Associations between clinic-referred boys and their fathers on childhood inattention-overactivity and aggression dimensions

The question asked in this study of 70 clinically referred 6- to 12-year-old boys with behavior problems was whether or not childhood inattention-overactivity and aggression are transmitted specifically from biological fathers to sons. Fathers' self-reported childhood inattention-overactivity on a retrospectively valid measure was exclusively associated with parents' ratings of their sons' current attention problems on the Mothers' Operational Measure for Subgrouping (MOMS), the Revised Child Behavior Checklist (RCBCL), and an approximated DSM-IV inattention dimension. Fathers' self-reported childhood aggression was not associated with ratings of their sons' aggression on the MOMS or DADS (a parallel instrument for fathers), nor on DSM-III oppositional or conduct disorder dimensions, but it was exclusively associated with RCBCL ratings of sons' aggressive and delinquent behavior. None of the nonspecific correlations (father inattention-overactivity with son aggression or father aggression with son inattention-overactivity) was significant.

Senior house officers in medicine: postal survey of training and work experience

OBJECTIVES

To describe working conditions for senior house officers in medicine in Scotland and to relate these to the quality of clinical training they receive.

DESIGN

Postal questionnaire survey.

SUBJECTS

All senior house officers in medicine and related specialties in post in Scotland in October 1995 (n = 437); 252 (58%) respondents.

MAIN OUTCOME MEASURES

Questionnaires covered hours, working patterns, measures of workload, an attitudes to work scale, and experience of education and training.

RESULTS

In the week before the questionnaire, doctors on rotas had worked a mean of 7.4 (95% confidence interval 5.8 to 9.0) hours in excess of their contracts, compared with 3.7 (2.0 to 5.5) hours for those on partial shifts. The most common reason for this was "the needs of the patients or the service." Those on partial shifts reported significantly less continuity of care with patients than those on rotas (Mann-Whitney U test, z = -4.2, P < 0.0001) or full shifts (z = -2.08, P = 0.03). Doctors in general medicine reported significantly higher measures of workload (number of acute admissions, number of times called out, and fewest hours' uninterrupted sleep) than those in subspecialties. Consultants' clinical teaching and style of conducting a ward round were significantly related to factors extracted from the attitudes to work scale.

CONCLUSIONS

The quality of senior house officers' training is detrimentally affected by a variety of conditions, especially the need for closer support and supervision, the need for greater feedback, and the lack of time that consultants have to dedicate to clinical training. Efforts should be made to improve these conditions and to reinforce a close working relationship between trainee and supervising consultant.

Cysteine biosynthesis in higher plants: a new member of the Arabidopsis thaliana serine acetyltransferase small gene-family obtained by functional complementation of an Escherichia coli cysteine auxotroph

A cDNA clone, Sat-52, encoding a novel isoform of serine acetyltransferase (EC 2.3.1.30) was isolated by functional complementation of an Escherichia coli cysE mutant defective in serine acetyltransferase. The 1158 base pair clone contains a full-length open reading frame encoding a deduced protein of 312 amino acids with an M(r) of 32.77 kDa. Northern analysis revealed a single transcript of ca 1.19 kb that did not increase in abundance under sulfate limitation. Genomic Southern hybridization suggests the presence of a single copy of the Sat-52 gene.

Eliciting parental report following pediatric traumatic brain injury: preliminary findings on the Pediatric Inventory of Neurobehavioral Symptoms

The current article presents preliminary normative data for the Pediatric Inventory of Neurobehavioral Symptoms (PINS), a parent rating scale consisting of symptoms associated with post-traumatic cerebral dysfunction, such as disinhibition, perseveration, reduced spontaneity, inappropriate affective responses, episodic phenomena, and disruptions of biologic function. Comparison data from a sample of 50 elementary age children who had sustained traumatic brain injury (TBI) reveals significant differences on the PINS total score and each of five subscale scores. Two of the 5 PINS subscales (Episodic Symptoms, Biologic Signs) significantly differentiated the TBI and Attention Deficit Hyperactivity Disorder (n = 35) groups, suggesting that these may be clinical features that distinguish post-traumatic cerebral dysfunction from developmental psychopathology. Despite the need for additional research, the PINS appears to be a promising new measure in advancing our understanding of the neurobehavioral sequelae of pediatric traumatic brain injury.

Influenza vaccination of health care workers in long-term-care hospitals reduces the mortality of elderly patients

Vaccination of health care workers (HCWs) is recommended as a strategy for preventing influenza in elderly patients in long-term care. However, there have been no controlled studies to show whether this approach is effective. During the winter of 1994-1995, 1059 patients in 12 geriatric medical long-term-care sites, randomized for vaccination of HCWs, were studied. In hospitals where HCWs were offered vaccination, 653 (61%) of 1078 were vaccinated. Vaccination of HCWs was associated with reductions in total patient mortality from 17% to 10% (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.40-0.80) and in influenza-like illness (OR, 0.57; 95% CI, 0.34-0.94). Vaccination of patients was not associated with significant effects on mortality (OR, 1.15; 95% CI, 0.81-1.64). Results of this study support recommendations for vaccination against influenza of HCWs in long-term geriatric care. Vaccination of frail elderly long-term-care patients may not give clinically worthwhile benefits.

Three members of a novel small gene-family from Arabidopsis thaliana able to complement functionally an Escherichia coli mutant defective in PAPS reductase activity encode proteins with a thioredoxin-like domain and "APS reductase" activity

Three different cDNAs, Prh-19, Prh-26, and Prh-43 [3'-phosphoadenosine-5'-phosphosulfate (PAPS) reductase homolog], have been isolated by complementation of an Escherichia coli cysH mutant, defective in PAPS reductase activity, to prototrophy with an Arabidopsis thaliana cDNA library in the expression vector lambda YES. Sequence analysis of the cDNAs revealed continuous open reading frames encoding polypeptides of 465, 458, and 453 amino acids, with calculated molecular masses of 51.3, 50.5, and 50.4 kDa, respectively, that have strong homology with fungal, yeast and bacterial PAPS reductases. However, unlike microbial PAPS reductases, each PRH protein has an N-terminal extension, characteristic of a plastid transit peptide, and a C-terminal extension that has amino acid and deduced three-dimensional homology to thioredoxin proteins. Adenosine 5'-phosphosulfate (APS) was shown to be a much more efficient substrate than PAPS when the activity of the PRH proteins was tested by their ability to convert 35S-labeled substrate to acid-volatile 35S-sulfite. We speculate that the thioredoxin-like domain is involved in catalytic function, and that the PRH proteins may function as novel "APS reductase" enzymes. Southern hybridization analysis showed the presence of a small multigene family in the Arabidopsis genome. RNA blot hybridization with gene-specific probes revealed for each gene the presence of a transcript of approximately 1.85 kb in leaves, stems, and roots that increased on sulfate starvation. To our knowledge, this is the first report of the cloning and characterization of plant genes that encode proteins with APS reductase activity and supports the suggestion that APS can be utilized directly, without activation to PAPS, as an intermediary substrate in reductive sulfate assimilation.

Human cloning: a case of no harm done?

Some have objected to the laboratory cloning of human preembryos on the grounds that the procedure would violate the dignity of and respect owed to human preembryos. Others have argued that human cloning ought be permitted if it will predictably benefit, or at least not burden, individuals who are, unlike the human preembryo, clearly entitled to our respect and concern. Taking this latter position, the legal theorist John A. Robertson has argued that, since cloning does not harm anyone who is clearly entitled to our respect and concern, it should be permitted. In particular, the offspring of cloning, he argues, cannot be genuinely harmed by cloning, since they owe their very existence to the cloning procedure. In this paper, I argue that cloning coupled with its related procedures does in fact place the flesh and blood human offspring of cloning at risk of genuine harm. I thus provide a basis for questioning the moral permissibility of cloning and its related technologies without implying that the human preembryo has dignity or is owed respect.

Episodic symptoms in dysfunctioning children and adolescents following mild and severe traumatic brain injury

The present investigation examines the phenomenology of episodic symptoms in dysfunctioning children and adolescents following mild (n = 25) or severe (n = 25) traumatic brain injury (TBI). TBI patients in both groups commonly endorsed symptoms such as staring spells, memory gaps, and temper outbursts. Anticonvulsant response in the 27 patients treated, reflected moderate to substantial improvement in 92%. A dose-response relationship between injury severity and number of episodic symptoms was not observed; however, patients in the severe TBI sample did produce significantly more defective performances on a dichotic word-listening task (DWLT) and lower IQ values. Defective DWLT performance was also significantly associated with greater number of episodic symptoms endorsed, but only in the mild TBI sample. Parallels with epilepsy spectrum disorder and clinical implications for paediatric TBI are discussed.

The prevalence of joint contractures in residents in NHS continuing care

A group of 222 residents in NHS continuing care were studied in order to assess the prevalence of joint contractures in the very disabled elderly and to establish whether there was an association between the presence of contractures and functional ability; 121 (55%) had at least one contracted joint. There was no clear linear relationship between length of stay in continuing care and the presence of contractures. Those with upper limb contractures were nearly twice as likely to be unable to feed themselves as those without contractures (p < 0.0001). The presence of at least one lower limb contracture was significantly associated with reduced mobility (p < 0.0001). An association was also demonstrated between the presence of lower limb contractures and frequency with which the patient walked. The role of disease and immobility in the development of contractures is discussed as well as the potential for the prevention and treatment of contractures.

Assessing olfaction following pediatric traumatic brain injury

A brief procedure for screening the olfactory function in elementary-age children was developed in the present investigation When the performance of pediatric patients with mild traumatic brain injury (TBI) was compared with that of a matched sample with severe TBI, the severe TBI sample was one and one-half times as likely to exhibit an impaired sense of smell of formal testing (p<0 05) Subsequent analyses demonstrated that patients with olfactory deficits were three times as likely to manifest executive dysfunction as reported by their parents on a behavior rating scale In contrast to formal testing, individual interview revealed that TBI subjects and their parents were seldom aware of olfactory deficits Thus, formal testing of olfaction following pediatric head trauma should not be deferred.

Cloning and characterization of an Arabidopsis thaliana cDNA clone encoding an organellar isoform of serine acetyltransferase

We have cloned an Arabidopsis thaliana cDNA encoding serine acetyltransferase (EC 2.3.1.30) by functional complementation of the Escherichia coli cysE mutant JM15. The cDNA clone Sat-1 conferred serine acetyltransferase activity (with apparent Km for the two substrates acetyl CoA and L-serine of 0.043 and 3.47 mmol/dm3 respectively) on the cysE mutant. The 1515 bp full-length cDNA encodes a deduced protein of 391 amino acids which includes a putative chloroplastic targeting presequence. Northern analysis revealed a single message of 1.5 kb, while Southern hybridisation suggests a small multigene family of related sequences.

External validation of oppositional disorder and attention deficit disorder with hyperactivity

Validity of the distinction between oppositional disorder (OD) and attention deficit disorder with hyperactivity (ADDH) was examined in a sample of 6- to 12-year-old boys with behavior problems. Problem identification, cognitive/attentional, family context, and behavioral symptom differences were examined among nine boys with OD only, 20 with ADDH, 40 with comorbid OD and ADDH, and 28 with neither disruptive behavior disorder. Systematic comparisons of groups including and excluding the OD and ADDH diagnoses were undertaken to determine the existence of pure OD and pure ADDH disorder effects. The most consistent result was the lack of evidence for either pure OD or pure ADDH effects. Most of the significant findings reflected differences between the nondisruptive (neither) and comorbid groups. The results support the importance of comorbidity, but they provide little support for disorder-specific distinctions between oppositional and attention deficit disorders.

Neurobehavioural dysfunction following mild traumatic brain injury in childhood: a case report with positive findings on positron emission tomography (PET)

The present case study describes the neurobehavioural, neurodiagnostic, and positron emission tomography (PET) scan findings in a child who sustained a whiplash-type injury in a motor vehicle accident. Although neck and back pain were reported immediately, neurobehavioural symptoms, such as staring spells, gradually increased in frequency over a 2-year period following the accident. At 4 years after the accident the patient's symptoms persisted, as reported by teachers and parents, and more extensive diagnostic work-up was initiated. Standard EEG was normal while two ambulatory EEGs were abnormal and interpreted as epileptiform. A PET scan showed evidence of marked hypometabolism in both temporal lobes. Neuropsychological findings were consistent with PET findings and reflected verbal and visual memory deficits in the context of high average intelligence. Treatment with carbamazepine, verapamil, and fluoxetine greatly improved the patient's symptoms. The present case illustrates an example of a poor outcome in a paediatric case of mild traumatic brain injury, the importance of PET in demonstrating definitive evidence of brain dysfunction, and the child's positive response to anticonvulsant medication.

Energy intake and expenditure in elderly patients admitted to hospital with acute illness

Studies on hospitalized elderly subjects have demonstrated that negative energy balance is common during hospitalization, but have concentrated primarily on long-stay and psychogeriatric patients. There is little information on energy balance in elderly patients admitted with acute illness from the community, despite the importance of this patient group and the presence of a number of factors likely to predispose such patients to negative energy balance. In the present study energy balance was quantified in twenty patients (eight males, mean age 82 (SD 5) years; twelve females, mean age 84 (SD 6) years) admitted from the community with acute illness, and predicted basal metabolic rate (BMR) was compared with measured resting metabolic rate (RMR). Most patients were in negative energy balance during hospitalization, and median measured energy intake (EI): measured RMR ratio was 1.0 (range 0.7-1.8). The mean difference between measured EI and estimated total energy expenditure was -1.3 MJ/d (range -3.4 to +2.5 MJ/d). Estimated total energy expenditure exceeded measured EI in fifteen of the patients and there was a significant decline in mid-arm muscle circumference (paired t, P < 0.05) during hospitalization. We conclude that moderate negative energy balance is common in this patient group, and that these patients are at risk of undernutrition during their hospital stay.

Investigation of liposome-based immunomigration sensors for the detection of polychlorinated biphenyls

The use of immunospecific liposome migration offers many advantages for the extralaboratory detection of environmental contaminants. Devices utilizing this technique are fast, easy to use, and robust and respond to the presence of analyte at low-parts-per-billion concentrations. Investigations have been carried out that determine optimal interactions for key components of these assays, and techniques are presented for the development of generalized liposome immunoassays. Two complementary prototype liposome-based immunomigration techniques have been developed for the detection of polychlorinated biphenyls (PCBs). The liposome immunocompetition assay format measures the competitive reaction between analyte-tagged liposomes and the sample analyte for immobilized antibodies and can detect 0.4 nmol of PCB in less than 8 min. A more sensitive format, the liposome immunoaggregation (LIA) assay detects the inhibition of immunospecific liposome aggregation in solution and can detect 2.6 pmol of PCB in less than 23 min. Laser diffraction particle sizing has been used to study LIA-induced increases in liposome size over time and to determine optimal conditions for the application of this technique. Both formats utilize capillary action to transport liposome-containing solutions along strips of nitrocellulose. Measurement of color intensity is then carried out visually or with a desktop scanner.

The Dichotic Word Listening Test: Preliminary observations in American and Canadian samples

The present article describes observations of 670 American and Canadian child and adult control subjects on the recently developed Dichotic Word Listening Test (DWLT). The task was also administered to a sample of American children with traumatic brain injuries (n=21) of varying severity and a sample of American adults with mild traumatic injuries (n=36). The conceptual focus in this line of research was on using normative observations to identify clinically defective channels of auditory processing among patients. The principal findings were as follow: 1) the DWLT was sensitive to the effects of cerebral dysfunction following traumatic brain injury; 2) differences among normal samples with different demographic backgrounds were frequently observed, arguing for the development of local norms; 3) a shorter form of the DWLT task (DWLT30) can be used for screening purposes with relatively little reduction in sensitivity to cerebral dysfunction; 4) there appeared to be considerable improvement of DWLT performance between the ages of five and seven, due largely to higher scores from the left auditory channel; and 5) there were indications that use of French (rather than English) as one's native language before age six can negatively influence performance in adulthood on an English version of the DWLT. In general, the present findings suggest that the DWLT is likely to have relatively broad applicability for neuropsychological assessment across the life-span.

Yet another short-form of the Wechsler scales for use in neuropsychological assessment

The general purpose of the present study was to make Hamsher's seven subtest short-form of the WAIS-R (or WAIS) more accessible to neuropsychologists. Formulas are presented for both instruments which permit calculation of Verbal-Conceptual, Attention-Concentration, Perceptual-Organizational, and Full Scale deviation quotients. Results from two samples of psychiatric patients suggest that this abbreviated approach to using the Wechsler IQ batteries provides reasonably accurate estimates of traditional IQ scores. A case example illustrates how analysis of the various deviation quotients can contribute to neuropsychological reasoning at the level of the individual patient.

The diurnal variation of stroke in Ghana

In 68 patients presenting with stroke in Ghana a significant (P < 0.001) peak in onsets occurred between 0600 h and 1000 h. There were no significant differences in time of onset between men and women or hypertensive and non-hypertensive patients. Reasons for the peak of onsets are discussed. A similar diurnal pattern of stroke has been described in temperate countries: any benefits such as timing of prophylactic measures that ensue from research on stroke in temperate climates are likely to be of benefit if also applied to those at risk of stroke in a tropical climate.

Outbreaks of syphilis in rural Texas towns, 1991-1992

Between 1986 and 1990, rates of primary and secondary syphilis increased 134% in rural counties in the South. Reasons for the increases are speculative. During the 14 months ending in October 1992, outbreaks in four eastern Texas counties provided an opportunity to characterize syphilis in rural Texas. We reviewed records for 118 patients and 339 sex partners. Three outbreaks were concentrated in neighborhoods where crack cocaine dealers conducted business and exchange of sex for drugs or money was common; the fourth outbreak involved out-of-town prostitutes who visited undocumented alien workers. Among the 118 syphilis cases, 15 (13%) were primary, 35 (30%) were secondary. Most patients were black (105, 89%); the male-female ratio was 1:1. One woman gave birth to an infant with congenital syphilis. Almost half of the sex partners were infected. HIV pretest counseling was completed for only 55 patients (47%), and only 23 (19%) were tested for the human immunodeficiency virus. These four rural outbreaks of syphilis associated with crack cocaine and the exchange of sex for drugs or money mirror recent urban syphilis outbreaks. Patients in these rural syphilis outbreaks are at risk for HIV infection, but HIV testing has not been emphasized by public health workers.

The African AIDS case definition and HIV serology in medical in-patients at Komfo Anokye Teaching Hospital, Kumasi, Ghana

In 914 consecutive medical admissions to Komfo Anokye Teaching Hospital, the prevalence of infection with Human Immunodeficiency Virus type I (HIV-I) and Human Immunodeficiency Virus type 2 (HIV-2) was 12.6%. The prevalence in females was twice that found in males. The infection rate was maximum in the age group 25-29 years for females (45%) and 30-34 years for males (29%). There were 7 cases infected with HIV-2 alone, 55 cases infected with HIV-I alone and 53 cases with dual infection. The cases with HIV-2 infection tended to be older than those with HIV-I infection. For detecting HIV seropositivity in our patients the World Health Organization recommended case definition for AIDS in Africa gave a sensitivity of 32%, a specificity of 93% and a positive predictive value of 42%. The case definition gave the highest specificity and positive predictive values when cases of tuberculosis were not included in the analysis.

Structure of malhamensilipin A, an inhibitor of protein tyrosine kinase, from the cultured chrysophyte Poterioochromonas malhamensis

A new chlorosulfolipid, malhamensilpin A [1] was isolated from the cultured chrysophyte Poterioochromonas malhamensis. Malhamensilipin A was demonstrated to be a modest inhibitor of pp60v-src protein tyrosine kinase. The structure was determined by detailed spectral analysis to be a novel C24 hexachloro lipid containing a vinyl sulfate ester (2,11,12,13,15,16-hexachloro-14-hydroxy-n-tetracos-1E-enol-1-sulfa te).

A way of looking at the Dalla Corte case

When her baby was born last June, Rossana Dalla Corte, age sixty-two, was thought to be the oldest woman ever to have given birth. Her pregnancy was achieved at a private fertility clinic in Italy, the same clinic that treated “Jennifer F.,” a London woman who, on Christmas day, 1993, at the age of fifty-nine, gave birth to twins. The reproductive procedure, likely to become more common during the next few years, has received intense scrutiny from health officials in Great Britain, France, and Italy. Moral questions concerning that procedure already have been taken up by the popular press in the United States. Such questions can be expected to take on a new urgency as the United States considers reshaping its health care system and, specifically, the circumstances under which coverage for infertility treatment will be provided.

The roles of general and geriatric medicine in the provision of acute medical care for elderly patients

To determine whether there are differences between elderly patients admitted acutely to general medicine and those admitted to geriatric medical wards, and whether the patients are appropriately referred, a prospective survey of 426 consecutive patients aged 65 years or over admitted acutely to general medical and geriatric wards over a three month period was performed. A total of 286 patients were admitted to general medicine (GM) and 140 to the geriatric unit (GER). GER patients were older (81.0 v. 75.8 years) and had greater pre-morbid functional impairment and incontinence. Fewer GER patients presented with readily apparent organ specific diagnoses (56% v. 94%). Median length of stay was longer in GER patients (23 days v. 9 days). Variables independently predictive of GER admission were increasing age, increasing duration of illness, poor pre-morbid functional status and prior reliance on a carer. Length of stay was not associated with unit of admission allowing for the variables described above. GER patients are a different population. They have more chronic illness and functional impairment, and are more likely to require multidisciplinary assessment and rehabilitation in addition to treatment of presenting illness. Elderly patients are appropriately referred by General Practitioners (GPs) without a formal admissions policy.

Multiple partial seizure-like symptoms following 'minor' closed head injury

This report is a phenomenological study of 17 patients who developed multiple, partial seizure-like symptoms after sustaining relatively 'minor' closed head trauma. Unlike patients with classic complex partial seizure disorders, the symptoms of these head-injured patients did not tend to occur in stereotyped sequences. In contrast to meagre findings from neuroimaging and EEG evaluations, neuropsychological assessment of these patients often revealed evidence of static and episodic cognitive impairment. The majority of patients in this case series derived significant benefit from treatment with anticonvulsant medication; however, full return to premorbid levels of social and vocational competence was not typically observed. Recent findings from animal research on 'partial kindling' phenomena provide a hypothetical model for understanding how subclinical electrophysiological dysfunction may produce partial seizure-like symptoms and associated neurobehavioural dysfunction as longer-term sequelae of traumatic brain injury.