Development of family self-control skills

Family physicians require efficient and effective means for intervening with families of patients in order to positively affect the patient's health status. The purpose of this article is to present a new concept in behavioral intervention, family self-control skills, particularly stressing its potential use by physicians. The clinical interventions described here were developed in a family medicine clinic, and have been used successfully with several patients and families. The article identifies specific concepts and techniques found to be useful in promoting family self-control skills, and demonstrates their application in a family medicine setting. A case example is included to illustrate this approach.

Production of biologically active N alpha-desacetylthymosin alpha 1 in Escherichia coli through expression of a chemically synthesized gene

Thymosin alpha 1, an immune restorative polypeptide hormone, was synthesized in Escherichia coli by using recombinant DNA cloning techniques. Based on the known amino acid sequence, a gene coding for the thymosin alpha 1 polypeptide chain was designed and enzymatically assembled from chemically synthesized oligodeoxyribonucleotide fragments. The gene was ligated into plasmid pBR322 and placed under lac operon control, and N alpha-desacetylthymosin alpha 1 was expressed as part of a beta-galactosidase chimeric protein. Cyanogen bromide cleavage of this protein gave a mixture of polypeptides, among which thymosin alpha 1 activity was detected by radioimmunoassay (RIA). The E. coli product is identical with native thymosin alpha 1 isolated from calf thymus in the amino acid sequence but lacks the N-terminal acetyl group. Results of a guinea pig migration inhibition factor (MIF) assay, a terminal deoxyribonucleotidyl transferase (TdT) assay, and radioimmunoassay indicate that the N alpha-desacetylthymosin alpha 1 produced by deoxyribonucleic acid (DNA) cloning techniques has biological activity equivalent to that of the native hormone.

The family-oriented clinical simulation: an interdisciplinary tool for professional growth

An interdisciplinary, educational technique--the family-oriented clinical simulation--is described and compared and contrasted to other commonly used role-playing techniques. Implications for training and supervision of physical therapists and other health care professionals are discussed, including the technique's relevance as a vehicle for studying in an applied clinical context the interface of physical disease and its psychosocial manifestations. The article concludes with a description of the benefits and potential disadvantages of the technique.

A preliminary inquiry into perceptions of patient self-control

This article stresses the need for physicians to train patients in the self-control skills necessary for them to take greater responsibility for their own health care. As an initial step, the authors report the findings of a small pilot study in which they examined the perception of 16 obstetrician/gynecologists regarding their patients' degree of self-control as it related to medical problems. Findings suggested that this group of physicians exhibited confusion about the concept of self-control and its applicability to patient care. At the same time the authors identified areas of patient care in which, according to physicians' perceptions, the use of self-control skills might be beneficial. The study report indicates aspects of self-control that are of particular interest to physicians and concludes with suggestions for further research.

A revisionist theory for the integration of behavioral science into family medicine departments

This article describes the common cycle of infatuation and disillusionment which occurs when the family physician meets the behavioral scientist. Some inherent problems are involved in the relationship between physicians and psychologists. For physicians, these problems are related to prior training, time pressures, perceptions of the patient role, and their attitude toward role innovation. For behavioral scientists, problems include their expectations and prior training, conceptual rigidity, psychological mindedness, their views of physician and patient, and their sense of displacement and isolation in a medical setting. Suggestions are made for future collaboration, curriculum development, problem solving, and the elimination of biases and stereotypes.

Two-dimensional echocardiography in mitral annulus calcification

Mitral annular calcification, established by fluoroscopy, was studied by M-mode and two-dimensional echocardiography in 18 patients. M-mode echocardiography revealed the typical dense, linear echo of mitral annular calcification, but not its extent. Two-dimenstional echocardiography demonstrated a dense, elipsoidal echo at the junction of the left atrium and ventricle in the long axis view, and an area of calcification below the mitral valve in the short axis view. These patterns were not seen in 20 control patients without mitral annular calcification by fluoroscopy. Two-dimensional echocardiography establishes the site and extent of mitral annular calcification, minimizes the potential for diagnostic error associated with M-mode echocardiography, and is superior to M-mode echocardiography for the recognition of mitral annular calcification.

Adaptation to prismatic displacement by schizophrenics and normals

A sample of schizophrenic inpatients and a control sample of normal volunteers, matched for age and sex were tested on two tasks before and after an exposure condition in which they pointed repeatedly to a target while viewing their hands and the target through prisms. Both groups showed significant changes in both tasks--judging the straight-ahead, and pointing to a single target without sight of the hands. The groups did not differ from each other in the amount of changes in straight-ahead judgments, but normals showed greater adaptive change in the pointing task. These results contradict earlier reports that schizophrenics fail to adapt to altered visual-proprioceptive inputs; but they also help distinguish between modes of proprioceptive utilization that do and do not differentiate schizophrenics from normals.

Regulation of membrane peptides by the Pseudomonas plasmid alk regulon

Pseudomonas putida strains carrying the plasmid alk genes will grow on n-alkanes. Induced alk+ strains contain membrane activities for alkane hydroxylation and dehydrogenation of aliphatic primary alcohols. P. putida cytoplasmic and outer membranes can be separated by sucrose gradient centrifugation after disruption of cells by either mild detergent lysis or passage through a French press. Both the membrane component of alkane hydroxylase and membrane alcohol dehydrogenase fractionated with the cytoplasmic membrane. Induction of the alk regulon resulted in the appearance of at least three new plasmid-determined cytoplasmic membrane peptides of about 59,000 (59K), 47,000 (47K), and 40,000 (40K) daltons as well as the disappearance of a pair of chromosomally encoded outer membrane peptides of about 43,000 daltons. The 40K peptide is the membrane component of alkane hydroxylase and the product of the plasmid alkB gene because the alkB1029 mutation altered the properties of alkane hydroxylase in whole cells, reduced its thermal stability in cell extracts, and led to increased electrophoretic mobility of the inducible 40K peptide. These results are consistent with a model for vectorial oxidation of n-alkanes in the cytoplasmic membrane of P. putida.

Insertion element analysis and mapping of the Pseudomonas plasmid alk regulon

We characterized and mapped new mutations of the alk (alkane utilization) genes found on Pseudomonas plasmids of the Inc P-2 group. These mutations were isolated after (i) nitrosoguanidine mutagenesis, (ii) transposition of the Tn7 trimethoprim and streptomycin resistance determinant, and (iii) reversion of polarity effects of alk::Tn7 insertion mutations. Our results indicate the existence of two alk loci not previously described--alkD, whose product is required for synthesis of membrane alkane-oxidizing activities, and alkE, whose product is required for synthesis of inducible membrane alcohol dehydrogenase activity. Polarity of alk::Tn7 insertion mutations indicates the existence of an alkBAE operon. Mapping of alk loci by transduction in P. aeruginosa shows that there are at least three alk clusters in the CAM-OCT plasmid--alkRD, containing regulatory genes; alkBAE, containing genes for specific biochemical activities; and alkC, containing one or more genes needed for normal synthesis of membrane alcohol dehydrogenase. The alkRD and alkBAE clusters are linked but separated by about 42 kilobases. The alkC cluster is not linked to either of the other two alk regions. Altogether, these results indicate a complex genetic control of the alkane utilization phenotype in P. putida and P. aeruginosa involving at least six separate genes.

Transposition of DNA inserted into deletions of the Tn5 kanamycin resistance element

Tn5-trp hybrid transposons have been constructed by insertion of a trpPOED Hind III fragment into an in vivo Tn5 internal deletion mutant or by substitution of trp for the internal Tn5 Hind III fragment. These hybrids are called, respectively, Tn409 and Tn410. Both Tn409 and Tn410 will transpose into lambda in the presence of a complementing Tn5 element. In the absence of a wild Tn5, lysogens carrying R1162::Tn409 and R1162::Tn410 plasmids will yield lambdatrp phages at less than six per cent of the complemented frequency. This reduction indicates that Tn409 and Tn410 lack a diffusible transposition function provided by wild Tn5 elements. However, the formation of lambdatrp phages without complementation is real. Most of these transducing particles contain Tn409 and Tn410 still linked to the carrier R1162 plasmid. This observation suggests that uncomplemented Tn409 and Tn410 elements mediate the formation of lambda-transposon-plasmid cointegrate structures. Thus, the missing transposition function may be involved in resolving these cointegrate structures to the final lambda::Tn409 or lambda::Tn410 product.

Abnormal septal motion in patients with postoperative right bundle branch block pattern

Echocardiograms were performed on 25 patients with postoperative right bundle branch block pattern 3 to 93 months after surgery to assess the possible effects of abnormal cardiac excitation on septal motion. Each of the 25 patients demonstrated a unique pattern of septal motion characterized by the presence of an early systolic anterior septal notch, brief in duration and unrelated to subsequent systolic septal motion, right ventricular size, or surgical procedure. Beginning approximately 70 to 80 msec. after the initial QRS deflection, the septum abruptly moved anteriorly 2 to 7 mm. and then returned to a baseline position. The total duration of this abnormal septal motion lasted 78 to 155 msec. This echocardiographic pattern was not seen in any of 30 patients in two control groups. Twenty had a normal QRS pattern and ten demonstrated right ventricular hypertrophy. In addition, patients who underwent open heart surgery and had normal right ventricular conduction postoperatively did not show this echocardiographic pattern with either normal or paradoxical septal motion. This previously undescribed echocardiographic pattern demonstrates that septal motion is uniquely affected in patients with postoperative right bundle branch block pattern.

TOL is a broad-host-range plasmid

We readily isolated insertions of the carbenicillin resistance element Tn401 into the TOL plasmid in Pseudomonas putida. Hybrid TOL::Tn401 plasmids stably express the Cbr phenotype in Pseudomonas aeruginosa and Escherichia coli. Whereas the replicative and conjugative functions are expressed in both hosts, the ability to grow on m-toluate is only expressed in the Pseudomonas species.

Calcitonin therapy of children with osteogenesis imperfecta

Two children, ages 13 2/12 and 6 6/12 years, with osteogenesis imperfecta were treated with salmon calcitonin. During the course of therapy the older child developed calcitonin dose-related hypomagnesemia on two occasions. The younger child, coincident with otitis media and vomiting, developed hypomagnesemia, hypophosphatemia, hyponatremia, and hypokalemia. Since rib biopsies obtained before and after one year of treatment with salmon calcitonin failed to demonstrate any histologic changes, therapy was discontinued because of the induced metabolic consequences of calcitonin therapy.

Regulatory mutations of the Pseudomonas plasmid alk regulon

Pseudomonas putida strains with plasmids carrying pleiotropic alk mutations gave rise to alkane-positive "revertants," which differ from wild type. Some had restricted ability to utilize alkane and primary alcohol growth substrates, and others could grow on undecane and dodecanol, which are not utilized by alk+ strains. These revertants showed altered responses to normal inducers of alkA+, alkB+, and alkC+ activities. Some revertants were constitutive for these activities. Constitutive mutants could also be isolated directly from wild type, but they appeared spontaneously at a frequency of less than 2 X 10(-8). Regulatory mutations of all three types, pleiotropic negative, altered inducer specificity, and constitutive, were tightly linked in transduction crosses with a polar alkB mutation. These results demonstrate that the IncP-2 plasmid alk gene cluster constitutes a regulon. They also permit the identification of at least one cistron whose gene product participates in inducer recognition and suggest that the alkABC regulon is not under simple repressor control.

Fractionation of inducible alkane hydroxylase activity in Pseudomonas putida and characterization of hydroxylase-negative plasmid mutations

The plasmid-determined inducible alkane hydroxylase of Pseudomonas putida resolved into particulate and soluble fractions. Spinach reductase and spinach ferredoxin could replace the soluble hydroxylase component. Two alkane hydroxylase mutants show in vitro complementation (S. Benson and J. Shapiro, J. Bacteriol., 123: 759-760, 1975): one, alk-7, lacks an active soluble component and the other, alk-181, lacks an active particulate component. Together with previous results on a particulate alcohol dehydrogenase enzyme (Benson and Shapiro, J. Bacteriol., 126: 794-798, 1976), these results allowed us to assay three plasmid-determined inducible activities: soluble alkane hydroxylase (alkA+), particulate alkane hydroxylase (alkB+), and particulate alcohol dehydrogenase (alkC+). Growth tests and in vitro complementation assays revealed three groups of plasmid mutations that block expression of alkane hydroxylase activity: alkA, which so far includes only the alk-7 mutation; alkB, which includes alk-181 and 11 other mutations; and a pleiotropic-negative class, which includes nine mutations that lead to loss of alkA+, alkB+, and alkC+ activities. Thus, the alk+ gene cluster found on IncP-2 plasmids contains at least four cistrons. We believe it is significant that two of these determined the presence of membrane proteins. The accompanying paper shows that these loci are part of a single regulon.

Transposition of a beta-lactamase locus from RP1 into Pseudomonas putida degradative plasmids

The beta-lactamase gene from the RP1 plasmid transposes into at least two Pseudomonas putida degradative plasmids. Donor strains that carry RP1 (bla+ tet+ aphA+) and a degradative plasmid yield transconjugants that have only the bla+ marker of RP1. This occurs in up to 80% of all bla+ transconjugants. Segregation of the bla+ marker requires the presence of a degradative plasmid in the donor and is only observed in transconjugants that have received degradative markers. The bla+ tet aphA transconjugants show 100% linkage of bla+ to degradative markers in conjugation,transduction, and transformation crosses. A transduction cross of an (RP1), (SAL) donor shows that 8% of all SAL plasmids also carry the transposed bla+ marker. Tn401 is the name we assign to the bla+ transposon from RP1 observed in Pseudomonas. Its identity with the RP1 bla+ transposon observed in Escherichia coli is not known. In four cases, Tn401 has inserted into the camphor genes of the CAM-OCT plasmid.