The University of Louisville Medical School's comprehensive programs to increase its percentage of underrepresented-minority students

Since 1981, the University of Louisville (U of L) School of Medicine has developed several programs to increase the number of its underrepresented-minority (URM) matriculants and help them succeed during their medical education. The first such effort, begun in 1981, was the Professional Education Preparation Program for Kentucky high school students from underserved counties. Programs in Louisville's elementary and middle schools were initiated in 1996, and others continue through medical education and residency training. These existing supports for local URM students (most of whom are African Americans) were enhanced in 1996 by the Health Professions Partnership (HPP), a program sponsored by The Robert Wood Johnson Foundation and the Association of American Medical Colleges. With the HPP, the U of L intensified its focus on health careers preparation at the elementary and secondary education levels, and increased exchanges and collaboration between U of L health sciences faculty and teachers and students in the Jefferson Country Public Schools. Several funding sources have been used to maintain and develop the U of L's education pathway programs, including institutional, state, federal, and foundation funds. The authors describe the U of L's programs, focusing on the HPP, and state that as of 1998, the number of URM students enrolled in the U of L School of Medicine had reached almost 10% (up from 2-3% before 1993) and the graduation rate was 90%, (up from 76% before 1993). These increases are the result of many years of developing and implementing a continuum of preparation and retention programs.

Magnetic resonance imaging of brain in people at high risk of developing schizophrenia

BACKGROUND

Schizophrenia is a multifactorial disorder that is associated with disturbed cerebral development. Structural brain-imaging studies have consistently shown that the volumes of some parts of the brain, particularly the mesial temporal lobes, are smaller in patients with schizophrenia than in healthy people. Whether these abnormalities of brain structure predate the onset of symptoms is not known.

METHODS

100 people at high risk of developing schizophrenia (two or more first-degree or second-degree relatives affected), 20 patients in their first episode of schizophrenia, and 30 healthy controls underwent magnetic resonance imaging of the brain. The volumes of regions of interest were measured by standard techniques.

FINDINGS

Mean whole-brain volume was 1356 cm3 (SD 178) in the first-episode group, 1347 cm3 (122) in the high-risk group, and 1334 cm3 (149) in the controls (p=0.8). The mean volume of the left amygdala-hippocampal complex (AHC) was lower in the first-episode group (4.3 cm3 [0.6]) than in the high-risk group (4.6 cm3 [0.6]), and in turn than in the controls (4.8 cm3 [0.7]); these differences were significant (p<0.05) both for absolute volumes and values adjusted for brain volume and other confounders. The right AHC showed a similar pattern (absolute volumes 4.5 cm3 [0.7], 4.8 cm3 [0.6], 4.9 cm3 [0.9], respectively). Both thalamic nuclei were significantly smaller in the high-risk group than in the control group.

INTERPRETATION

People at high risk of developing schizophrenia for genetic reasons have several structural brain abnormalities that are similar to those in patients with the disorder. If at-risk individuals with particularly small AHC or thalami are most likely to develop schizophrenia, this feature might assist in early detection and treatment.

Central venous catheter infections treated with teicoplanin

A novel way of using teicoplanin in situ to treat central venous catheters is described. Profound immunosuppression and the fact that the lines remain indwelling for long periods are two of the main reasons for these infections. In children it is also difficult to prevent these lines being played with, which increases the likelihood of infection. The different types of infection that can occur in a central venous catheter are described and the clinical definition of a catheter infection is provided. In an initial study, infective episodes in a small group of 11 children were treated successfully with in situ amikacin. Most pathogens were Gram-negative cocci. None of the catheters had to be removed, and catheter life was prolonged by a mean of 118 d. Due to the high incidence of Staphylococcus epidermidis in the initial study, in situ teicoplanin was assessed in a subsequent study. Over the course of 1 yr, 20 line infections occurred in 12 children. Empirical amikacin therapy was instituted and switched to teicoplanin once the pathogen was confirmed as Gram-positive. An antibiotic-heparin mixture was introduced into the line and left in place for 24 h, after which time it was replaced with fresh mixture until cultures were sterile. All pathogens were sensitive to teicoplanin, all infections were treated successfully and no catheters had to be removed. Overall, catheter life was prolonged by a mean of 136 d. It was concluded that in situ teicoplanin was effective and well tolerated for line infections (no side-effects were reported during the study). A minimum of 6 d therapy was recommended. The patients with less severe infections would have been suitable for treatment at home by their parents, district nurse or general practitioner (GP).

Acquired von Willebrand's disease

von Willebrand's disease (vWD) is the commonest inherited bleeding disorder in man with an estimated incidence of 1 per thousand of the population. Acquired von Willebrand's disease (AvWD) is rare with less than 70 cases reported. AvWD is usually associated with autoimmune or clonal proliferation disorders and whilst the precise mechanism of acquired deficiency of von Willebrand factor (vWF) is poorly understood, the most likely candidate mechanism(s) are; antibodies inactivate or form a complex with immunologic or functional sites on vWF, or vWF multimers are selectively absorbed by malignant cells. Unlike hereditary vWD, the acquired form of the disease can be exceedingly difficult to manage. We report 4 cases of AvWD diagnosed at our centre over the past 3 yr. There was no evidence of a previous personal or family history of bleeding in any of the patients and AvWD was confirmed by laboratory testing. All 4 patients had a recognised primary medical condition known to be associated with AvWD (Waldenstrom's Macroglobulinaemia in 2 patients, hypothyroidism in 1 patient and monoclonal gammopathy of unknown significance (MGUS) in 1 patient). The acquired haemostatic defect corrected following treatment of the primary condition in 3 patients with the other patient requiring on demand von Willebrand Factor replacement to control spontaneous and surgery induced bleeding.

Hox-type and non-Hox homeobox gene sequences in genomic DNA of the sea urchin Holopneustes purpurescens

As a preliminary step in an analysis of Hox gene expression and radial body plan specification in sea urchin development, we amplified partial homeobox sequences in H. purpurescens by PCR using degenerate primers. The primers, HoxE and HoxF (Pendleton et al., 1993), spanned a highly conserved region of 82 nucleotides encompassing amino acids 21-47 of the homeodomain. Seven Hox-type homeobox sequences and two non-Hox homeobox sequences were identified. The seven Hox-type sequences were placed provisionally in Hox paralogous groups, one in paralogous group 3, three in paralogous groups 6-8 and three in paralogous groups 9 13. The non-Hox sequences had similarities with Xlox and Gbx homeobox genes.

The anthropometric assessment of dysmorphic features in schizophrenia as an index of its developmental origins

BACKGROUND

Evidence suggests that schizophrenia may be a disorder with origins in early intrauterine mal-development. We have constructed a comprehensive anthropometric scale for the evaluation of dysmorphic features as an index of the nature and timing of developmental disturbance.

METHOD

A detailed set of craniofacial and bodily measures was compiled and applied to 174 patients with schizophrenia and 80 matched control subjects.

RESULTS

Patients had significantly higher scores on this scale and displayed multiple anomalies of the craniofacial region with an overall narrowing and elongation of the mid-face and lower face. Twelve craniofacial anomalies independently distinguished patients from controls and these variables correctly classified 95% of patients and 80% of control subjects.

CONCLUSIONS

This new scale, while procedurally more exacting than the Waldrop scale, more clearly defines the topography of anomalies previously suspected in individuals with schizophrenia. These findings constitute direct evidence for disturbed craniofacial development in schizophrenia and indicate origins in the foetal period during which the characteristic human facial pattern evolves in close association with brain differentiation.

Postoperative care and complications of damage control surgery

Damage control procedures are being used with increasing frequency as the physiologic limits of the surgical patient are approached and recognized. These patients are returned to the SICU, where rapid restoration of circulating volume, normothermia, maintenance of oxygen delivery, and correction of transfusion-associated coagulopathy are essential to the success of the technique, which requires expeditious reoperation and completion of definitive surgical management. The potential need for early return to the operating room to control surgical bleeding must be recognized, as well as the difficulty in distinguishing between surgical bleeding and ongoing hemorrhage due to hypothermia and coagulopathy. Because the damage control technique is resource intensive and involves numerous personnel, organization and leadership are important to success.

Applying empowerment in mental health practice

The concept of empowerment has been widely discussed and its psychological and political meaning explored. However, it is rarely described in the context of nursing practice. This article focuses on the practice of empowering individuals with learning difficulties, within a secure setting. The ideas may be applied to any healthcare setting.

Type III collagen is crucial for collagen I fibrillogenesis and for normal cardiovascular development

Type III collagen is a fibrillar forming collagen comprising three alpha1(III) chains and is expressed in early embryos and throughout embryogenesis. In the adult, type III collagen is a major component of the extracellular matrix in a variety of internal organs and skin. Mutations in the COL3A1 gene have been implicated as a cause of type IV Ehlers-Danlos syndrome, a disease leading to aortic rupture in early adult life. To directly study the role of Col3a1 in development and disease, we have inactivated the Col3a1 gene in embryonic stem cells by homologous recombination. The mutated allele was transmitted through the mouse germ line and homozygous mutant animals were derived from heterozygous intercrosses. About 10% of the homozygous mutant animals survived to adulthood but have a much shorter life span compared with wild-type mice. The major cause of death of mutant mice was rupture of the major blood vessels, similar to patients with type IV Ehlers-Danlos syndrome. Ultrastructural analysis of tissues from mutant mice revealed that type III collagen is essential for normal collagen I fibrillogenesis in the cardiovascular system and other organs.

Iron Deficiency Developing in Patients with Homozygous Hypercholesterolaemia on Long-term Plasmapheresis is Significantly Contributed to by Extracorporeal Haemolysis

Patients with homozygous hypeicholesterolaemia are notoriously refractory to pharmacologic intervention, leaving regular long-term plasmapheresis as one of the most effective forms of therapy. In this situation we noted the universal development of anaemia; accordingly, its pathogenesis was investigated in a stable cohort of patients over a two year period. Radionuclide studies were carried out in 8 of the 9 available individuals: of these 3 who were not on treatment and 3 out of 5 on the apheresis programme had mean red cell lifespan below the lower level of our normal range. The creation of an arterio-venous fistula and subsequent performance of plasma exchange procedures every two weeks was followed by a falling haemoglobin concentration and the appearance of hypochromasia and microcytosis. The latter was the result of substantial loss of iron through venesection, in the discard plasma and by a transient peak of the iron in the urine: the last two compartments were studied using inductively coupled plasma atomic emission spectrometry (ICP-AES). Such depletion could not be compensated for by a dietary intake of iron that barely met the recommended daily allowance whereas the anaemia reversed readily on oral supplementation. This is the first report of extracorporeal haemolysis in this clinical setting and recognition of its pathophysiology directly influences management. Thus, oral iron supplementation should prevent anaemia and its symptoms whilst also circumventing the paradoxical hyperviscosity that might otherwise occur from iron deficiency.

Analysis of Mutator-induced mutations in the iojap gene of maize

The recessive nuclear mutation iojap (ij) in maize produces striped plants with normal chloroplasts in green sectors and poorly developed chloroplasts in the white sectors. The ij mutation is also characterized by an array of additional phenotypic affects which suggests a pivotal role for Ij in chloroplast development. The Ij gene from maize has been isolated; however, the sequence has not provided information on the action of the Ij gene product. As an extension of the analysis of the Ij gene we have generated a number of independent transposon insertion mutations using the Robertson's Mutator (Mu). Insertions were found to be distributed throughout the 5' half of the gene and all showed a similar striping pattern to that of the original ij mutation, ij-ref. While several of the new mutant alleles produced ij-homologous transcripts none produced detectable levels of the Ij polypeptide product. Chloroplast development in some cells appears to be able to proceed in the absence of the Ij polypeptide.

Evolution of Intragonadal Development in the Diminutive Asterinid Sea Stars Patiriella vivipara and P. parvivipara with an Overview of Development in the Asterinidae

The diminutive asterinid sea stars Patiriella vivipara and P. parvivipara incubate their embryos in the gonads to the advanced juvenile stage. Despite the small size of their eggs (135-150 μm diameter), development is lecithotrophic. Development proceeds through the wrinkled blastula, gastrula, and brachiolaria larval stages. The gastrulae and larvae are uniformly ciliated and swim, propelled by the cilia, in the gonadal fluid. The brachiolaria is pear-shaped and has a vestigial brachiolar attachment complex composed of three small brachia. At no stage in development are the embryos attached to the gonad. Metamorphosis occurs as the larvae swim in the gonadal lumen. Internal development involves formation of one large enterocoel at the anterior end of the archenteron and one small posterior enterocoel on the left side of the archenteron. The archenteron closes to form the rudiment for the adult gut. As a result of the small size of the egg and the nonfeeding mode of development, the larvae of P. vivipara and P. parvivipara are minute, about 270 μm and 210 {mu}m in length, respectively. Newly metamorphosed juveniles are about 240 μm and 310 μm in diameter, respectively. Postmetamorphic development involves substantial growth of the juveniles, which leave the parent at a diameter between 1.0 and 5.0 mm. The presence of a vestigial brachiolar complex and lecithotrophic development indicates that these species had a free-living lecithotrophic brachiolaria in their ancestry. We suggest that the evolution of viviparity in Patiriella sp. involved retention of a large egg by an ancestor that had a lecithotrophic brachiolaria followed by a secondary reduction in the size of the ovum and simplification of the larva. The range of life histories seen in Patiriella is atypical of asteroid genera and supports the contention that the evolution of viviparity and other modes of modified development in the Asteroidea follows phylogenetic lineages.

A case-control study of obstetric complications and later autistic disorder

The precise etiology of autism remains unclear. Obstetric adversity has been described as one factor that may increase the risk for the disorder. We examined the contemporaneous birth records of 49 children satisfying DSM-III-R criteria for autistic disorder, at four Dublin maternity hospitals, using the previous same-sex live birth in that hospital as a control. Data were evaluated blind to subject status using two obstetric complication (OC) rating scales. No significant differences in obstetric adversity were found between index and control groups. Autistic individuals did not differ from controls in terms of previously described risk factors for this disorder (maternal age, maternal parity, birth order, and low birth weight) in autism. These data do not support the view that OCs increase the risk for later autism.

Geriatric depression: a survey of nurses' knowledge and assessment practices

A sample of 149 registered nurses were surveyed to determine their knowledge of the symptoms of depression in the elderly and their assessment practices. Respondents were able to identify not only the traditionally associated symptoms but also two other behaviors, irritability and blaming others, which are not usually designated by other health care providers as associated with geriatric depression. These additional observations may reflect nurses' providing extensive physical as well as verbal care over much longer time periods for patients in inpatient and home settings than do other professionals. Recent findings in nursing research support the presence of these other behaviors as symptoms of depression. An additional finding revealed that nurses were not assessing their patients for depression even though they had a knowledge base of the symptoms.

Prevalence and correlates of mixed-handedness in schizophrenia

Increased rates of nonright-handedness have been reported in schizophrenia, but a clear distinction has not been made between left- and mixed-handedness. Handedness preferences in 96 patients fulfilling DSM-III criteria for schizophrenia and 43 normal comparison subjects were assessed with the Edinburgh Handedness Inventory. A 100% criterion was used to establish left- and right-handedness. Results were analyzed with mantel-Haenszel odds ratios adjusted for age and sex. The schizophrenic group showed a significant increase in the proportion of mixed-handers compared with the normal group. There was no increase in pure left-handedness in the schizophrenic relative to the normal group. Mixed-handedness in the schizophrenic patients was significantly associated with chronicity of illness. Mixed-handed patients were less likely to have a family history of psychotic illness than patients with strong right- or left-handedness. The results indicate a neurodevelopmental rather than a genetic origin for anomalous lateralization in schizophrenia.

An integrated genetic linkage map for eucalypts using RFLP, RAPD and isozyme markers

An integrated genetic linkage map for E. nitens was constructed in an outbred three-generation pedigree. Analysis of 210 RFLP, 125 RAPD and 4 isozyme loci resulted in 330 markers linked in 12 linkage groups covering 1462 cM (n=11 in eucalypts). The 12th linkage group is comprised of only 5 markers and will probably coalesce with another linkage group when further linked loci are located. Co-dominant RFLP loci segregating in both parents were used to integrate linkages identified in the male and female parents. Differences in recombination frequencies in the two parents were observed for a number of pairs of loci, and duplication of sequences was identified both within and between linkage groups. The markers were distributed randomly across the genome except for the RFLPs in linkage group 10 and for some loci showing segregation distortion, which were clustered into three regions of the map. The use of a large number of co-dominant RFLP loci in this map enables it to be used in other pedigrees of E. nitens and forms a basis for the detection and location of QTL in E. nitens and other eucalypt species.

A targeted mutation at the known collagenase cleavage site in mouse type I collagen impairs tissue remodeling

Degradation of type I collagen, the most abundant collagen, is initiated by collagenase cleavage at a highly conserved site between Gly775 and Ile776 of the alpha 1 (I) chain. Mutations at or around this site render type I collagen resistant to collagenase digestion in vitro. We show here that mice carrying a collagenase-resistant mutant Col1a-1 transgene die late in embryo-genesis, ascribable to overexpression of the transgene, since the same mutation introduced into the endogenous Col1a-1 gene by gene targeting permitted normal development of mutant mice to young adulthood. With increasing age, animals carrying the targeted mutation developed marked fibrosis of the dermis similar to that in human scleroderma. Postpartum involution of the uterus in the mutant mice was also impaired, with persistence of collagenous nodules in the uterine wall. Although type I collagen from the homozygous mutant mice was resistant to cleavage by human or rat fibroblast collagenases at the helical site, only the rat collagenase cleaved collagen trimers at an additional, novel site in the nonhelical N-telopeptide domain. Our results suggest that cleavage by murine collagenase at the N-telopeptide site could account for resorption of type I collagen during embryonic and early adult life. During intense collagen resorption, however, such as in the immediate postpartum uterus and in the dermis later in life, cleavage at the helical site is essential for normal collagen turnover. Thus, type I collagen is degraded by at least two differentially controlled mechanisms involving collagenases with distinct, but overlapping, substrate specificities.