RESUMEN

The adsorption behaviour of mixtures of the proteins ß-casein and hydrophobin at the hydrophilic solid-liquid surface have been studied by neutron reflectivity. The results of measurements from sequential adsorption and co-adsorption from solution are contrasted. The adsorption properties of protein mixtures are important for a wide range of applications. Because of competing factors the adsorption behaviour of protein mixtures at interfaces is often difficult to predict. This is particularly true for mixtures containing hydrophobin as hydrophobin possesses some unusual surface properties. At ß-casein concentrations ⩾0.1wt% ß-casein largely displaces a pre-adsorbed layer of hydrophobin at the interface, similar to that observed in hydrophobin-surfactant mixtures. In the composition and concentration range studied here for the co-adsorption of ß-casein-hydrophobin mixtures the adsorption is dominated by the ß-casein adsorption. The results provide an important insight into how the competitive adsorption in protein mixtures of hydrophobin and ß-casein can impact upon the modification of solid surface properties and the potential for a wide range of colloid stabilisation applications.

Asunto(s)

RESUMEN

BACKGROUND AND OBJECTIVE: Safe prescribing requires accurate and practical information about drugs. Our objective was to measure the utility of current sources of prescribing guidance when used to inform practical prescribing decisions, and to compare current sources of prescribing guidance in the UK with idealized prescribing guidance. METHODS: We developed 25 clinical scenarios. Two independent assessors rated and ranked the performance of five common sources of prescribing guidance in the UK when used to answer the clinical scenarios. A third adjudicator facilitated review of any disparities. An idealized list of contents for prescribing guidance was developed and sent for comments to academics and users of prescribing guidance. Following consultation an operational check was used to assess compliance with the idealized criteria. The main outcome measures were relative utility in answering the clinical scenarios and compliance with the idealized prescribing guidance. RESULTS: Current sources of prescribing guidance used in the UK differ in their utility, when measured using clinical scenarios. The British National Formulary (BNF) and EMIS LV were the best performing sources in terms of both ranking [mean rank 1·24 and 2·20] and rating [%excellent or adequate 100% and 72%]. Current sources differed in the extent to which they fulfilled criteria for ideal prescribing guidance, but the BNF, and EMIS LV to a lesser extent, closely matched the criteria. DISCUSSION: We have demonstrated how clinical scenarios can be used to assess prescribing guidance resources. Producers of prescribing guidance documents should consider our idealized template. Prescribers require high-quality information to support their practice. CONCLUSION: Our test was helpful in distinguishing between prescribing resources. Producers of prescribing guidance should consider the utility of their products to end-users, particularly in those more complex areas where prescribers may need most support. Existing UK prescribing guidance resources differ in their ability to provide assistance to prescribers.

Asunto(s)

RESUMEN

Medical errors are increasingly being highlighted as an unnecessary cause of morbidity and mortality. Such situations are increasingly likely to occur if each country has its own improved name for each individual drug, particularly as healthcare staff are becoming increasingly mobile across the world. Standardization of drug names will help reduce the risk of such errors. However because of the change between BANs and rINNS there is potential for short-term problems. Healthcare staff need to be aware of such problems to try and minimize the damage they could potentially cause. In the longer term these name changes will hopefully prevent errors from occurring.

Asunto(s)

RESUMEN

OBJECTIVES: To assess the extent of teaching about the Committee on Safety of Medicine's Yellow Card scheme and adverse drug reactions within UK Schools of Medicine and Pharmacy. METHODS: A self-completed questionnaire sent to all heads of undergraduate schools of medicine and pharmacy within the UK. RESULTS: The majority of undergraduate syllabi feature the Yellow Card Scheme. Knowledge of the Yellow Card Scheme was assessed in 79% of pharmacy programmes and 57% of medical schools. Specialist speakers on the Yellow Card Scheme were infrequently used. Fewer than half of respondents provided students with a guide to reporting ADRs (43% pharmacy and 43% medical). There is some disagreement about the value of supplying students with printed material about the Yellow Card Scheme. Half of medical Schools did not think that supplying 'Current Problems In Pharmacovigilance' would be useful. CONCLUSIONS: It was found that in both medicine and pharmacy, courses differed substantially in teaching about the Yellow Card Scheme and adverse drug reactions (ADRs). There is scope for increased involvement of the Medicines and Healthcare products Regulatory Agency in undergraduate education, in line with recommendations from the National Audit Office.

Asunto(s)

RESUMEN

INTRODUCTION: Spironolactone is increasingly being used in the treatment of heart failure. However, it has been associated with cases of hyperkalaemia. The common use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin-2 receptor (AT2) antagonists in heart failure increases the risk of hyperkalaemia. OBJECTIVE: To identify the risk of spironolactone withdrawal, hyperkalaemia and severe hyperkalaemia in patients prescribed spironolactone together with either an ACE inhibitor or an AT2 antagonist. METHODS: Retrospective identification and analysis of patients co-prescribed an ACE inhibitor or an AT2 antagonist with spironolactone. Patients' records were linked to their biochemical results and the doses of spironolactone, ACE inhibitor and AT2 antagonists received by them. RESULTS: We found that a higher proportion of patients in our cohort stopped taking spironolactone compared with the Randomised Aldactone Evaluation Study and a higher proportion developed hyperkalaemia, a predicted adverse effect of spironolactone combination with an ACE inhibitor or an AT2 antagonist. Patients with diabetes mellitus and those with a haematocrit below 0.36, were more likely to develop hyperkalaemia than those without these traits. CONCLUSIONS: Spironolactone is a common cause of hyperkalaemia when used in combination with either an ACE inhibitor or an AT2 antagonist. This reinforces the need for care when extrapolating the results of clinical trials to daily clinical practice.

Asunto(s)

RESUMEN

AIMS: We studied the international classification of disease (ICD) hospital discharge codes to find unreported adverse drug reactions (ADRs), and asked doctors about their attitudes to reporting some of these cases. METHODS: We examined the ICD codes assigned on discharge to identify ADRs and compared these with spontaneous reports made to the Committee on Safety of Medicines (CSM). Doctors involved were sent brief résumés of cases and asked if they would report them. RESULTS: 49 of 21 365 patient episodes were coded on discharge as ADRs, of which 33 were 'reportable'. Fourteen spontaneous reports were received by the CSM during the same period. The two groups did not overlap. 25 of 60 doctors responded to our questionnaire, and would have reported only 8 of 75 cases outlined. CONCLUSIONS: The ICD coding allowed us to identify important ADRs which most doctors would not report spontaneously.

Asunto(s)

RESUMEN

The IOM study does an admirable job of discussing trends affecting the future of workers and the workplace. Based on theses trends, there will be vast unmet needs, as well as tremendous opportunities, for occupational health and safety professionals, particularly occupational health nurses, to help meet these needs. Individual occupational health and safety professionals will do well to study the trends, assess their current knowledge and skills, and seek the education and training required to develop and enhance the necessary competencies. They will need to: pay special attention to areas of behavioral health, work organization, communication (especially risk commnication), management, team learning, work force diversity, information systems, prevention interventions, health care delivery systems, and evaluation methods (IOM, 2000). They will need to develop, document, and communicate new and creative models for providing occupational health and safety services. Also, see the Advisory, "Job Security for the 21st Century," on page 164A.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

1. Environmental hazards are ubiquitous. Many exist in the workplace or occur as a result of work process exposures. 2. Environmental health is a natural component of the expanding practice of occupational health nursing. 3. AAOHN's vision for occupational and environmental health will continue to set the standard and provide leadership in the specialty.

Asunto(s)

RESUMEN

Strain ATCC 39006 of Serratia marcescens makes the same carbapenem, (5R)-carbapen-2-em-3-carboxylic acid (Car), as the Erwinia carotovora strain GS101. Unlike E. carotovora, where the onset of production occurs in the late-exponential phase of growth in response to the accumulation of the small diffusible pheromone N-(3-oxohexanoyl)-L-homoserine lactone (OHHL), in S. marcescens carbapenem is produced throughout the growth phase and does not appear to involve any diffusible pheromone molecule. Two cosmids capable of restoring antibiotic production in E. carotovora group I carbapenem mutants were isolated from an S. marcescens gene library. These cosmids were shown to contain a homologue of the E. carotovora carR gene, encoding a CarR protein with homology to the LuxR family of transcriptional regulators. The S. marcescens carR was subcloned and shown to be capable of complementing in trans, in the absence of OHHL, an E. carotovora carR carI double mutant, releasing the heterologous E. carotovora host from pheromone dependence for carbapenem production. The apparent OHHL-independence of the S. marcescens CarR explains the constitutive nature of carbapenem production in this strain of S. marcescens.

Asunto(s)

RESUMEN

N-acyl homoserine lactones are bacterial signalling molecules involved in regulating diverse metabolic functions, particularly those relating to virulence, in concert with cell density. Each aspect of the signalling pathway, from production and recognition of the signal to expression of the target genes, offers a potential opportunity for exploitation. Attention is now focusing on the development of novel methods for bacterial enumeration, modulation of bacterial virulence and flexible, coordinated expression of heterologous genes through the use of N-acyl-homoserine-lactone-based systems.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

1. AAOHN's strategic plan for 1993-98 was developed through a collaborative effort with emphasis on member input. 2. A model for the strategic plan which emphasized data acquisition and analysis was developed. 3. A revised mission statement and standards for occupational health nursing practice, along with expanded scope of practice, were developed.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Skill in reading long words is prerequisite to dyslexics' literacy. Instant recognition of printed symbols is easy for those readers with photographic memories, but dyslexics often fail to recognize visually many long words which are actually familiar to them auditorially. Scientific, automatic, multisensory procedures for dividing longer words into easily read syllables can enable students to translate visual symbols rapidly and thereby to read, write, or spell accurately words of any length.Over one thousand dyslexics, aged seven to fifteen, guided the interdisciplinary team at Texas Scottish Rite Hospital in Dallas to develop, observe results, and test specific structured, sequential steps in working out longer words. The ten-year study (1965-1975) in the Language Laboratory of the Hospital established the Alphabetic Phonics curriculum which is now used successfully, not only in remedial groups but in regular classes of any size or age, in public and private schools in 45 states and six foreign countries.The newly-established Aylett Royall Cox Institute in Dallas prepares teachers and Master Instructors to train both students and other teachers. Comparable Alphabetic Phonics Teacher Training Centers are already established in Houston and Lubbock, Texas, in Oklahoma City, and at Columbia University Teachers College in New York.

Asunto(s)