Objective: To assess the value of cusum analysis in hospital bed management. Design: Comparative analysis of medical patient flows, bed occupancy, and emergency department admission rates and access block over 2 years. Setting: Internal Medicine Services and Emergency Department in a teaching hospital. Interventions: Improvements in bed use and changes in the level of available beds. Main outcome measures: Average length of stay; percentage occupancy of available beds; number of patients waiting more than 8 hours for admission (access block); number of medical patients occupying beds in non‐medical wards; and number of elective surgical admissions. Results: Cusum analysis provided a simple means of revealing important trends in patient flows that were not obvious in conventional time‐series data. This prompted improvements in bed use that resulted in a decrease of 9500 occupied bed‐days over a year. Unfortunately and unexpectedly, after some initial improvement, the levels of access block, medical ward congestion and elective surgical admissions all then deteriorated significantly. This was probably caused by excessive bed closures in response to the initial improvement in bed use. Conclusion: Cusum analysis is a useful technique for the early detection of significant changes in patient flows and bed use, and in determining the appropriate number of beds required for a given rate of patient flow.
A kindred is described, six members of which fulfilled criteria for the syndrome of familial hypocalciuric hypercalcaemia (FHH). The majority of these individuals were asymptomatic: their hypercalcaemia was revealed by biochemical screening after parathyroid surgery had failed to diminish the elevated serum calcium concentration of the index case. In contrast to those members of the family diagnosed as adults, the daughter subsequently born to the index case included in her expression of FHH clinical features of severe neonatal primary hyperparathyroidism. Four hyperplastic parathyroid glands were excised, and following surgical intervention the baby improved clinically and accelerated the healing of her skeletal lesions. Her case suggests that an association does exist between FHH and neonatal primary hyperparathyroidism. Of the ten individuals at risk, inheritance of hypocalciuric hypercalcaemia was paralleled in eight cases by inheritance of the HLA haplotype All BW55 CW3 DR4. Such possible linkage has not previously been reported.
Protein kinase C is a proposed mediator of pituitary ACTH secretion. To investigate this role of protein kinase C, we studied the effect of 12-0-tetradecanoylphorbol-13-acetate (TPA), an inducer of protein kinase C activation, on in vitro pituitary ACTH release. Normal rat anterior pituitaries were e z matica l ly 9 Y dispersed to monolayer culture. Dishes with 3.5 x 10 cells were incubated 3 days, washed, and incubated in test media for 3.5 hours. TPA stimulated ACTH(RIA) release in a dose related fashion with an ED of 0.7 ng/ml and a maximal stimulation of 900% over unstimulaqgd cel Is. I ncreasi ng the concentration of culture media calcium from 0 to 1 mM, 3mM and 6 mM led to a significant increase of TPA induced ACTH release from 4.80 to 6.79, 8.41, and 8.62 ng/dish respectively. Nifedipine (10 pM), a membrane calcium channel blocker, and penfluridol (10 pM), a calcium calmodulin antagonist, inhibited TPA (1 ng/ml) mediated ACTH release by 21% and 31% respectively (p < 0.01). Using a specific RIA technique for rat CRF,we have determined the IR-CRF concentrations in acid extracts of hypothalamic,pancreatic and gastrointestinal tissues in fasting and fed immature rats(] day before birth, 0,1,3,7,14,21,28 and 42 days after birth). IR-CRP from these tissue extracts gave dilution curves that were parallel to the rat CRF standard curve and co-eluted with synthetic rat CRF on Sephadex G-50 gel chromatography. The mean hypothalamic IR-CRP concentration was 7.4+4.6ng/g wet weight of tissue 1 day before birth and remained almost constant during the first week of life. Then,it increased gradually about 2-fold up to day 42. The mean IR-CRP concentrations in the pancreas and jejunum were very low before birth,but they increased abruptly about four times higher than that in the hypothalamus immediately after birth. Thereafter,they declined progressively with age. On the other hand,themean IR-CRF concentrations in the gastric antrum and duodenum were much lower than that in the hypothalamus throughout maturation. No significant difference was seen between fasting and fed rats in any age group. Conc1usion;The mean IR-CRY concentrations in the pancreas and jejunum had the very high peak while that in the hypothalamus remained constant in early neonatal period. These findings suggest that CRY in the pancreas and jejunum may play a particular role in neonatal rats. Switzerland.Alpha-MSH has been reported to occur in the plasma of pregnant women (Nature 273: 163, 1978). Since it appeared that the RIA used for those studies was not sufficiently sensitive and specific, we have developed a new solid-phase RIA for alpha-MSH with a sensitivity of 2-4 pg per ml of plasma and a negligible cross-reaction with other hormones (ACTH: <0.1%). Goats were immunized with chemically defined carrier protein-MSH complexes and the antibodies covalently coupled to a non-sedimenting acrylamide polymer. The new antibody-carrier complex allows an immune extraction from samples containing 30-50% plasma before a:dition of the tracer, so that any '...
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