In October PLoS Medicine, a new fully-online medical journal, will publish its first issue [1]. (PLoS is the Public Library of Science.)
This Abbott Labs website suggests that two hours after last intravenous dose of nesiritide (Natrecor), the BNP assay reveals only endogenous peptide [1].
"Natrecor® (nesiritide, recombinant BNP) has been used for treatment in patients with acute, decompensated heart failure. The efficacy of BNP monitoring, pre- and post-treatment with Natrecor, has been studied.* Measurements of BNP two hours or more post-treatment detect only the endogenous levels of BNP." [From the Abbott Labs website]
*Maisel AS, Cremo R, Gardetto N, et al. The effects of nesiritide on serum levels of B-type natriuretic peptide (BNP) in patients admitted for decompensated congestive heart failure [Abstr]. Circulation (Suppl II) 2002;106:II-565. [I am still searching for the online link to this publication]
Medical residents at Case Western Reserve University (St. Vincent Charity Hospital) have their own weblog "for the residents, by the residents" [1]
They use Blogger as their online publication tool [2]. This bedside.org weblog uses Movable Type [3].
Bush (savings accounts)
Kerry (lower "premiums")
Nader (Physicians for National Health Plan)
Their health plans in their own words.
The Agency for Healthcare Research & Quality (AHRQ) posts case histories of medical errors [1].
"This site features expert analysis of medical errors reported anonymously by our readers, interactive learning modules on patient safety ('Spotlight Cases'), and forums for online discussion. CME credit is available."
One of their cases is a "glucose roller coaster." High blood glucose levels were treated with insulin. Then low sugars treated with D50. As discussed earlier this month on our rounds, the sugars were high erroneously since the blood sent to the lab had been drawn above an IV site [2]. Bradley Sharpe from the University of California San Francisco comments on the risks of sign-out, cross-coverage, night-float, and incessant unprioritized pages. His commentary is well worth a visit. He suggests practical reforms as implemented at UCSF.
Another error reduction effort, Ohioans First, is a local campaign that emphasizes proper use of abbreviations [3]. (No abbreviation for "units" or "daily" or "micrograms", and no trailing or leading zeroes.)
How far do we best lower blood pressure in older persons? (Question came up with Karla's patient who had fallen).
A recent JAMA article finds vigorous evidence lacking for some recommendations of JNC VII (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) [1, 2]
"Data Synthesis
There is strong evidence from clinical trials to support the treatment of systolic hypertesion (SH) in older persons with SBP of at least 160 mm Hg. Large-scale trials to assess the value of antihypertensive therapy for older patients with SBP of 140 to 159 mm Hg have not been performed, and recommendations to treat these patients are based on observational studies that show a graded relationship of cardiovascular risk with increasing SBP. The studies most strongly support the use of thiazide diuretics and long-acting calcium channel blockers as first-line therapy to treat SH."
"Conclusions
Treatment of SH in older patients with SBP of at least 160 mm Hg is supported by strong evidence. The evidence available to support treatment of patients to the level of 140 mm Hg or those with baseline SBP of 140 to 159 mm Hg is less strong; thus, these treatment decisions should be more sensitive to patient preferences and tolerance of therapy."
...souvenir photo of our lunchtime greeter [1].
...more on Cycladic sculpture [2,3].
Walk amidst sculpture any time of year--Pyramid Hill is just north of I-275 at Colerain exit [4]. Regional sculpture can be found online at the Sculpture Center [5].
I have not yet found the 2004 Olympics Opening Ceremony on DVD. (Lots photos are online at this temporary link [6]. Scroll down to see the extensive photos. It is sprinkled with political fervor about Cyprus.)
The following text describes the ceremony, and the role of Cycladic sculpture. Source of the text is the producer's webpage [6]. (The text and still images lack Sarah's animation.)
'Allegory'
The most technically challenging part of the ceremony, 'Allegory' (fable) took the audience on a journey through landmark periods of Greek history -- spanning thousands of years -- using sculpture as a metaphor for the growth and evolution of Greek civilization and its contribution across the arts and sciences, and politics and philosophy.
* At the recitation of the poem 'Mythistorema 3' which tells of the burden that the Greeks bear through their heritage, a centaur -- representing the duality of man as part intellectual, part physical and a key figure in Greek mythology -- was revealed at the water's edge. He threw a javelin, which caused a giant Cycladic head, an object, which dates back to 2700 BC, to emerge dramatically from the lake's center and come to rest on the surface of the water. A dazzling display of mathematical formula and geometric shapes -- a tribute to the great physicists and mathematicians of ancient Greece, such as Pythagoras, Democritus and Euclides -- then appeared, as if inscribed over its surface in a magnificent laser show. * The Cycladic head then rose above the water's surface and broke apart into eight pieces, which travelled outward through the air to reveal the figure of a Kouros, a sculpted marble body from the 500 BC. The Kouros also broke apart, this time to reveal a classical Greek statue from the 400 BC. Finally, the classical statue broke apart. The 18 rock fragments then moved through the air before settling just a few meters above the water like celestial bodies floating in space. * Revealed at the core of this floating landscape was a male figure crouching on top of a perfect white cube -- a symbol of the earth. The man stood and began walking, the cube twisting and rotating beneath his feet representing man's evolutionary journey towards becoming a logical, spiritual being, searching for knowledge. * The galaxy of floating rocks surrounding the cube then rose into the air as the faces of the rock fragments were transformed through video into images of human faces and bodies -- a celebration of the beauty and diversity of humanity. * Finally, the rock fragments lowered and came to rest in the water to represent the Greek Islands. Two lovers ran into the water, throwing off their clothes to play and swim in the 'sea', at which point Eros, the god of love, emerged from the water, flew above the lovers and out toward the edge of the scene to greet the next arrivals into the stadium. 'Clepsydra' - a grand procession
Clepsydras were ancient clocks that measured units of time through the steady flow of water and sand. Here they symbolized the passing of time as depicted in this dream-like and colorful parade. Depicting stylized figures brought to life from Greek frescoes, mosaics, sculptures and paintings; this was a chronological procession, atop a moving stage, of images ranging from prehistoric to modern times. Ten scenes of mythology, discovery, history and culture culminated with a final scene featuring the first Olympic Games of the modern era: Athens, 1896.
The book of life
With the sounds of the operatic soprano Maria Callas filling the stadium, Eros swooped down to greet a pregnant woman, the final figure of the 'Clepsydra' parade. She descended from her stage and moved into the water; her pregnant belly gently glowing as she waded into the water while a galaxy of lights submerged beneath the water began to radiate outward from her. In ancient times, the stars in the sky were thought to be the milk of the Goddess Hera, wife of Zeus. Hera awoke to discover that an unknown baby, the son of Zeus, had been breastfeeding. The baby grew up to be the hero Hercules and Hera's milk nurtured his immortality -- the root of the expression 'the milky way'.
The stadium was then bathed in sparkling stars as the audience activated their own lights to complete the picture before a huge mist screen rose from the center of the lake to reveal stars floating upward to form a spiralling strand of DNA which concluded the symbolic journey from man's first attempt to understand himself (the Cycladic Head) to his most recent and profound discovery -- the decoding of DNA.
The olive tree
All the performers assembled around the water as all the rocks rose and retracted back towards the center of the space. As 'Asteri tou Voria', a song of journey and celebration was sung, the rocks formed a mountain crowned by an olive tree. The olive tree has been sacred among Mediterranean nations for thousands of years and is also the ancient symbol of the Athenian City State. The olive wreath was the ultimate prize for a victorious athlete and the olive branch is also a global symbol of peace and freedom.
The athletes of the world - the parade
Traditionally, as the birthplace of the Olympics, Greece has the honor of entering the stadium first, followed by all the other teams in alphabetical order. On this occasion, countries entered in sequence according to the Greek alphabet led by placard bearers wearing costumes inspired by ancient Greek vases. For the first time, athletes took a spiral route into the stadium and onto the 'field of play' -- a reference back to the 'DNA' theme.