Does teaching theory of mind have an effect on the ability to develop conversation in children with autism?

The present research examined whether teaching children with autism to pass tasks that assess mental state understanding had any positive effects on communication. Two aspects of communication previously shown to be deficient in children with autism were considered. These are conversational ability, in particular the ability to expand on conversation, and the use of mental state terms in speech. Results showed that no discernible improvement was seen on either measure of communication following mental state teaching. Discussion centers on real versus superficial changes in understanding mental states as a result of teaching.

Spontaneous mutation frequencies and spectra in p53 (+/+) and p53 (-/-) mice: a test of the 'guardian of the genome' hypothesis in the Big Blue transgenic mouse mutation detection system

TSG-p53/Big Blue double transgenic mice offer a powerful tool for examining the effect of a p53 germline mutation on spontaneous somatic mutation in vivo. After sequencing the DNA-binding domain of the lacI gene, we previously reported no differences in mutant frequency between p53 nullizygous (-/-) and p53 wild-type (+/+) mice in liver, spleen and brain. However, jackpot mutations elsewhere in the gene may have obscured a real difference in mutation frequency and the small sample size of mutations not at CpG dinucleotides (n = 23) may have been insufficient to reveal differences in mutation spectra. Herein we have sequenced the entire lacI gene, including the promoter and lacZ operator regions. 123 additional independent mutations have been found including 70 mutations not at CpG sites. The mutation frequency was determined by correcting for jackpot mutations. There were no statistically significant differences in mutation frequency or spectrum between the p53 (+/+) and p53 (-/-) genotypes in any of the three tissues.

Recruitment for controlled clinical trials: literature summary and annotated bibliography

This article is a literature summary and annotated bibliography of research on recruitment for controlled clinical trials published through 1995. It extends and revises a similar review published in this journal a decade ago. The current commentary focuses on intervening developments in recruitment, including diverse populations, HIV trials, primary prevention trials, recruitment strategies, overall planning and management, patient and physician attitudes, adherence, generalizability, and cost. Profound barriers may exist in the recruitment of diverse populations, involving language, cultural factors, beliefs about medical research, and the appropriateness of available protocols. Extensive literature exists on patient and physician barriers to participation. Trials in HIV-infected or AIDs-diagnosed individuals introduce special considerations, including issues of confidentiality, parallel track design, and populations difficult to define and track. Recruitment strategies such as patient registries, occupational screening, direct mail, and the media are now prominent in the literature. Successful planning and management of an overall recruitment plan include piloting strategies, monitoring recruitment by data tracking systems, and hiring quality staff. Generalizability of study results is influenced by the characteristics of participants and by their adherence to study protocol. With increasingly limited funding to conduct clinical trials, efforts to quantify and reduce recruitment costs are being made. While over 4000 titles were identified, primarily by MEDLINE literature search, the articles summarized emphasize data-supported and -confirmed conclusions, and broad coverage of disease areas. We annotate here 91 outstanding articles useful for formulation of overall recruitment approaches in clinical trials.

Developing a multidisciplinary protocol for enteral feeding

The management of planned change is discussed using a change model. Protocols are described and defined. The process of multidisciplinary protocol development is identified. Nurses are encouraged to reflect upon the process of practice change.

Reciprocity, emotional well-being, and family functioning as determinants of family satisfaction in caregivers of elderly parents

The purpose of this study was to test a theoretical model developed to explain family satisfaction among 171 caregivers of elderly parents. Using LISREL to estimate path coefficients, the findings support family satisfaction as directly and indirectly influenced by reciprocity, emotional well-being and family functioning. Explanatory variables accounted for 70% of the variance in predicting family satisfaction. Intrinsic rewards derived from giving care, positive affect, and family functioning contributed to higher levels of family satisfaction, while dysphoria contributed significantly to lower levels. Family satisfaction was also indirectly influenced by positive and negative exchanges received by the parent. Increasing caregivers awareness of the reciprocal nature of their relationships with all family members may be an effective strategy in helping them appreciate their contribution to the well-being of their parents and achieve satisfaction in the caregiving role.

Molecular evolution and diversity in Bacillus anthracis as detected by amplified fragment length polymorphism markers

Bacillus anthracis causes anthrax and represents one of the most molecularly monomorphic bacteria known. We have used AFLP (amplified fragment length polymorphism) DNA markers to analyze 78 B. anthracis isolates and six related Bacillus species for molecular variation. AFLP markers are extremely sensitive to even small sequence variation, using PCR and high-resolution electrophoresis to examine restriction fragments. Using this approach, we examined ca. 6.3% of the Bacillus genome for length mutations and ca. 0.36% for point mutations. Extensive variation was observed among taxa, and both cladistic and phenetic analyses were used to construct a phylogeny of B. anthracis and its closest relatives. This genome-wide analysis of 357 AFLP characters (polymorphic fragments) indicates that B. cereus and B. thuringiensis are the closest taxa to B. anthracis, with B. mycoides slightly more distant. B. subtilis, B. polymyxa, and B. stearothermophilus shared few AFLP markers with B. anthracis and were used as outgroups to root the analysis. In contrast to the variation among taxa, only rare AFLP marker variation was observed within B. anthracis, which may be the most genetically uniform bacterial species known. However, AFLP markers did establish the presence or absence of the pXO1 and pXO2 plasmids and detected 31 polymorphic chromosomal regions among the 79 B. anthracis isolates. Cluster analysis identified two very distinct genetic lineages among the B. anthracis isolates. The level of variation and its geographic distribution are consistent with a historically recent African origin for this pathogenic organism. Based on AFLP marker similarity, the ongoing anthrax epidemic in Canada and the northern United States is due to a single strain introduction that has remained stable over at least 30 years and a 1,000-mile distribution.

Spinal anesthesia versus intravenous sedation for transvaginal oocyte retrieval: Reproductive outcome, side-effects and recovery profiles

Transvaginal ultrasonically guided oocyte retrieval is commonly performed as part of in vitro fertilization efforts. The impact of anesthetic management on patient outcome from this procedure has not been well characterized. At our institution, patients are offered a choice of either heavy intravenous sedation or spinal anesthesia with minimal or no sedatives. In this pilot study, we retrospectively reviewed the anesthetic management, reproductive outcome and recovery room experience for all patients having oocyte retrieval during a 2-year interval (n = 95). Fifty-one oocyte retrievals were performed under spinal anesthesia, while 44 patients received solely intravenous sedatives. Both groups had similar reproductive outcomes. The intravenous sedation group required a significantly longer period until recovery room discharge criteria were met (P = 0.03), and were more likely to have postoperative emetic episodes (46% versus 6% in the spinal anesthesia group: P < 0.01). Two unplanned hospital admissions occurred in the intravenous sedation group: both were related to uncontrolled nausea and vomiting. We conclude that spinal anesthesia may have advantages over intravenous sedation for oocyte retrieval.

Focusing Properties of X-Ray Spectrometers with 2D-Curved Crystals for Extended X-Ray Sources of Hot Plasmas

The focusing properties of very large (≈33 × 33 cm2) spherically and toroidally curved crystals with a radius of curvature of ≈10 m were determined numerically with an x-ray tracing code and are compared to those of cylindrically bent crystals. Large spherically and toroidally curved crystals are of interest for the diagnostic of future large tokamak fusion experiments and possibly for other extended x-ray sources. Compared with cylindrically bent crystals-which are now widely used for the plasma diagnostic in tokamak experiments, in particular, for Doppler-broadening measurements to determine the central ion temperature-2D-curved crystal spectrometers can provide a significant enhancement of the intensity due to the additional focusing of the sagittal rays.

Dimensional assessment of personality in an out-patient sample: relations of the systems of Millon and Cloninger

The Cloninger Temperament and Character Inventory (TCI) and the Millon Clinical Multiaxial Inventory (MCMI-II) are both self-report inventories that can be used to assess personality reliably in clinical samples. Both instruments were administered to 103 consecutive psychiatric out-patients with or without personality disorders. The goals were to assess the convergent validity of the two instruments, to replicate the findings of Svrakic et al. (1993) Archives of General Psychiatry, 50, 991-999, about the differential diagnosis of Axis II disorders, and to analyse the relations of Millon's measures of Axis I disorders with Cloninger's measures. We observed a strong convergent validity between the instruments; the seven dimensions of the TCI accounted for most of the variance in MCMI-II measures of both Axis 1 and Axis 2 disorders. As reported by Svrakic et al. (1993) Archives of General Psychiatry, 50, 991-999, in in-patients, low self-directedness and low cooperativeness were confirmed to be the essential features of all personality disorders in out-patients. In addition, self-transcendence, the third of Cloninger's character dimensions, was observed to be a strong correlate of severe Axis-1 psychopathology, including manic and delusional disorders.

Pediatric locum tenens provided by an academic center

BACKGROUND

Locum tenens, the use of a substitute physician to replace a physician who must be temporarily absent from his practice, is widely accepted in the United States. Locum tenens has not previously been described or studied in pediatric practice.

OBJECTIVE

This article describes a locum tenens service for Colorado and Wyoming pediatricians provided by the Division of General Pediatrics and Pediatric Emergency Medicine at the University of Colorado School of Medicine and the Children's Hospital of Denver. An analysis and an evaluation of the program are presented, and implications are discussed.

METHODS

All program data were prospectively collected and tabulated and later analyzed for the period from July 1, 1994, through June 30, 1995. A survey of all physicians using the Pediatric Locum Tenens Service was conducted within 2 months of service to evaluate the program and to refine the orientation, credentialing, and evaluation processes.

RESULTS

During the year, 35 pediatricians (14% of pediatricians in Colorado and Wyoming) made 97 requests for 398 days of locum tenens coverage. Coverage was used for vacation (85%), medical education (10%), medical leave (3%), and family matters (2%). Solo and rural pediatricians used the service at a higher rate than pediatricians in group or urban practices. Eighty-six percent had never used locum tenens coverage before because of either the expense (67%) or their unwillingness to trust their practices to physicians or services with whom or with which they were unfamiliar (50%). The majority (83%) were willing to pay an amount for locum tenens equal to the net income derived from the locum tenens coverage in the practice. None indicated a willingness to pay more than that. Referrals and admissions to the Children's Hospital from the pediatricians who used the service increased by 22% during the study period compared with the preceding year, whereas referrals and admissions increased by 9% among all other Colorado and Wyoming pediatricians. All pediatricians completed surveys, and satisfaction with the locum tenens pediatricians, charges, and program administration was high. Their suggestions are described.

DISCUSSION

The following topics are discussed: (1) the economics of pediatric locum tenens; (2) the use of a locum tenens service as a physician relations program by children's hospitals or academic departments of pediatrics; (3) guidelines for orientation of locum tenens pediatricians; and (4) a proposed evaluation and credentialing process for locum tenens physicians.

Economic swings and demographic changes in the history of Latin America

In this paper we study the effects of short-term fluctuations in indicators of economic well-being on selected demographic response such as births, marriages and deaths at age intervals in eleven Latin American countries between 1910 and 1990. We use conventional distributed lag models to assess the magnitude and direction of effects and test a variety of hypotheses some of which have been posed to hold in Western Europe and others that are more specific and tailored to the Latin American context. We also compare the magnitude and direction of effects obtained among these countries with those obtained for pre-industrial Europe and uncover the existence of broadly similar patterns.

The demography of menopause

Menopause marks a time of dramatic hormonal and often social change for women. Both risk factors and health needs are likely to change as women pass through menopause. This paper examines the demographic characteristics of the world population of menopausal and post-menopausal women, and also examines the implication of menopause for mortality risks. The numbers of women involved are large. Using age 50 as a proxy for menopause, about 25 million women pass through menopause each year, and we estimate that in 1990 there were 467 million post-menopausal women in the world, with an average age of about 60 years. By 2030, the world population of menopausal and postmenopausal women is projected to increase to 1.2 billion, with 47 million new entrants each year. The mortality implications of menopause are also substantial. Ratios of female to male mortality risks from all causes and from all major cause groups except neoplasms decline to low levels around menopause or shortly thereafter, and then rise again to near unity. This pattern is taken as evidence that the female reproductive period is broadly protective of health, but that this protection disappears after menopause. The main protective effect is through reduced risk of cardiovascular disease mortality, partially offset by increased risks of cancer mortality, particularly of the breast and endometrium.

Maternal mortality

A new approach to measuring maternal mortality indicates that there are some 585,000 maternal deaths, 99% of them in developing countries. This is around 80,000 deaths more than earlier estimates have suggested and indicates a substantial underestimation of maternal mortality in the past. There is a greater disparity in levels of maternal mortality between industrialized and developing countries than in any other public health indicator. While significant progress has been made in reducing infant mortality, the same is not true for maternal mortality. Although the actions needed to reduce maternal mortality have long been known, 1 woman in 50 is still dying as a result of pregnancy-related complications and the figure rises to 1 in 10 in many parts of Africa. By contrast, the figure for developed countries can be as low as 1 in 8,000.

Structural organization of a Bacillus subtilis operon encoding menaquinone biosynthetic enzymes

Menaquinone (MK) is a non-protein component of the Bacillus subtilis (Bs) electron transport chain synthesized from chorismate through a series of MK-specific reactions. The genes encoding biosynthesis of the naphthoquinone ring of MK are clustered at 273 degrees on the Bs chromosome. A 3.9-kb region capable of rescuing men mutants blocked in the early stages of MK biosynthesis was sequenced and found to contain three major open reading frames (ORFs). The first ORF (menF) has a predicted size of 51.8 kDa and 34% amino-acid identity with the isochorismate synthases of Escherichia coli (EntC) and Aeromonas hydrophila (AmoA), ORF2 (menD) a predicted size of 60.2 kDa and 21% identity with MenD of E. coli. ORF3 has a predicted size of 21.4 kDa and 29% identity to triacylglycerol lipase of Psychrobacter immobilis. No sequence corresponding to menC was identified. Plasmid integrational studies of the men gene cluster had suggested the presence of promoters secondary to the previously identified p1 men promoter. Sequence analysis revealed a putative promoter region upstream from ORF3.

The use, efficacy and monitoring of artificial nutritional support in a teaching hospital

The implementation of circulated guidelines has been audited, by assessing the extent to which nutritional goals were set and achieved and recording the levels of morbidity as a result of complications. Adults receiving artificial nutritional support were studied over a six month period. Nutritional assessment was used to determine adequacy of prescription and efficacy of the support. Energy requirements were retrospectively calculated and compared with prescriptions and actual intakes. Complications and interruptions to the regimens which resulted in lost feeding time were recorded, as were patient outcomes. Nutrient prescriptions were inadequate, delivery of prescriptions was incomplete and thus nutrient supply inadequate.

Treatment of childhood diarrhea in rural Egypt

The Egypt National Control of Diarrheal Diseases Project, implemented between 1983 and 1991, is widely regarded as one of the most successful national oral rehydration programs. Data from a longitudinal household survey conducted in 1990-91 in rural Egypt indicate substantial increases in both knowledge and use of oral rehydration salts during the 1980s. However, the same data show that treatment of acute diarrheal episodes is still far from optimal. In particular, the use of oral rehydration during diarrheal episodes is far from universal, the prescription of antibiotics is still too frequent, and antidiarrheal drugs of no therapeutic value are still widely used. Analysis of the factors associated with different treatment patterns shows that children with severe diarrhea, those aged 6-23 months and those from poor households were more likely to be given ORS; boys were somewhat less likely to receive ORS than girls, but mother's education showed no consistent effects. The type of treatment received is strongly influenced by the source of care. Government clinics are more likely than private physicians or pharmacies to prescribe ORS, whereas children taken to the latter two sources of care are more likely to be given antibiotics and antidiarrheals. To improve diarrhea treatment patterns in Egypt, not only must the public service educational campaign be reinstated and strengthened, but training programs must also be targeted at the treatment practices of private physicians.

Working with traumatic material: effects on Holocaust Memorial Museum staff

Preparation for the opening of the United States Holocaust Memorial Museum in Washington, D.C., in April 1993, exposed workers to potentially disturbing personal artifacts of Holocaust victims and other reminders of the horrors of the Holocaust. The process of psychological consultation is described, and the resultant approaches to interventions designed to lower distress among museum workers and volunteers are discussed.

Diarrhoeal disease, oral rehydration, and childhood mortality in rural Egypt

The Egyptian National Control of Diarrhoeal Diseases Project (NCDDP) is reported to have had great success in improving case management of diarrhoea, and in reducing diarrhoea-related mortality among children, while deaths due to other causes have remained unchanged. Recent reports have claimed that with this dramatic decline in diarrhoea mortality, respiratory infection is now the main cause of child death in Egypt. As a result, the degree of commitment to control of diarrhoeal disease activities has been greatly reduced. We present new data from a large prospective study that confirms much of the success of the NCDDP, but which questions the extent of the claimed project impact on mortality. Child mortality has declined greatly over the past decade. However, deaths from other causes have declined almost as much as those from diarrhoea, and most importantly, diarrhoea remains the main cause of death among children. Our discussion demonstrates the need for appropriate methodology in evaluating the mortality impact of an intervention, and to the very great importance of reinvigorating control of diarrhoeal diseases activities in Egypt.

The effect of physician training on treatment of respiratory infections: evidence from rural Egypt

A three-round survey of child mortality, morbidity and treatment conducted in rural lower Egypt in 1990-91 found relatively poor treatment practices for respiratory infections. Only about 56 per cent of children with a respiratory infection received appropriate treatment. Antibiotics were prescribed for more than half of all mild coughs and colds, but were not prescribed for a quarter or more of serious cases. A training program for government physicians conducted midway through the survey improved treatment practice slightly in government facilities. However, training alone is unlikely to improve treatment much. Better supervision, and information campaigns focused directly on mothers, are suggested as necessary components of a successful project.

A flowchart-oriented interview language (FOIL) and its application to a low-back pain interview system

The flowchart-oriented interview language (FOIL) is a computer programme that converts flowchart information into C programming language code. The programme was written to simplify development and maintenance of the Birmingham Back Pain Interview System. In addition FOIL gives the user of the interview system the flexibility of changing the questionnaires to suit their local needs. FOIL may be used for any flowchart-oriented problem. The flowchart specification and the questions are defined in ASCII character files.