Developing visiting surgical services for rural and remote Australian communities

The University Department of Surgery at Queen Elizabeth II Medical Centre (Perth, Western Australia) has undertaken a pilot project to provide surgical services to country communities where no such service exists. Three surgeons undertake a regular schedule of appointments, and are accompanied by final-year medical students to give them experience with common conditions rarely managed in teaching hospitals. The service is supported by a central administrative office and coordinated by a general practitioner, who negotiates with the regional healthcare providers. Patients are referred by their general practitioner, who may work with the surgeon as anaesthetist or surgical assistant.     

The relationship between age and depressive symptoms in two national surveys.

There is inconsistency in the literature on the relationship between age and depressive symptoms. Although a careful review shows that some of this inconsistency can be reconciled by recognizing the nonlinear relationship (J. P. Newmann, 1989), 2 additional issues remain unclear. One is that most previous studies used depression screening scales that contain somatic items that could introduce an age bias. The other is that most previous studies combined samples of men and women even though there is evidence that the sex difference in depressive symptoms varies with age. These 2 issues are addressed in this article, using analyzed data from 2 large national surveys. There is a consistent, but quite modest, nonlinear association between age, somatic, and nonsomatic depressive symptoms in both surveys. There is no significant sex difference in the age curves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of spray nozzle design on liquid-solid contact in fluidized beds

In industrial fluid cokers the feedstock, consisting of heavy bituminous hydrocarbons, is atomized with steam and injected into a hot fluidized bed of coke. Good and uniform contact of the liquid droplets with the solid particles is required to provide heat for the cracking reactions while minimizing mass transfer effects. Experiments in a pilot plant coker have suggested that the initial particle/liquid mixing, in the spray jet, is rather poor. Experiments in a X-ray scanner showed that liquid droplets and entrained particles accumulate just below the tip of the jet plume to form agglomerates.An experimental technique was used to quantitatively determine the quality of mixing with a variety of nozzle configurations including several novel designs. By improving spray stability, redistributing liquid droplets to the solids-rich region of the jet and increasing the surface area of the gas-liquid jet-fluidized bed interface, liquid/solid contact is improved.     

Hypothermic ischaemia of the liver: a re-perfusion phenomenon

BACKGROUND: The effects of hypothermic injury to the liver were investigated on an isolated perfusion circuit by comparing porcine livers with varying degrees of preservation injury. METHODS: A group of unstored livers (n = 5) were compared to livers stored in University of Wisconsin (UW) solution for 18 h (n = 5), and a group of livers stored in Hartmann's solution for 18 h (n = 5). RESULTS: We observed that the degree of platelet sequestration was directly related to the severity of the preservation injury. After 2 h of isolated liver perfusion, the perfusate platelet count fell from 148 +/- 14 x 10(9)/L to 84 +/- 13 x 10(9)/L for control livers. In comparison for livers stored in UW solution, the platelet count fell from 173 +/- 43 x 10(9)/L to 61 +/- 14 x 10(9)/L representing a 64.8% fall, while for those stored in Hartmann's solution, an even more profound fall from 152 +/- 36 x 10(9)/L to 19 +/- 9 x 10(9)/L (87.5% fall) was observed. The difference between the UW-stored and Hartmann's-stored livers was significant (P < 0.05). However, using this model, the degree of leukocyte sequestration did not differentiate the groups. Both histological and ultrastructural examination of liver biopsies taken immediately following revascularization demonstrated that for mild degrees of preservation injury following hypothermic storage, changes occur to the sinusoidal lining cells well before changes to the parenchymal elements. CONCLUSIONS: These findings substantiate the hypothesis that the primary injury associated with hypothermia involves the sinusoidal lining cells (non-parenchymal elements), that it is predominantly a reperfusion phenomenon and that efforts at improving preservation should therefore be targeted primarily at these cells and not the hepatocytes.     

A systematic review of the potential hurdles of interoperability to the emergency services in major incidents: recommendations for solutions and alternatives

This study presents a narrative synthesis of a systematic literature review relating to multi-agency interoperability and major incident decision-making in high risk, high stake environments. The review methodology includes the identification of relevant studies, a critical appraisal of the concepts inherent in the main review question and a narrative synthesis of the central themes that relate to the study as a whole. The review firstly outlines what, currently, appear to be the perceived defining features of successful interoperability by using the SAFE-T phase model of major incident decision-making. It then considers whether these defining features are realistically achievable in major incident practice. Findings suggest that the current definition of an interoperable network is too demanding for the inherent complexity and dynamic nature of the major incident task environment. Individual teams tend to focus on agency-specific behaviour, as opposed to coordinated multi-team functioning, and so collective interoperability is not achieved. Inevitably, this reduces the ability to perform collaborative behaviours, including decision-making and action implementation. The paper concludes that aiming for the current conceptualisation of interoperability along a hierarchical command structure may actually inhibit effective decision-making. Instead, multi-agency systems would do better to work towards an improved understanding of a non-hierarchical and decentralised yet interoperable major incident management network. Recommendations include the need to relate theory and practice in the development of multi-agency decision-making via simulation-based training and to deepen our understanding of interoperability to prevent inertia in high risk, high stake major incident environments.     

1994年我国工程塑料进展

根据国内有关工程塑料的文献,报道了1994年国内热塑性树脂及塑料、热固性树脂及塑料、成型加工技术的进展,以及工程塑料在国民经济各个领域中的研究开发和应用。     

Alpha olefin sulfonates from a commercial SO3-Air reactor

Alpha olefin sulfonate (AOS) can be made by SO₃-air sulfonation of straight chain alpha olefins followed by saponification of the neutralized product. The sulfonation step forms unsaturated sulfonic acids, sultones and sultone sulfonic acids. Hydrolysis of the various sultones yields a mixture of unsaturated and hydroxy sulfonates. Sulfonation of commercial mixtures of straight chain alpha olefins in a large-scale SO₃ falling film unit has given AOS of 1.5–3.0% oil based on active content and tristimulus color of about 40% saturation (2% solution) which is readily bleachable with 1–3% NaOCl to about 10–15% saturation. Performance of AOS made from C₁₅−C₁₈ alpha olefin is comparable to that of the high-foaming C₁₁−C₁₄ LAS in both detergency and dishwashing foam. It is superior to similar products made from internal straight chain olefins. The product shows a low order of toxicity and biodegrad-ability slightly better than that of LAS. A C₁₅−C₁₆ AOS blend is especially attractive in liquid detergent formulations. Presented at the AOCS Meeting, Los Angeles, April 1966.     

Personalized Targeted Therapy for Lung Cancer

Lung cancer has long been recognized as an extremely heterogeneous disease, since its development is unique in every patient in terms of clinical characterizations, prognosis, response and tolerance to treatment. Personalized medicine refers to the use of markers to predict which patient will most likely benefit from a treatment. In lung cancer, the well-developed epidermal growth factor receptor (EGFR) and the newly emerging EML4-anaplastic lymphoma kinase (ALK) are important therapeutic targets. This review covers the basic mechanism of EGFR and EML4-ALK activation, the predictive biomarkers, the mechanism of resistance, and the current targeted tyrosine kinase inhibitors. The efficacy of EGFR and ALK targeted therapies will be discussed in this review by summarizing the prospective clinical trials, which were performed in biomarker-based selected patients. In addition, the revolutionary sequencing and systems strategies will also be included in this review since these technologies will provide a comprehensive understanding in the molecular characterization of cancer, allow better stratification of patients for the most appropriate targeted therapies, eventually resulting in a more promising personalized treatment. The relatively low incidence of EGFR and ALK in non-Asian patients and the lack of response in mutant patients limit the application of the therapies targeting EGFR or ALK. Nevertheless, it is foreseeable that the sequencing and systems strategies may offer a solution for those patients.     

The in vitro and in vivo investigation of inhaled migraine therapies using a novel aerosol delivery system consisting of an air pressurized capsule device (APCD) in combination with a pMDI spacer for endotracheal dosing into beagle dogs

Abstract

Context: Aerosol delivery to animals in preclinical settings has historically been very challenging, requiring the use of techniques, such as intratracheal instillation and dry powder insufflation, that are somewhat invasive, inefficient and not representative of clinical inhalation.

Objective: The objective of this work is to develop a system to deliver dry powder to dogs in an efficient and effective manner for the study of new anti-migraine compounds in development.

Materials and methods: The new device uses a metered aliquot of a dry gas to force dry powder drug from a pre-filled HPMC capsule into an AeroChamber® spacer for subsequent inhalation by the animal.

Results: The delivery of two invesigational migraine drugs via the new device was assessed in vitro using abbreviated Andersen cascade impaction and showed the device is capable of generating a reproducible delivered dose of up to ～68% with more than 50% of the dose in the respirable range. In vivo studies have also been performed showing that this device effectively delivered the migraine drugs to spontaneously breathing dogs using a proprietary validated dog inhalation model.

Discussion: Results confirmed that the air pressurized capsule device (APCD) was effective in delivering the APIs to lungs of the animals. The in vivo data verified the advantages of inhaled delivery over oral delivery for this class of drugs and were used to establish the cardiopulmonary and respiratory side effect liability profile for these compounds.

Conclusions: This work has demonstrated the utility of this device for quick and accurate screening of prospective drug candidates, representing a significant improvement in ease of use and reprodicibility over current delivery methods.