A poliovirus-susceptible transgenic mouse model as a possible replacement for the monkey neurovirulence test of oral poliovirus vaccine

Two poliovirus-susceptible transgenic mouse (Tg PVR) strains, Tg1 and Tg21, were compared with the monkey test for their sensitivity to neurovirulence of live oral poliovirus vaccine (OPV). Intracerebral (i.c.) and intraspinal (i.s.) routes of inoculation were investigated to determine the most suitable combination of mouse strain and route. Evaluation of the mouse tests was performed using several indicators; clinical score and failure time were selected as the most efficient. Tg1 and Tg21 mice inoculated i.s. with type 2, and Tg21 mice inoculated i.s. with type 3 OPV were determined to be the most appropriate systems, whereas they are shown not to be suitable for type 1 OPV. The sensitivity of each of the two mouse models was at least equal to that of the monkey test, suggesting that these mouse systems might be considered as a potential replacement for the monkey test of OPV. However, more data are needed to establish regulatory criteria of acceptability for vaccine lots tested in Tg PVR mice. This is the first study conducted with Tg PVR mice with all three types of poliovirus vaccine preparations.

Consecutive salmonella outbreaks traced to the same bakery

Two consecutive community outbreaks of Salmonella enteritidis phage type 4 (PT4) traced to the same bakery occurred in Cardiff, Wales during August-September 1992. In the first outbreak, illness was associated with eating custard slices (odds ratio 23.8, 95% confidence interval 6.5-94.4, P < 0.0001), and in the second, with eating fresh cream cakes (odds ratio 15.8, 95% confidence interval 1.6-374, P = 0.004). Environmental investigations implicated cross-contamination during preparation of the cold-custard mix as the cause of the first outbreak, and inadequate cleaning and disinfection of nozzles used for piping cream in the second outbreak. S. enteritidis PT4 was isolated from fresh cream sponge cake retained by a case and from two fresh cream cakes and four environmental swabs obtained at the bakery. This incident illustrates the hazard of widespread environmental contamination with salmonella and the need for thorough environmental cleansing for any premises implicated in an outbreak of food poisoning.

Cryptosporidiosis outbreak associated with an educational farm holiday

In April 1995 an outbreak of cryptosporidiosis occurred among 43 schoolchildren and four staff after a week's holiday at a rural farm. A retrospective cohort study found illness to be 3.8 times more likely in those who handled calves and 1.5 times more likely in those who habitually bit their nails or sucked their thumbs. Cryptosporidium oocysts were detected in faecal specimens from six of the 29 pupils and one of the four staff who were ill. Infection occurred in children despite supervised handwashing. The infection hazards of farm visits need more publicity, and further study on the risks of cryptosporidiosis transmission in the farm environment is required to guide preventive measures.

The successful pharmacological treatment of adolescents and young adults with borderline personality disorder: a preliminary open trial of flupenthixol

Borderline personality disorder is a significantly disabling disturbance often arising in adolescents or young adults. In the absence of demonstrated effective treatments in this population, this open prospective study evaluated the effect of low dose (3 mg per day) flupenthixol in 13 rigorously diagnosed adolescents with borderline personality disorder. Therapeutic outcome over eight weeks of treatment assessed across measures of impulsivity, depression/dysphoria, general psychopathology and global functioning showed significant improvement in all spheres. These findings suggest that low dose flupenthixol may have a role to play in the short-term treatment of this population.

Multipurpose practice guideline modules for clinical decision analysis and quality improvement

This study aimed to measure the loss of information in communication between clinical researchers and information system developers, to design a tool for sharing clinical practice guidelines, and to test the feasibility of this tool in knowledge base development. The analysis of a sample of 101 randomized controlled clinical trials indicated that exact numeric results were published in only 64 percent of the trials. While structured abstracts were associated with improved total quality scores (p0.001), there was no significant improvement in reporting numeric results (p=0.31). Based on the documented loss of information and the needs of various parties involved, the concept of a multipurpose knowledge module was developed for sharing clinical practice recommendations. Such clinical practice guideline modules were applied in developing the knowledge base of a quality feedback expert system (QFES).

Hypertensive episode associated with phenelzine and tap beer--a reanalysis of the role of pressor amines in beer

A case report of a hypertensive crisis resulting from the ingestion of tap beer in a patient on an irreversible monamine oxidase inhibitor (MAOI; phenelzine) stimulated the investigation of different kinds of beer for tyramine concentration. The objective was to determine the tyramine concentration in tap and bottled beers. A total of 98 beer samples (79 different brands of beer) were analyzed by high-performance liquid chromatography for tyramine. Of these 98 beers, 49 were bottled or canned beers and 49 were beers on tap. All of the bottled beers analyzed had safe tyramine concentrations (< or = 10 mg/liter; range, 0 to 3.16 mg/liter) and, thus, do not require restriction in patients receiving MAOIs. Therefore, the consumption of canned or bottled beer, including dealcoholized beer, in moderation (fewer than four bottles or cans; 1.5 liters within a 4-hour period) appears to be safe and does not require restriction in patients receiving MAOIs. Only 4 of 98 beer samples studied were found to have a dangerous (> 10 mg/liter) tyramine concentration, one of which was the index beer. The tyramine concentration in these four beers ranged from 26.34 to 112.91 mg/liter. All four of these beers were tap beers produced by bottom fermentation (lagers) and brewed by a secondary fermentation process. Although we did not find any visible bacterial growth in the tap beers with high tyramine content, this finding does not preclude the possibility that bacterial contamination, bacterial growth, production of tyramine, and eventually bacterial death occurred at some earlier time. Therefore, to err on the side of caution, it is recommended that patients on irreversible MAOIs avoid beers on tap.

Space exploration and toxicology: a new frontier

Results of the microbial and immunological studies discussed above clearly illustrate an in-flight or post-flight blunting of the cellular immune mechanism in humans and test animals, coincident with a relative increase in pathogenic microorganisms. This situation predicts an increased incidence of in-flight infectious disease events. To prevent this from occurring, most observers agree that a robust program of preflight and in-flight immunological and microbiological monitoring, combined with an effective countermeasures program, are required for optimally successful long-duration spaceflight.

Immunomodulation by metals

A symposium entitled Immunomodulation by Metals was held at the 32nd Annual Meeting of the Society of Toxicology (SOT) in New Orleans, Louisiana. The symposium was co-sponsored by the Immunotoxicology and Metals Specialty Sections of SOT and was designed to describe the types of adverse immunological reactions which occur in response to environmental and/or occupational exposure to metals. Epidemiological evidence and underlying mechanisms responsible for the observed alterations were also discussed. The following is a summary of each of the individual presentations.

Transgenic PVR Tg-1 mice for testing of poliovirus type 3 neurovirulence: comparison with monkey test

Transgenic mice susceptible to poliovirus were recently produced by two groups of investigators. In this study, we compared the sensitivity of PVR Tg-1 transgenic mice and rhesus monkeys to poliovirus type 3. We found that intracerebrally inoculated Tg-1 mice are able to differentiate wild-type strain from attenuated strains and from a vaccine revertant. However, this mouse system can not discriminate between live poliovirus vaccine lots which passed the intraspinal (i.s.) monkey neurovirulence safety test (WHO) and those that failed. Unlike the monkey test which can detect as failed those vaccine lots which possess above 1% revertants at the 472 (U-->C) position, the test in Tg-1 mice inoculated intracerebrally (i.c.) did not recognize virus preparations containing even three percent revertants. Thus, the PVR Tg-1 i.c. mouse model is suitable for epidemiological and other virological studies, but it does not appear to be useful for neurovirulence testing of live poliovirus vaccines. A solution to the latter may be found in the use of a more sensitive i.s. route of inoculation of PVR Tg mice.

Anxiety disorders in children and adolescents: clinical and related issues in pharmacological treatment

Anxiety disorders in children and adolescents are receiving more attention from clinicians and researchers. Psychopharmacological approaches to controlling symptoms of anxiety are possible as part of a multi-model treatment approach. This paper provides an overview of some recent findings in child and adolescent anxiety disorders that may influence treatment decisions. It also reviews studies of the use of benzodiazepines and tricyclic antidepressants in treating children and adolescents who suffer from anxiety disorders, and suggests methods of integrating pharmacological treatment with other modalities in these disorders.

An open naturalistic trial of fluoxetine in adolescents and young adults with treatment-resistant major depression

ABSTRACT Fifteen adolescents and young adults (ages 16-24) with a DSM-III-R diagnosis of major depression, who failed to respond to prior treatment with tricyclic antidepressants, were treated in an open trial using fluoxetine. Of the 11 patients who completed a 6-7 week trial, 64% showed a therapeutic response (>/=50% change) on the Hamilton Depression Rating Scale (HDRS), and 73% showed a positive response when rated by the Clinical Global Impression Scale (CGI). Side effects generally were mild, and the most common were tremor, dry mouth, nausea, sweating, and decreased appetite. Sweating, drowsiness, dry mouth, tremor, and alopecia appeared more commonly than in adult studies. One patient became manic, and none showed an increase in suicidal ideation. A starting dose of 20 mg daily often was tolerated poorly, and patients generally did better with 5-10 mg daily for the first week. Some patients appeared to exhibit antidepressant responses on 5-10 mg daily. These preliminary data suggest that fluoxetine, in doses ranging from 5 to 40 mg daily, when used in combination with psychosocial treatments, may be an effective antidepressant in adolescents or young adults who have not previously responded to adequate tricyclic therapy. Double-blind placebo-controlled studies are needed to evaluate the potential efficacy of fluoxetine in treating major depression in adolescents and young adults.

Inhibition of neutral endopeptidase amplifies the effects of endogenous atrial natriuretic peptide on blood pressure and fluid partition

Neutral endopeptidase (EC 3.4.24.11) is a wide-spread enzyme that degrades atrial natriuretic peptide (ANP). We studied the effects of a potent neutral endopeptidase inhibitor, SQ 28,603, given intravenously (30 mg/kg over 45 min) to anesthetized, bilaterally nephrectomized Sprague-Dawley rats. Infusion of vehicle alone was accompanied by a modest increase, 3.2 +/- 2.2% (mean +/- SE), in mean arterial blood pressure (MAP) and a slight rise in hematocrit (Hct) of 0.9 +/- 0.7%. After administration of SQ 28,603, MAP fell 3.2 +/- 0.5%, and Hct rose 4.9 +/- 0.5%, both significantly different from the changes with vehicle alone; the lesser increase in plasma protein concentration (2.5 +/- 0.4%) suggested an increase in vascular permeability to both plasma protein and fluid similar to that caused by ANP. When SQ 28,603 was given to rats pretreated with rabbit antirat ANP antiserum, blood pressure rose by 3.8 +/- 0.5%, and Hct increased by 1.0 +/- 0.4%, values very similar to those observed with vehicle alone. Inhibition of neutral endopeptidase therefore amplifies the actions of endogenous ANP on blood pressure and fluid partition.

The CNS as a cost manager

The role of the clinical nurse specialist (CNS) in a cost-conscious environment includes the need to be alert to opportunities for cost-containment. Efforts to improve the quality of nursing care need to be balanced with the ability to manage costs. The CNS is in a key position to guide and influence decision-making about cost savings. This article reviews costs in health care and the elements of total nursing costs. CNSs can affect costs in three areas: direct costs, indirect costs, and supplies/equipment. Practical examples in each of the three areas are given for actions that are potentially useful to the CNS who desires to reduce the costs to patients and document the cost savings generated by nursing.

Presynaptic transmitter release is specified by postsynaptic neurons of Aplysia buccal ganglia

1. In Aplysia buccal ganglia, in which dual presynaptic neurons innervate multiple postsynaptic cells, strengths of the same identified synapses differ from animal to animal, consistent with developmental or plastic modulation. Synaptic strengths are specified by the postsynaptic neuron, so that synaptic current amplitudes are similar for inputs from different presynaptic cells converging on a postsynaptic cell but different for branches of the same neuron diverging onto different targets. 2. The coefficient of variation method of quantal analysis reveals that differences in synaptic strength, although specified postsynaptically, result partially from differences in the number of quanta released by presynaptic terminals. 3. This quantization is consistent with classical presynaptic models and suggests retrograde modulation of quantal release as postulated for hippocampal long-term potentiation.

The Iowa model: a proposed model for nursing administration

The purpose of the Iowa Model is to serve both as a heuristic device and as a framework for articulating knowledge for nursing administration research, practice, and education. The model delineates two domains of knowledge (systems and outcomes), each with three levels (patient aggregates, the organization, and the health care system). Concepts useful for knowledge development are identified for each level. Practice, research, and curricular applications of the model are made.

Pseudonotch of the atlas vertebra simulating fracture with computed tomographic diagnosis. A case report

Pseudonotch of the atlas represents a normal variation of the atlas related to a notched protuberance of the medial surface of its lateral masses. A case is presented in which cervical spine roentgenography revealed a prominent pseudonotch that mimicked a fracture of the lateral masses of the atlas. Minimal rotation of C-1 on C-2 was present without apophyseal joint subluxation. Computed tomography imaging provided an accurate diagnosis.

Creating a resource database for nursing service administration

In response to the current information explosion in nursing service administration (NSA), the authors felt a need to collect and organize available resources for use by their faculty and graduate students. An electronic database was developed to facilitate the use of the collected print and software resources. This article describes the creation of the NSA Resource Database from the time the need for it was realized to its completion. There is discussion regarding the criteria used for writing the database, what the database screens look like and why and what the database contains. The article also discusses the use and users of the NSA Resource Database to date.

CT-guided transthoracic needle biopsy

CT-guided biopsy of pulmonary and mediastinal lesions is safe and effective. It is most valuable in those cases in which fluoroscopic guidance is not possible due to resolution or anatomic consideration. CT guidance permits puncture of lesions as small as 0.5 cm, typically not seen fluoroscopically. Sensitivity of biopsy in malignant lung lesions in our series of 83 cases was 92%. Pneumothorax is the most frequent complication (10-60%) and requires chest tube insertion in 5-15% of patients.

Necrotizing tracheobronchitis (NTB) following high frequency ventilation: role of an angiotensin converting enzyme inhibitor

The purpose of this investigation was to study the effect of an angiotensin converting enzyme inhibitor (enalaprilat) on the morphologic manifestations of experimentally induced necrotizing tracheobronchitis (NTB). Twenty piglets were anesthetized before saline lung lavage. High frequency flow interrupter (HFFI) ventilation was used with a strategy known to produce NTB. Animals were randomly assigned to receive IV enalaprilat 0.1 mg/kg (ENP-Hi), enalaprilat 0.01 mg/kg (ENP-Lo), or saline (C). After 8 hours of ventilation, the piglets were sacrificed. Total airway injury scores (mean +/- S.D.) were 1.2 +/- 0.7 for ENP-Hi, 0.2 +/- 0.2 for ENP-Lo, and 21.3 +/- 16 for group C. Enalaprilat minimizes NTB lesions in neonatal piglets exposed to high frequency oscillatory ventilation. Although the origin of NTB is multifactorial, airway mucosa ischemia may play an important role. Enalaprilat may compensate for the reduction of mucosal blood flow by limiting formation of angiotensin II and/or preventing degradation of bradykinin.

Adjunct executive appointment for faculty. An innovation in nursing collaboration

The need for collaboration has never been greater. The healthcare delivery system faces unprecedented challenges arising from prospective payment, competition in the marketplace, higher patient acuity levels, and a shortage of professional nursing staff. The authors discuss a service-education collaboration model based on adjunct executive appointments of faculty members to healthcare organizations. The authors describe the model, a conceptual framework to guide its development, case studies of its implementation, and a summary of the benefits and risks associated with the initial implementation of the model.