Preference and performance measures of handedness

Handedness cannot be predicted using a single performance measure, and preference measures of handedness are unreliable because of their subjectivity. This report was designed to examine the relationship between hand performance and hand preference using six different measures: the Waterloo Handedness Questionnaire (a measure of hand preference), the Wathand Box (a performance-based indicator of hand preference), two pegboard tasks, finger tapping, and grip strength and to determine the most accurate performance-based predictor of hand preference as measured by the Waterloo Handedness Questionnaire. Multiple linear regression analysis showed that together, the Wathand Box score and the lateralized place phase of the grooved pegboard task were the most accurate predictors of hand preference.

Fatal anaphylaxis following jack jumper ant sting in southern Tasmania

The "jack jumper" ant (Myrmecia pilosula) is a major cause of anaphylaxis in Tasmania. We describe four deaths attributed to stings by this ant between 1980 and 1999. All victims were men aged 40 years or over with significant comorbidities; two were taking angiotensin-converting enzyme inhibitors, which may increase risk of severe anaphylaxis. Three victims had known ant-sting allergy, but only one carried adrenaline, which he did not use. Another believed he was protected by previous attempts at hyposensitisation with whole ant-body extract. There is potential to prevent deaths by careful education of people with known allergy, prescribing of adrenaline for auto-injection and development of an effective hyposensitisation therapy.

Nothing is going to stop me now: obstacles perceived by low-income women as they become self-sufficient

As low-income women struggle to become self-sufficient, they encounter many obstacles. The literature identifies physical and mental health problems, inadequate childcare, inadequate occupational skills, lack of transportation, criminal histories, and limited educational abilities as major barriers to be overcome in this transition. Qualitative data collected from low-income women attending Innovative Alternatives for Women, an occupational skills and health information training center which was developed and implemented by a nurse, refutes several of the previously identified obstacles. Inadequate childcare and transportation were not seen as barriers to success by the program participants, but were viewed as socially acceptable reasons for not working. Eight obstacles were identified by the program participants as being the real reasons for their lack of success. The identified obstacles included the following: lack of self-esteem, especially relating to school; "bad" relationships with men; lack of support from family and friends; limited life options; lack of training for nonwelfare recipients; lack of quality programs; criminal histories; and fear of success.

Plasma alkalinization for tricyclic antidepressant toxicity: a systematic review

OBJECTIVE

To review the evidence that plasma alkalinization improves the outcome in tricyclic antidepressant toxicity.

METHODS

Medline search from 1966 to October 2000 (articles in all languages were included) and examination of bibliographies. Published papers including animal studies, in vitro studies, human case reports, case series and retrospective studies were reviewed.

RESULTS

Our search identified 115 publications, all of which were retrieved. Human studies included eight case reports, four case series, one controlled study and two retrospective chart reviews. No randomized controlled human trials were found. Twelve animal studies were identified that investigated pH manipulation or saline load and their effects on physiological parameters in tricyclic antidepressant toxicity.

CONCLUSIONS

The practice of alkalinization for tricyclic antidepressant toxicity is based on animal studies, case reports and opinion. The mechanism of action appears to be multifaceted and may vary between different tricyclic antidepressants. Significant interspecies variation makes extrapolation from animal studies to humans difficult. Alkalinization therapy appears reasonable in patients with compromising dysrhythmias and shock when supportive interventions have been ineffective; however, the available evidence does not support prophylactic alkalinization in the absence of life-threatening cardiovascular toxicity.

Effect of ambulance 12-lead ECG recording on times to hospital reperfusion in acute myocardial infarction

OBJECTIVE

To review the evidence that recording a prehospital 12-lead electrocardiogram (ECG) reduces time from hospital arrival to initiation of reperfusion therapy for acute myocardial infarction (AMI).

DATA SOURCES

Medline search from 1966 to the present (articles in all languages) and examination of bibliographies.

STUDY SELECTION

Published studies of prehospital 12-lead ECG recording that included control groups and reported time intervals from hospital arrival to start of reperfusion therapy.

DATA EXTRACTION

Eight articles satisfied selection criteria (two randomised controlled trials, four non-randomised interventional studies and two prospective observational studies).

DATA SYNTHESIS

Widely varying study methodologies precluded meta-analysis. All studies had methodological problems, but hospital delays were consistently reduced. Such improvements appear to be small in hospitals where delays are already minimal.

CONCLUSIONS

Little evidence is available to support routine prehospital 12-lead ECG recording if the median hospital time to reperfusion is already less than 30 minutes. Improvement of in-hospital treatment times may be a better initial strategy than prehospital 12-lead ECG recording, as this will benefit more patients and allow ambulance services to better allocate their available resources.

Selectivity of diadenosine polyphosphates for rat P2X receptor subunits

The pharmacological activity of diadenosine polyphosphates was investigated at three recombinant P2X receptors (rat P2X1, rat P2X3, rat P2X4) expressed in Xenopus oocytes and studied under voltage-clamp conditions. For the rat P2X1 receptor, only P1,P6-diadenosine hexaphosphate (Ap6A) was a full agonist yet 2-3 folds less potent than ATP. At rat P2X3, P1,p4-diadenosine tetraphosphate (Ap4A), P1,P5-diadenosine pentaphosphate (Ap5A) and Ap6A were full agonists and more potent than ATP. Ap4A alone was equipotent with ATP at rat P2X4, but only as a partial agonist. Compared to known data for rat P2X2 and human P2X1 receptors, our findings contrast with rat P2X2 where only Ap4A is a full agonist although four folds less potent than ATP. At rat and human orthologues of P2X1, Ap5A was a partial agonist with similar potency. These data provide a useful basis for selective agonists of P2X receptor subunits.

Enhancing early discharge with home follow-up: a pilot project

Although early hospital discharge of mothers and infants reduces health care costs, it also decreases the opportunities for women to learn the mothering role with the help of health care providers. This article describes the development of a program in which hospital staff nurses provide follow-up care to new mothers and their infants in the home. In addition, it compares the nonroutine health care expenditures in the postpartum period of mother-infant dyads receiving this service and of dyads who did not.

High-dose chemotherapy, autologous bone marrow or stem cell transplantation and post-transplant consolidation chemotherapy in patients with advanced breast cancer

This study was designed to determine the complete response (CR) rate, event-free survival (EFS) and overall survival (OS) in patients with metastatic breast cancer treated with an adriamycin-based induction regimen, high-dose chemotherapy consisting of cyclophosphamide and thiotepa with autologous bone marrow or stem cell reinfusion, followed by post-transplant 5-fluorouracil and cisplatin. Forty-eight consecutive patients were enrolled and 35 received two to four cycles of a cytoreductive chemotherapy regimen followed by high-dose chemotherapy which included cyclophosphamide and thiotepa. Thirty-three patients with non-progressive disease received at least one cycle of post-transplant 5-fluorouracil and cisplatin. Fifty percent of patients with evaluable disease responded to induction chemotherapy. Three of the 34 patients (9%) evaluable for response to high-dose chemotherapy achieved CR, eight (24%) achieved partial response (PR), 12 (35%) had stable disease (SD) and 11 (32%) had progressive disease (PD). The median time to neutrophil recovery was 11.5 days (range, 8 to 40 days) post- reinfusion. The median time to platelet independence was 14.5 days (range, 8 to 44 days). The median follow-up is 24.5 months (range, 1 to 96 months). The actuarial probability of EFS for all patients is 17% at 4 years. The EFS for patients receiving all four cycles of post-transplant chemotherapy is 27% at 4 years, compared to 36% at 1 year for patients not receiving any post-transplant chemotherapy. Ten of the 48 patients (21%) are alive, and seven of these (15%) have no evidence of disease. High-dose chemotherapy with autologous bone marrow or peripheral blood-derived stem cell transplantation followed by post-transplant consolidation chemotherapy in patients with metastatic breast cancer results in a proportion of patients without evidence of disease at 4 years.

Transrectal ultrasound guided manipulation of the canine prostate with minimum intervention

The canine prostate is a widely used and well established animal model for the assessment of therapeutic effects of laser technology in the search for better options for the treatment of benign prostatic hyperplasia. Conventionally for such experiments, the canine prostate is approached by laparotomy or transperineal urethrotomy. We have demonstrated a technique involving the use of ultrasound guided biopsy of the liver and prostate, and percutaneous laser treatment of the prostate, which has proved to be effective in reducing adverse effects on the experimental animals but without compromising scientific requirements for the experiments. We conclude that state-of-the-art percutaneous procedures not only refine animal intervention significantly but are also technically feasible for most laser studies using the canine prostate as an experimental model in the live animal.

Incorporating political socialization theory into baccalaureate nursing education

Political socialization theory explains how an individual develops a political belief system. As the health care system undergoes dramatic changes, nursing faculty should use political socialization theory to enhance the education of student nurses. A political thread can be woven through the nursing curricula, and students can be socialized to the political role. The new generation of nurses must incorporate a political component into their professional role identity. Political socialization theory can guide nursing faculty as knowledge of the political system and political skills are incorporated into nursing curricula.

Sequential changes in serum iron and ferritin in patients undergoing high-dose chemotherapy and radiation with autologous bone marrow transplantation: possible implications for treatment related toxicity

In an effort to define the pattern of iron flux during high-dose chemotherapy or chemo/radiotherapy, we prospectively measured serum iron, iron binding capacity, and ferritin in patients undergoing autologous bone marrow transplantation for various malignancies. Sequential measurement of serum iron from days -7 to +12 was carried out in 88 evaluable patients, and simultaneous measurement of iron, ferritin, and total iron binding capacity was carried out in 32 patients. We found that there was a predictable rise in serum iron on day -2 or -3, and that this was accompanied by an increase in the saturation of transferrin. In addition, there was a similar increase in serum ferritin levels, which peaked by day +2. We suggest that the timing of this change in serum iron and saturation of transferrin may be important in mediating endothelial cell damage and, hence, organ toxicity in the setting of AuBMT. Based on these findings, we suggest that large clinical studies could be a source of patient samples to measure surrogate endpoints such as lipid peroxidation products (malondialdehyde or isoprostanes), or protein oxidation products following high-dose chemo/radiotherapy to determine the role of iron in cellular injury. It is possible that pharmacological manipulations to reduce free radical production or to chelate iron during the days prior to bone marrow reinfusion might help to reduce tissue injury in the setting of bone marrow transplantation.

Competition of Li(I) and Mg(II) for ATP binding: a 31P NMR study

We have examined the changes in the 31P NMR chemical shifts of ATP in aqueous solution, upon addition of NaCl and LiCl at ambient temperature. NaCl and LiCl cause qualitatively similar downfield changes, although the effect of LiCl is somewhat larger. For a 2:1 mixture of Na-ATP or tris-ATP and MgCl2 at 0 degrees C, separate beta-P peaks are observed for uncomplexed ATP and ATP complexed with Mg(II) at 121.6 MHz. Addition of LiCl slightly shifts the uncomplexed Na-ATP or tris-ATP peak downfield but does not measurably shift the Mg-ATP peak or change relative intensities. Thus, Li behaves more like Na than Mg in its ATP complexation behavior, making this system a poor model for competition between Li and Mg for macromolecular binding.

Recanalization of tube overgrowth: a useful new indication for laser in palliation of malignant dysphagia

Overgrowth of an esophageal prosthesis by cancer is a late complication of insertion which presents a difficult management problem. We have treated 14 such patients; 9 had Celestin tubes and 5 Atkinson tubes in situ for a median of 7 months. The median patient age was 75 years; 3 had squamous cell carcinomas and 11 adenocarcinomas; 12 were at the lowest thoracic esophagus or cardia, and 2 were anastomotic. Eleven tubes were overgrown at the top, two at the bottom only, and one at both ends. Dysphagia was graded from 0 to 4 (0 = normal; 4 = dysphagia for liquids). All patients but one improved with treatment. The median pre-treatment grade was 4 (range, 2 to 4) and post-treatment was 2 (0 to 3). This improvement was significant (p less than 0.01) Wilcoxon-signal rank). Most patients required only one or two endoscopies. The median survival was 9 weeks from first laser session (range, 3 to 36 weeks). We feel these results justify laser treatment in most patients in whom cancer overgrowth causes blockage of an esophageal prosthesis.

Plasma antigen levels of the lipoprotein-associated coagulation inhibitor in patient samples

Human plasma contains an inhibitor of tissue factor-initiated coagulation known as the lipoprotein-associated coagulation inhibitor (LACI) or also known as the extrinsic pathway inhibitor (EPI). A competitive fluorescent immunoassay was developed to measure the plasma concentration of LACI in samples from normal individuals and patients with a variety of diseases. The LACI concentration in an adult control population varied from 60% to 160% of the mean with a mean value corresponding to 89 ng/mL or 2.25 nmol/L. Plasma LACI levels were not decreased in patients with severe chronic hepatic failure, warfarin therapy, primary pulmonary hypertension, thrombosis, or the lupus anticoagulant. Plasma LACI antigen was decreased in some, but not all patients with gram-negative bacteremia and evidence for disseminated intravascular coagulation. Plasma LACI levels were elevated in women undergoing the early stages of labor (29%), in patients receiving intravenous tissue-type plasminogen activator (45%), and in patients receiving intravenous heparin (375%). A radioligand blot of the pre- and post-heparin plasma samples shows the increase to be in a 40-Kd form of LACI. Very low levels of plasma LACI antigen were found in patients with homozygous abetalipoproteinemia and hypobetalipoproteinemia, diseases associated with low plasma levels of apolipoprotein B containing lipoproteins. Following the injection of heparin into one patient with homozygous abetalipoproteinemia, the plasma LACI antigen level increased to a level comparable with that in normal individuals after heparin treatment.

Concentration of vitamin B6 and activities of enzymes of B6 metabolism in the blood of alcoholic and nonalcoholic men

The purpose of this study was to compare concentrations of vitamin B6 compounds and the activities of enzymes that synthesize or catabolize pyridoxal 5'-phosphate in the plasma and erythrocytes of nonalcoholic and alcoholic subjects. Blood was obtained from male nonalcoholics and chronic alcoholics with minimal liver damage and normal hematology. Plasma, erythrocyte, and urinary B6 compounds were analyzed by high performance liquid chromatography, and pyridoxal phosphate was also measured enzymatically. Erythrocyte pyridoxine kinase and pyridoxine phosphate oxidase and erythrocyte and plasma pyridoxine phosphate phosphatases were assayed. Plasma pyridoxal phosphate concentration was significantly lower in the alcoholics (31.3 +/- 3.6 nmol/liter) than in the nonalcoholics (58.7 +/- 7.5 nmol/liter). The concentrations of the other B6 compounds in plasma, erythrocytes, and urine were not different in the two groups. Plasma alkaline pyridoxine phosphate phosphatase activity was significantly higher in the alcoholics (4.05 +/- 0.36 nmol/(h.mg] than in the nonalcoholics (3.01 +/- 0.18 nmol/(h.mg]. The activities of erythrocyte kinase, oxidase, and phosphatases were not significantly different in the two groups. The relationship of plasma pyridoxal phosphate concentration to its metabolites and the activities of the enzymes involved in its metabolism was determined. Plasma pyridoxine phosphate phosphatase activity assayed at pH 9.0 or 7.4 correlated negatively with plasma pyridoxal phosphate concentration. The low pyridoxal phosphate concentration observed in the plasma of the alcoholic subjects may in part be related to increased plasma phosphatase activity.