State and trait differences in depressive self-perceptions

A number of investigators have interpreted a tendency for depressed people to recall more negative than positive self-referent adjectives as evidence for a depressive self-schema made up of predominantly negative characterological information. We sought to confirm this account by eliciting the subjective self-perceptions of the depressed. Depressed patients and controls were required to rate whether or not a series of positive and negative adjectives applied to them during the previous week, at any time, and generally. The depressed distinguished clearly between these questions and, although describing themselves currently in largely negative terms, described their general state as equally composed of positive and negative elements.

No need for needs norms--why central planning cannot work for health care

It is widely recognised that South Africa, like other countries, has inequities in health and in access to health care. Centralised formal planning is used by the Department of National Health and Population Development and advocated by others as the approach to social justice and equitable distribution of health care resources. This approach is typical of the central planning of command economies. The reasons why central planning cannot work for health care are explained and an alternative approach is suggested which emphasises decentralised management. This is in line with recent policy statements by the Minister of Health that place a high priority on decentralisation and democratisation. The proposal has important implications for the way in which information systems are developed and used. Much information that central planners say they need is also required for effective management, but with some crucial differences. Planners use ad hoc historical information with little understanding of the local context. Managers, in contrast, regularly need current information for use within the local context. It is therefore recommended that efforts by central planners to acquire information be redirected towards building the capabilities of the health care services to provide and use information for management at all levels.

The Effects Of Technology And Basin Specific Learning On The Discovery Rate

Abstract

Technological innovation and basin specific learning are identified as potential sources of improvement in the discovery rate. Examples of both exist in the drilling history of Canada's Scotian Shelf This paper presents an historical analysis of the impacts of both on the Shelf's discovery rate. This was accomplished using a simulation modelling framework that treats the probability of discovering a natural gas pool as proportional to pool size. The model includes a discovery efficiency parameter which measures the geologic learning and technological sophistication of exploration firms. Repeated simulations allow the calculation of discovery efficiency parameters at discrete points in the exploration history of the Shelf. These, in turn, were used to measure the impact of technological innovation and increments in basin specific learning in the context of the Scotian Shelf's exploration history.

Introduction

Technological innovation during the 1970s and 1980s changed the methods of exploring, developing and producing petroleum resources. It will continue to play an important role in determining the character and pattern of future petroleum developments, particularly as the industry begins to rely increasingly on the resources located in frontier areas. Work to date on the impacts of technological innovation has focussed on its effects on drilling costs(1–4). These studies concluded that technological change during the 1950s and 1960s more than kept pace with the tendency of the oil and gas industry to move toward the exploration and development of more costly resources.

Technological innovation, however, affects more than drilling costs. Rensburg and Malik(5) have suggested that technological change may be divided into two categories:changes in exploration technology; andchanges in drilling technology.

Changes in exploration technology tend toward increasing the quantity of resources discovered, increasing the discovery rate, and lowering discovery costs. Changes in drilling technology tend toward lowering the costs associated with exploration and extraction, and can affect the discovery rate by putting previously unavailable resources within technological and economic reach.

Technology, however, is not the only source of potential improvement in the discovery rate. Ryan(6) postulated that the rate at which oil is discovered is proportional to "the amount of undiscovered oil and the knowledge of where the oil resides". When the number of completed wells in a basin is small, the geologic knowledge of the basin is also likely to be small. As more wells are drilled, firms learn progressively more about the geologic characteristics of the basin. Ultimately, knowledge of the basin's geology will no longer increase and, with the exhaustion of identified exploration prospects, drilling in the basin will come to an end. The approach is consistent with Arrow's(7) "Learning by doing" hypothesis "that technical change (here measured by the discovery efficiency parameter) in general can be ascribed to experience" and "that it is the very activity of production which gives rise to problems for which favourable responses are selected over time". Thus, accumulated experience in a given exploration environment produces the information on which future decisions can be based.

Comparison of attitudes of donors and recipients to oocyte donation

The attitudes of volunteer donors and recipients undergoing treatment in an ovum donation programme were studied in order to assess both the psychological and psycho-social aspects of the procedure. A questionnaire was sent to 35 donors and 60 recipients. All donations were unpaid. Fifty-eight were anonymous donations and three were known. Eighty-six per cent of recipients and 74% of donors had told at least one person other than their partner. Eighty per cent of donors and 66% of recipients agreed that donors should not be paid. Sixty-three per cent of donors would donate if the recipient was told their name but only 26% of recipients would accept if the donor was given their name. Seventy per cent of the donors would donate to someone they knew but would rather donate anonymously. Ninety per cent of recipients were strongly against the donor contacting the child later in life but 54% of donors had no objection to the child contacting them. Eighty-six per cent of recipients and 56% of donors felt that if they had been born from a donated oocyte, they would not want to know.

Priorities for provision of health care services for children in the Cape Province

Geographical areas in the Cape Province are ranked by their need for resources for child health care as determined by several proxy indicators of child health. Low birthweight and perinatal mortality rates for 1989, infant and age-specific childhood death rates, as well as death rates for tuberculosis, gastroenteritis and measles for 1985 are used as indicators of need. The ten magisterial districts having the highest priority for resources are, in decreasing order of need: De Aar, Colesberg, Uitenhage, Sterkstroom, Gordonia, Prince Albert, Philipstown, Victoria West, Kirkwood and Richmond. Limitations in the data are: wide, unquantifiable confidence limits, non-independence of different indicators, lack of timeliness, and incomplete statistics. Despite these problems with the data there are several reasons for employing them. Firstly, the quality of the data is only likely to be improved if they are actually used, and, secondly, there is no alternative. Areas identified as high priority need investigation in situ because corrective action is required for either the data collection system, or child health. Recommendations for improvements in resource management in child health care are: regionalisation of a unitary health care service, more timely data collection in geographically standardised regions, introduction of management objectives, and resource allocation guided by health status indicators.

From Freud to cognitive science: a contemporary account of the unconscious

We present an account of two influential approaches to the unconscious; those of Freud and of cognitive science. It is argued that although Freud's ideas require updating in some respects, in other ways many of them have stood the test of time. We describe the similarities and differences between the two approaches and the attention each pays to innate cognitive and emotional competencies. Finally, we provide a contemporary cognitive account of the unconscious that attempts to combine the best both approaches within an information-processing framework.

Placebo-controlled trial to evaluate zidovudine in treatment of human immunodeficiency virus infection in asymptomatic patients with hemophilia. NHF-ACTG 036 Study Group

One hundred ninety-three asymptomatic patients with hereditary coagulation disorders and human immunodeficiency virus (HIV) infection were studied in a controlled trial of zidovudine (ZDV) versus a placebo (with an average of 9.7 months on study). Pretreatment characteristics were well balanced between the placebo and drug-treated groups, including CD4 distributions, types of clotting disorders, transaminase abnormalities, and use of various hemostatic agents. At the time of analysis, 161 patients either were still receiving treatment or had previously reached an endpoint of disease progression while receiving treatment. Twenty-five patients withdrew voluntarily. The toxic effects noted included granulocytopenia and anemia, especially in older patients, and subjective symptoms of asthenia, malaise, and nausea, consistent with the known consequences of treatment with 300 mg ZDV five times daily. There was a trend toward more diagnoses of acquired immunodeficiency syndrome (AIDS), advanced or early AIDS-related complex (ARC), single ARC symptoms, or death in placebo recipients as compared with those receiving ZDV (22 v 13). Because older patients with hemophilia have more rapid disease progression, the same efficacy analysis was performed in the 89 patients aged more than 30 years who were receiving treatment. In this subgroup, there was a similar trend (11 v 6). With regard to the most advanced problems of the infection among the older patients, there were five patients who were newly diagnosed with AIDS or died in the placebo group versus none in the ZDV group (P = .02) among the older patients. The pretreatment distribution of CD4 counts for the placebo and ZDV groups were similar, but patients aged more than 30 years had significantly (P less than .049) fewer CD4 cells than patients aged less than 30 years. A beneficial ZDV effect is also supported by a trend toward higher CD4 counts (a 48-cell increase in the ZDV group at 24 weeks as compared with a four-cell increase in the placebo group) and a significant (P = .03) difference in weight gain in the ZDV patients aged more than 30 years (8 pounds) as compared with the older placebo patients (aged more than 30 years) (2 pounds) at week 24. The findings in the asymptomatic hemophilic patients aged more than 30 years support a useful effect of ZDV, which is similar to observations in the larger study of its use in asymptomatic, nonhemophilic patients.

A report on 100 cycles of oocyte donation; factors affecting the outcome

Eighty-two patients had 100 cycles of oocyte donation from 68 donors resulting in 27 clinical pregnancies. The source of donated oocytes was 42 fertile volunteers and 26 patients from the assisted conception programme. The pregnancy rate was significantly higher when intra-Fallopian transfer was performed (36%; 21/59), compared with intrauterine transfer (15%; 6/41). The pregnancy rate following fresh gamete/embryo transfer (39%; 15/39) was slightly higher than for frozen embryo transfer (20%; 12/61). The age of the recipient significantly affected the pregnancy rate. The pregnancy rate was 50% in the 25-29 years age group and steadily dropped to 9.7% in the 45-49 age group. The pregnancy rate in patients with primary ovarian failure (50%; 8/16) was significantly higher than in patients with secondary ovarian failure (18%; 9/50). The pregnancy rate was significantly greater when parous donors (33%; 23/69) were used compared with non-parous donors (13%; 4/31). The number of gametes/embryos transferred significantly affected the pregnancy rate regardless of the treatment used. If one or two gametes/embryos were transferred, the pregnancy rate was 11% compared with 33% if three to four embryos were transferred. The age of the donors did not affect the pregnancy rate. The majority of the donors were under the age of 35 years. The best results (50% per cycle) were therefore achieved using gametes from parous donors and transferring three to four oocytes fresh to the Fallopian tubes of a young recipient.

Primary structure of the putative human oncogene, pim-1

A full-length (6.1-kb) human genomic pim-1 gene, together with its immediate 5'-upstream promoter sequence (Ppim) was isolated and sequenced. The human pim-1 gene shares an overall nucleotide (nt) sequence identity of 53% with the previously reported murine pim-1 gene. It consists of six exons and five introns and contains a protein-coding region that is identical in nt sequence to a full-length human pim-1 cDNA. The gene codes for a predicted Pim-1 protein of 313 amino acids (aa) with an Mr of 35,690 and a pI of 5.7. The deduced aa sequence of the human Pim-1 has 94% identity with the murine Pim-1 whereas the nt sequences of the two genes are 88% identical. All of the conserved aa residues of the mouse pim-1 gene, which are homologous to known protein kinases are conserved in the predicted human protein. The human Ppim region is very G + C-rich (69%) and shares greater than 80% identity with the murine Ppim. The Ppim has no TATA- or CAAT-box sequences but does contain a number of nt sequences similar to the putative binding sites of several presumptive transcription factors.

A comparison of the attitudes of volunteer donors and infertile patient donors on an ovum donation programme

The attitudes of anonymous volunteer donors (n = 20) and infertile patients who were undergoing treatment in an IVF programme and who donated oocytes (n = 15) towards the donation, the recipient, the potential children conceived, the recording of information and their experience of the procedures were sought by posted questionnaires. All donations were made for altruistic reasons and no payments other than expenses were made. Both groups agree that donors should not be paid and they both deny any connection with the child resulting from their donation. The majority in both groups also did not object if their eggs were donated to unmarried single women and they did not wish to meet with the recipient. The majority of both groups would however agree to donate to known recipients. Over 80% had told others of their donation and a similar number in the volunteer group held no objection to the recipients knowing their name whilst only 40% held the same view in the patient donor group (17/20 versus 6/15 P less than 0.02). The feelings of the groups was also different in relation to their desire to know if a child was born from their eggs. Eighty five per cent in the volunteer group (17/20) would like to know the outcome and only 40% (6/15) of the patient donor would want to know the outcome, P less than 0.02. Although greater than 50% in both groups experienced side effects, 60% of volunteers and 90% of patient donors expressed a willingness to donate eggs again.(ABSTRACT TRUNCATED AT 250 WORDS)

Timed oocyte collection in an assisted conception programme using GnRH analogue

Three-hundred-and-twenty-five patients on an assisted conception programme underwent 378 cycles of oocyte retrieval (OPU) following ovarian stimulation using a GnRH analogue and human menopausal gonadotrophins (HMG), a regimen which allows programmed cycles and delayed oocyte retrieval. Eighteen cycles were excluded (failed OPU in three and failure of fertilization in 15). In 360 cycles, patients completed their treatment with either in-vitro fertilization/embryo transfer (IVF/ET) (116) or gamete intra-Fallopian transfer (GIFT) (244), of which 241 took place at the normal time and 119 were delayed for 24 h or more to avoid weekend operating. The overall pregnancy rate per OPU was 29.5%, with the IVF group being 24.1% and the GIFT group being 32.8%. In the group of patients in whom OPU was delayed, the pregnancy rate was significantly higher in each sub-group than in the corresponding non-delayed sub-group (overall, 37.0 versus 25.7%; IVF/ET, 38.5 versus 16.9%; GIFT, 36.3 versus 31.1%). There was a significantly higher number of oocytes collected, gametes/embryos transferred in the group whose OPU had been delayed. In patients receiving GnRH analogue and HMG for ovarian stimulation, delaying oocyte retrieval is not harmful, may result in an improved outcome and allows OPU to be performed on routine operating lists. This facility, together with the improved pregnancy rates associated with this protocol of ovarian stimulation should improve the cost-effectiveness of assisted conception programmes.

Discriminating rejection from CMV infection in renal allograft recipients using flow cytometry

The ability to distinguish among rejection, cytomegalovirus (CMV) infection, and cyclosporin toxicity in the symptomatic renal allograft recipient remains one of the major issues in clinical transplantation. The practical application of immunologic monitoring of peripheral blood lymphocytes through the use of fluorescently labeled monoclonal antibodies and single-color flow cytometry has been limited by the inability to demonstrate significant correlations between the levels of specific T-cell subset populations and the cause of impaired renal function. In the present study using two-color analysis, we monitored the expression of interleukin-2 receptor (IL-2R) and HLA-DR antigen on the T-cells of a group of 51 renal cadaveric allograft recipients receiving cyclosporin, azathioprine, and prednisone for an average of 4 months after transplantation. We found that the proportion of CD3+ cells coexpressing IL-2R increased above baseline during 12 out of 14 rejection episodes that took place during the course of the study (P less than 10(-6)). Alternatively, we found that the proportion of cells coexpressing HLA-DR antigen on CD2+ cells increased above baseline during 11 out of 11 CMV infections (P less than 10(-6)). There was no correlation between the level of IL-2R+CD3+ cells and CMV infection or between the level of CD2+DR+ cells and rejection. These relationships showed a high degree of sensitivity and specificity when used to discriminate among possible etiologies for decreased renal function in the symptomatic patient.

Effect of a meal on blood pressure in the elderly

As post-prandial hypotension may be a cause of falls in older people, blood pressure was measured for one hour following a test meal in 22 elderly patients. There was a small fall in both systolic and diastolic blood pressure but no change in heart rate. Although the changes were small and no symptoms occurred, post-prandial hypotension might be important in elderly patients who had other abnormalities in blood pressure regulation.

Serum zinc and copper levels in children with meningococcal disease

Mean serum zinc and copper levels were depressed in 94 children aged 1 month to 9 years who presented with meningococcal disease. The mean serum zinc level was 44 micrograms/dl (reference value 78 micrograms/dl, SD 18) and the mean serum copper level 157 micrograms/dl (reference value 159 micrograms/dl, SD 27). Nineteen patients had serum zinc levels less than 25 micrograms/dl and ten patients had serum copper levels less than 101 micrograms/dl. Serum zinc levels were significantly lower in patients who were septicaemic or in whom manifestations of severe disease such as shock, more than 20 petechiae, ecchymoses and evidence of disseminated intravascular coagulation occurred compared to those without these features. Serum copper concentrations were higher than reference levels in patients with meningitis and in less severely ill patients. Copper levels were significantly lower in patients with septicaemia, severe disease, shock, more than 20 petechiae, ecchymoses, disseminated intravascular coagulation, leucopenia and patients who died compared with patients without these features.

Vancomycin disposition: the importance of age

We examined the influence of age on vancomycin kinetics in 12 normal healthy men (six young and six elderly) after an intravenous infusion of 6 mg/kg. Serial blood and urine samples were collected for up to 2 days after dosing and were assayed for unchanged drug by a specific radioimmunoassay. Serum concentrations of vancomycin after infusion declined in a multiphasic manner. Both serum and urinary excretion data were simultaneously fit by a three-compartment model with SAAM-27 computer programs. Estimates of mean t1/2 obtained from the terminal phase of the drug disposition profile showed the t1/2 to be longer in the elderly than in the young subjects (12.1 and 7.2 hr). Although there was no change in the initial distribution volume of the central compartment, total systemic and renal clearances were reduced in the elderly and did not correlate with renal function. The increase in the vancomycin volume of distribution at steady state was ascribed to enhanced tissue binding of drug in the elderly, since the mean fraction of vancomycin bound in systemic pool of the young and elderly did not differ (0.53 and 0.56). In-depth analysis of excretion data tends to support suggestions of vancomycin excretion solely by glomerular filtration. Our data strongly suggest the need for adjustment or modification of recommended vancomycin dosing schedules in the elderly.

Cytogenetic studies in the offspring of LSD users

The presumed carcinogenic and chromosome-breaking potential of d-lysergic acid diethylamide (d-LSD 25) in human somatic cells has been reviewed by Fernandez et al. (1973). Reports concerning its teratogenic effect in experimental animals and man have been either contradictory or inconclusive. The following possible teratogenic mechanisms may be considered: (1) A direct effect on organogenesis of LSD ingested by the mother during early pregnancy; (2) A similar disturbance of organogenesis by a persistent metabolite of LSD ingested by the mother at some time prior to the pregnancy; (3) Chromosome damage or point mutations in parental germ cells exposed to LSD before initiation of a pregnancy.