A technique for establishing the identity of 'isolated' fossil hominin limb bones

Associated skeletons, which are specimens preserving more than one body part from the same individual, are especially important for taxonomic and functional analyses. This study concentrates on the subset of associated skeletons which preserve the reciprocal surfaces of a joint. It uses laser scanning to explore whether the shapes of the reciprocal surfaces of a joint of an individual are significantly more congruent than the surfaces of randomly-matched pairings taken from the same species. Laser scanning was used to capture the distal articular surface of the left tibia of OH35 and the trochlear articular surface of the talus of OH8, both from Bed I, Olduvai Gorge, Tanzania. The degree of congruency between those articular surfaces was tested against the congruency of the talocrural joint of AL 288-1 (Australopithecus afarensis), and the congruency of both associated and randomly-matched talocrural joints of modern humans, chimpanzees and gorillas. The results suggest that OH35 and OH8 do not come from the same individual and may not come from the same species. Although this analysis leaves open the taxonomic affinity of OH35, it demonstrates the potential of laser scanning for capturing 3D data in palaeoanthropology. It also demonstrates the potential for using the relative congruency of reciprocal joint surfaces as a test of the likelihood that isolated limb bones are components of a single individual.

Teaching the clinical interpretation of peripheral blood smears to a second-year medical school class using the PeripheralBlood-Tutor computer program

The interpretation of peripheral blood smears has an important role in the diagnosis of hematologic diseases and is, therefore, part of the education of physicians and technologists. We describe a computer program, PeripheralBlood-Tutor (Lippincott-Raven, Philadelphia, Pa), that teaches the morphologic features of normal and abnormal peripheral blood smears; we also describe the evaluation of the effectiveness of the program in 133 second-year medical students who were required to use the program in their hematology course. The version of the PeripheralBlood-Tutor used in the study had 2 distinct but equivalent 20-question examinations; one examination, the pretest, was taken before the students viewed the contents of the program, and the other examination, the posttest, was taken after completing the program. The mean score on the pretest was 61% (SD, 14%), the mean on the posttest was 91% (SD, 10%), and the improvement was significant. In addition, 4 questions about peripheral blood smears, which were based on printed images, were administered at the end of the hematology course. The students scored an average of 2.75 (SD, 0.86), and a positive correlation was found between these scores and the scores on the Tutor posttest. The results of the study suggest that PeripheralBlood-Tutor is feasible to implement, and it helps students learn to interpret peripheral blood smears. The use of PeripheralBlood-Tutor is now a requirement in the medical school curriculum, the medical technology program, and the pathology residency at the University of Washington, Seattle.

Taxonomic and functional implications of mandibular scaling in early hominins

Body mass estimates for fossil hominin taxa can be obtained from suitable postcranial and cranial variables. However, the nature of the taphonomic processes that winnow the mammalian fossil record are such that these data are usually only available for the minority of the specimens that comprise the hypodigm of a species. This study has investigated the link between species mean body mass and the height and width of the mandibular corpus in a core sample of 23 species of extant simians. The slopes of the least-squares regressions for the whole sample and for the hominoid subset are similar. However, the intercepts differ so that for a given body mass, a hominoid will generally have a smaller mandible than a generalized simian. The same mandibular measurements were taken on 75 early hominin mandibles assigned to eight species groups. When mandibular corpus height- and width-derived estimates of body mass for the fossil taxa were compared with available postcranial and cranial-derived body mass estimates, the eight early hominin species sort into four groups. The first, which includes A. afarensis and A. africanus, has mandibles which follow a "generalized simian" scaling relationship. The second group, which comprises the two "robust" australopithecine species, P. boisei and P. robustus, has mandibles which scale with body mass as if they are "super-simians," for they have substantially larger mandibles than a simian with the same body mass. The two "early Homo" species, H. habilis sensu stricto and H. rudolfensis, make up the third group. It has mandibular scaling relationships that are intermediate between that of the comparative simian sample and that of the hominoid subsample. The last of the four groups comprises H. ergaster and H. erectus; their mandibles scale with body mass as if they were hominoids, so that of the four groups they have the smallest mandibles per unit body mass. These results are related to comparable information about relative tooth size. Their relevance for attempts to interpret the dietary adaptations of early hominins are explored.

Infrared microspectroscopy and artificial neural networks in the diagnosis of cervical cancer

Infrared spectra of 88 normal and 32 abnormal (mild to severe dysplasia) cervical smear samples were used as a databank to investigate the usefulness of artificial neural networks (ANN) in the diagnosis of cervical smears. The spectra were first reduced, using principal component analysis (PCA), to seven wavenumber components that are the major contributors to the variance. A number of different ANN architectures were investigated that could differentiate between normal and abnormal cervical smears. Although the ANNs were trained to differentiate only normal from abnormal smears, the results using an independent test data set indicated that within the abnormal category mild dysplasia could be distinguished from severe dysplasia. The results using this restricted data set indicate that neural networks coupled to infrared microspectroscopy could provide an alternative automated means of screening for cervical cancer.

Pellagra in a woman using alternative remedies

A young woman presented with pellagra. Dietary intake of niacin was in excess of recommended guidelines. She had a low body mass index and was taking a number of alternative remedies. Resolution was rapid with oral nicotinic acid and discontinuation of the remedies.

Potent topical steroid in a Chinese herbal cream

Steroids have been discovered previously in oral "herbal" preparations. Using liquid chromatography, we have now confirmed the presence of the potent topical steroid, clobetasol proprionate, in a Chinese herbal cream.

The economic impact of high-risk pregnancies

To compare the costs of prenatal care, labor and delivery, and postnatal care of 775 high-risk (HR) pregnancies with costs of 2,825 low-risk pregnancies, data were collected from retrospective chart review and computerized financial records of infants and mothers. Claims paid to providers, hospitals, and ancillary services were the direct medical costs of care for Sentara Health Plan. The total prenatal, labor and delivery, and postnatal costs were more than 6 million dollars and 3.5 million dollars for premature and term babies, respectively. Postnatal and total costs were related inversely to gestational ages and birth weights and directly related to length of stay. The data indicate the substantially increased cost of identified HR pregnancies. The gestational age and birth weight correlate with postnatal and total costs.

Contact dermatitis from cetostearyl alcohol

Emulsifiers are an uncommon cause of allergic contact dermatitis. Five cases of allergic contact dermatitis to cetostearyl alcohol are presented. In all five cases, multiple positive reactions to other allergens were present, usually topical corticosteroid creams.

Nosocomial Trichophyton tonsurans in a long stay ward

AIMS

To document a nosocomial outbreak of Trichophyton tonsurans infection in a long stay ward.

METHOD

Retrospective review of mycology cultures taken from patients and staff during 1993-5 and clinical examination of both patients and staff.

RESULTS

Thirty-three mycology samples from 13 patients and staff, cultured T tonsurans during the period 1993-5. Twenty-two patients and staff were examined; 4 had mycology confirmed T tonsurans (2 scalp, 2 fingernail). Treatment with terbinafine 250 mg/day for 2 months resulted in clinical clearance (only 1 positive culture in 16 months follow-up).

SUMMARY

T tonsurans is emerging as an important pathogen which may cause nosocomial infections.

Herpes zoster brachial plexus neuritis

This is the first report of brachial plexus inflammation associated with clinical herpes zoster paresis. A 78-year-old female with a 3-week history of herpes zoster of the C4, C5, and C6 dermatomes developed left upper arm monoplegia. She died from an acute myocardial infarction. Post-mortem provided a rare opportunity to study the neuropathology of herpes zoster motor involvement. Histology of the brachial plexus showed extensive lymphocytic infiltration, myelin breakdown, and preservation of axons without vasculitis. The cervical spinal cord showed perivascular lymphocytic cuffing and no anterior horn necrosis. We suggest, the brachial plexus inflammation was a distal extension of a dorsal ganglionitis. Brachial plexus neuritis may be a direct cause of reversible upper limb paresis in herpes zoster. We demonstrate the motor neuropathy is an inflammatory demyelinative process consistent with the recovery observed in a number of patients. We postulate post-herpetic neuralgia may be related to an ongoing inflammatory process.

Human evolution

The common ancestor of modern humans and the great apes is estimated to have lived between 5 and 8 Myrs ago, but the earliest evidence in the human, or hominid, fossil record is Ardipithecus ramidus, from a 4.5 Myr Ethiopian site. This genus was succeeded by Australopithecus, within which four species are presently recognised. All combine a relatively primitive postcranial skeleton, a dentition with expanded chewing teeth and a small brain. The most primitive species in our own genus, Homo habilis and Homo rudolfensis, are little advanced over the australopithecines and with hindsight their inclusion in Homo may not be appropriate. The first species to share a substantial number of features with later Homo is Homo ergaster, or 'early African Homo erectus', which appears in the fossil record around 2.0 Myr. Outside Africa, fossil hominids appear as Homo erectus-like hominids, in mainland Asia and in Indonesia close to 2 Myr ago; the earliest good evidence of 'archaic Homo' in Europe is dated at between 600-700 Kyr before the present. Anatomically modern human, or Homo sapiens, fossils are seen first in the fossil record in Africa around 150 Kyr ago. Taken together with molecular evidence on the extent of DNA variation, this suggests that the transition from 'archaic' to 'modern' Homo may have taken place in Africa.

Multiple medicament allergies in two patients with chronic leg ulceration

Medicament allergies in patients with chronic leg ulcers is well recognized. In the past, topical antibiotics, rubber additives and wool alcohols have been the most common reported allergens. Allergy to topical corticosteroids has been reported. We document two cases of multiple corticosteroid allergy in patients with chronic leg ulceration.

Semistructured child sexual abuse interviews: interview and child characteristics related to credibility of disclosure

This study provided the first empirical description of child and interviewer behaviors occurring within semistructured assessment interviews with children suspected of being victims of sexual abuse. Specifically, relationships between child and interviewer characteristics and interview credibility were examined. Using the Child Abuse Interview Interaction Coding System (CAIICS, Wood, 1990), 55 videotaped interviews of high-risk sex abuse cases seen at a multidisciplinary assessment center were behaviorally coded. Support was found for the interrater reliability and criterion related validity of the CAIICS was found. Results also revealed that children were initially rated as relaxed and displayed few emotional behaviors. Thus, the assumption that a credible disclosure of abuse must necessarily include the display of emotion by the child was not supported. Second, several behavioral differences between preschool and school-aged children were identified: however, no meaningful gender differences were found. Third, supporting evidence was found for both age and gender effects in judgments of interview credibility, with girls and school-aged children judged as more credible. Fourth, while the interviewer did engage in so called leading behaviors, these behaviors were not found to be related to rating of interview credibility. However, interviewer behaviors may have affected interview credibility through an intervening variable. Finally, implications, for further use of the CAIICS for examining interviewer-child interactions, evaluating standards of practice, and assisting with interviewer training are discussed.

Hominid palaeobiology: have studies of comparative development come of age?

It is 70 years since Adolf Schultz urged his colleagues to consider how studies of primate growth and development could help them interpret the course of human evolution. This paper considers the evolutionary context of comparative growth studies. It compares and contrasts aspects of the ontogeny of living modern humans and chimpanzees, and considers whether relatively simple models of heterochronic change can account for the modifications which have taken place during the course of human evolutionary history.

Comparison of secondary structures in water of chondroitin-4-sulfate and dermatan sulfate: implications in the formation of tertiary structures

Chondroitin-4-sulfate (CS4) and dermatan sulfate (DS) were examined in D2O solution, with or without NaCl, by NMR at 300 MHz, to investigate the physicochemical consequences of epimerization of glucuronate (GlcUA in CS4) to iduronate (IdoUA in DS). Nuclear Overhauser effects (NOEs) and spin-lattice relaxation times following selective and nonselective inversion were measured at up to 70 degrees C. (1) NOEs confirmed 4C1 conformations of sugar rings in N-acetylgalactosamine and GlcUA, and 1C4 or 2S0 in IdoUA. Conflict between NMR data and periodate oxidation kinetics over IdoUA conformations is resolvable by postulating conversion of monodentate periodate-1C4 complexes to conformations in which periodate oxidation can procede. (2) Pairs of glycosidic protons in CS4 and DS showed strong NOEs, implying that stretches of 2-fold helix were present, with carboxylate and acetamido groups close to each other on the same side of tapelike molecules, extending previous work in dimethyl sulfoxide solution. CS4 and DS have large hydrophobic patches in this configuration, similar to those in keratan sulfate and hyaluronan. (3) Selective and nonselective inversion-recoveries implied similar segmental and backbone mobilities and hence flexibilities in CS4 and DS. This is discussed in terms of intrinsic flexibility of glycosidic conformations, modified by hydrogen-bonded arrays. (4) We postulate that hydrophobic and hydrogen bonding drives DS self-aggregation. Stronger self-aggregation of DS compared with CS4 is attributed to increased intermolecular hydrogen-bonding in DS, secondary to decreased intramolecular hydrogen-binding. This is partly because the axial OH groups in 1C4 IdoUA cannot hydrogen-bond to neighboring sugars as can the equatorial OH groups in GlcUA of CS4.

A new device for pleural drainage in newborn infants

OBJECTIVE

We tested a chest tube device and insertion technique designed to reduce complications and expedite effective thoracostomy tube placement.

METHODOLOGY

This is a case series study. We placed chest tubes using this device in 25 infants ranging in weight from 425 to 3500 g. This investigation was performed in a regional referral center neonatal intensive care unit.

RESULTS

Using this device, chest tube insertion was safe and effective. No complications were identified.

CONCLUSION

We believe percutaneous placement of small-bore pigtail catheters using this technique represents a useful alternative to the standard approach of thoracostomy tube placement in small infants.

SYNOPSIS

To reduce complications during thoracostomy tube placement and to expedite tube insertion, we modified a chest tube device for use in premature infants. This technique and device facilitates quick and accurate placement. We placed chest tubes using this device in 25 infants ranging from 425 to 3500 g. Using this device, chest tube insertion is quick, easy, and safe. No complications were identified. We believe percutaneous placement of small-bore pigtail catheters using this technique represents a useful alternative to the standard approaches of thoracostomy tube placement in small infants.

Symptomatic fluid retention in patients on continuous peritoneal dialysis

The clinical features, pathogenesis, management, prognosis, and predictors of symptomatic fluid gain (SFR) were analyzed for 71 episodes occurring in 66 patients on continuous peritoneal dialysis, 94.4% on continuous ambulatory peritoneal dialysis (CAPD) and 5.6% on continuous cycling peritoneal dialysis. Compared with a control group of 149 CAPD patients, the SFR group had a higher percentage of diabetics (64 versus 46%) and a higher frequency of noncompliance with fluid restriction (76 versus 22%), salt restriction (74 versus 23%), and performance of dialysis (30 versus 7%) (all at P < or = 0.015). Peripheral edema (100%), pulmonary congestion (80%), pleural effusions (76%), and systolic (83%) and diastolic (66%) hypertension were the most common manifestations of SFR. The annual hospitalization rate for SFR was 4.1 +/- 5.8 days per patient. SFR resulted in the discontinuation of CAPD in 10 patients and death in 1 patient. Serum sodium concentration was not different between dry and maximal weight in the SFR group. Thirty-eight (58%) of SFR and 61 (41%) of control patients were evaluated by peritoneal equilibration tests (PET). SFR patients had lower PET drain volume (2.08 +/- 0.47 versus 2.54 +/- 0.23 L) and a higher frequency of high peritoneal solute transport (32.2 versus 2.4%). In this group, logistic regression identified dietary noncompliance, low PET drain volume, and young age as independent predictors of SFR. Response to management and preventive measures was inconsistent. The best results were obtained by the use of short dwell exchanges with hypertonic dialysate in compliant patients with high peritoneal solute transport. SFR has serious consequences in CAPD. (ABSTRACT TRUNCATED AT 250 WORDS)

Presentation of acute Wernicke's encephalopathy and treatment with thiamine

Thirty two cases of acute Wernicke's encephalopathy were observed in a period of 33 months, and prior to the mandatory thiamine enrichment of Australian bread-making flour in 1991. These cases were carefully assessed by multiple tests at specified intervals prior to, and following thiamine administration until discharge from hospital. Structured scoring of neurological signs and symptoms, CT scans, psychometry, nutritional measurements, and liver biopsies were performed. There was variation in the presentation and severity of clinical signs and symptoms and in response to treatment. All patients had alcohol-related liver disease, and the results indicated that fatty liver was important in presentation and in response to treatment with thiamine. Other forms of alcohol related brain damage were present in these patients, most of whom were in the 4th or 5th decade of life and had been drinking beer to excess for more than 20 years.

Promoting an awareness of retractions: the Louisiana State University Medical Center in Shreveport experience

The current mission statement of the Medical Library Association states that it is "dedicated to improving health through professional excellence and leadership of its members in the ... provision of information services and educational programs ..." With this goal in mind, retractions offer medical librarians a professional challenge to become involved in the scientific process. Through results of a survey conducted among the consortium of South Central Academic Medical Libraries (SCAMeL), this paper reveals opinions on the importance of retraction awareness and who is responsible for disseminating this knowledge. The paper also reports what the Louisiana State University Medical Center at Shreveport Library and other SCAMeL member libraries are doing to promote awareness.

Coalitions and family problem solving with preadolescents in referred, at-risk, and comparison families

This study tested the hypothesis that the mother-father coalition, parent-child coalitions, and parental warmth expressed toward the child are associated with family problem solving in families with a preadolescent child referred for treatment of behavior problems (n = 30), families with a child at-risk for conduct disorder (n = 68), and a sample of comparison families (n = 90). Referred and at-risk families displayed less effective problem solving. A regression analysis, which controlled for gender of the child, family structure, family income, marital satisfaction, and severity of child problems, showed that strong parental coalitions were linked to low levels of family problem solving in at-risk and referred families. Parent-child coalitions had little apparent impact while parental warmth was highly correlated with better family problem solving. The results may be interpreted as evidence for a tendency for parents in at-risk and referred families to "scapegoat" a preadolescent during family problem-solving sessions. This may undermine progress on family problem solutions and may complicate family-based prevention and treatment programs that use family problem-solving sessions.

Paranthropus boisei: an example of evolutionary stasis?

Of the presently recognised early hominid species, Paranthropus boisei is one of the better known from the fossil record and arguably the most distinctive; the latter interpretation rests on the numbers of apparently derived characters it incorporates. The species as traditionally diagnosed is distributed across approximately one million years and is presently confined to samples from East African sites. The hypodigm has been examined for evidence of intraspecific phyletic evolution, with particular emphasis on the areas best represented in the fossil record, namely the teeth and mandible. The results of this examination of 55 mandibular and dental variables which uses the gamma test statistic for the detection of trend, and nonparametric spline regression (Loess regression) for investigating pattern and rate of temporal change, show that within Paranthropus boisei sensu stricto most evidence of temporally related morphological trends relates to the morphology of the P4 crown. There is little or no evidence of any tendency to increase in overall size through time. Fossils from the Omo Shungura Formation and West Turkana which have been recovered from a time period earlier than the P. boisei sensu stricto hypodigm resemble the latter taxon in some features, but differ from it in aspects of cranial morphology. There is insufficient fossil evidence of the earlier taxon to tell whether it changes through time, but when trends of 47 mandibular and dental variables are assessed across the combined East African "robust" australopithecine sample, there is evidence for a relatively abrupt change around 2.2-2.3 Myr in approximately 25% of the dental and mandibular remains. Some of these changes correspond with the temporal trends within P. boisei sensu stricto, but others, such as mandible height, do not. If the earlier material is ancestral to P. boisei sensu stricto, evidence from the teeth and jaws is consistent with a punctuated origin for the latter taxon.

A new laser-ultrasound transducer for medical applications

A new type of probe is presented, which combines an ultrasound receiver constructed from piezoelectric polymer materials with a coaxial optical fibre for laser-induced ultrasound. The initial application of this probe, which may be further miniaturized, is in intra-arterial imaging and therapy. Overall diameters of the prototype probes presently range from 2.5 mm to 10.0 mm. Pulsed laser beams are introduced through the optical fibre to form a photoacoustic source within the material under investigation. Ultrasonic waves are induced in the material due to the photo-acoustic effect and received on return by a forward-looking piezoelectric polymer transducer. In principle, other high-power laser beams can also be introduced through the same optical fibre for therapeutic use. Initial development and characterization of this combined probe is reported in this paper, together with some results.

Implications of early hominid labyrinthine morphology for evolution of human bipedal locomotion

The upright posture and obligatory bipedalism of modern humans are unique among living primates. The evolutionary history of this behaviour has traditionally been pursued by functional analysis of the postcranial skeleton and the preserved footprint trails of fossil hominids. Here we report a systematic attempt to reconstruct the locomotor behaviour of early hominids by looking at a major component of the mechanism for the unconscious perception of movement, namely by examining the vestibular system of living primates and early hominids. High-resolution computed tomography was used to generate cross-sectional images of the bony labyrinth. Among the fossil hominids the earliest species to demonstrate the modern human morphology is Homo erectus. In contrast, the semicircular canal dimensions in crania from southern Africa attributed to Australopithecus and Paranthropus resemble those of the extant great apes. Among early Homo specimens, the canal dimensions of Stw 53 are unlike those seen in any of the hominids or great apes, whereas those of SK 847 are modern-human-like.

Exercise blood pressure response and skeletal muscle vasodilator capacity in normotensives with positive and negative family history of hypertension

OBJECTIVE

To study exercise blood pressure response in association with exercising muscle maximal vasodilatory capacity in normotensives with a positive and negative family history of hypertension.

SUBJECTS

Twenty-eight normotensive healthy subjects were recruited. Of these, two females and 13 males had a positive, and three females and 10 males had a negative, family history of hypertension.

METHODS

Both groups of subjects rode a bicycle ergometer while systolic blood pressure, diastolic blood pressure and heart rate were measured at 30%, 60% and peak oxygen uptake rate. The vasodilatory capacity was examined in the lower leg by measuring the minimal vascular resistance during peak reactive hyperemia after 10 min arterial occlusion.

RESULTS

Age, body weight, resting blood pressure, peak oxygen uptake rate and casual lower leg vascular resistance were not significantly different between the two groups of subjects. Significantly higher exercise systolic blood pressure (9%) and diastolic blood pressure (9%) were seen in the subjects with positive family history of hypertension compared with the subjects with negative family history of hypertension. Exercise heart rate was significantly higher in the subjects with negative than in those with positive family history of hypertension. The vascular resistance at peak vasodilation was 22% higher in the subjects with positive than in the subjects with negative family history of hypertension.

CONCLUSIONS

This study demonstrates that the dynamic exercise blood pressure is exaggerated and skeletal muscle vasodilatory capacity is limited in normotensives with genetic risk of hypertension. This suggests that the higher pressor response to physical stress that is found in normotensives with a family history of hypertension may be attributed to the resistance vessels in the exercising muscle.

Anophthalmia, cleft lip/palate, facial anomalies, and CNS anomalies and hypothalamic disorder in a newborn: a midline developmental field defect

We describe an infant with a unique pattern of midline defects, including anophthalmia, cleft lip and palate, macrocephaly, cutis aplasia, and micrognathia. CNS anomalies including massive hydrocephalus with destruction of most recognizable structures were observed. The infant also developed panhypopituitarism, diabetes insipidus, and a seizure disorder. We postulate that this patient could represent a more complex form of the Delleman syndrome or a new morphogenetic syndrome secondary to ventral induction with extension to the developmental fields of the first and second branchial arches.

The use of macrophytes in bioremediation

The development of reedbed technology for bioremediation is reviewed. The future development, potential and implementation of these systems are considered in detail together with the cost effectiveness and ease of maintenance.

Acquired immunodeficiency syndrome-related lymphoma of the lung presenting as empyema thoracis

B-cell lymphoma in patients infected with the human immunodeficiency virus is usually a disseminated process that occasionally involves the lungs. Surgical diagnosis is often necessary to distinguish this from other neoplasms or opportunistic infections of the lung. We report a case of pulmonary B-cell lymphoma in a patient infected with human immunodeficiency virus who presented with a left empyema thoracis and an associated left lower lobe abscess secondary to bronchial obstruction. Resection was performed and the patient subsequently recovered from the acute process and survived an additional 6 months. This report demonstrates that surgical intervention may be necessary for both the diagnosis of pulmonary lymphoma and the definitive management of infectious complications that may arise as a result of pulmonary neoplastic disease in patients with acquired immunodeficiency syndrome.

The interparental relationship and family problem solving with preadolescent males

This study examines associations between the quality of the interparental relationship and how well 68 family triads (mother, father, preadolescent son) solved salient problems which arose at home. Four aspects of the interparental relationship (marital satisfaction, parental agreement, conflict during family problem solving, and parental coalitions) were included in a regression analysis which controlled for family structure and child externalizing. A longitudinal design assessed families when mean child age was 9.7 years and 2 years later. Parental agreement consistently facilitated family problem solving. However, strong parental coalitions inhibited family problem solving, which may be attributed to frustrated autonomy needs of preadolescent males in response to the parental coalition. Stepfamilies had less effective problem solving at Time 1. The results confirm the benefits of parental agreement to child outcomes via enhanced family problem solving but show a reverse effect when agreement occurs in the context of coalitions against a preadolescent son.

SEXUAL HARASSMENT OF HEALTH CARE STUDENTS BY PATIENTS

1. Forty percent of the 158 nursing and occupational therapy students surveyed reported being victims of sexual harassment. 2. When confronted with sexual advances or assaults, students used previously learned coping strategies. Thirty-nine percent ignored the behavior or joked about it. 3. A training program was designed and implemented to make students feel better able--and more empowered--to handle sexual harassment.