Ionization and photoelectric smoke alarms in rural Alaskan homes

OBJECTIVE

To compare rates of nuisance alarms and disconnection between ionization and photoelectric smoke alarms.

DESIGN

A prospective cohort study.

SETTING

Four Inupiat Eskimo villages in the Northwest Arctic Borough region of Alaska, 48 km (30 mi) above the Arctic Circle.

SUBJECTS

Households in 4 communities with similar populations, number of homes, mean income, size of household, and square footage per home.

INTERVENTION

Two villages had photoelectric alarms installed (58 homes), and 2 other villages had ionization alarms installed (65 homes) in standard locations. Follow-up household surveys were conducted after 6 months to determine rates of false alarms and detector disconnection. All of the households that could be contacted 104/123 agreed to participate in the follow-up surveys. Main outcome measures The proportion of households experiencing false alarms and the proportion of disabled alarms in households in each of the test communities.

RESULTS

Homes with ionization alarms had more than 8 times the rate of false alarms as those with photoelectric alarms. Eleven of the ionization alarms (19%) were disconnected compared with 2 of the photoelectric devices (4%).

CONCLUSIONS

In small rural residences, photoelectric smoke alarms have lower rates of false alarms and disconnection. Photoelectric alarms may be the preferred choice for dwellings with limited living space or frequent false alarms.

Quantitative comparisons of in vitro assays for estrogenic activities

Substances that may act as estrogens show a broad chemical structural diversity. To thoroughly address the question of possible adverse estrogenic effects, reliable methods are needed to detect and identify the chemicals of these diverse structural classes. We compared three assays--in vitro estrogen receptor competitive binding assays (ER binding assays), yeast-based reporter gene assays (yeast assays), and the MCF-7 cell proliferation assay (E-SCREEN assay)--to determine their quantitative agreement in identifying structurally diverse estrogens. We examined assay performance for relative sensitivity, detection of active/inactive chemicals, and estrogen/antiestrogen activities. In this examination, we combined individual data sets in a specific, quantitative data mining exercise. Data sets for at least 29 chemicals from five laboratories were analyzed pair-wise by X-Y plots. The ER binding assay was a good predictor for the other two assay results when the antiestrogens were excluded (r(2) is 0.78 for the yeast assays and 0.85 for the E-SCREEN assays). Additionally, the examination strongly suggests that biologic information that is not apparent from any of the individual assays can be discovered by quantitative pair-wise comparisons among assays. Antiestrogens are identified as outliers in the ER binding/yeast assay, while complete antagonists are identified in the ER binding and E-SCREEN assays. Furthermore, the presence of outliers may be explained by different mechanisms that induce an endocrine response, different impurities in different batches of chemicals, different species sensitivity, or limitations of the assay techniques. Although these assays involve different levels of biologic complexity, the major conclusion is that they generally provided consistent information in quantitatively determining estrogenic activity for the five data sets examined. The results should provide guidance for expanded data mining examinations and the selection of appropriate assays to screen estrogenic endocrine disruptors.

A comparison of the impact of hospital reform on medical subcultures in some Australian and New Zealand hospitals

This article examines similarities and differences in the way that hospital staff in Australia and New Zealand are evaluating efforts to improve quality, clinical effectiveness and service integration, and to strengthen clinical accountability. We draw on data from a cross-national study of hospital staff in Australia and New Zealand. The results highlight the way in which respondents' views about reform are influenced by the interplay of two factors: the impact of respondents' occupational backgrounds (our findings point to differences in the profession-based subcultures of medicine, nursing and general management and the way that these are reflected in respondents' assessments of particular aspects of reform); and the way that the impact of professional subcultures may be mitigated by differences between the systems in which respondents were located, including differences between the programs of reform that have been pursued in each country. The implications of these findings are discussed.

A dose-ranging study of rapacuronium in pediatric patients

BACKGROUND

The aim of this study was to determine the dose or doses of the new rapid-onset, short-acting, neuromuscular blocking drug rapacuronium that would provide satisfactory conditions for tracheal intubation at 60 s in infants and children.

METHODS

Sixty-five infants (< 1 yr), 51 younger children (1-6 yr), and 49 older children (7-12 yr) were studied. Anesthesia was induced with thiopental-nitrous oxide-oxygen. Tracheal intubation was attempted 60 s after administration of one of five doses of rapacuronium (0.5, 1.0, 1.5, 2.0, or 2.5 mg/kg) and intubating conditions were assessed using a four-point scale. Following tracheal intubation, anesthesia was maintained with nitrous oxide-oxygen and alfentanil (12.5-50 microg/kg) as necessary. Neuromuscular transmission was monitored in an uncalibrated fashion using an acceleromyograph.

RESULTS

Intubating conditions were good or excellent at 60 s in all infants after doses of 1.5 mg/kg or more and in all younger and older children after doses of 2.0 mg/kg or more. The duration of action of rapacuronium was dose- and age-dependent. Mean times to reappearance of the third twitch of the train-of-four (TOF; T3) were less than 10 min in infants at doses of 1.5 mg/kg or less and in younger and older children at doses of 2.0 mg/kg or less. Recovery of T3 after 1.0-2.0 mg/kg rapacuronium was significantly slower in infants compared with younger (P = 0.001) and older (P = 0.02) children. Five adverse experiences were related to rapacuronium administration: Bronchospasm (two instances), tachycardia (one instance), and increased salivation (two instances). None were serious.

CONCLUSIONS

Doses of 1.5 and 2.0 mg/kg rapacuronium can produce satisfactory intubating conditions at 60 s in anesthetized infants and children, respectively, and are associated with a short duration of action.

The estrogen receptor relative binding affinities of 188 natural and xenochemicals: structural diversity of ligands

We have utilized a validated (standardized) estrogen receptor (ER) competitive-binding assay to determine the ER affinity for a large, structurally diverse group of chemicals. Uteri from ovariectomized Sprague-Dawley rats were the ER source for the competitive-binding assay. Initially, test chemicals were screened at high concentrations to determine whether a chemical competed with [3H]-estradiol for the ER. Test chemicals that exhibited affinity for the ER in the first tier were subsequently assayed using a wide range of concentrations to characterize the binding curve and to determine each chemical's IC50 and relative binding affinity (RBA) values. Overall, we assayed 188 chemicals, covering a 1 x 10(6)-fold range of RBAs from several different chemical or use categories, including steroidal estrogens, synthetic estrogens, antiestrogens, other miscellaneous steroids, alkylphenols, diphenyl derivatives, organochlorines, pesticides, alkylhydroxybenzoate preservatives (parabens), phthalates, benzophenone compounds, and a number of other miscellaneous chemicals. Of the 188 chemicals tested, 100 bound to the ER while 88 were non-binders. Included in the 100 chemicals that bound to the ER were 4-benzyloxyphenol, 2,4-dihydroxybenzophenone, and 2,2'-methylenebis(4-chlorophenol), compounds that have not been shown previously to bind the ER. It was also evident that certain structural features, such as an overall ring structure, were important for ER binding. The current study provides the most structurally diverse ER RBA data set with the widest range of RBA values published to date.

Predicted changes in pre-mRNA secondary structure vary in their association with exon skipping for mutations in exons 2, 4, and 8 of the Hprt gene and exon 51 of the fibrillin gene

Exon skipping that accompanies exonic mutation might be caused by an effect of the mutation on pre-mRNA secondary structure. Previous attempts to associate predicted secondary structure of pre-mRNA with exon skipping have been hindered by either a small number of available mutations, sub-optimal structures, or weak effects on exon skipping. This report identifies more extensive sets of mutations from the human and hamster Hprt gene whose association with exon skipping is clear. Optimal secondary structures of the wild-type and mutant pre-mRNA surrounding each exon were predicted by energy minimization and were compared by energy dot plots. A significant association was found between the occurrence of exon skipping and the disruption of a stem containing the acceptor site consensus sequences of exon 8 of the human Hprt gene. However, no change in secondary structure was associated with skipping of exon 4 of the hamster Hprt gene. Using updated energy parameters we found a different structure than that previously reported for exon 2 of the hamster Hprt gene. In contrast to the previously reported structure, no significant association was found between predicted structural changes and skipping of exon 2. For all three Hprt exons studied, there was a significantly greater number of deoxythymidine substitutions among mutations accompanied by exon skipping than among mutations without exon skipping. For exon 8, deoxythymidine substitution was also associated with structural changes in the stem containing the acceptor site consensus sequences. For exon 51 of the human fibrillin gene, structural differences from wild type were predicted for all four mutations accompanied by exon skipping that were not were predicted for a single mutation without exon skipping. Our results suggest that both primary and secondary pre-mRNA structure contribute to definition of Hprt exons, which may involve exonic splicing enhancers.

Determining clinically meaningful cognitive impairment following traumatic brain injury

AIMS

To study the reliability and validity of ratings of: neuropsychological impairment with test data from traumatically brain-injured patients.

METHODS

Neuropsychological test results from 66 traumatically brain-injured adults and 27 orthopaedic controls were rated for neuropsychological impairment by an experienced neuropsychologist and three undergraduate students provided with brief training in test interpretation. Ratings were based on the discrepancy between a patient's current cognitive level and their estimated premorbid cognitive level. Decision making rules were utilised in making the ratings. The raters, who were blind with respect to the patients diagnostic group membership, independently rated test results. Test results were rerated using the same method approximately two weeks later.

RESULTS

The ratings of novice raters were in good to very good agreement with the ratings of an expert. All raters evidenced very good to excellent test-retest reliability. Higher rates of neuropsychological impairment were found in the traumatically brain-injured group than in the orthopaedic control group. Discriminant function analysis suggested that raters employed information from all neuropsychological measures (with the exception of current intellectual level), in making their overall ratings of neuropsychological impairment.

CONCLUSION

These findings provide encouraging preliminary evidence in support of the reliability and validity of individual case-based ratings of neuropsychological impairment. The high false positive rate in the control sample may reflect the relatively low specificity of neuropsychological impairment.

Effects of a body image curriculum for college students on improved body image

OBJECTIVE

This study evaluated the effects of an undergraduate body image course, "Body Traps: Perspectives on Body Image," on decreasing body dissatisfaction, weight concern, and disordered eating behaviors.

METHODS

Twenty-four undergraduate females enrolled in the body image course. Measures of body image and disordered eating patterns were assessed at baseline and at postintervention.

RESULTS

Subjects significantly decreased the frequency and severity of their body dissatisfaction and disordered eating. No changes in body mass index or global self-esteem were observed.

DISCUSSION

This is the first investigation to demonstrate that a formal, academic course can result in the reduction of both attitudinal and behavioral eating disorder risk factors. Future controlled studies need to be undertaken to substantiate this effect.

Comparison of estrogen receptor alpha and beta subtypes based on comparative molecular field analysis (CoMFA)

A substantial body of evidence indicates that both humans and wildlife suffer adverse health effects from exposure to environmental chemicals that are capable of interacting with the endocrine system. The recent cloning of the estrogen receptor beta subtype (ER-beta) suggests that the selective effects of estrogenic compounds may arise in part by the control of different subsets of estrogen-responsive promoters by the two ER subtypes, ER-alpha and ER-beta. In order to identify the structural prerequisites for ligand-ER binding and to discriminate ER-alpha and ER-beta in terms of their ligand-binding specificities, Comparative Molecular Field Analysis (CoMFA) was employed to construct a three-dimensional Quantitative Structure-Activity Relationship (3D-QSAR) model on a data set of 31 structurally-diverse compounds for which competitive binding affinities have been measured against both ER-alpha and ER-beta. Structural alignment of the molecules in CoMFA was achieved by maximizing overlap of their steric and electrostatic fields using the Steric and Electrostatic ALignment (SEAL) algorithm. The final CoMFA models, generated by correlating the calculated 3D steric and electrostatic fields with the experimentally observed binding affinities using partial least-squares (PLS) regression, exhibited excellent self-consistency (r2 > 0.99) as well as high internal predictive ability (q2 > 0.65) based on cross-validation. CoMFA-predicted values of RBA for a test set of compounds outside of the training set were consistent with experimental observations. These CoMFA models can serve as guides for the rational design of ER ligands that possess preferential binding affinities for either ER-alpha or ER-beta. These models can also prove useful in risk assessment programs to identify real or suspected EDCs.

'I wanted to be a nurse ... but I didn't get that far': women with serious ongoing mental health problems speak about their lives

Within mental health services there are fewer women than men with serious mental health problems and there is evidence that their needs are relatively neglected resulting in specific deleterious effects. In research, as in services, the abilities of women with serious mental health problems appear to be under-estimated, and there is almost a total absence of research into the views and experiences of such women. This study aimed to explore the lives of women with serious ongoing mental health problems and their experience of services, to develop understanding of the context and impact of mental distress. In a series of 5 focus group interviews, the women, who were using a range of services for people with long-term mental health problems, described lives which, even before the onset of mental health problems, were marked by material, social and personal disadvantage. Their mental health problems led to numerous losses: loss of homes, jobs, relationships, children and loss of 'normality', yet the women retained hopes and aspirations for the future. The women clearly identified aspects of the service that they valued, in particular the support and company of women workers and other women service users. The implications of these findings are discussed in relation to planning and providing mental health services for women.

Deliberate exposure to motor vehicle exhaust gas: the psychosocial profile of attempted suicide

OBJECTIVE

Deliberate exposure to motor vehicle exhaust gas has become the second most commonly used method of suicide in Australia. In an attempt to understand the factors contributing to the rise in popularity of this method, the psychosocial profiles, factors influencing method choice and circumstances of the act of self-harm were examined in a group of survivors.

METHOD

A cross-sectional cohort study of 30 patients presenting for hyperbaric oxygen treatment having survived deliberate exposure to car exhaust gas was undertaken. A structured clinical interview was administered together with scales measuring depression, hopelessness and suicidal intent. Daily assessment of mental state and cognitive function was performed.

RESULTS

Factors common to the majority of subjects included male gender, age group of 20-50 years, and alcohol abuse. Relationship discord was the most common precipitating factor. Reasons given for choice of this method included the availability and accessibility of motor vehicles, painlessness, awareness that the method was lethal, knowledge of another person's successful suicide by this method and awareness of the method through media portrayal. Most of the cars used did not have engines fitted with catalytic converters, substantially increasing the risk of toxicity. Regret of the attempt, denial of further suicidal ideation after the event, and the absence of a suicide note were common findings. Most denied excessive time spent planning. The most common diagnosis in this group was adjustment disorder with depressed mood. Suicide intent scores were not high, inconsistent with the majority of patients being aware of the lethality of the method.

CONCLUSION

Sociodemographic findings resemble those of psychological autopsy studies of subjects completing suicide by this method. Survival in this group was due to failure of the method or unexpected discovery rather than patient factors. This population described the method as highly acceptable and accessible emphasising the urgent need for reduction of access to this means of suicide in Australia.

An evaluation of services for women with long-term mental health problems

This paper presents the results of an evaluation study of services for women with long-term mental health problems. The study, which was conducted in a long-term rehabilitation and community care service, examined the adequacy, accessibility, and responsiveness of services provided for women users; explored differences between the men and women using the service and those newly admitted to it; and explored the views and experiences of service providers and the women users themselves. The results of the study confirm and extend those of previous studies and suggest a number of service recommendations. The unevenness in attention to the needs of women across services needs to be addressed. Services should be more attractive to women. Agencies and facilities for women outside mental health services should be supported to ensure that they can accommodate women with long-term mental health problems, and the women themselves need to be offered the support necessary to ensure they have access to such facilities. Finally, efforts must be made to ensure that services both recognize the losses that women with long-term mental health problems have experienced and foster their continued hopes and aspirations for the future.

Evaluation of quantitative structure-activity relationship methods for large-scale prediction of chemicals binding to the estrogen receptor

Three different QSAR methods, Comparative Molecular Field Analysis (CoMFA), classical QSAR (utilizing the CODESSA program), and Hologram QSAR (HQSAR), are compared in terms of their potential for screening large data sets of chemicals as endocrine disrupting compounds (EDCs). While CoMFA and CODESSA (Comprehensive Descriptors for Structural and Statistical Analysis) have been commercially available for some time, HQSAR is a novel QSAR technique. HQSAR attempts to correlate molecular structure with biological activity for a series of compounds using molecular holograms constructed from counts of sub-structural molecular fragments. In addition to using r2 and q2 (cross-validated r2) in assessing the statistical quality of QSAR models, another statistical parameter was defined to be the ratio of the standard error to the activity range. The statistical quality of the QSAR models constructed using CoMFA and HQSAR techniques were comparable and were generally better than those produced with CODESSA. It is notable that only 2D-connectivity, bond and elemental atom-type information were considered in building HQSAR models. Since HQSAR requires no conformational analysis or structural alignment, it is straightforward to use and lends itself readily to the rapid screening of large numbers of compounds. Among the QSAR methods considered, HQSAR appears to offer many attractive features, such as speed, reproducibility and ease of use, which portend its utility for prioritizing large numbers of potential EDCs for subsequent toxicological testing and risk assessment.

Pharmacokinetics of sparfloxacin in the serum and vitreous humor of rabbits: physicochemical properties that regulate penetration of quinolone antimicrobials

We have used a recently described animal model to characterize the ocular pharmacokinetics of sparfloxacin in vitreous humor of uninfected albino rabbits following systemic administration and direct intraocular injection. The relationships of lipophilicity, protein binding, and molecular weight to the penetration and elimination of sparfloxacin were compared to those of ciprofloxacin, fleroxacin, and ofloxacin. To determine whether elimination was active, elimination rates following direct injection with and without probenecid or heat-killed bacteria were compared. Sparfloxacin concentrations were measured in the serum and vitreous humor by a biological assay. Protein binding and lipophilicity were determined, respectively, by ultrafiltration and oil-water partitioning. Pharmacokinetic parameters were characterized with RSTRIP, an iterative, nonlinear, weighted, least-squares-regression program. The relationship between each independent variable and mean quinolone concentration or elimination rate in the vitreous humor was determined by multiple linear regression. The mean concentration of sparfloxacin in the vitreous humor was 59.4% +/- 12.2% of that in serum. Penetration of sparfloxacin, ciprofloxacin, fleroxacin, and ofloxacin into, and elimination from, the vitreous humor correlated with lipophilicity (r2 > 0.999). The linear-regression equation describing this relationship was not improved by including the inverse of the square root of the molecular weight and/or the degree of protein binding. Elimination rates for each quinolone were decreased by the intraocular administration of probenecid. Heat-killed Staphylococcus epidermidis decreased the rate of elimination of fleroxacin. Penetration of sparfloxacin into the noninflamed vitreous humor was greater than that of any quinolone previously examined. There was an excellent correlation between lipophilicity and vitreous entry or elimination for sparfloxacin as well as ciprofloxacin, fleroxacin, and ofloxacin. There are two modes of quinolone translocation into and out of the vitreous humor: diffusion into the eye and both diffusion and carrier-mediated elimination out of the vitreous humor.

The use of the bicipital groove for alignment of the humeral stem in shoulder arthroplasty

Four hundred twenty humeri were measured to determine humeral head retroversion and its relation to the location of the bicipital groove. Average head retroversion was found to be 28.3 degrees (+/- 13.2 degrees), and the angular orientation of the bicipital groove referenced to the transepicondylar axis was 55.5 degrees (+/- 13.8 degrees). The average difference between these angular orientations was 27.3 degrees (+/- 14.2 degrees). This result implies that the bicipital groove can be used as a landmark for prosthetic stem positioning in shoulder arthroplasty if the center of the lateral aspect of the stem is posteriorly offset approximately 30 degrees from the center of the groove. However, because of the appreciable variation in these averages, the use of the bicipital groove as a reference can result in a significant error of humeral stem alignment, which should be considered when determining the retroversion for a particular patient.

Quantitative structure-activity relationships (QSARs) for estrogen binding to the estrogen receptor: predictions across species

The recognition of adverse effects due to environmental endocrine disruptors in humans and wildlife has focused attention on the need for predictive tools to select the most likely estrogenic chemicals from a very large number of chemicals for subsequent screening and/or testing for potential environmental toxicity. A three-dimensional quantitative structure-activity relationship (QSAR) model using comparative molecular field analysis (CoMFA) was constructed based on relative binding affinity (RBA) data from an estrogen receptor (ER) binding assay using calf uterine cytosol. The model demonstrated significant correlation of the calculated steric and electrostatic fields with RBA and yielded predictions that agreed well with experimental values over the entire range of RBA values. Analysis of the CoMFA three-dimensional contour plots revealed a consistent picture of the structural features that are largely responsible for the observed variations in RBA. Importantly, we established a correlation between the predicted RBA values for calf ER and their actual RBA values for human ER. These findings suggest a means to begin to construct a more comprehensive estrogen knowledge base by combining RBA assay data from multiple species in 3D-QSAR based predictive models, which could then be used to screen untested chemicals for their potential to bind to the ER. Another QSAR model was developed based on classical physicochemical descriptors generated using the CODESSA (Comprehensive Descriptors for Structural and Statistical Analysis) program. The predictive ability of the CoMFA model was superior to the corresponding CODESSA model.

QSAR models for binding of estrogenic compounds to estrogen receptor alpha and beta subtypes

We have developed Quantitative Structure-Activity Relationship (QSAR) models based on Comparative Molecular Field Analysis (CoMFA) for 31 estrogenic chemicals whose relative binding affinity (RBA) is available for both ER-alpha and ER-beta. The models demonstrated a significant correlation (r2>0.95) between the CoMFA-calculated steric/electrostatic fields and corresponding RBA data and a good predictive capability (q2>0.6) based on cross-validation. The CoMFA models and contour plots obtained for ER-alpha and ER-beta suggest a close similarity between the receptors in terms of mode of binding and provide a rational basis for ligand selectivity.

In vitro activities of ciprofloxacin and rifampin alone and in combination against growing and nongrowing strains of methicillin-susceptible and methicillin-resistant Staphylococcus aureus

We characterized the effects of ciprofloxacin and rifampin alone and in combination on Staphylococcus aureus in vitro. The effects of drug combinations (e.g., indifferent, antagonistic, or additive interactions) on growth inhibition were compared by disk approximation studies and by determining the fractional inhibitory concentrations. Bactericidal effects in log-phase bacteria and in nongrowing isolates were characterized by time-kill methods. The effect of drug combinations was dependent upon whether or not cells were growing and whether killing or growth inhibition was the endpoint used to measure drug interaction. Despite bactericidal antagonism in time-kill experiments, our in vitro studies suggest several possible explanations for the observed benefits in patients treated with a combination of ciprofloxacin and rifampin for deep-seated staphylococcal infections. Notably, when growth inhibition rather than killing was used to characterize drug interaction, indifference rather than antagonism was observed. An additive bactericidal effect was observed in nongrowing bacteria suspended in phosphate-buffered saline. While rifampin antagonized the bactericidal effects of ciprofloxacin, ciprofloxacin did not antagonize the bactericidal effects of rifampin. Each antimicrobial prevented the emergence of subpopulations that were resistant to the other.

Therapy for lesbians?

Abstract From a lesbian feminist perspective the problematic nature of developments in 'lesbian' and 'feminist' psychological therapies is considered. It is argued that such therapies are, despite their expressed aims, essentially anti-lesbian and anti-feminist.