Functional analysis of aberrant behavior through measurement of separate response topographies

Functional analysis results for multiple topographies of aberrant behavior were graphed in an aggregate fashion and then separately for 48 clients. The results indicated that multiple topographies of behavior may be maintained by different contingencies. These results indicate that graphing functional analysis data in an aggregate fashion and then separately may improve the accuracy of their interpretation.

A qualitative analysis of family member needs and concerns in the population of patients with burns

The importance of family support to ameliorate the recovery of a patient with burns has been documented in the literature. However, there is a dearth of research that identifies family members' needs and concerns during the hospitalization of patients with burns. Study aims were as follows: (1) identify support needs and concerns of family members of adult and pediatric patients currently in a burn center and (2) explore the relationship between family needs and the patient's severity of injury. An observational design was used that incorporated semistructured interviews with family members 1 to 3 days after the burn. A convenience sample of family members of burn center patients (n = 97) was recruited over 9 months. Content analysis was used to establish themes from interview data. Interrater reliability on coding of thematic units from 15% of the interviews was 86%; discrepancies were corrected to 100%. The average family member was 42.3 years old, female, white, and at least a high school graduate. Family members' concerns included general patient concerns, physical concerns about the patient, satisfaction of personal needs, and psychologic concerns about the patient. Major sources of support were family and friends, burn center staff, and spirituality. Family members of pediatric patients identified pain and skin graft surgery as priority worries. Satisfaction of personal needs, financial support, and information needs were greater among family members of intensive care unit patients in comparison with step-down patients. These findings underscore the importance of communication and reassurance between the burn team and the family members. Alterations to the support provided to families can be made on the basis of study subjects' responses.

A covariance function for feed intake, live weight, and milk yield estimated using a random regression model

To enable investigation of genetic variation during early lactation in heifers, multitrait covariance functions were used to describe genetic covariances among feed intake, live weight, and milk yield during the first 15 wk of lactation (n = 628). Random regression models were used to estimate covariance functions for the additive genetic and permanent environmental effects. Fixed effects were date of the week that records were collected, a group effect, and week of lactation. Second or third order polynomials were sufficient to describe the additive genetic variation for milk yield, dry matter intake, and live weight during the first 15 wk of lactation. Estimates for the genetic covariance function demonstrated that a high milk yield is only moderately correlated with high feed intake (0.21) but is very strongly correlated to an increase of intake and a loss of live weight during the first 15 wk of lactation. Levels of weight and intake were correlated strongly (0.81). The reduced fit covariance function was used to estimate genetic correlations between traits at different lactation stages. Estimates for the genetic correlations between wk 1 and 15 were 0.62, 0.24, and 0.79 for milk yield, dry matter intake, and live weight, respectively. Feed intake during early lactation was negatively correlated with milk yield, but feed intake during the later weeks was positively correlated with milk yield. The implication is that when selection is for a linear combination of milk yield, feed intake, and live weight (i.e., energy balance or efficiency), it is important to consider when each trait is measured during lactation.

Laser hair removal: where are we now?

The hair removal market is evolving rapidly. The goal has always been long-term epilation. Success is dependent on understanding hair biology and physiology and on knowledge of laser physics, skin optics, and tissue preservation with respect to these emerging laser technologies. These topics will be reviewed, as will specific categories of laser systems in the hair removal arena and the clinical aspects of laser hair removal today.

Detection of pathological zinc accumulation in neurons: methods for autopsy, biopsy, and cultured tissue

It has been repeatedly shown that synaptically released zinc contributes to excitotoxic neuronal injury in ischemia, epilepsy, and mechanical head trauma. Such zinc-induced injury leaves an unmistakable "footprint" in the injured neurons, allowing an easy and unambiguous postmortem diagnosis. This footprint is the presence of weakly bound, histochemically reactive zinc in the cytoplasm of the perikaryon and proximal dendrites. Such staining appears to be a necessary and sufficient marker for zinc-induced neuronal injury. Here we show how to prepare and stain tissue from biopsy, autopsy, or experimental animal sources for maximal contrast and visibility of zinc-injured neurons.

The Workbook Portfolio: facilitating undergraduate student learning in the mental health clinical area

Undergraduate nursing students are confronted with a multitude of challenges during their mental health clinical placements. Many of the required skills are dissimilar to other areas of nursing and students must also develop the cognitive skills that influence the behavioural ones. However, mental health and mental health nursing are influenced and determined by a complex, and sometimes contradictory, range of external influences. Such ambiguity can be confusing for even the most experienced practitioner, let alone an undergraduate student. This article describes the use of a model that has been developed to assist the student in tackling such complex issues. The Workbook Portfolio has identifiable components that encourage the development of reflective and analytical skills. Our article explains the workings of this model in a fashion that allows other educators to utilise it to benefit students in the mental health setting.

A numerical approach to non-circular birdcage RF coil optimization: verification with a fourth-order coil

It is demonstrated that birdcage resonators, satisfying conditions of quadrature operation and radiofrequency field homogeneity, can be realized in practice on formers of non-circular cross section described by an equation of the form (x/a)n + (y/b)n = 1 where a and b are constants and n > or = 2 is an integer. Using a ladder network analogous to that of a conventional circular birdcage, optimization algorithms were employed to determine the elemental current distribution on the non-circular cylindrical surfaces. A comparison of circular, elliptical, symmetric and asymmetric fourth-order (n = 4) section birdcage current distributions is presented. A short, asymmetric fourth-order cage was constructed and tested experimentally at 3 T and compared with a conventional circular-section head coil.

Indomethacin inhibits expansion of experimental aortic aneurysms via inhibition of the cox2 isoform of cyclooxygenase

PURPOSE

Cyclooxygenase, either the cox1 or cox2 isoform, controls synthesis of prostaglandin E2 (PGE2), which regulates expression of matrix metalloprotease-9 (MMP-9). PGE2 and MMP-9 are elevated in aortic aneurysms. The mechanisms and time course of the inhibition of aneurysm expansion with a nonspecific cyclooxygenase inhibitor, indomethacin, were determined in an animal model.

METHODS

Rats underwent aortic perfusion with saline (n = 40) as controls or with elastase. Elastase-treated animals received no treatment (n = 82) or received indomethacin (n = 73). Aortic diameters were determined at the time of aortic perfusion and when the rats were killed. The aortas were harvested and used for whole organ culture, substrate gel zymography, or histologic analysis.

RESULTS

The control group demonstrated little change in aortic diameter. All the elastase-only animals developed aneurysms (maximal aortic diameter, 5.27 +/- 2.37 mm on day 14). Indomethacin markedly decreased the rate of aortic expansion (maximum aortic diameter, 3.45 +/- 1.11 mm; P <.001 vs the elastase-only group). The enzyme-linked immunosorbent assay of aortic explant culture media showed that PGE2 synthesis paralleled aortic expansion, and indomethacin decreased PGE2 synthesis. Histologically, the aortic elastin architecture was destroyed in the elastase group, but was preserved with indomethacin treatment. In situ, hybridization for cox1 and cox2 showed that cox2, but not cox1, was expressed and was co-localized by immunohistochemistry to macrophages associated with the aortic wall. Decreased levels of MMP-9 activity with indomethacin were shown by means of substrate zymography. MMP-9 was also localized to macrophages.

CONCLUSION

Indomethacin attenuates aneurysm growth, and its effects are mediated via inhibition of the cox2 isoform of cyclooxygenase, which decreases PGE2 and MMP-9 synthesis.

Pediatric liver disease

Pediatric hepatology has advanced greatly over the past few years. Many more children with severe liver disease are now surviving into adulthood. There is a number of conditions not seen in adult practice that have been the focus of research efforts, and many of these efforts have borne fruit in the past year. Disorders characterized by intrahepatic cholestasis in particular have now been substantially unravelled, and this work has elucidated a great deal about hepatic physiology. Liver-directed gene therapy is on the threshold of human application. This research has been facilitated by excellent animal models and the advent of isolated hepatocyte transplantation. Relatively common conditions such as biliary atresia, however, remain largely unexplained and the viral hepatitides have no effective form of treatment. It remains a hope that our increase in knowledge in the fields of genetics and immunology will translate into advances in therapy.

Rationalizing rural hospital services in Kazakstan

The Soviet health care system placed great emphasis on specialist hospitalization. Primary care, in contrast, was viewed primarily as prophylactic and also identified patients for admission to hospital. This led to long lengths of stays, since patients were provided with outpatient type care in hospital, and unnecessary admissions. The reduction in funding for the health system has exacerbated the top heavy nature of the system and made restructuring of the sector essential. Rural areas in Kazakstan follow a similar structure to other parts of the former Soviet Union. In 1996 a project was undertaken to review the provision of hospital services in one rural rayon (district) just outside Almaty. The approach taken was to emphasize the relationship between activity and financial data. It did this by analysing the link between clinical decisions taken to reduce lengths of stay, management decisions to modify staffing and costs of care. It was shown that substantial savings could be made together with improvements in the quality of care, through a programme of planned restructuring. Some success in inducing change is reported but without a major change in approach to local level management. In order to achieve changes it is important that short and long term alternatives to hospitalization are developed.

Home care of the elderly with mental health needs

A King's Fund report on mental health in London (1997) highlighted the difficulty of adequately meeting the needs of older people with mental health problems. This article describes the work of the home nursing team, a London project that aims to provide appropriate care for this group of clients during the acute phase of their illness. The six-member mixed-grade nursing team provides care in the client's own home, providing an alternative to hospital admission. The team aims to be sensitive to the needs and wishes of clients and involve them in decisions about their care. Team members work closely with carers and other services, ensuring continuity of care.

Genetic and environmental smoothing of lactation curves with cubic splines

Most approaches to modeling lactation curves involve parametric curves with fixed or random coefficients. In either case, the resulting models require the specification on an underlying parametric curve. The fitting of splines represents a semiparametric approach to the problem. In the context of animal breeding, cubic smoothing splines are particularly convenient because they can be incorporated into a suitably constructed mixed model. The potential for the use of splines in modeling lactation curves is explored with a simple example, and the results are compared with those using a random regression model. The spline model provides greater flexibility at the cost of additional computation. Splines are shown to be capable of picking up features of the lactation curve that are missed by the random regression model.

The validity of dietary assessment in general practice

OBJECTIVE

To validate a range of dietary assessment instruments in general practice.

METHODS

Using a randomised block design, brief assessment instruments and more complex conventional dietary assessment tools were compared with an accepted "relative" standard--a seven day weighed dietary record. The standard was checked using biomarkers, and by performing test-retest reliability in additional subjects (n = 29).

OUTCOMES

Agreement with weighed record. Percentage agreement with weighed record, rank correlation from scatter plot, rank correlation from Bland-Altman plot. Reliability of the weighed record.

SETTING

Practice nurse treatment room in a single suburban general practice.

SUBJECTS

Patients with risk factors for cardiovascular disease (n = 61) or age/sex stratified general population group (n = 50).

RESULTS

Brief self completion dietary assessment tools based on food groups caten during a week show reasonable agreement with the relative standard. For % energy from fat and saturated fat, non-starch polysaccharide, grams of fruit and vegetables and starchy foods consumed the range of agreement with the standard was: median % difference -6% to 12%, rank correlation 0.5 to 0.6. This agreement is of a similar order to the reliability of the weighed record, as good as or better than test standard agreement for more time consuming instruments, and compares favourably with research instruments validated in other settings. Under-reporting of energy intake was common (40%) and more likely if subjects were obese (body mass idex (BMI) > or = 30 60% under-reported; BMI < 30 29%, p < 0.001).

CONCLUSION

Under-reporting of absolute energy intake is common, particularly among obese patients. Simple self assessment tools based on food groups, designed for practice nurse dietary assessment, show acceptable agreement with a standard, and suggest such tools are sufficiently accurate for clinical work, research, and possibly population dietary monitoring.

Reduced immunotoxicity and preservation of antibacterial activity in a releasable side-chain carbapenem antibiotic

A carbapenem antibiotic, L-786,392, was designed so that the side chain that provides high-affinity binding to the penicillin-binding proteins responsible for bacterial resistance was also the structural basis for ameliorating immunopathology. Expulsion of the side chain upon opening of the beta-lactam ring retained antibacterial activity while safely expelling the immunodominant epitope. L-786,392 was well tolerated in animal safety studies and had significant in vitro and in vivo activities against methicillin- and vancomycin-resistant Staphylococci and vancomycin-resistant Enterococci.

Importance of format and design in print patient information

PURPOSE

The purposes of this descriptive study were to: identify characteristics of print education materials that healthcare providers report as important to patients; compare whether Physician Data Query (PDQ) information that was provided in its original form, or was redesigned in color and black and white, influenced the distribution of this information; and explore whether providing PDQ information via patient information racks would increase patients' awareness of and use of PDQ information.

DESCRIPTION OF STUDY

Forty-four oncology healthcare professionals were asked to complete a survey identifying characteristics that they believed important for effective print educational materials. PDQ statements were reformatted and placed in brochure racks for a 6-month period. The number of statements distributed before and after this time period were compared. Subsequently, PDQ statements were placed sequentially for a 3-week period in brochure racks in the following formats: original form as printed from the computer, redesigned with color print; and redesigned with black ink only.

RESULTS

The following characteristics were rated "very important" aspects of print educational materials by oncology healthcare professionals: appropriate reading level; clarity; credibility of the information; whether information is current/up-to-date; and patient acceptance of material. The characteristic receiving the fewest "very important" marks was attractiveness/eye appeal. The reported low marks on attractiveness/eye appeal contradict the concurrent findings that, after the redesign of PDQ statements (change in booklet size, use of color, increase in foot size for text and headings, and inclusion of a vertical bar to separate columns), there was a ninefold increase in the number PDQ statements distributed. Eighty-nine percent of the statements distributed were the redesigned version. The use of color, however, did not appear to make a difference in the number of PDQ statements disseminated after the redesign.

CLINICAL IMPLICATIONS

In developing print education materials for cancer patients, the format, design, and placement of materials for patient access need to be considered. There are many valuable educational materials available on computer databases. Downloading the information and placing it in a brochure format may be an ideal approach for providing access to this information. Furthermore, because physicians and nurses have different priorities for printed patient education materials, it is important to involve both groups in the developments of the brochures.

Feasibility of vermicomposting dairy biosolids using a modified system to avoid earthworm mortality

A laboratory study was conducted to examine the feasibility of vermicomposting dairy biosolids (dairy sludge), either alone or with either of the bulking agents-cereal straw or wood shavings, using the epigeic earthworm-Eisinea andrei. Earthworms added directly to these three substrates died within 48 hours. A system was developed to overcome the toxic effect of unprocessed dairy biosolids. The substrates were placed over a layer of vermicomposted sheep manure into which the earthworms were inoculated. Within two weeks, all earthworms were within the upper layer of substrate. Compared to sheep manure which is a favourable substrate for vermicomposting, the three substrates containing dairy biosolids were more effective in supporting earthworm growth and reproduction. The final products obtained after 63 days of vermicomposting had 39-53% less organic carbon than the initial substrates. Organic fractionation indicated that vermicomposting increased the stability of the materials to biological decomposition. The vermicomposts obtained from the three substrates with dairy biosolids had low heavy metal contents and electrical conductivities, and did not inhibit plant growth when compared with a commercial vermicompost in a bioassay.

The Genome Sequence DataBase: towards an integrated functional genomics resource

During 1998 the primary focus of the Genome Sequence DataBase (GSDB; http://www.ncgr.org/gsdb ) located at the National Center for Genome Resources (NCGR) has been to improve data quality, improve data collections, and provide new methods and tools to access and analyze data. Data quality has been improved by extensive curation of certain data fields necessary for maintaining data collections and for using certain tools. Data quality has also been increased by improvements to the suite of programs that import data from the International Nucleotide Sequence Database Collaboration (IC). The Sequence Tag Alignment and Consensus Knowledgebase (STACK), a database of human expressed gene sequences developed by the South African National Bioinformatics Institute (SANBI), became available within the last year, allowing public access to this valuable resource of expressed sequences. Data access was improved by the addition of the Sequence Viewer, a platform-independent graphical viewer for GSDB sequence data. This tool has also been integrated with other searching and data retrieval tools. A BLAST homology search service was also made available, allowing researchers to search all of the data, including the unique data, that are available from GSDB. These improvements are designed to make GSDB more accessible to users, extend the rich searching capability already present in GSDB, and to facilitate the transition to an integrated system containing many different types of biological data.

Interferon-gamma and interleukin-4 responses in relation to serum IgE levels in persons infected with human T lymphotropic virus type I and Strongyloides stercoralis

Possible immunologic interaction between infection with human T lymphotropic virus type 1 (HTLV-1), a retrovirus, and the intestinal parasite Strongyloides stercoralis was investigated in persons infected with one or both agents. This was done by examining the cytokine responses of peripheral blood mononuclear cells (PBMC) to mitogens and Strongyloides antigen. PBMC of subjects infected with HTLV-1 spontaneously produced interferon (IFN)-gamma with levels that correlated inversely with serum IgE levels. HTLV-1-infected subjects also had poor interleukin (IL)-4 responses to mitogenic stimulation, unlike persons without HTLV-1 infection. It is postulated that the IFN-gamma produced by activated T cells in some HTLV-1-infected persons acts to down-regulate IL-4 with consequent reduction of serum IgE levels. The impaired IgE responses and other effects of IL-4 down-regulation may be contributing factors to more severe disease and impaired response to treatment of strongyloidiasis in some HTLV-1-infected persons.

A maize FK506-sensitive immunophilin, mzFKBP-66, is a peptidylproline cis-trans-isomerase that interacts with calmodulin and a 36-kDa cytoplasmic protein

A member of a eukaryotic gene superfamily, encoding a peptidylproline cis-trans-isomerase (rotamase) has been isolated from a maize (Zea mays L. A69Y+) endosperm cDNA library. The maize sequence (mzFKBP-66) encodes a 66-kDa polypeptide most closely related to the subclass of rotamases which bind an immunosuppressive drug, FK506, (termed FK506-binding proteins FKBPs), and possesses four tandem copies of the FKBP-like binding domain. The sequence mzFKBP-66 is expressed ubiquitously in the maize plant, and the protein encoded is present in both cytosolic and nuclear compartments within the cell. Both the native mzFKBP-66 and a recombinant protein overexpressed in Escherichia coli showed peptidylproline cis-trans-isomerase (PPIase) activity at rates comparable to those reported for mammalian immunophilins. This activity was also sensitive to inhibition by FK506. Immunoaffinity chromatography using anti-mzFKBP66 demonstrated an association of the protein with an unknown 36-kDa polypeptide, and affinity chromatography of mzFKBP-66 on calmodulin-agarose beads indicated the presence of a calmodulin-binding site. The existence of mzFKBP-66-associated proteins suggests that plant immunophilins may act as part of multicomponent complexes, as has been shown for other representatives of this class of enzyme.

Health insurance as a catalyst to change in former communist countries?

A large number of former communist countries are currently undergoing a process of insurance led health sector change. Social health insurance is seen as a major source of income for the health sector, as a way of inducing fundamental restructuring of provision and of encouraging greater individual awareness of the costs (and benefits) of publicly financed health care. Attempts to introduce social medical insurance have generally been criticized by western policy analysts yet continue to have much appeal in each country. Obtaining additional revenue for the health sector is clearly a major motivation for these reforms. Yet available evidence suggests that many countries will obtain revenue that is lower and less stable than envisaged. For some countries other reasons for insurance may be as important. One of the most important is the greater autonomy given to the national Ministry of Health and local health departments over expenditure allocation. Recent experience of voluntary insurance in Turkmenistan confirms many of the fears about the feasibility and impact of social health insurance. Yet establishing an attractive but contained benefits package has been popular with the population and offers a potentially useful approach for inducing more fundamental reform.

Latex allergy in operating room nurses

OBJECTIVE

To determine the prevalence of allergy to natural rubber latex and potential crossreacting foods in operating room nurses.

METHOD

Two hundred forty-seven operating room nurses completed a latex allergy questionnaire. They were questioned about symptoms of latex reactivity and about other allergies particularly to foods that may crossreact with latex. Informed consent was obtained and skin prick testing was performed with natural rubber latex and five latex extracts representing low (0.08 to 0.25 microgram/mL) and high (18 to 106 micrograms/mL) natural rubber latex protein gloves. Skin prick tests were done with four potentially crossreacting foods (banana, avocado, kiwi, and potato), saline, and histamine controls.

RESULTS

One hundred thirty-five (54.7%) nurses described allergic symptoms they attributed to latex exposure. Of these 12 (4.9%) tested positive to latex extracts alone, 12 (4.9%) tested positive to food extracts alone, and 5 (2.0%) tested positive to both latex and crossreactive foods. Three of the 17 (17.6%) nurses testing positive to latex gave no history of reactivity to latex. Indirect latex ELISA was done on the serum of skin test-positive patients with a 70.6% sensitivity.

CONCLUSION

Of the nurses tested, 6.9% had positive skin prick tests to latex extracts; 17.6% of these were asymptomatic and 29.4% had associated food positive skin prick tests.