Professional expertise of occupational therapists in community practice: results of an Ontario survey

This paper presents findings of a study, The Community Practice Project, that examined the situation of occupational therapists practising in community based settings in the province of Ontario, Canada in 1992. In addition to providing a profile of the typical community based therapist, the study considered issues relating to: the principal roles in places of employment; specific job skills and areas of professional expertise utilized in the community; and how well occupational therapists; formal training prepared them for their community oriented roles and tasks. Results indicate that great opportunities exist and job satisfaction is high in community settings. Nonetheless, therapists feel inadequately prepared for the new role of consultant and its concomitant skills in a field that has re-oriented itself toward the client and is increasingly focused on health promotion and disability prevention.

Pathways into the work force: antecedents of school and work force status

OBJECTIVE

The study aim was to identify risk factors for specific pathways into the work force using data from the Ontario Child Health Study Follow-up.

METHOD

Potential predictor variables were derived from data collected in 1983 on adolescents aged 13 to 16 years. The subjects were followed up 4 years later and the school/work force outcome was determined. Bivariate and multivariate statistical analyses were used to identify variables with a strong independent association with this outcome.

RESULTS

Subjects in the work force were four times more likely than those attending school to have come from a low-income family and at least two times more likely to have a family background of low maternal education, to have failed a grade, or to have used substances heavily during early adolescence. Subjects with two or more of these risk factors were likely to be in part-time work or unemployed.

CONCLUSIONS

Preventive interventions should be targeted at children from poor families, or who fail at school, or show early onset of substance abuse and other deviant behaviors. Studies are needed to further elucidate the relationship between these risk factors and pathways into the work force and beyond.

Cow's milk versus soy-based formula in mild and moderate diarrhea: a randomized, controlled trial

We determined the efficacy of a soy-based formula compared with a cow's milk formula in infant refeeding after acute diarrhea in a randomized controlled double-blind clinical trial. Infants 2-12 months of age with diarrhea of less than one week's duration and mild or moderate dehydration admitted to a pediatric hospital or in the practice of a participating primary care pediatrician were investigated. Seventy-six patients were enrolled and 73 completed the study; 39 infants received a soy-based formula (Isomil) and 34 received a cow's milk formula (SMA). Hospitalized patients were rehydrated with an oral glucose-electrolyte solution or an iv dextrose-sodium solution. Outpatients received oral glucose-electrolyte solution. In all patients, the study formula was commenced ad libitum during the first 24 h as determined by the attending pediatrician. The primary outcome measure was duration of diarrhea, defined as time to first normal stool, when subsequent stools were normal for a 24-h period. In addition, a predetermined secondary outcome was proportion of treatment failures, defined as the need to reinstitute clear fluids because of emesis, refusal to accept study formula, need for iv fluids due to negative fluid balance or diarrhea persisting beyond 7 days after enrollment. Total duration of diarrhea was significantly longer (p = 0.03) in those receiving cow's milk (mean +/- SD 6.6 +/- 4.2 days) than in those receiving soy-based formula (4.5 +/- 3.6 days). Volume of formula intake and weight gain at 14 days were not different in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Lack of evidence of Chlamydia pneumoniae infection in infants with acute lower respiratory tract disease

In order to determine whether there is serologic evidence of Chlamydia pneumoniae infection in young infants with acute lower respiratory tract infection, serum samples from 86 subjects aged less than 6 months were assayed for IgG and IgM antibodies to Chlamydia pneumoniae using a microimmunofluorescence method. Infants hospitalized in Toronto, Canada, were enrolled between 15 March 1991 and 15 March 1992. No patient had infection determined by the serologic results. IgG antibody was detected at low concentrations in 32 patients, with an inverse relationship between titer and chronological age. In our setting, Chlamydia pneumoniae does not appear to be an important lower respiratory pathogen in young infants.

Chromosomal translocation in T-cell leukemia line HUT 78 results in a MYC fusion transcript

Primary cultures and established cell lines derived from human T-cell leukemias were analyzed for genomic rearrangements in the region 3' of the MYC locus. A T-cell leukemia line, HUT 78, whose 3' MYC region is rearranged, carries a chromosome t(2;8) juxtaposition; i.e., a locus derived from chromosome region 2q34 is attached to the 3' end of one MYC allele. The t(2;8) rearrangement in the HUT 78 cell line results in expression of a fused transcript encompassing the MYC gene and a locus designated TCL4 (T-cell leukemia/lymphoma 4), which normally resides on chromosome 2. The steady-state level of MYC-TCL4 fusion transcripts in HUT 78 cells is significantly higher than the MYC RNA level found in several other B- and T-cell lines. The production of fused MYC-TCL4 transcripts in a leukemic cell line raises the possibility that other B- and T-cell leukemias may express MYC fusion transcripts as an integral step in their pathogenesis.

Prediction of human papilloma virus antigen in cervical squamous epithelium by koilocyte nuclear morphology and "wart scores": confirmation by immunoperoxidase

Koilocytes (balloon cells) in cervical squamous epithelium can be distinguished by their nuclear morphology as members of two populations A and B. The proposition that population A was infected with human papilloma virus (HPV) and population B was not, was examined immunohistologically. A peroxidase-antiperoxidase technique using polyclonal HPV antibody failed to support the hypothesis and showed small fractions of both populations to be infected with the virus (A = 5 of 25; B = 2 of 19). Nuclear morphology alone is thus inadequate to distinguish infected from non-infected koilocytes, or balloon cells. When a number of well established histological changes in squamous epithelia infected with HPV were examined, graded, and summated to obtain a "wart score," however, a reasonably accurate prediction of HPV infection emerged.

Temperature gradients in pigs during whole-body hyperthermia at 42 degrees C

Temperature was simultaneously measured by thermistors in multiple deep-body and peripheral sites in adult pigs heated continuously at 42 degrees C (rectal) and above for 4-24 h. During hyperthermia, the relations between different body temperatures were maintained and up to 1.0 degrees C separated temperature measurements at sites such as liver and bone marrow. These persistent temperature gradients must be borne in mind when evaluating tumor response in patients subjected to whole-body heating for disseminated cancer. Temperatures recorded by rectal, deep esophageal, or tympanic membrane sensors provided a reliable index of core temperature (including brain temperature) under equilibrium conditions at 42 degrees C, but only esophageal and tympanic sensors could safely be used to monitor the induction phase of hyperthermia and the adjustive changes in body-heat content required to stabilize core temperature during sustained hyperthermia. Pigs withstood repeated heating at 42 degrees C for 6 h, and recovered rapidly, but died after 24 h of hyperthermia. Pigs subjected to unrestrained heating died at 45 degrees C (esophagus).

Effects of ageing on the pharmacokinetics of pancuronium

The effects of age on the pharmacokinetics of pancuronium were investigated. The distribution volume of pancuronium did not appear to be age-dependent, but elimination of the drug decreased with increasing age. The clinical implications of these findings are discussed.

A pharmacodynamic model for pancuronium

It has been demonstrated that a simple two-compartment kinetic model may account for the changes in plasma concentration of pancuronium after i.v. administration. However, it can be shown that this simple model does not account satisfactory for the observed changes in muscle twitch response. By the addition of a receptor (biophase) compartment, twitch response can be reconciled with model behavior and the characteristics resemble those predicted by animal studies. The complete model is applied to the problem of total renal failure, and shows that patients with this condition are likely to be marginally resistant to small doses of pancuronium, with a normal rate of recovery. However, larger doses are likely to result in delayed recovery, the duration of effect increasing in a dose-dependent manner.

Inhalation anesthesia with methoxyflurane for guinea pig ear surgery

Anesthesia with methoxyflurane is ideal for long-term middle ear experiments on guinea pigs. This communication describes the use of a conventional pediatric anesthetic circuit that delivers a mixture of methoxyflurane and air by a face mask; it is effective, safe, and simple to use.

Pancuronium and the placental barrier

Maternal and cord levels of pancuronium were estimated using a fluorimetric method in a series of ten patients. Low concentrations of pancuronium (0-04--0-1 microng/ml) were found in all the cord samples analysed, indicating placental transfer of pancuronium.

Pharmacokinetic analysis using an electrical analogue

After i.v. administration, the distribution and elimination of many drugs may be simulated by a compartmental mathematical model. The analogue can be used to construct such models in electrical terms. When programmed with an appropriate model, the analogue can be used in a wide range of predictive studies. The application of the analogue is illustrated by analysis of serial plasma concentrations of fentanyl and pancuronium.

Pharmacokinetics of pancuronium in patients with normal and impaired renal function

Plasma concentrations of pancuronium were measured using a fluorimetric method in six patients with normal renal function and seven patients in chronic renal failure. A tow-compartment open model was used in the pharmacokinetic analysis of the data. With this model, the clearance of pancuronium was found to be reduced significantly in the patients with renal failure, and in these individuals the volume of the central (distribution) compartment was increased significantly. The clinical implications of these findings are discussed.