Three years of an adult burns support group: an analysis

A retrospective analysis, by survey, of the benefits of a support group and preference for its structure is presented. Psychosocial support after burn injury is identified as important and a support group is recommended as being routine in the aftercare for burns' patients.

Physicochemical and metabolic basis for the differing neurotoxicity of the pyrrolizidine alkaloids, trichodesmine and monocrotaline

Monocrotaline and trichodesmine are structurally closely related pyrrolizidine alkaloids (PAs) exhibiting different extrahepatic toxicities, trichodesmine being neurotoxic (LD(50) 57 mu mol/kg) and monocrotaline pneumotoxic (LD(50) 335 mu mol/kg). We have compared certain physicochemical properties and metabolic activities of these two PAs in order to understand the quantitative and qualitative differences in toxicity. Both PAs were metabolized in the isolated, perfused rat liver to highly reactive pyrrolic dehydroalkaloids that appear to be responsible for the toxicity of PAs. More dehydrotrichodesmine (468 nmol/g liver) than dehydromonocrotaline (116 nmol/g liver) was released from liver into perfusate on perfusion for 1 hr with 0.5 mM of the parent PA. Dehydrotrichodesmine had a significantly longer aqueous half-life (5.4 sec) than that of dehydromonocrotaline (3.4 sec). In vivo, significantly higher levels of bound pyrroles were found in the brain 18 hr after injection of trichodesmine (25 mg/kg; i.p.) than were seen following either an equal dose (25 mg/kg; i.p.) or an equitoxic dose (90 mg/kg; i.p.) of monocrotaline. Trichodesmine had a higher partition coefficient than monocrotaline for both chloroform and heptane, indicating its greater lipophilicity. The pK(a) of trichodesmine (7.07) was only slightly higher than that of monocrotaline (pK(a¿ 6.83), suggesting that a difference in degree of ionization was not a major factor affecting the relative ability of the dehydroalkaloids to cross the blood-brain barrier. We conclude that the greater lethality and neurotoxicity of trichodesmine compared to monocrotaline is due to two structural characteristics: (i) steric hindrance at position 14 of dehydrotrichodesmine results in greater resistance to hydrolysis, allowing more to be released from the liver and to be delivered to the brain; (ii) the larger isopropyl substituent at position 14 of dehydrotrichodesmine renders the molecule more lipophilic, leading to greater penetration of the brain.

Neonatal and pediatric critical care: ethical decision making

The current standards for surrogate decision making for children are analyzed in this article. A number of potential pitfalls are involved with this issue, including questions about the child's maturity and competence. The present approach for medical decision making for noncompetent children is the "best interest" standard. In many medical decisions, the "best interest" standard is not applicable and a "rational parent" standard is presented.

Obesity in the Caribbean

People of African origin who live in the Caribbean share a common genetic heritage but live in socioeconomic environments that diverge widely. A cross-cultural study of males and females from Jamaica, St. Lucia and Barbados investigated the prevalence of hypertension and its environmental determinants. Standardized measurement techniques allowed comparable measurements of weight, height, waist and hip circumferences, and blood pressure. The population values for body mass index (BMI), per cent overweight (males BMI > or = 27.8 kg/m2; females BMI > or = 27.3 kg/m2) and per cent obese (males BMI > or = 31.1 kg/m2; females BMI > or = 32.3 kg/m2) are presented. Prevalence of hypertension is based on the age-adjusted total population. The gradient in per capita gross national product in Jamaica, St. Lucia and Barbados parallels the gradient in the proportions of population in those countries who are obese. BMI explained 26% of the variance in blood pressure in females and 13% in males. Obesity is a significant problem in the Caribbean, as it is in many other developing countries, and it is associated with a high prevalence of hypertension, particularly in women.

Obesity in peoples of the African diaspora

People of African descent in the Caribbean and the USA originated from the Bight of Benin in West Africa. Although these populations share a common genetic heritage, they now live under different socioeconomical conditions. Assuming genetic similarity, a cross-cultural examination of these peoples in West Africa, the Caribbean and the USA may attenuate the effect of genetic factors and allow the assessment of environmental contributions to a biological outcome. We carried out an epidemiological survey to determine the prevalence of hypertension and the contribution of risk factors to the variation in blood pressure. We measured the height, weight, waist and hip circumferences, and blood pressure of adults in Nigeria, Cameroon, Jamaica, St. Lucia, Barbados and the USA. In urban populations there was a trend towards increasing weight, height, body mass index, and proportions of those overweight and obese going from West Africa to the USA, with the Caribbean being intermediate. The prevalence of hypertension lay on a similar gradient. Given a common genetic susceptibility, urbanization and western acculturation are therefore associated with increasing hypertension and obesity.

Psychosocial correlates of chest pain among African-American women

While 10-30% of individuals with chest pain who undergo cardiac arteriography are found to have no demonstrable pathology, women are far more likely than men to have normal coronary arteries in the presence of angina. Black women, in particular, frequently seek medical attention for persistent episodes of chest pain. This cross-sectional study was designed to examine the potential role of psychological and social factors in relation to chest pain among black women. Among our population-based sample of 188 women, 48% reported experiencing chest pain. Seventeen of these cases met the Rose criteria for classification as cardiac pain while 74 of them reported pain not consistent with cardiac origin. A statistically significant difference was observed in the stress scores among the women; the highest stress scores occurred among those with Rose angina and the lowest scores were obtained from those women reporting no chest pain experiences (p < 0.001). There was no association detected between the presence and type of chest pain and psychosocial measures of depression and coping abilities. These results confirm the high rates of chest pain experienced among black women, and provide insight into the role of psychological factors that should be considered in the identification of treatment options.

Infant with mos45,x/46,XY/47,XYY/48,XYYY: genetic and clinical findings

We describe an infant with mos45,X/46,XY/47,XYY/48,XYYY who presented with ambiguous genitalia. Her phenotype was also remarkable for minor ear and eye anomalies and coarctation of the aorta with bicuspid aortic valve. Laparoscopy revealed bilateral Fallopian tubes and a left infantile testis with epididymis. Chromosomal analyses of blood, skin, aorta, right Fallopian tube, and left gonadal tissue showed mos45,X/46,XY/47,XYY/48,XYYY. The 46,XY cell line was identified with routine trypsin-Giemsa banding only in cultured cells from an aortic biopsy. Fluorescence in-situ hybridization (FISH) was utilized to identify the presence of 46,XY cells in other tissues. The clinical manifestations of this patient are discussed and compared with those of similar cases of Y chromosome aneuploidy. To our knowledge, this is the first report of a patient with this unusual karyotype.

Familial resemblance for anthropometric measurements and relative fat distribution among African Americans

Obesity has emerged as a major public health problem in the African-American community and its determinants are poorly understood. The purpose of this study was to examine familial patterns of the degree of heaviness and of regional fat deposits. Seven anthropometric measurements (height, weight, body mass index [BMI], waist and hip circumferences, waist-to-hip ratio and arm circumferences) were examined in a population sample of African-American nuclear families recruited from the Chicago area. Participants included 162 parent pairs and 114 sets of siblings (a total of 295 sons and daughters). Adjustments to correct for the effect of age and sex were performed separately for parents and siblings and the residuals were transformed to normalized z-scores to calculate intraclass correlations between family members. With the exception of waist-to-hip ratio, all variables showed positive familial resemblance, although the degree and level of statistical significance varied by type of relationship. Significant familial resemblance was observed for peripheral fat deposit, as measured by hip and arm circumferences (range: 0.04 for spouse pairs to 0.42 for daughter pairs), and obesity, as measured by BMI (range: 0.12 for spouses to 0.33 for mother-daughter comparison). Significant sex and generation differences were observed for height and hip. We conclude that African Americans exhibit significant familial resemblance for stature, degree of heaviness and regional fat deposits. Understanding the relative contributions of shared genes and shared environmental factors to the observed familial patterns could yield important insights into the origins of obesity in this high risk population.

Gene delivery and expression mediated by an integrin-binding peptide

The ability to transfer sufficient DNA to specific target cells remains one of the main limitations to the development of gene therapy. For this reason much attention is being paid to the development of new gene delivery systems, both viral and non-viral. We describe gene transfer with a polycation-DNA complex which contains an integrin-binding domain. Integrin-mediated gene delivery has several potential advantages. Such complexes are less likely than other receptor-mediated gene delivery complexes to be constrained by the size of the complex. The ligands are small peptides, resembling naturally occurring integrin ligands, which minimises the possibility of complexes inducing an immune response in vivo.

Interleukin-11 stimulates multilineage progenitors, but not stem cells, in murine and human long-term marrow cultures

Interleukin-11 (IL-11) is a bone marrow microenvironment-derived growth factor with pleiotropic effects on a variety of hematopoietic cells. To more accurately assess the effects of IL-11 on stem and progenitor compartments within the hematopoietic microenvironment (HM), we added recombinant human (rh) IL-11 to human and murine long-term bone marrow cultures (LTMC) and analyzed primitive (high proliferative potential-colony forming cells [HPP-CFC], long-term culture-initiating cells [LTC-IC], and long-term reconstituting stem cells) and progenitor (day 12 colony forming unit-spleen [CFU-S12], colony forming unit-megakaryocyte [CFU-Mk] and colony forming unit-granulocyte/macrophage [CFU-GM]) compartments throughout the duration of the cultures. rhIL-11 (100 ng/mL) added twice weekly resulted in significantly increased nonadherent (NA) cellularity, CFU-GM, and CFU-Mk production in human LTMC. Addition of rhIL-11 to murine LTMC was associated with a 5- to 40-fold increase in CFU-GM and a four- to 20-fold increase in day 12 CFU-S in NA cells. However, IL-11 had no significant effect on total HPP-CFC concentration and decreased the size of the more primitive stem/progenitor compartment as evidenced by both decreased LTC-IC frequency in human LTMC and decreased frequency of long-term reconstituting stem cells in murine LTMC. These data suggest that IL-11 may increase commitment of stem cells into a multipotential progenitor compartment.

Soar and the case for unified theories of cognition

Despite the potential importance to cognitive psychology of unified theories no attempt has been made to assess concretely the methodological problems that such theorising produces. This paper addresses this issue of unified theorising, and in particular the arguments for unified theories put forward by Newell (1990). Close examination of these arguments reveals that Newell's approach does not adequately counter the difficulties which beset the grand theories of the 1930s, nor the problems of irrelevant specification which arise in modern computational psychological work. These difficulties do not prevent the development of unified theories, but they do pose serious problems, problems which it is argued can only be met by rigorous empirical testing together with extreme methodological sensitivity. The methodological concerns lead us to examine Soar, perhaps the most well-developed unified theory, from methodological, computational, and empirical perspectives. Our conclusions are that, whilst Soar represents an impressive body of research, its methodological foundations are insecure, it is ill specified as a computational/psychological theory, and under empirical testing it does not stand up to close scrutiny as a unified theory. The Soar research programme as it currently stands thus fails to meet the necessary methodological demands imposed by unified theorising.

Bacteriology of urinary tract stones

It has been reported that up to half of renal stones and associated urine specimens have been positive on culture, and that up to 50% of such stones contain magnesium ammonium phosphate. In a prospective study using infrared and wet chemical analysis, we found positive cultures in only 7 of 132 renal, 5 of 105 ureteral and 6 of 21 bladder stones obtained surgically and handled with sterility. Of the culture positive calculi only 43% from the kidney, none from the ureter and 50% from the bladder contained detectable magnesium ammonium phosphate. However, magnesium ammonium phosphate was detectable in 20% of renal, 2% of ureteral and 27% of bladder stones with negative cultures. Of the culture positive renal and ureteral calculi 42% were predominantly calcium phosphate and 17% were predominantly calcium oxalate. For culture negative stones 25% and 51% from the kidney, and 15% and 82% from the ureter were composed of predominantly calcium phosphate and calcium oxalate, respectively. Among the culture positive stones, related positive urine cultures were noted in 100% of the renal, 20% of the ureteral and 50% of the bladder cases, compared to 26%, 10% and 27%, respectively, of culture negative calculi. The same organism was found in the stone and urine in only 38% of the cases. The lower frequency of positive urine cultures, of stones with magnesium ammonium phosphate, and especially of culture positive renal and ureteral stones (5%) than in previous reports suggests that stone culture may be of less value than indicated previously, except for bladder calculi and large renal stones, such as the branched type.

Anti-(human immunodeficiency virus) activity of polyoxotungstates and their inhibition of human immunodeficiency virus reverse transcriptase

Heteropolyoxotungstates of the Keggin class containing different heteroatoms were tested for inhibition of two strains of human immunodeficiency virus 1 (HIV-1); they exhibited varying antiviral activity. Compounds containing boron were inactive, only one of those containing phosphorus showed selective anti-viral activity, whereas all silicon-containing compounds exhibited significant anti-viral activity in C8166 cells infected with the IIIB strain. Their effectiveness was some 10-fold higher in JM cells with selectivity indices of about 2000. The silicotungstates were effective inhibitors of HIV reverse transcriptase, showing greater inhibition with RNA/DNA template primers than with DNA/DNA template.primer. Kinetic analysis demonstrated that they inhibit the enzyme by different mechanisms, as, of the four compounds examined, two competed with template.primer and two competed with deoxynucleoside triphosphate. Inhibition of DNA polymerase activity by these compounds was compared using polymerases from different sources, including human; although not necessarily most specific for HIV-1 reverse transcriptase, they did not inhibit all DNA polymerases to a similar degree.

An improved cleansing regime for a modified foam cavity dressing

An investigation of the clinical and microbiological outcomes of a new stent disinfection regime using an improved silicone foam cavity dressing

Ergonomic modifications: examining cost and effectiveness

This study examined the cost and effectiveness of making ergonomic modifications for injured workers at the time of return to work. Factors which were considered to be indicative of effective modifications included whether the worker was still working at the job for which modifications had been made, the amount of time between modification and follow-up call and the employer's rating of the effectiveness of the modifications. Thirty-one subjects were all past clients at a midwestern rehabilitation facility. Average subject age was 40.9 years; and there were 14 males and 17 females. Information relative to the modifications was gathered from the subjects' employers through the use of a telephone questionnaire. Results indicated an average cost per person of $251.71 and $61.69 for an average cost per modification, 35% were still working the same job with or without restrictions at an average follow-up time of 70.7 weeks. The employers' average ratings of the cost effectiveness and effectiveness in keeping the employee on the job were 4.3 and 3.8, respectively on a scale of 1-5 (5 being very effective). Results suggest that ergonomic modifications can be cost effective in keeping the worker on the job.

Two- and Three-body Ion-Electron Recombination Rate Coefficients in Neon

The rates of recombination of electrons with Net ions over a wide range of pressure (1001000 Torr) and at temperatures of 133, 233 and 295 K were measured. Two- and three-body recombination processes were resolved. The observed two-body rate coefficient is lower than earlier reports. The three-body rate measured agrees well with predictions from Flarinery's modified theory by Bates for termolecular ion-electron recombination in a monatomic gas.

The effect of massage on oxygen consumption at rest

This study determined the effect of massage on oxygen consumption at rest. Ten healthy, adult males (mean age = 28 years) volunteered to serve as subjects. During the Control Session, each subject was placed in the supine position on a massage table to remain motionless for 30 minutes. During the Treatment Session, each subject received a 30-minute sports massage of the lower extremities. Oxygen consumption was determined via the Beckman Metabolic Measurement Cart, which was upgraded to estimate cardiac output using the CO2 rebreathing (equilibrium) method. Paired t-tests were used for all tests of statistical significance. There was no significant difference in the subjects' oxygen consumption with the massage. Also, there were no significant differences in heart rate, stroke volume, cardiac output, and arteriovenous oxygen difference during the massage. These findings indicate (1) that massaging the lower extremities results in neither an increase nor a decrease in the subjects' expenditure of energy at rest and (2) that the energy cost of metabolism at rest is determined by the same central and/or peripheral adjustments.

Primer residues deposited by handguns

There is much anecdotal information being disseminated, even offered in expert witness testimony, concerning the deposit of primer residues on the hands of persons in front of the muzzle of handguns. We present data for 9 mm and 380 Auto pistols and for a 38 caliber revolver depicting the procedure for obtaining wipings taken from targets representing the hands of a gunshot victim. These wipings from pork tissue were then analyzed for the primer residue metals antimony, barium, and lead. The data show that the two primary metals, antimony and barium, are deposited on the targets out to 4 feet for the pistols and out to three feet for the 38-caliber revolver. Testing will continue in actual cases with the gun and ammunition involved in the shooting.

Endoscopic ultrasound in the evaluation of Barrett's esophagus: a preliminary report

OBJECTIVE

Endoscopic screening of Barrett's esophagus (BE) for dysplasia is imprecise and controversial. Endoscopic ultrasound (EUS) allows a detailed circumferential image of the esophageal wall. Our objective in this study was to assess the utility of EUS for surveillance in Barrett's esophagus.

METHODS

Consecutive patients with proven BE undergoing endoscopy were evaluated with EUS. Esophageal wall thickness (EWT) was measured as the distance from the balloon-mucosal interface to the outermost hyperechoic line. EWT was determined as the average of all measurements done every 2-3 cm along the esophagus. Identical measurements were performed in a series of controls.

RESULTS

Fifteen patients with BE and 13 control patients were studied. Two patients had focal submucosal thickening on EUS with EWTs of 10 mm and 7 mm. Surgical resection of the esophagus in these two cases with high-grade dysplasia revealed submucosal carcinoma at the area of EUS-documented thickening. The mean EWT of controls measured 2.6 mm, nondysplastic BE measured 3.3 mm, and BE with dysplasia measured 4.0 mm. The EWT of both dysplastic and nondysplastic Barrett's was significantly greater than that of the controls (p < 0.02, Student's t test).

CONCLUSIONS

1) As measured by EUS, the esophageal wall is significantly thickened in the columnar-lined portion of Barrett's esophagus. 2) EUS-detected focal thickening may represent submucosal carcinoma in areas of dysplasia and guide early surgery. Thus, EUS may play a role in evaluating the patients with dysplasia in Barrett's esophagus.