Periostin (an osteoblast-specific factor) is expressed within the embryonic mouse heart during valve formation

Periostin was originally isolated as a osteoblast-specific factor that functions as a cell adhesion molecule for preosteoblasts and is thought to be involved in osteoblast recruitment, attachment and spreading. Additionally, periostin expression has previously been shown to be significantly increased by both transforming growth factor beta-1(TGFbeta1) and bone morphogenetic protein (BMP)-2. Likewise the endocardial cushions that form within embryonic heart tube (embryonic day (E)10-13) are formed by the recruitment, attachment and spreading of endocardial cells into the overlying extracellular matrix, in response to secreted growth factors of the TGFbeta and BMP families. In order to determine whether periostin is similarly involved in heart morphogenesis, in situ hybridization and reverse transcription-polymerase chain reaction were used to detect periostin mRNA expression in the developing mouse heart. We show for the first time that periostin mRNA is expressed in the developing mouse embryonic and fetal heart, and that it is localized to the endocardial cushions that ultimately divide the primitive heart tube into a four-chambered heart.

Changes in the biomechanical properties of neutrophils and endothelial cells during adhesion

This study examined changes in the biomechanical properties of cultured pulmonary microvascular endothelial cells (ECs) and neutrophils induced by adhesion of neutrophils to these ECs. The biomechanical properties of cells were evaluated using magnetic twisting cytometry, which measures the angular rotation of ferromagnetic beads bound to cells through antibody ligation on application of a specified magnetic torque. Adhesion of neutrophils to 24-hour tumor necrosis factor-alpha (TNF-alpha)-treated ECs, but not to untreated ECs, induced an increase in EC stiffness within 2 minutes, which was accompanied by an increase and a reorganization of F-actin in ECs. A cell-permeant, phosphoinositide-binding peptide attenuated the EC stiffening response, suggesting that intracellular phosphoinositides are required. The stiffening response was not inhibited by ML-7, a myosin light-chain kinase inhibitor, or BAPTA, an intracellular Ca2+ chelator. Moreover, the phosphorylation pattern of the regulatory myosin light chains was unaltered within 15 minutes of neutrophil adherence. These data suggested that the EC stiffening response appeared not to be mediated by myosin light-chain-dependent mechanisms. Concomitantly, neutrophil adhesion to 24-hour TNF-alpha-treated ECs also induced changes in the biomechanical properties of neutrophils compared to neutrophils bound to untreated ECs. Taken together, these results demonstrated that neutrophil adhesion to TNF-alpha-treated ECs induces changes in the biomechanical properties of both cell types through actin cytoskeletal remodeling. These changes may modulate neutrophil transmigration across the endothelium during inflammation.

Recent interview-based measures of competency to stand trial: a critical review augmented with research data

Forensic experts are frequently asked to conduct competency-to-stand trial evaluations and address the substantive prongs propounded in Dusky v. United States (1960). In understanding its application to competency evaluations, alternative conceptualizations of Dusky are critically examined. With Dusky providing the conceptual framework, three interview-based competency measures are reviewed: the Georgia Court Competency Test (GCCT), the MacArthur Competence Assessment Tool-Criminal Adjudication (Mac-CAT-CA), and the Evaluation of Competency to Stand Trial-Revised (ECST-R). This review has a twin focus on reliability of each measure and its correspondence to Dusky prongs. The current review is augmented by new factor analytic data on the MacCAT-CA and ECST-R. The article concludes with specific recommendations for competency evaluations.

Predictors of adolescent psychopathy: the role of impulsivity, hyperactivity, and sensation seeking

Clinical applications to psychopathy encompass downward extensions to adolescent populations. In alliance with clinical practice, several prominent researchers have formulated prediction models for adolescent psychopathy that include various forms of behavioral dysregulation, including impulsivity, attention-deficit/hyperactivity disorder (ADHD), and sensation seeking. As a cross-sectional study, the current investigation systematically examined behavioral dysregulation in 79 male adolescents who, as a result of adjudication, were placed them in a maximum-security facility. Impulsivity appeared to be the best predictor of both psychopathy and conduct problems. In addition, conduct-disordered symptoms were predicted mostly by impulsivity, with minor contributions from sensation seeking and ADHD symptoms.

The uncritical acceptance of risk assessment in forensic practice

Forensic psychologists are frequently asked to conduction evaluations of risk assessment. While risk assessment has considerable merit, recent applications to forensic psychology raise concerns about whether these evaluations are thorough and balanced. Forensic adult risk-assessment models stress risk factors, and deemphasize or disregard entirely the other side of the equation: protective factors. Mediating and moderating effects must also be considered. Moreover, base-rate estimates may produce erroneous results if applied imprudently to forensic samples without regard to their unstable prevalence rates or the far-reaching effects of settings, referral questions, and evaluation procedures. Psychologists are offered a preliminary list of relevant issues for evaluating the merits of risk assessment in their forensic practices.

Subthalamic stimulation in Parkinson's disease. Preliminary results

OBJECTIVES

We wanted to evaluate chronic subthalamic nucleus (STN) stimulation as an alternative to pallidotomy for severe Parkinson's disease symptomatology.

METHODS

Nine patients met clinical criteria for unilateral standard pallidotomy. All had severe medically refractory drug-induced dyskinesia and had reached maximal daily levodopa therapy. Pre- and postoperative videos, neuropsychometric testings and clinical stagings were administered. Three patients were selected to undergo stereotactic implantation of a deep brain stimulator (DBS) after Institutional Review Board approval and informed consent. These were performed using digitized microrecordings. The other group received unilateral pallidotomy.

RESULTS

At a mean follow-up of 6 months, our results support recent findings of significant major improvement in motor scores, activity of daily living and decrease in amount of daily levodopa intake by close to 50% after 3 months of stimulation.

CONCLUSIONS

Chronic stimulation of the STN appears to provide significant motor improvement in patients with severe Parkinson's disease and is more beneficial than pallidotomy.

Decreased neural crest stem cell expansion is responsible for the conotruncal heart defects within the splotch (Sp(2H))/Pax3 mouse mutant

OBJECTIVE

Several mouse models of cardiac neural crest cell (NCC)-associated conotruncal heart defects exist, but the specific cellular and molecular defects within cardiac NCC morphogenesis remain largely unknown. Our objective was to investigate the underlying mechanisms resulting in outflow tract defects and why insufficient cardiac NCC reach the heart of the Splotch (Sp(2H)) mouse mutant embryo.

METHODS

For this study we used in vitro cell culture techniques, in vivo mouse-chick chimeras, BrdU cell proliferation labeling, TUNEL labeling to visualize apoptosis and the molecular markers AP-2, Wnt-1 and Wnt-3a to characterize NCC morphogenesis in vivo.

RESULTS

Expression of the NCC marker AP-2 revealed an extensive reduction in migratory NCC, however the rates of cell proliferation and apoptosis were unaffected, and do not account for the Sp(2H) NCC-associated heart defects. Further expression analysis revealed that Wnt-1, but not Wnt-3a, is expressed at decreased levels within Sp(2H) and that the cardiac NCC fail to undergo normal NC stem cell proliferative expansion prior to migration while still in the neural folds. However, when placed into a wild-type matrix or a tissue culture environment, the Sp(2H) cardiac NCC could migrate normally. Additionally, this reduced population of Sp(2H) NC stem cells do migrate properly within the Sp(2H) environment, as observed by neurofilament expression and cardiac innervation.

CONCLUSIONS

Taken together, all these data indicate that the Sp(2H) defect is intrinsic to the NC stem cells themselves and that there is a decrease in the number of pre-migratory cardiac NCC that form. It appears that this decrease in NCC number is the primary defect that ultimately leads to a lack of a cardiac NCC-derived Sp(2H) outflow tract septum.

A prospective randomized-controlled trial of ventricular fibrillation detection time in a DDDR ventricular defibrillator. Ventak AV II DR Study Investigators

Implantable cardioverter defibrillators (ICDs) with dual chamber and dual chamber rate responsive pacing may offer hemodynamic advantages for some ICD patients. Separate ICDs and DDDR pacemakers can result in device to device interactions, inappropriate shocks, and underdetection of ventricular fibrillation (VF). The objectives of this study were to compare the VF detection times between the Ventak AV II DR and the Ventak AV during high rate DDDR and DDD pacing and to test the safety of dynamic ventricular refractory period shortening. Patients receiving an ICD were randomized in a paired comparison to pacing at 150 beats/min (DDD pacing) or 175 beats/min (DDDR pacing) during ICD threshold testing to create a "worst case scenario" for VF detection. The VF detection rate was set to 180 beats/min, and VF was induced during high rate pacing with alternating current. The device was then allowed to detect and treat VF. The induction was repeated for each patient at each programmed setting so that all patients were tested at both programmed settings. Paired analysis was performed. Patient characteristics were a mean age of 69 +/- 11 years, 78% were men, coronary artery disease was present in 85%, and a mean left ventricular ejection fraction of 0.34 +/- 0.11. Fifty-two episodes of VF were induced in 26 patients. Despite the high pacing rate, all VF episodes were appropriately detected. The mean VF detection time was 2.4 +/- 1.0 seconds during DDD pacing and 2.9 +/- 1.9 seconds during DDDR pacing (P = NS). DDD and DDDR programming resulted in appropriate detection of all episodes of VF with similar detection times despite the "worst case scenario" tested. Delays in detection may be seen with long programmed ventricular refractory periods which shorten the VF sensing window and may be avoided with dynamic ventricular refractory period shortening.

The mental state at the time of the offense measure: its validation and admissibility under Daubert

Melton et al. (Melton GB, Petrila J, Poythress NG, Slobogin C: Psychological Evaluations for the Courts (ed 2). New York: Guilford, 1997) recently advocated the use of the Mental State at the Time of the Offense (MSE-Offense) measure not only as a screen for insanity evaluations but also as the sole measure in "obvious" cases of insanity. Given this recommendation for expanding the role of the MSE-Offense, the current authors have evaluated the available data based on its construction and validation. We found fundamental flaws in its development and grave shortcomings in its validation. Based on these limitations, we conclude that the MSE-Offense is unacceptable under the Daubert standard (Daubert v. Merrell Dow Pharmaceuticals, Inc., U.S. 113 S. Ct. 2786 (1993)) for either the screening or determination of criminal responsibility.

The Entamoeba histolytica mitochondrion-derived organelle (crypton) contains double-stranded DNA and appears to be bound by a double membrane

Amebae have an Hsp60-associated, mitochondrion-derived organelle (crypton). In this study, the crypton was stained with multiple DNA-binding fluorochromes and a monoclonal anti-double-stranded DNA antibody. Transmission microscopy of partially purified cryptons revealed organelles bound by a double membrane.

The most abundant glycoprotein of amebic cyst walls (Jacob) is a lectin with five Cys-rich, chitin-binding domains

The infectious stage of amebae is the chitin-walled cyst, which is resistant to stomach acids. In this study an extraordinarily abundant, encystation-specific glycoprotein (Jacob) was identified on two-dimensional protein gels of cyst walls purified from Entamoeba invadens. Jacob, which was acidic and had an apparent molecular mass of approximately 100 kDa, contained sugars that bound to concanavalin A and ricin. The jacob gene encoded a 45-kDa protein with a ladder-like series of five Cys-rich domains. These Cys-rich domains were reminiscent of but not homologous to the Cys-rich chitin-binding domains of insect chitinases and peritrophic matrix proteins that surround the food bolus in the insect gut. Jacob bound purified chitin and chitin remaining in sodium dodecyl sulfate-treated cyst walls. Conversely, the E. histolytica plasma membrane Gal/GalNAc lectin bound sugars of intact cyst walls and purified Jacob. In the presence of galactose, E. invadens formed wall-less cysts, which were quadranucleate and contained Jacob and chitinase (another encystation-specific protein) in secretory vesicles. A galactose lectin was found to be present on the surface of wall-less cysts, which phagocytosed bacteria and mucin-coated beads. These results suggest that the E. invadens cyst wall forms when the plasma membrane galactose lectin binds sugars on Jacob, which in turn binds chitin via its five chitin-binding domains.

Docetaxel for patients with paclitaxel-resistant Müllerian carcinoma

PURPOSE

To determine the efficacy and toxicity of docetaxel in patients with müllerian carcinoma resistant to paclitaxel.

PATIENTS AND METHODS

Thirty-two patients with epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer who failed paclitaxel-based chemotherapy received either 100 or 75 mg/m(2) of docetaxel every 3 weeks. Resistance to paclitaxel was defined as either progression of disease during treatment, failure to achieve regression of disease after at least four courses, or rapid recurrence (within 6 months) after completion of therapy.

RESULTS

Eighteen patients were treated on a formal protocol and fourteen with the commercially available docetaxel. Thirty were assessable for response. Toxicities were thoroughly evaluated in the 18 patients on protocol. Twenty-seven patients (85%) had epithelial ovarian cancer. The overall response rate was 23% (one complete and six partial responses), with a median survival time of 44 weeks (9.5 months). Nine patients had stable disease and 14 progressive disease. Among 19 patients who progressed during prior paclitaxel treatment, two (11%) responded to docetaxel, compared with five (45%) of 11 patients in other paclitaxel-resistance categories. The responders had a median taxane-free interval (ie, the time between the last paclitaxel and first docetaxel treatment) of 73 weeks, compared with 19 weeks for the nonresponder group. Toxic effects were as expected.

CONCLUSION

Docetaxel is an active chemotherapeutic agent in patients with müllerian carcinoma previously treated with paclitaxel-based chemotherapy, especially in the patients who had a long taxane-free interval after a previous short response to paclitaxel.

The psychopathy checklist--screening version: an examination of criteria and subcriteria in three forensic samples

The development and refinement of psychopathy represent a critical issue in clinical and forensic practice. During the last decade, important advances in the operationalization of psychopathy were achieved, primarily through the development of the Psychopathy Checklist (PCL) and its subsequent versions (PCL-R and PCL:SV). PCL ratings are based primarily on item descriptions or subcriteria. The current study serves to break new ground as the first systematic investigation of PCL:SV subcriteria by addressing their psychometric properties and exploring their construct and criterion-related validation. Previously unanalyzed data from three samples were integrated: female offenders, male forensic patients, and male adolescent offenders. Results largely support the use of subcriteria as homogeneous components of criteria and provide strong initial evidence of their construct validity. Results are less conclusive regarding criterion-related validity. For female offenders, they suggested the potential value of specific PCL:SV subcriteria for predicting verbal aggression. Confirmatory factor analysis provided encouraging results on the applicability of the standard two-factor model of psychopathy. However, a first-order principal axis factoring suggested further refinements in our understanding of psychopathy.

Predictions of violent and total infractions among institutionalized male juvenile offenders

Forensic practitioners in settings with institutionalized adolescent offenders are frequently responsible for the accurate classification of problematic and potentially violent youths. Methods of assessment often include traditional tests, such as the MMPI and MMPI-A, and interview-based determinations of psychopathy. In a study of residential male adolescent offenders, the MMPI-A and the Screening Version of the Psychopathy Checklist (PCL:SV) were used to predict total, violent, self-injurious, and nonviolent infractions in a treatment-oriented facility for delinquents. In predicting the overall number of infractions, the MMPI-A was superior to the PCL:SV. Psychopaths manifested a significantly higher rate of violent infractions than nonpsychopaths. Finally, ethnic differences raise serious concerns about the generalizability of the PCL:SV; differences were found in the relationship between psychopathy and infractions based on ethnicity.

Roles for the winged helix transcription factors MF1 and MFH1 in cardiovascular development revealed by nonallelic noncomplementation of null alleles

The murine Mf1 and Mfh1 genes have overlapping patterns of expression in the embryo and encode forkhead/winged helix transcription factors with virtually identical DNA binding domains. Previous studies have shown that Mfh1 null mutants have severe cardiovascular defects, including interruptions and coarctations of the aortic arch and ventricular septal defects (Iida et al., Development 124, 4627-4638, 1997). Here, we show that Mf1(lacZ) homozygous null mutants also have a similar spectrum of cardiovascular abnormalities. Moreover, most embryos doubly heterozygous for Mfh1(tm1) and Mf1(lacZ) die before birth with interruptions and coarctations of the aortic arch, dysgenesis of the aortic and pulmonary valves, ventricular septal defects, and other cardiac anomalies. This nonallelic noncomplementation and the similar patterns of expression of the two genes in the mesenchyme and endothelial cells of the branchial arches, outflow tract, and heart suggest that Mf1 and Mfh1 play interactive roles in the morphogenesis of the cardiovascular system. Implications for the development of human congenital heart defects are discussed.

Validation of the Millon Clinical Multiaxial Inventory for Axis II disorders: does it meet the Daubert standard?

Relevant to forensic practice, the Supreme Court in Daubert v. Merrell Dow Pharmaceuticals, Inc. (1993) established the boundaries for the admissibility of scientific evidence that take into account its trustworthiness as assessed via evidentiary reliability. In conducting forensic evaluations, psychologists and other mental health professionals must be able to offer valid diagnoses, including Axis II disorders. The most widely available measure of personality disorders is the Million Clinical Multiaxial Inventory (MCMI) and its subsequent revisions (MCMI-II and MCMI-III). We address the critical question, "Do the MCMI-II and MCMI-III meet the requirements of Daubert?" Fundamental problems in the scientific validity and error rates for MCMI-III appear to preclude its admissibility under Daubert for the assessment of Axis II disorders. We address the construct validity for the MCMI and MCMI-II via a meta-analysis of 33 studies. The resulting multitrait-multimethod approach allowed us to address their convergent and discriminant validity through method effects (Marsh, 1990). With reference to Daubert, the results suggest a circumscribed use for the MCMI-II with good evidence of construct validity for Avoidant, Schizotypal, and Borderline personality disorders.

Abnormal skeletogenesis occurs coincident with increased apoptosis in the Splotch (Sp2H) mutant: putative roles for Pax3 and PDGFRalpha in rib patterning

Although the importance of the transcription factor Pax3 has been identified in many embryological processes including neural crest cell migration, neural tube closure, and limb muscle formation, its role in proper formation of the ribs has not been well characterized. We have used the Splotch mouse which has a mutation in the Pax3 gene to determine what role Pax3 may play in rib morphogenesis. Homozygous Splotch embryos collected from days 13.5 to 16.5 of gestation displayed severe rib abnormalities including fusions at both the proximal and distal regions. Given its expression in the dermomyotome, we sought to determine when Pax3 expression in the Splotch mutant initially becomes abnormal and which rib segment progenitors may be affected. Prior to somite differentiation at 9.5 dpc (days post coitum), Pax3 is normally expressed in the somites; after differentiation, however, Pax3 expression is diminished in Splotch embryos. We also determined that significantly increased levels of apoptosis occur in the thoracic region by 11.0 dpc relative to wild-type littermates. Because Patch mouse mutants which fail to express PDGF alpha-receptor also have rib abnormalities, we sought to determine whether Pax3 may influence the expression of this receptor. By in situ hybridization, we determined that initially the expression of PDGFRalpha is normal in Splotch mutants at 10.0 dpc, but decreases by 12.5 dpc in the thoracic somite region, suggesting that Pax3 may act upstream of PDGFRalpha. Taken together, our results show that Pax3 expression is important for normal rib development and that increased apoptosis occurs in the thoracic muscles. We suggest that Pax3 may influence the expression of PDGFRalpha, and that the reduced and/or deficient thoracic muscles may contribute to the resulting rib abnormalities.

Epidural analgesia and active management of labor: effects on length of labor and mode of delivery

OBJECTIVE

To determine whether cervical dilatation at the time of placement of patient-requested epidural affects cesarean rates or lengths of labors in actively managed parturients.

METHODS

The charts of 255 women randomized to active management of labor (n = 125) or control protocols (n = 130) were reviewed and stratified to early epidural placement (up to 4 cm cervical dilatation) versus late placement (more than 4 cm).

RESULTS

Women with early epidural placement had shorter labors than those with late placement (11.6 +/- 4.6 versus 13.2 +/- 5.6 hours; P = .02). Active management reduced the length of labor compared with controls regardless of epidural timing, with a reduction of 1.4 hours in early epidural placement (10.9 +/- 4.7 versus 12.3 +/- 4.3 hours; P = .04) and 3.6 hours in those with later placement (11.0 +/- 3.6 versus 14.6 +/- 6.2 hours; P = .004). Cesarean rates did not vary significantly (early 14.5% versus late 7.9%; P = .21). Early epidural placement did not lengthen the second stage of labor or increase operative vaginal delivery rates.

CONCLUSION

Early epidural placement did not affect lengths of labor or cesarean rates and was actually associated with shorter labor compared with late epidural placement. Women managed actively in labor, regardless of timing of epidural placement, had shorter labors than controls.

Chitinase secretion by encysting Entamoeba invadens and transfected Entamoeba histolytica trophozoites: localization of secretory vesicles, endoplasmic reticulum, and Golgi apparatus

Entamoeba histolytica, the protozoan parasite that phagocytoses bacteria and host cells, has a vesicle/vacuole-filled cytosol like that of macrophages. In contrast, the infectious cyst form has four nuclei and a chitin wall. Here, anti-chitinase antibodies identified hundreds of small secretory vesicles in encysting E. invadens parasites and in E. histolytica trophozoites overexpressing chitinase under an actin gene promoter. Abundant small secretory vesicles were also identified with antibodies to the surface antigen Ariel and with a fluorescent substrate of cysteine proteinases. Removal of an N-terminal signal sequence directed chitinase to the cytosol. Addition of a C-terminal KDEL peptide, identified on amebic BiP, retained chitinase in a putative endoplasmic reticulum, which was composed of a few vesicles of mixed sizes. A putative Golgi apparatus, which was Brefeldin A sensitive and composed of a few large, perinuclear vesicles, was identified with antibodies to ADP-ribosylating factor and to epsilon-COP. We conclude that the amebic secretory pathway is similar to those of other eukaryotic cells, even if its appearance is somewhat different.

Hsp60 is targeted to a cryptic mitochondrion-derived organelle ("crypton") in the microaerophilic protozoan parasite Entamoeba histolytica

Entamoeba histolytica is a microaerophilic protozoan parasite in which neither mitochondria nor mitochondrion-derived organelles have been previously observed. Recently, a segment of an E. histolytica gene was identified that encoded a protein similar to the mitochondrial 60-kDa heat shock protein (Hsp60 or chaperonin 60), which refolds nuclear-encoded proteins after passage through organellar membranes. The possible function and localization of the amebic Hsp60 were explored here. Like Hsp60 of mitochondria, amebic Hsp60 RNA and protein were both strongly induced by incubating parasites at 42 degreesC. 5' and 3' rapid amplifications of cDNA ends were used to obtain the entire E. histolytica hsp60 coding region, which predicted a 536-amino-acid Hsp60. The E. histolytica hsp60 gene protected from heat shock Escherichia coli groEL mutants, demonstrating the chaperonin function of the amebic Hsp60. The E. histolytica Hsp60, which lacked characteristic carboxy-terminal Gly-Met repeats, had a 21-amino-acid amino-terminal, organelle-targeting presequence that was cleaved in vivo. This presequence was necessary to target Hsp60 to one (and occasionally two or three) short, cylindrical organelle(s). In contrast, amebic alcohol dehydrogenase 1 and ferredoxin, which are bacteria-like enzymes, were diffusely distributed throughout the cytosol. We suggest that the Hsp60-associated, mitochondrion-derived organelle identified here be named "crypton," as its structure was previously hidden and its function is still cryptic.

Evaluation of a novel dry latex preparation for demonstration of infectious mononucleosis heterophile antibody in comparison with three established tests

A new, dried antigen-coated latex preparation for the demonstration of infectious mononucleosis (IM) heterophile antibody (Dryspot IM kit; Oxoid, Ltd., Basingstoke, Hampshire, United Kingdom) was compared with the IM kit (a liquid latex reagent from the same source), an immunoassay (ImmunoCard Mono; Meridian Diagnostics), and an absorption test (Monospot; Meridian Diagnostics). The latter was used as a standard for initial statistical comparisons. Discrepancies were resolved by using Epstein-Barr virus serology. Of the 328 routine samples tested, 77 were positive and 222 were negative by all IM heterophile antibody-based kits. Twenty-nine samples gave discrepant results. Following resolution of discrepant results, the sensitivity and specificity values for the IM Dryspot kit were 87.0 and 98.7%, those for the Oxoid liquid latex IM kit were 83.0 and 99.6%, and those for the ImmunoCard Mono immunoassay were 85.0 and 100.0%, respectively. The evaluation shows that the Dryspot kit, which is uniquely straightforward to use and may be stored at room temperature, is comparable in performance to other rapid heterophile tests for the confirmation of IM.

The R-CRAS and insanity evaluations: a re-examination of construct validity. Rogers Criminal Responsibility Assessment Scales

Insanity evaluations are characterized by continued professional debate and the paucity of empirical research. To address the latter, the construct validity of the Rogers Criminal Responsibility Assessment Scales (R-CRAS; Rogers, 1984) was examined via an extensive re-analysis of 413 insanity cases. A series of six separate discriminant analyses was examined to address major components of insanity evaluations. These analyses yielded highly discriminating patterns (M hit rates of 94.3%) and accounted for substantial proportion of the variance (M=63.7%). In general, predicted relationships between individual variables and the discriminant functions were supported. We also addressed the usefulness of the R-CRAS additional variables for the assessment of insanity. We found that these variables contributed substantially to the determination of criminal responsibility. Finally, we pose important and polemical issues for forensic experts conducting evaluations of criminal responsibility.

Reducing the risk of hepatitis to staff

Hepatitis continues to pose a serious risk to the health of staff and patients. A number of procedures can be put in place to protect the health and safety of nurses exposed to the risk. Nurses should be aware of systems and policies in their own work area.

The PAI and feigning: A cautionary note on its use in forensic-correctional settings

Indicators of feigned PAI profiles were derived from comparisons of simulators instructed to feign and genuine patient groups. Concerns are raised regarding whether these indicators are applicable to forensic and correctional populations and can be cross-validated with a known-groups comparison. Compiling data on 57 malingerers and 58 genuine patients from two forensic and correctional sites, three primary indicators of feigning, Negative Impression (NIM) scale, Malingering Index, and the Rogers Discriminant Function (RDF) were investigated. Results suggested that the RDF was not applicable to forensic referrals. However, NIM 77T appeared to be a useful screen for forensic samples. In addition, convergent evidence of feigning was found across designs (simulation and known-groups) and samples (non-forensic and forensic) for extreme elevations on NIM (>/=110T) and Malingering Index (>/=5).

Segmental expression of aggrecan in the non-segmented perinotochordal sheath underlies normal segmentation of the vertebral column

The embryonic vertebral column is derived from the unsegmented axial mesenchyme surrounding the notochord, and its development and differentiation are influenced by the notochord. The role of cartilage in determining the ultimate pattern of the segmental skeleton has been well documented, but a gene whose segmental expression corresponds to the pattern of the developing skeleton has yet to be identified. We show that chick aggrecan is initially expressed within the entire length of the notochord, and as development proceeds, aggrecan expression becomes restricted to the surrounding perinotochordal sheath in a segmental pattern, mirroring the differentiated somite pattern.

Medication compliance in patients with chronic schizophrenia: implications for the community management of mentally disordered offenders

The safe and effective management of mentally disordered offenders is a paramount concern in decisions for community placement. Treatment effectiveness is often vitiated by medication noncompliance. In the current study, clinical and sociodemographic correlates of treatment compliance were examined in outpatients with schizophrenia. Level of medication compliance, assessed independently by treatment staff at two outpatient settings, resulted in 40 compliant, 38 noncompliant, and 12 partially compliant patients. Key symptoms associated with medication noncompliance were anger, delusions, and hallucinations. As an initial investigation, a stepwise discriminant analysis was moderately successful at predicting medication noncompliance. The implications of these findings to mentally disordered offenders are explored.

Radiation therapy for the management of biopsy proved local recurrence after radical prostatectomy

PURPOSE

We determine which clinical characteristics correlate with a successful outcome following external beam radiation for the management of biopsy proved, locally recurrent prostate cancer after radical prostatectomy.

MATERIALS AND METHODS

The clinical records of 34 patients who were treated at our institution with external beam radiation for biopsy proved local disease recurrence after radical prostatectomy were reviewed. Mean followup was 77.9 months after radical prostatectomy and 38.3 months after radiotherapy. Preoperative, postoperative and pathological characteristics were examined for the ability to predict failure following radiotherapy.

RESULTS

Of the 34 patients 9 (26%) exhibited persistently low and stable serum prostate specific antigen (PSA) (less than 0.5 ng./ml.), while 7 (21%) had an undetectable serum PSA (less than 0.1 ng./ml.) during followup. These 16 patients were considered to be successfully treated by radiation and in the remaining 18 (53%) radiation was considered to have failed. The likelihood of successful treatment at 3 years after radiotherapy for all patients was 48%. Preoperative PSA, PSA at first elevation, postoperative PSA velocity and pathological stage were not significant predictors of a successful outcome following radiation treatment. Patients with a serum PSA of 4 ng./ml. or less before receiving radiotherapy and those with a prostatectomy specimen Gleason score of 7 or less were significantly more likely to be successfully treated by radiotherapy.

CONCLUSIONS

Radiation therapy is a viable treatment option for select patients with biopsy proved local disease recurrence following radical prostatectomy. The chance of achieving and maintaining a persistently low and stable or undetectable serum PSA is likely in those patients with a prostatectomy specimen Gleason score of 7 or less and a pre-radiation PSA of 4.0 ng./ml. or less. More effective treatment regimens are needed for those patients in whom radical prostatectomy fails.

Profound symptomatic bradycardia associated with combined mibefradil and beta-blocker therapy

We report two cases where the addition of mibefradil to long term beta-blocker therapy in managing hypertension produced profound symptomatic bradycardia requiring cardiac pacing. Reports of a number of interactions between mibefradil and other cardioactive drugs have now led to its withdrawal from the market worldwide.

Factor V inhibitor in a liver transplant patient associated with porcine xenoperfusion

The development of a high-titer factor V inhibitor is described in a patient who underwent orthotopic liver transplantation followed by porcine xenoperfusion after an acute rejection episode. The inhibitor showed no cross-reactivity to either porcine or bovine factor V, nor was it accessible to human platelet factor V. The limitations of treatment modalities including intravenous immunoglobulin, steroids, cytotoxic therapy, intense plasmapheresis and platelet transfusions are discussed.

A comparison of forensic and nonforensic malingerers: a prototypical analysis of explanatory models

Explanatory models of malingering strive to understand the primary motivation underlying attempts to feign. Rogers, Sewell, and Goldstein (1994) provided empirical support for the conceptualization of pathogenic, criminological, and adaptational models. In the current study, a prototypical analysis of 221 forensic experts results in a slightly refined formulation: the adaptational models was decomposed into its two broad dimensions (cost-benefit analysis and adversarial setting). An important findings is that the factor structure for the explanatory models remained stable when applied to both forensic and nonforensic cases. As a first investigation, significant differences were observed in prototypical cases of malingering by the category of referral (forensic or nonforensic) and by type of feigning (mental disorders, cognitive impairment, and medical syndromes). Surprisingly, the feigning of medical syndromes appeared to play a relatively prominent role in both forensic and nonforensic cases and to be influenced by the apparent adversarial context of the assessment. Finally, important gender differences were observed, especially with nonforensic prototypical cases of malingering.

Preliminary validation of the MMPI-A for a male delinquent sample: an investigation of clinical correlates and discriminant validity

Adolescent psychopathology, until recently, has been a largely neglected area of research and poses unique challenges for psychological assessments. In response to the specific need for adolescent-focused measures, the MMPI-A (Butcher et al., 1992) was among several measures to be developed. Although a sizeable literature exists on the original MMPI (Hathaway & McKinley, 1943) and adolescent populations, relatively few empirical studies have been published on the MMPI-A. The primary purpose of this study was the examination of clinical correlates for the MMPI-A for a male delinquent sample. MMPI-A protocols were collected from 99 adolescents at a North Texas juvenile correctional facility, and systematic comparisons were conducted between the Basic Scales and symptoms/diagnoses derived from the Schedule of Affective Disorders and Schizophrenia for School-Age Children (K-SADS-III-R; Ambrosini, Metz, Prabucki, & Lee, 1989). Using only K-SADS-III-R symptoms with high reliabilities (rs > .80), a comprehensive list of correlates was generated for the Clinical, Supplementary, and Content Scales. Additionally, stepwise discriminant functions successfully classified MMPI-A protocols according to K-SADS-III-R diagnoses. As an exploratory analysis, ethnic differences on MMPI-A profiles were also investigated, revealing significant differences among groups.

Characterization and chromosomal localization of PTP-NP-2, a new isoform of protein tyrosine phosphatase-like receptor, expressed on synaptic boutons

Recently, there have been several reports describing the cloning and characterization of the novel family of protein tyrosine phosphatase-like receptor molecules (known as IA-2 and PTP-NP/PTP-IAR/IA-2beta/phogrin), which may act as autoantigens in diabetes. Here, we report the molecular characterization and chromosomal localization of a new isoform of this family in brain termed PTP-NP-2 (for PTP-NP tyrosine phosphatase isoform), and its function in rat primary hippocampal neurons. PTP-NP-2 has 48% identity to IA-2. The principal difference between PTP-NP-2 and PTP-NP is a 17-amino-acid insert near the N-terminus of PTP-NP that is absent in PTP-NP-2. Genomic DNA analysis indicates that the 17-amino-acid insert is coded by a separate exon, suggesting that both IA-2beta and PTP-NP-2 are isoforms arising by alternate splicing of the same gene. Reverse transcriptase-PCR revealed that both isoforms are present in human SH-SY5Y neuroblastoma cells. PTP-NP-2 mRNA expression is highly restricted, with a 5.5-kb specific transcript in human fetal and adult brain and 5.5 and 3. 8 kb in human adult pancreas. SH-SY5Y neuroblastoma and U87-MG glioblastoma cells showed specific transcripts of 5.5 and 3.8<HSP SP = "0.25">kb, respectively, indicating the existence of several isoforms of this molecule in the nervous system. The human gene encoding PTP-NP-2 was assigned to human chromosome 7q22-qter using Southern blot analysis of genomic DNAs from rodent/human somatic hybrid cell lines. Confocal microscopy analyses of rat primary hippocampal neurons revealed that PTP-NP-2 is abundantly expressed on synaptic boutons in primary neurons. Wild-type PTP-NP-2 showed no measurable tyrosine phosphatase activity using an in-vitro pNPP assay. Examination of the PTP-NP-2 catalytic consensus sequence revealed that this sequence differed from the typical tyrosine phosphatase-domain consensus sequence by an alanine to aspartate change (amino acid 930). Mutation of aspartate 930 to alanine produced a catalytically active enzyme, suggesting that native PTP-NP and its isoform PTP-NP-2 are catalytically inactive receptor protein tyrosine phosphatase homologues. Taken together, these results indicate that the tyrosine phosphatase PTP-NP-2 is a new isoform of PTP-NP tyrosine phosphatase, is expressed on synaptic boutons and may participate in the regulation of synaptic bouton endocytosis.

Validity and reliability in a Flemish population of the WHO-MONICA Optional Study of Physical Activity Questionnaire

PURPOSE

This study assessed the validity and reliability of a self-administered physical activity questionnaire used in the WHO-MONICA project.

METHODS

Subjects (N = 167) were physical education and physical therapy alumni. The questionnaire (MOSPA-Q) covers a 1-yr period and measures the average weekly time and energy expenditure spent in one's occupation, transport-related activities, household chores, and leisure time activities. Test-retest reliability was reported as the intra-class correlation between calculated time or energy expenditure in different questionnaire items determined from two MOSPA-Q administrations. Validity was assessed using biometrical and physiological parameters as criterion measures.

RESULTS

Test-retest reliability ranged from 0.45 to 0.92 with the highest correlation coefficients obtained for the leisure time physical activities. The correlation between calculated daily total energy expenditure (TEE, Kcal.d-1) and lean body mass was 0.53 (P < 0.001). The correlation between energy expenditure in leisure time activities (Kcal.wk-1) and VO2peak was 0.44.

CONCLUSIONS

The MOSPA-Q provides a relatively valid and reliable estimate of physical activity.

Assessment of malingering with simulation designs: threats to external validity

Comprehensive forensic evaluations are predicated on the accurate appraisal of response styles that may affect evaluatees' clinical presentation and experts' conclusions associated with psycholegal issues. In the assessment of malingering, forensic experts often rely heavily on standardized measures that have been validated exclusively via analogue research. While such research augments internal validity, the threats to external validity are readily apparent. As the first study of these threats, type of incentive (positive versus negative), context (a familiar versus unfamiliar scenario), and relevance to the participants was investigated systematically with a between-subjects factorial design. A sample of 231 undergraduates was asked to either (a) feign major depression and given an easily understood description of this disorder or (b) serve as controls responding honestly. They were administered a brief measure of psychopathology (Hopkins Symptom Checklist; Derogatis, Lipman, Rickels, Uhlenhuth, & Covi, 1974) and a recent screen for malingering (Screening Inventory of Malingered Symptoms or SIMS; Smith, 1992) in 1 of 18 experimental conditions. Results suggested that incentive had a main effect on the SIMS. More specifically, simulators under negative incentives appeared more focused in their feigning; they produced more bogus depressed symptoms, but fewer symptoms unrelated to depression. Interactions were also observed between context and incentive, and context and relevance. Implications of these results are explored for both analogue research on malingering and current forensic practice.

NRP/B, a novel nuclear matrix protein, associates with p110(RB) and is involved in neuronal differentiation

The nuclear matrix is defined as the insoluble framework of the nucleus and has been implicated in the regulation of gene expression, the cell cycle, and nuclear structural integrity via linkage to intermediate filaments of the cytoskeleton. We have discovered a novel nuclear matrix protein, NRP/B (nuclear restricted protein/brain), which contains two major structural elements: a BTB domain-like structure in the predicted NH2 terminus, and a "kelch motif" in the predicted COOH-terminal domain. NRP/B mRNA (5.5 kb) is predominantly expressed in human fetal and adult brain with minor expression in kidney and pancreas. During mouse embryogenesis, NRP/B mRNA expression is upregulated in the nervous system. The NRP/B protein is expressed in rat primary hippocampal neurons, but not in primary astrocytes. NRP/B expression was upregulated during the differentiation of murine Neuro 2A and human SH-SY5Y neuroblastoma cells. Overexpression of NRP/B in these cells augmented neuronal process formation. Treatment with antisense NRP/B oligodeoxynucleotides inhibited the neurite development of rat primary hippocampal neurons as well as the neuronal process formation during neuronal differentiation of PC-12 cells. Since the hypophosphorylated form of retinoblastoma protein (p110(RB)) is found to be associated with the nuclear matrix and overexpression of p110(RB) induces neuronal differentiation, we investigated whether NRP/B is associated with p110(RB). Both in vivo and in vitro experiments demonstrate that NRP/B can be phosphorylated and can bind to the functionally active hypophosphorylated form of the p110(RB) during neuronal differentiation of SH-SY5Y neuroblastoma cells induced by retinoic acid. Our studies indicate that NRP/B is a novel nuclear matrix protein, specifically expressed in primary neurons, that interacts with p110(RB) and participates in the regulation of neuronal process formation.

Convergent validity of the personality assessment inventory: A study of emergency referrals in a correctional setting

The Personality Assessment Inventory (PAI) is a new generation multiscale inventory that is widely used in clinical settings. The current study examined its convergent validity with emergency referrals in a metropolitan correctional facility. A sample of 80 referrals completed two phases of an assessment study. As a measure of convergent validity, results on select PAI scales were compared to the Schedule of Affective Disorders and Schizophrenia (SADS), the Structured Interview of Reported Symptoms (SIRS), and the Suicide Probability Scale (SPS). Overall, results indicated moderate to good convergent validity for the following: (a) screening for feigned profiles, (b) establishing clinical correlates of common disorders, and (c) evaluating the potential for suicidal ideation.

Construct validity of psychopathy in a female offender sample: a multitrait-multimethod evaluation

The authors examined the construct of psychopathy as applied to 103 female offenders, using the multitrait-multimethod matrix proposed by D. T. Campbell and D. W. Fiske (1959). Instruments used in the study included the following: (a) Antisocial Scale of the Personality Assessment Inventory (L. C. Morey, 1991); (b) Psychopathy Checklist--Revised (R. D. Hare, 1990); and (c) Antisocial scale of the Personality Disorder Examination (A. W. Loranger, 1988). Criterion-related validity was also evaluated to determine the relationship between psychopathy and staff ratings of aggressive and disruptive behavior within the institution. Results revealed significant convergence and divergence across the instruments supporting the construct of psychopathy in a female offender sample. The measures of psychopathy demonstrated moderate convergence with staff ratings of violence, verbal aggression, manipulativeness, lack of remorse, and noncompliance. It is interesting to note that an exploratory factor analysis of the PCL-R identified a substantially different factor structure for women than has been previously found for male psychopathy.

Psychopathy and recidivism among female inmates

Despite a plethora of studies investigating psychopathy among male offenders, little is known about the applicability of this construct to female populations. Research has shown that prevalence rate, symptom presentation, and diagnostic comorbidity differ for females as compared to males. The current study is the first to examine the relationship between psychopathy and recidivism among women. Recidivism data on a sample of 78 female inmates were examined at a 1-year interval in relation to the Psychopathy Checklist-Revised (PCL-R), inclusion criteria for the Antisocial Personality Disorder Diagnosis from the Personality Disorder Examination (PDE), and selected scales from the Personality Assessment Inventory (PAI; Antisocial and Aggression scales). The egocentricity subscale of the PAI, Factor 1 of the PCL-R, and the verbal aggression subscale of the PAI were the best predictors of future recidivism. Specific differences emerged between male and female offenders when comparing the present data with previous studies of male psychopaths.

Overcoming the barriers: national to European to G7

An information revolution is underway which will have an impact on all sectors of society. It will fundamentally change national and international health systems. The global Internet is a key influence and will change the balance of power within and between healthcare professions, and between them and the general public. This revolution offers enormous potential benefits to global health but there is also potential for harm. There are a wide range of barriers to realising the potential benefits. They lie in areas such as the protection of personal information; ownership and legal accountability; data meanings: structures and database navigation; deficiencies in the global Internet and lack of access by many communities. This paper considers the nature of those barriers. In 1994, the Group of Seven Nations launched an initiative to stimulate a global information society. Theme 8 deals with healthcare and therein Sub-project 5 'Enabling Mechanisms', which the author leads, is seeking to identify barriers and the authoritative international sources of advise and good practice. It is conducting an international survey, the results of which should be published by the end of 1997. This paper describes the aims of this Sub-project.

Blood ammonia--heart rate relationship during graded exercise is not influenced by glycogen depletion

The blood lactate (La) - heart rate (HR) relationship assessed during a graded maximal exercise test (GXT) is often used to provide training guidelines to athletes. Glycogen depletion is a condition that is known to influence the La response during a GXT and therefore can bias the interpretation of La curves. The purpose of our study was to determine an influence of glycogen depletion through long-term exercise (GDE) on blood La and ammonia (NH3) accumulation during a GXT. Eleven persons (5 males, 6 females; 26.3 +/- 4 yrs) performed a cycle ergometer GXT (3 min protocol) on two separate occasions with a 1-week interval. Using a randomized cross-over design, one of the two GXTs was preceded by a GDE. After GDE, blood NH3 increased more rapidly in the depleted versus control state whereas La increased less rapidly in the depleted state. The NH3 to HR relationship was not altered by glycogen depletion. We conclude, therefore, that determination of NH3 during a GXT may provide helpful additional information for training recommendations which is not available through La determination only.