Assuring professional pastoral care for every nursing home resident

Ministry to persons in nursing homes is built on two mandates: "... He has sent me to bring good news to the oppressed, to bind up the brokenhearted, to proclaim liberty to the captives, and release to the prisoners; ... to comfort all who mourn ..." (Isaiah 61:1-3). The federal government provides the second: "Quality of Life. A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life" (OBRA '87, Guidance to Surveyors in Long Term Care Facilities, Code of Federal Regulations, Health Care Financing Administration, 1995, section 483.15, F240). This article discusses both the religious and the U.S. political history of caring for the old and frail. It concludes by describing political efforts in one state to increase the quality of that care and pastoral efforts to support the nursing assistants in long-term care facilities.

Contact-evoked changes in EMG activity during human grasp

Contact-evoked changes in EMG activity during human grasp. 2215 Cutaneous receptors in the digits discharge bursts of activity on contact with an object during human grasp. In this study, we investigated the contribution of this sensory activity to the responses of muscles involved in the task. Twelve subjects performed a standardized precision grasp task without the aid of vision. Electromyographic (EMG) responses in trials when the object was present were compared with those in which the object, and hence the associated afferent responses, were unexpectedly absent. Significant differences in EMG amplitude occurred in the interval 50-100 ms after contact in all subjects and in 33/46 of the muscles sampled. The differences emerged as early as 34 ms after contact and comprised as much as a fourfold change in EMG from 50 to 100 ms after contact with the object. Typically, EMG responses were larger when the object was present (OP), though there were cases, particularly in the thenar muscles, in which the responses increased when the object was absent (OA). Local anesthesia of the thumb and index finger attenuated contact-evoked EMG activity in at least one muscle in all four subjects tested. In one subject, contact-evoked responses were abolished completely during the anesthesia in all four muscles sampled. The results indicate that the sensory activity signaling contact plays a key role in regulating EMG activity during human grasp. Much of this feedback action is attributable to cutaneous receptors in the digits and probably involves both spinal and supraspinal pathways.

Comparison of the core size distribution in iron dextran complexes using Mössbauer spectroscopy and X-ray diffraction

Mössbauer spectra of a series of iron dextran complexes in the intermediate temperature range where both sextet and doublet coexist may be used to obtain a qualitative description of the distribution of core sizes in these samples. Eight samples from five suppliers have been examined at 100 and 77 K. These differ markedly in the relative doublet contribution to the total spectral area and also in the hyperfine fields characterizing the sextets. The results indicate three distinct types of distribution. One sample from each type has also been examined at 4 K, where the doublet component has vanished and the hyperfine field distribution has become narrow and symmetric. These data are compared with estimates of average core diameters from X-ray line broadening.

Discrete systolic potentials during ventricular tachycardia in patients with prior myocardial infarction

INTRODUCTION

Isolated diastolic potentials have been found to be helpful in identifying critical sites for ablation of ventricular tachycardia (VT) in patients with coronary artery disease. However, discrete potentials that occur during systole have not been previously described. The purpose of this study was to determine the significance of discrete systolic potentials during VT in patients with coronary artery disease.

METHODS AND RESULTS

Twenty-seven patients with a mean age of 66 +/- 12 years ( +/- standard deviation) who had coronary artery disease underwent radiofrequency catheter ablation of 42 VTs that had a mean cycle length of 486 +/- 78 msec. The only criterion used to select target sites for ablation was concealed entrainment, which was present at 92 sites. Thirty-five of the 42 VTs (83%) were successfully ablated. A discrete systolic potential was recorded during 7 of the 42 VTs (17%). In all cases, the interval between the discrete systolic potential and the next QRS complex was equal to the stimulus-QRS interval during concealed entrainment. At all seven sites where a discrete systolic potential was recorded, delivery of radiofrequency energy resulted in successful ablation of the VT.

CONCLUSION

Discrete systolic potentials may be present in patients with coronary artery disease in approximately 17% of VTs in which there is concealed entrainment. If the interval between the discrete systolic potential and the next QRS complex matches the stimulus-QRS interval during concealed entrainment, delivery of radiofrequency energy is likely to result in successful ablation of the VT.

Dietary and genetic interactions in the regulation of plasma lipoprotein(a)

Lipoprotein(a) is a plasma particle which is considered to be a risk factor for the development of coronary heart disease. Plasma levels of lipoprotein(a) are affected by different types of dietary fat and steroid hormones. Two regions upstream of the apolipoprotein(a) promoter have been isolated which could be the site of regulation of apolipoprotein(a) gene transcription.

Clinical value of the postpacing interval for mapping of ventricular tachycardia in patients with prior myocardial infarction

INTRODUCTION

The postpacing interval (PPI) has been used to discriminate bystander sites from critical sites within a ventricular tachycardia (VT) reentry circuit, with a PPI that is similar to the VT cycle length (CL) being indicative of a site within the reentry circuit. The purpose of this study was to assess the clinical value of the PPI for identifying effective target sites for ablation of VT at sites of concealed entrainment in patients with prior myocardial infarction.

METHODS AND RESULTS

In 24 patients with coronary artery disease and a past history of myocardial infarction, 36 VTs with a mean CL of 483+/-80 msec (+/- SD) were mapped and targeted for radiofrequency (RF) ablation. The only criterion used to select target sites for ablation was concealed entrainment. In a post hoc analysis, the PPI was measured at 47 ineffective and 26 effective ablation sites. The mean PPI-VTCL difference at the 26 effective sites (114+/-137 msec) did not differ significantly from the mean at the 47 ineffective sites (177+/-161 msec; P = 0.1). The sensitivity of a PPI-VTCL difference < or = 30 msec for identifying an effective ablation site was 46%, the specificity 64%, the positive predictive value 41%, and the negative predictive value 68%.

CONCLUSION

The PPI-VTCL difference is not useful for discriminating between sites of concealed entrainment that are within or outside of a VT reentry circuit in patients with prior infarction. Therefore, in patients with prior infarction, the PPI is not clinically useful for identifying sites of concealed entrainment at which RF ablation should or should not be attempted.

Is the incidence of SIDS increasing in Asia?

The incidence of SIDS in western countries has decreased since the late 1980s after active SIDS prevention campaigns. By contrast, both Taiwan and Japan have reported an increase in incidences. In this report data from England, Wales, Scotland, Northern Ireland, Japan and Hong Kong are analysed. Regression coefficient and linearity of regression tests were used to determine if there was any significant increase or decrease in post-neonatal mortality (PNNM), SIDS mortality and mortality among infants 1-5 months old. A statistically significant decrease in SIDS was recognized in England, Wales, Scotland and Northern Ireland, whereas statistically significant increases were noted for Japan and Hong Kong. However in Japan and Hong Kong both the PNNM and mortality of infants between 1-5 months in age fell significantly, suggesting that the increased SIDS rates could be due to a change in diagnostic labelling. Further study will be required to determine whether this increase in the incidence of SIDS is genuine or only an artifact.

A controlled trial of venlafaxine in trichotillomania: interim phase I results

This article reports the preliminary findings of a two-phase trial examining the efficacy of venlafaxine in trichotillomania. Phase 1 is a 12-week, open-label, prospective trial of venlafaxine in trichotillomania. Venlafaxine was effective in significantly reducing the symptoms of trichotillomania; 8 of 12 patients were considered responders. The implications of the efficacy of venlafaxine in trichotillomania are discussed, including its important advantages over other available antidepressant and anxiolytic medications.

Screening systems for detecting inhibitors of cell wall transglycosylation in Enterococcus. Cell wall transglycosylation inhibitors in Enterococcus

We devised two screening systems to detect cell wall transglycosylation inhibitors. One screen utilizes a mutant of Enterococcus faecalis strain A256 that is dependent on vancomycin or moenomycin for growth. In the absence of transglycosylation inhibitors the strain fails to grow, while in the presence of inhibitors, cells are rescued. A second screening organism E. faecalis strain MDD212 utilizes a translational fusion of the lacZ gene to the vanH promoter in a derivative of E. faecalis that contains a vancomycin resistance determinant. Induction of beta-galactosidase occurs when cells are exposed to inhibitors of transglycosylation. Our natural products drug source of fungal fermentations was tested with these screens. Several cultures that produced the same family of compounds, called the thielavins, were detected. Thielavin B inhibited the formation of peptidoglycan in an in vitro assay, suggesting that these screening systems can detect compounds that interfere with cell wall transglycosylation.

Accessing Prior Knowledge to Remember Text: A Comparison of Advance Organizers and Maps

Two theories, schema and dual coding, and the conjoint retention model were contrasted to explain the role of geographic familiarity and prior knowledge in map-passage retention. One hundred, eighty-six college students listened to a passage taking place in either a familiar or unfamiliar geographic domain and viewed either a map or no map of either of the two geographic areas. One-third of each group received either a general or specific advance organizer of the passage topic, or no organizer at all. Results revealed that maps function to bridge what learners already know about an area and what they need to remember from a passage. However, prior knowledge of geography is activated by the geographic propositions contained in a passage, with or without a map. Thus, maps serve a mnemonic function of imagery, but learners' prior knowledge of the geography of the map's space mediates the value of the map. Learners are able to generate an image of the map themselves if there are locational markers in the passage, and the geography of those markers are familiar. Copyright 1998 Academic Press.

Clomipramine challenge responses covary with Tridimensional Personality Questionnaire scores in healthy subjects

Cloninger's Unified Biosocial Theory of Personality postulates a relationship between the relative functional activity of central serotonergic, dopaminergic, and noradrenergic neurotransmitter systems, and the strength of three elemental dimensions of personality. These dimensions are Harm Avoidance, Novelty Seeking, and Reward Dependence, respectively. Accordingly, we predicted that neuroendocrine responses to serotonergic challenge would correlate with Harm Avoidance scores, but not with Novelty Seeking or Reward Dependence scores. We examined the relationship between the prolactin and cortisol responses to a 12.5-mg intravenous clomipramine challenge and these personality dimensions as measured by Cloninger's Tridimensional Personality Questionnaire in 32 healthy subjects. The cortisol response correlated only with Harm Avoidance scores, as predicted; however, prolactin response did not correlate with Harm Avoidance scores. Instead, it demonstrated an inverse relationship with Novelty Seeking scores. There was a positive relationship of baseline prolactin with Harm Avoidance in a post hoc analysis. Cortisol response to serotonergic challenge may be a better indicator for responsivity of serotonergic systems as they relate to the personality dimension of Harm Avoidance than is prolactin. Prolactin responses may be overly affected by dopaminergic influences; however, baseline prolactin may still be a valid indicator of serotonergic tone.

2:1 atrioventricular block during atrioventricular node reentrant tachycardia

OBJECTIVES

The purpose of this study was to determine the incidence and to clarify the mechanism of 2:1 atrioventricular (AV) block during AV node reentrant tachycardia induced in the electrophysiology laboratory.

BACKGROUND

In patients with 2:1 AV block during AV node reentrant tachycardia, the absence of a His bundle potential in the blocked beats has been considered evidence of intranodal, lower common pathway block.

METHODS

In consecutive patients with AV node reentrant tachycardia, the incidence of 2:1 AV block and the response to atropine and a single ventricular extrastimulus was observed.

RESULTS

Persistent 2:1 AV block occurred in 13 of 139 patients with AV node reentrant tachycardia. A His bundle deflection was present in the blocked beats in eight patients and absent in five. Patients with 2:1 AV block had a shorter tachycardia cycle length than did patients without such block (mean +/- SD 312 +/- 32 vs. 353 +/- 55 ms, p < 0.01). Atropine did not alter the 2:1 block in any patient. In every patient, a single ventricular extrastimulus introduced during the tachycardia converted the 2:1 block to 1:1 conduction.

CONCLUSIONS

The incidence of induced 2:1 AV block during AV node reentrant tachycardia is approximately 10%. The lack of a response to atropine and the consistent conversion of 2:1 block to 1:1 conduction by a ventricular extrastimulus indicate that, regardless of the presence or absence of a His bundle potential in blocked beats, 2:1 block during AV node reentrant tachycardia is due to functional infranodal block.

The effects of age, gender, and season on serotonergic function in healthy subjects

1. Several factors, including age, gender, and season of the year, have been reported to affect physiologic indices of central serotonergic function, although some of these findings have not been consistent across groups of subjects and types of serotonergic measures. 2. The authors investigated the role that each of these variables might play in the neuroendocrine response to acute intravenous challenge with the serotonin reuptake inhibitor clomipramine (CMI) in healthy volunteers. 3. Thirty seven healthy subjects (17 women and 20 men), with an age range of 19 to 50 years, received 12.5 mg of CMI intravenously under standardized conditions. 4. The maximum change from baseline in plasma prolactin concentrations ("delta-max") was significantly related to age, after controlling for gender and season. 5. In contrast, neither gender nor season was significantly related to prolactin delta-max, after controlling for the other two variables. 6. Although the age range and sample size are relatively limited, the results from this study suggest that age, but not gender or season, may influence serotonergic function, as measured by the prolactin response to CMI challenge.

Comparison of atrial-His intervals in patients with and without dual atrioventricular nodal physiology and atrioventricular nodal reentrant tachycardia

The purpose of this study was to compare the atrial-His intervals generated during programmed atrial stimulation in patients with and without dual atrioventricular nodal physiology and with and without inducible atrioventricular nodal reentrant tachycardia. Programmed atrial stimulation at a basic-drive cycle length of 500 to 600 msec was performed in 180 patients. The minimum atrial-His interval was defined as the atrial-His interval of the basic-drive beats. The maximum atrial-His interval was defined as the longest A2H2 interval. The criterion for dual atrioventricular nodal physiology was an increment of 50 msec in the A2H2 interval in association with a 10 msec decrement in the A1A2 interval. The minimum atrial-His interval was significantly shorter (106 +/- 34 msec vs 116 +/- 29 msec; p < 0.05) and the maximum atrial-His interval significantly longer (304 +/- 101 msec vs 222 +/- 56 msec; p < 0.001) in the 87 patients who had atrioventricular nodal reentry than in the 93 patients who did not. Among the 87 patients who had atrioventricular nodal reentry, the maximum atrial-His interval was significantly longer in 53 patients who had dual atrioventricular nodal physiology than in 34 patients who did not (340 +/- 105 msec vs 249 +/- 62 msec; p < 0.001). Among the 66 patients who had dual atrioventricular nodal physiology, the maximum atrial-His interval was significantly longer in 53 patients who had atrioventricular nodal reentry than in 13 patients who did not (340 +/- 105 msec vs 268 +/- 61 msec; p < 0.01). The insensitivity of the conventional dual atrioventricular nodal physiology criterion for the detection of dual atrioventricular nodal pathways is in part attributable to a lesser degree of slowing of conduction in the slow pathway relative to the fast pathway in some patients who have atrioventricular nodal reentry. The inability to demonstrate atrioventricular nodal reentry despite the presence of dual atrioventricular nodal physiology in some persons may be attributable in part to an inadequate degree of conduction delay in the slow pathway.

Slow pathway ablation in patients with documented but noninducible paroxysmal supraventricular tachycardia

OBJECTIVES

The purpose of this study was to assess the clinical efficacy of radiofrequency ablation of the slow pathway in patients with documented but noninducible paroxysmal supraventricular tachycardia (PSVT) who have evidence of dual atrioventricular (AV) node pathways.

BACKGROUND

Patients with a documented history of PSVT at times do not have inducible PSVT in the electrophysiology laboratory. Because dual AV node pathways serve as the substrate for AV node reentrant tachycardia (AVNRT), ablation of the slow pathway potentially may be useful in these patients.

METHODS

The subjects in this prospective study were seven consecutive patients who underwent an electrophysiologic procedure because of documented PSVT and were found to have dual AV node physiology or inducible single AV node echo beats, but no inducible PSVT despite the administration of isoproterenol and atropine. Their mean (+/- SD) age was 33 +/- 13 years, and they had been symptomatic for 12 +/- 12 years. The frequency of the episodes of PSVT ranged from > or = 1/day to 1/month. The rate of the documented episodes ranged from 170 to 260 beats/min, and discrete P waves were not apparent. Slow pathway ablation was performed with 9 +/- 4 applications of radiofrequency energy using a combined anatomic and electrogram mapping approach.

RESULTS

All evidence of dual AV node pathways was eliminated in six patients, and dual AV node physiology remained present in one patient. During a mean follow-up period of 15 +/- 10 months (range 8 to 27), no patient had a recurrence of symptomatic tachycardia (success rate 95% confidence interval 65% to 100%).

CONCLUSIONS

Slow pathway ablation may be clinically useful in patients with documented but noinducible PSVT who have evidence of dual AV node pathways.

Ligneous conjunctivitis in four Doberman pinschers

Ligneous conjunctivitis (LC) was diagnosed in four unrelated Doberman pinschers. Thick, opaque membranes of the palpebral conjunctivae and nictitating membranes were present bilaterally. Three dogs had concurrent signs of multisystemic disease. A thick, amorphous, eosinophilic, hyaline-like material in the substantia propria of the conjunctiva--containing a moderate, mononuclear cell infiltrate--was evident on histological examination. A predominance of T lymphocytes, few macrophages, and weak positive staining for immunoglobulin G (IgG) and immunoglobulin A (IgA) were evident by immunohistochemical staining. The clinical and histological appearance of LC in Doberman pinschers and humans is similar.

Ophthalmic manifestations and complications of dental disease in dogs and cats

Ophthalmic manifestations of dental disease may occur in dogs and cats because of the proximity between posterior maxillary teeth and the orbit. Ophthalmic disorders may be diagnosed promptly, but the initiating dental disease may be overlooked. Inappropriate diagnosis and treatment of dental disease may result in loss of teeth, irreversible vision-threatening ophthalmic disease, or, ultimately, loss of the globe. When ophthalmic examination results are suggestive of a primary dental disorder, thorough examination of the maxillary teeth is imperative to diagnose appropriately the underlying dental disease. Therapy should include treatment of the dental disease and secondary ophthalmic disorders.

Locally acquired Brachylaima sp. (Digenea: Brachylaimidae) intestinal fluke infection in two South Australian infants

Eggs of a small intestinal trematode were found in the faeces of two 21-month-old children from the same rural district of South Australia who presented 18 months apart with mild abdominal pain and diarrhoea. Treatment with praziquantel resulted in egg clearance and resolution of gastrointestinal symptoms. A brachylaimid intestinal trematode involving the common house mouse, poultry and introduced European helicid snails is well established in South Australia. Both infants had been seen eating raw snails, and snails from their environment were found to be infected with metacercariae of a brachylaimid trematode.

Can cervical cancer be prevented by a see, screen, and treat program? A pilot study

OBJECTIVE

Our purpose was to determine the feasibility of providing a cervical screening facility to the underprivileged communities through an educational program and a mobile clinic in which cytologic smears could be taken, screened immediately, and, when appropriate, the patients treated on site with minimal delay.

STUDY DESIGN

A prospective study was conducted in two parts on 5045 patients living in squatter areas around Cape Town, South Africa. The patients were educated about cervical cancer and its prevention and were offered a free Papanicolaou smear taken in a fully equipped mobile clinic. These were immediately stained and processed. Patients diagnosed cytologically as having high-grade squamous intraepithelial lesions were assessed colposcopically and, when indicated, immediately treated by large loop excision of the transformation zone under local anesthesia.

RESULTS

In phase 1, colposcopy was done in the nearest colposcopy clinic, 20 km from the screening site. The defaulter rate was 66%. In phase 2, colposcopy and treatment were offered on site. A total of 97% of patients referred for colposcopy attended the clinic, and all patients requiring treatment have been adequately treated.

CONCLUSION

With a rapid turnaround time for the reporting of cytologic results and given a colposcopy and treatment facility available located at the screening site at the time women receive their results, the majority of women will undergo colposcopy and treatment.

A guide to writing medical reports on survivors of torture

Based on a number of years' experience by volunteer doctors engaged in the examination and welfare of refugees and asylum-seekers who have claimed that they have suffered torture a scheme of history-taking and physical examination is offered. The role of the medical expert in the investigation of abuse of human rights is discussed, as is the need for the presentation and format of the interpretation to be carefully considered.

Isolation of the Heterofullerene C59N as Its Dimer (C59N)2

The heterofullerene ion C(59)N(+) is formed efficiently in the gas phase during fast atom bombardment mass spectroscopy of a cluster-opened N-MEM (N-methoxyethoxy methyl) ketolactam. This transformation is shown to occur also in solution in the presence of strong acid, affording biazafullerenyl (C(59)N)(2) in good yield. It is proposed that the azafullerene dimer is formed upon in situ reduction of the highly reactive azafulleronium ion. The isolation and characterization of biazafullerenyl opens a viable route for the preparation of other heterofullerenes in solution.