFT. The most common indication for mobilising the transport team was an unstable clinical condition that required neurosurgical care. The average transport service time was 57.7 min per transport (SD 11.0). Resource utilisation consisted of fixed and variable costs that summed up to a cost of HKD $87,224.3 (USD $11,182.6) per year and the crude cost of providing IFT service by the ED was HKD$852.2 (USD $109.3) per patient. CONCLUSION: The crude cost of providing IFT service by the ED was reasonable and acceptable.

Functional and rheological properties of proteins in frozen turkey breast meat with different ultimate pH.

Functional and rheological properties of proteins from frozen turkey breast meat with different ultimate pH at 24 h postmortem (pH(24)) have been studied. Sixteen breast fillets from Hybrid Tom turkeys were initially selected based on lightness (L*) values for each color group (pale, normal, and dark), with a total of 48 breast fillets. Further selection of 8 breast samples was made within each class of meat according to the pH(24). The average L* and pH values of the samples were within the following range: pale (L* >52; pH ≤5.7), normal (46 < L* < 52; 5.9 < pH <6.1), and dark (L* <46; pH ≥6.3), referred to as low, normal, and high pH meat, respectively. Ultimate pH did not cause major changes in the emulsifying and foaming properties of the extracted sarcoplasmic and myofibrillar proteins. An SDS-PAGE profile of proteins from low and normal pH meat was similar, which revealed that the extent of protein denaturation was the same. Low pH meat had the lowest water-holding capacity compared with normal and high pH meat as shown by the increase in cooking loss, which can be explained by factors other than protein denaturation. Gel strength analysis and folding test revealed that gel-forming ability was better for high pH meat compared with low and normal pH meat.Dynamic viscoelastic behavior showed that myosin denaturation temperature was independent of pH(24). Normal and high pH meat had similar hardness, springiness, and chewiness values as revealed by texture profile analysis. The results from this study indicate that high pH meat had similar or better functional properties than normal pH meat. Therefore, high pH meat is suitable for further processed products, whereas low pH meat may need additional treatment or ingredient formulations to improve its functionality.

Skin carcinogenesis: cholesterol-5alpha,6alpha-epoxide hydrase activity in mouse skin irradiated with ultraviolet light.

Cholesterol-5alpha,6alpha-epoxide hydrase activity was 96 percent greater in skin of hairless mice that were receiving suberythemic ultraviolet light irradiation for 15 weeks than in nonirradiated controls. This enzyme system, which metabolizes cholesterol-5alpha,6alpha-epoxide (a known carcinogen), appears to be substrateinducible and is apparently responsible for the concomitant reduction of the sterol carcinogen that occurs prior to tumor induction.

Combined effects of land reclamation, channel dredging upon the bioavailable concentration of polycyclic aromatic hydrocarbons (PAHs) in Victoria Harbour sediment, Hong Kong.

The up-to-date concentration of polycyclic aromatic hydrocarbons (PAHs) in sediment materials of Victoria Harbour was investigated so as to evaluate the pollution potential associated with the reclamation projects in Hong Kong. A total of 100 sediment samples were collected at 20 locations. Except the control point in reservoir, the PAHs concentrations were detectable levels all sites (131-628.3ng/g, dw) and such values were higher than Dutch Target and Intervention Values (the New Dutch standard in 2016). The PAHs concentration indicating that construction waste and wastewater discharges were the main pollutant sources. Results of correlation in single cell gel electrophoresis assay (comet assay) studies also revealed that the PAHs concentration was highly correlated (<0.01) with DNA migration (i.e. the length of tail moment of fish cells) in 5mg/ml of PAHs. The above observation indicates that the PAHs present in the sediment may substantially effect the marine ecosystem. Although the dredged sediment can be a useful sea-filling material for land reclamation; however, the continuing leaching of PAHs and its impact on the aquatic environment need to be studied further.

Effects of dietary constituents on ultraviolet light-mediated carcinogenesis.

The effects of several dietary supplements of antioxidants and enzyme inducers on ultraviolet light-mediated carcinogenesis were investigated. Glutathione (reduced) was without effect, but butylated hydroxytoluene, phenobarbital, and disulfiram all significantly suppressed the initiation and development of actinic lesions and tumors. On the basis of the present study and related previous ones, tumor inhibition appears to be due not to an umbrageous effect but rather to the induction of systemic physiological responses.

Antioxidant-mediated reversal of ultraviolet light cytotoxicity.

Several antioxidants were tested for their protective effect in Chinese hamster embryo cell against ultraviolet light (UVL)-irradiation. Ascorbic acid, DL-alpha-tocopherol, butylated hydroxytoluene, and reduced glutathione were all shown to reverse UVL-induced cytotoxicity. At concentrations tested, no protective effect was detected when any of these antioxidants were added prior to UVL irradiation.

Suppression of ultraviolet light-induced tumor formation by dietary antioxidants.

Dietary antioxidants were effective in reducing the number and severity of ultraviolet light-induced squamous cell carcinomas in skin of hairless mice. This and previous studies suggest that antioxidants may play a role in both inhibition of the primary event(s) involved in ultraviolet light-mediated tumor induction and the subsequent development of precancerous lesions into tumors.

Distribution of cholesterol-5alpha,6alpha-epoxide formation and its metabolism in mouse skin.

The distribution of cholesterol-5alpha,6alpha-epoxide in ultraviolet light-irradiated mouse skin was determined. Highest levels of cholesterol-5alpha,6alpha-epoxide were found in the epidermis and distributed rather evenly throughout all subcellular fractions. Low but potentially significant levels of the compound diffused from the epidermis. Metabolic studies demonstrated that cholesterol-5alpha,6alpha-epoxide was converted to cholestane-3ss,5alpha,6ss-triol by an enzyme, cholesterol-5alpha,6alpha-epoxide hydrase, which was localized in the epidermal fractions sedimenting at 10,000 and 100,000 X g. Comparative studies indicated a much higher capacity for metabolism of cholesterol-5alpha,6alpha-expoide in liver than in skin. The effect of the epoxide and its metabolic product on the skin is discussed.

Systemic protection by antioxidants against UVL-induced erythema.

An antioxidant supplemented diet provided marked systemic protection against ultraviolet light mediated erythema in hairless mice. Among the individual constituents of the diet, butylated hydroxytoluene was most effective whereas glutathione and vitamins C and E afforded negligible protection. The mixture of antioxidants, and butylated hydroxytoluene individually, demonstrated diminished, but significant, protection when applied topically. The safety of this systemic photoprotectant and its clinical relevance at present is unknown.

The distribution of fluoride of prenatal origin in the rat--a pilot study.

Sixteen female, Sprague-Dawley rats were divided into four equal groups. Two groups served as controls receiving low or regular concentrations of fluoride (F); animals in the other two groups were given drinking water, containing 100 parts/10(6) F, for 3 weeks either during or immediately before pregnancy. Thirteen days after delivery, the pups and dams were killed and various tissues analysed for F content. Prenatal F supplementation increased F concentrations in plasma, mandibular incisors and femoral epiphyses of pups by 25, 36 and 38% respectively, when given during pregnancy. Only a slight increase of 9 and 11% in the respective F concentrations of incisors and epiphyses occurred when the supplement was given before pregnancy. The fluoride level of milk was consistently higher than that of the maternal plasma. These results suggest the need for further study of prenatal F supplementation.

The role of caffeinated beverages in dental fluorosis.

Recent studies have demonstrated that the incidence of dental fluorosis has increased during the past decade. Greater availability and use of fluoride-containing gels, mouth rinses, dentifrices, etc., improper prescribing of fluoride supplements and ingestion of fluoride dentifrice by some children are some of the suggested determinants of dental fluorosis. However, based on the increase in consumption of tea, coffee, and other caffeine-containing beverages by the children, and the augmentative effect of caffeine on fluoride bioavailability, we theorize that the rise in incidence of dental fluorosis in North America is mainly due to the replacement of water intake by caffeine-containing beverages among the young population.

A pragmatic approach to timely disease surveillance in the emergency department.

BACKGROUND: Computerised emergency department (ED) logs have been in use for more than 20 years. Despite this, public health authorities have failed to fully utilise this important surveillance tool. SETTING: Alice Ho Miu Ling Nethersole Hospital (AHNH) is a 500 bed community hospital with ED attendance of 350-400 patients a day in Hong Kong. INTERVENTION: After the introduction of an ED computerised management system across Hong Kong in 1997, AHNH monitored common presentations using standard statistical software. Deviations from average attendance frequency were reported to public authorities. Experience during 1999 and 2000 calendar years is reported. RESULTS: Apart from the usual seasonal variation in presentations such as respiratory tract infection and gastroenteritis, specific public health interventions appeared warranted in presentations related to dog bites, bee stings, rubella, hand foot and mouth, chicken pox, and scooter injuries. DISCUSSION: ED computer information systems should be an effective tool for disease surveillance. In communities where this is not the case, public health authorities should insist on timely access and reporting of ED attendance data.

Computerisation of accident and emergency departments in Hong Kong.

This article reviews the history and progress of the computerisation of accident and emergency departments in Hong Kong. The Hospital Information System was the first computerisation project to be launched in a public hospital in Hong Kong, when the Princess Margaret Hospital was selected as a pilot site in April 1991. The network infrastructure comprised a central processor that linked to all workstations in the hospital in an integrated network. With the introduction of bar-coding technology and the implementation of an interfaced network, the Accident and Emergency Information System version 1.0 was launched at the Prince of Wales Hospital in March 1993. A Clinical Management System was then piloted at the Accident and Emergency Department of the Alice Ho Miu Ling Nethersole Hospital in December 1997; it contained clinical data of individual patients, including diagnoses, drug treatments, discharge summaries, allergies, and medical histories. Laboratory, diagnostic radiology, and electrocardiography results were also available in this system. With the extensive development of Internet technology within the Hospital Authority, clinical information can now be retrieved in any hospital in a couple of minutes. The availability of important clinical information will be of great help to emergency physicians in the delivery of quality care to patients.

Hospital preparedness for chemical and biological incidents in Hong Kong.

The risk of mass exposure to toxic substances has increased steadily during the twentieth century due to the expansion of industry and the deliberate development and use of agents of chemical warfare. Although Hong Kong is considered a relatively safe place, hoax anthrax attacks have occurred since 17 October 2001. People who have been seriously injured by hazardous materials have a greater chance of recovery without complications when appropriate emergency treatments are provided. Recognition and identification of hazardous materials, assessment of the conditions, decontamination, and protection of staff and facilities are important elements in the formulation of a contingency plan. The objective of this article is to outline the efforts of the Hong Kong Hospital Authority in formulating a hospital response to incidents involving hazardous materials.

Influence of vitamins and iron on plasma fluoride levels in rats.

Thirty female Sprague-Dawley rats (250 +/- 10 g) were divided randomly into five equal groups. After overnight fasting, a silastic catheter was placed in the jugular vein of each rat. Each group was intragastrically administered 0.25 mg F/250 g rat weight in 1 ml of one of the following forms of fluoride supplements: Pediaflor (Abbott/Ross, Columbus, OH), Tri-Vi-Flor, Tri-Vi-Flor + iron; Poly-Vi-Flor or Poly-Vi-Flor + iron (Mead Johnson Nutritionals, Bristol-Myers Squibb Co., Evansville, IN). Timed blood samples were collected and plasma fluoride concentration was determined using the microdiffusion method. The presence of iron and vitamins affect the bioavailability of fluoride as measured by the area under the time-plasma fluoride concentration curve.

Topical fluorides: efficacy, administration, and safety.

Fluoride's role in decreasing dental caries has been recognized for decades. The professional fluoride treatment has recently been augmented with home-use fluoride products. The introduction of many attractive products makes it difficult for dental professionals to know which are effective. Both professional and home-use products are described, as are proven techniques for their use. Recognition of fluoride toxicity, and its prevention and treatment, are also discussed.

Effects of topical fluoride treatment on tensile bond strength of pit and fissure sealants.

Clinicians often do not place pit and fissure sealants immediately after topical fluoride treatment because fluoride treatment might reduce bonding to enamel. The effect of NaF, SnF2, and APF on the in-vitro bond strength of two sealants to enamel was determined. The fluoride treatments and control (artificial saliva) were applied to enamel surfaces for four minutes and rinsed. A filled sealant (FluoroShield) and an unfilled sealant (Concise) were bonded to the etched enamel and debonded in tension using a universal testing machine. NaF increased the bond strength of the unfilled sealant; SnF2 and APF had no significant effect. NaF and APF decreased the bond strength of filled sealant while SnF2 had no significant effect. The bond strength of the filled sealant was higher than or equal to that of the unfilled sealant. Exposure of enamel to NaF, SnF2, or APF prior to placement of unfilled or filled sealants has no effect on in vitro bond strength between the enamel and the sealants.

Impact of imported beverages on fluoridated and nonfluoridated communities.

In order to compare the effect of beverages "imported" from nearby communities on the fluoride intake of a fluoridated community with that of a nonfluoridated community, 45 different carbonated and juice drinks were sampled from Houston (fluoridated) and San Antonio (nonfluoridated) and examined for their fluoride concentrations. In spite of the fact that an individual lives in a low fluoride community, the risk of fluorosis exists through fluoride consumption in beverages as well as from the water supply and fluoride therapy. It is therefore important for dental practitioners to carefully evaluate their patients' entire fluoride exposure before prescribing fluoride supplements.

Dental hygienist and patient comparisons of fluoride varnishes to fluoride gels.

PURPOSE: The purpose of this study was to evaluate a fluoride varnish and compare it to fluoride gels in categories including taste, comfort, efficiency, discoloration, moisture control, safety, and ease of application. METHODS: Methods. Twenty-five licensed dental hygienists and 148 patients completed questionnaires comparing fluoride varnish to fluoride gel for the following categories: taste, comfort, efficiency, discoloration, moisture control, and safety. Responses were analyzed using descriptive statistics and a chi-square test. RESULTS: The 25 dental hygienists rated fluoride varnish (Duraphat) superior to fluoride gels in all categories. Eighty-three (56.5%) of the 148 patients reported the varnish application to be more comfortable than gel while 29 (20%) found it the same. In taste comparison, 90 (71.4%) preferred the varnish, while 16 (12.7%) rated it the same. The time required was reported as better for the varnish technique by 59 (50.4%) and equal to the gels by 32 (20.3%). Discoloration of the teeth by the varnish was found not noticeable or not objectionable by 66 (49.3%) and somewhat objectionable or too noticeable for comfort in public by 68 (50.7%). However, 85 (64.3%) reported that they would choose to have the varnish treatment while 33 (25%) would not. Dental hygienist responses on questions 1-4 relative to the number of years in practice were not found to be significantly different. CONCLUSION: The patients and dental hygienists in this study preferred fluoride varnishes to gels. However, since some patients objected to the temporary discoloration, varnishes may not be suitable for everyone.

Effect of topical fluoride on retention of pit and fissure sealants.

PURPOSE: The purpose of this study was to evaluate the clinical effect of topical fluoride on retention of light-cured (CLC) and self-cured (CSC) pit and fissure sealants. METHODS: CLC and CSC sealants were placed in vivo on opposite sides of the arch before and after fluoride treatment. A total of 122 sealants were placed on virgin permanent molars and premolars of 16 dental hygiene students enrolled in a two-year program. Sealant retention in both fluoridated and non-fluoridated teeth was evaluated at 6, 12, and 18 month intervals. RESULTS: Overall sealant retention for both fluoridated and non-fluoridated teeth at 6, 12 and 18 months was 68%, 48%, and 49%, respectively. There was a significant difference (p < 0.001) when fluoridated vs. non-fluoridated teeth were compared. Retention was greater on the fluoridated teeth, with respect to the sealant material (CLC-fluoride). Significant differences (p < 0.001) were found when CLC-fluoride and CLC-no fluoride treatment groups were compared. However, no significant differences were found in retention when CSC-fluoride and CSC-no fluoride groups were compared, or when CLC was compared to CSC irrespective of fluoridation. Significant differences (p < 0.0001) were found when sealant retention on molars was compared to premolars--retention of sealants was greater on premolars. CONCLUSION: This study suggests that sealant retention may not be adversely affected by a topical fluoride treatment applied immediately prior to placement.