Sensitivity and specificity of asthma definitions and symptoms used in a survey of childhood asthma

We compared the ability of definitions/symptoms of asthma to identify urban, elementary schoolchildren with physician-diagnosed asthma and bronchial hyperresponsiveness (BHR) post-exercise challenge. Definitions of asthma from the literature were compared, including American Thoracic Society (ATS) and British Medical Research Council (BMRC) definitions. Modified ATS had the highest sensitivity (77%), whereas BMRC had the highest specificity (99%). The most sensitive symptom was "wheeze with cold" (89%). The most specific symptoms were "medication required," and "breathing normal between attacks" (95%). Definitions and symptoms were poor predictors of BHR. Researchers can use these estimates in selecting and defining specific populations of children with asthma.

Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit

OBJECTIVE

To establish the validity and reliability of a new sedation scale, the Motor Activity Assessment Scale (MAAS).

DESIGN

Prospective, psychometric evaluation.

SETTING

Sixteen-bed surgical intensive care unit (SICU) of a 937-bed tertiary care, university-affiliated teaching hospital.

PATIENTS

Twenty-five randomly selected, adult, mechanically ventilated, nonneurosurgical patients who were admitted to the SICU > or = 12 hrs after surgery and were not receiving neuromuscular blockers.

INTERVENTION

Four hundred assessments (eight per patient) were completed consecutively but independently, in pairs, at standardized times (both day and night) by two nurses who were preselected for each assessment from a pool of 32 pretrained SICU nurses.

MEASUREMENTS AND MAIN RESULTS

To estimate validity, paired assessments (four/patient) compared the MAAS result with the subjective assessment using a 10-cm visual analog sedation scale, the percent change in blood pressure and heart rate from the previous 4-hr baselines, and the number of recent agitation-related sequelae. To estimate reliability, paired assessments (four/patient) measured correlation between assessments of the same type (e.g., MAAS-MAAS). Generalized estimating equations, which accounted for the four repeated measures in each patient, supported MAAS validity by finding a linear trend between MAAS and the visual analog scale (p < .001), blood pressure (p < .001), heart rate (p < .001), and agitation-related sequelae (p < .001) end points. The MAAS (kappa = 0.83 [95% confidence interval, 0.72 to 0.94]) was found to be more reliable than subjective assessment using the visual analog scale (intraclass correlation coefficient = 0.32 [95% confidence interval, 0.05 to 0.55]).

CONCLUSIONS

The MAAS is a valid and reliable sedation scale for use with mechanically ventilated patients in the SICU. Further studies are warranted regarding the effect of MAAS implementation in our SICU on patient outcomes, such as quality of sedation and length of mechanical ventilation, as well as the use of the MAAS in other patient populations (e.g., medical).

Infant temperament and anxious symptoms in school age children

A group of 164 children from different infant temperament categories were seen at 7 years of age for a laboratory battery that included behavioral and physiological measurements. The major results indicated that children who had been classified as high reactive infants at 4 months of age, compared with infants classified as low reactive, (a) were more vulnerable to the development of anxious symptoms at age 7 years, (b) were more subdued in their interactions with a female examiner, (c) made fewer errors on a task requiring inhibition of a reflex, and (d) were more reflective. Further, the high reactives who developed anxious symptoms differed from the high reactives without anxious symptoms with respect to fearful behavior in the second year and, at age 7 years, higher diastolic blood pressure, a narrower facial skeleton, and greater magnitude of cooling of the temperature of the fingertips to cognitive challenge. Finally, variation in magnitude of interference to fearful or aggressive pictures on a modified Stroop procedure failed to differentiate anxious from nonanxious or high from low reactive children.

A three-state model for connexin37 gating kinetics

The gating behavior of human connexin 37 (hCx37) is unaffected by the nature of the bathing monovalent (for Na, K, Rb). It is modified by [Mg] in the millimolar range. For fitting the kinetics, we propose a simple extension to three states of the canonical 2-state model of the hemichannel. The extra closed state allows for some immobilization of a hemichannel at high transjunctional voltages. The model is reasonably efficient at fitting data at various voltage protocols. Interpreting the fits of the data at different [Mg] is consistent with a binding site for Mg.

A comparative study of apoptosis and necrosis in HepG2 cells: oxidant-induced caspase inactivation leads to necrosis

Apoptosis and necrosis are two distinct forms of cell death that can occur in response to various agents. In the present study the HepG2 cell line was used for a comparative study of CD95-mediated apoptosis and menadione-induced necrosis. Apoptosis coincided with the release of cytochrome c from mitochondria, activation of caspases, cleavage of cellular proteins, and also involved nuclear condensation and DNA fragmentation. Necrosis was not accompanied by DNA fragmentation, caspase activation or cleavage of caspase target proteins, despite cytochrome c release from mitochondria. In fact, the addition of menadione to cells undergoing CD95-mediated apoptosis blocked their caspase activity. Inhibition of caspases coincided with an accumulation of reactive oxygen species (ROS) and ATP depletion. In order to determine the predominance of either of these events in the inhibition of caspase, cells were either co-incubated with antioxidant enzymes or their ATP level was manipulated to maintain it at a relatively high level during the experiments. Co-incubation with catalase, but not Cu/Zn superoxide dismutase, substantially reduced the levels of ROS and reversed the inhibitory effect of menadione on caspase activity. In contrast, increasing cellular ATP level had little effect on restoring caspase activity. These data suggest that menadione inhibits caspase activity by the generation of hydrogen peroxide through redox cycling and that caspase inactivation by this mechanism may prevent cell death by apoptosis in this oxidative-stress model.

Maintaining healthy boundaries in professional relationships: a balancing act

For most people, the term boundary brings to mind an image of some physical barrier that keeps something in or out, such as a fence or a wall. These examples are physical, but boundaries also can be emotional or interpersonal. Just as physical boundaries keep some things in and others out, so do emotional ones. Emotional or interpersonal boundaries are the necessary space between people that allows a sense of individuality and separateness. This sense of uniqueness is essential for the development of a healthy person and ultimately the development of a professional identity.

Effect of payer status on outcomes of coronary artery bypass surgery in blacks

BACKGROUND

Black patients with coronary artery disease have a higher mortality rate than white Americans. They also have a higher prevalence of hypertension, diabetes mellitus, and renal disease, which may have an effect on mortality rates. The deleterious effect of these comorbidities may be exacerbated by impaired access to secondary prevention strategies and longitudinal care. Therefore, the presence or absence of comprehensive care as indicated by payer status may then affect survival on surgically treated patients. In this study we examined the role of cardiovascular risk factors and insurance carrier status on early outcomes of coronary artery bypass grafting (CABG) surgery in blacks versus white Americans.

METHODS AND RESULTS

From January 1990 to December 1996, 2776 patients (2003 men, 773 women; mean age 63 +/- 10 years), underwent isolated CABG in a multispecialty practice serving a major metropolitan population. There were 494 (17.8%) black patients and 2282 (82.2%) white patients. The proportion of black patients in each payer category was 17.8% commercial, 14.1% managed care, 52.9% Medicaid, and 19.5% Medicare. The effect of preoperative risk factors, including status of operation (elective, urgent, or emergent), sex, race, redo CABG, presence of renal disease, diabetes mellitus, congestive heart failure, myocardial infarction, the completeness of revascularization, age, and left ventricular ejection fraction were analyzed with the chi 2 test for categorical variables and the Student t test for age and ejection fraction. A multiple logistic regression analysis was performed to assess the effect of all variables on mortality rates simultaneously. Black patients had a higher incidence of diabetes mellitus, hypertension, and renal disease than white patients (P < 0.001). Overall, 30-day mortality rate was 2.5% (58 of 2282) in white patients versus 5.5% (25 of 494) for black patients (P < 0.003). Multivariate analysis showed that only emergency surgery status (OR 3.59, P < 0.01), redo CABG (OR 3.78, P < 0.001), hypertension (OR 2.32, P < 0.03), history of congestive heart failure (OR 2.1, P < 0.004), older age (OR 1.07, P < 0.001), and low ejection fraction (OR 0.98, P < 0.003) correlated with mortality rates. Race and payer status were not significant predictors of death.

CONCLUSIONS

These data on CABG surgery in black patients suggest that early death is due to associated risk factors and not due to race or insurance payer status.

A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults

A randomized, single-blind controlled trial was conducted to test the efficacy of a community-based group intervention to reduce fear of falling and associated restrictions in activity levels among older adults. A sample of 434 persons age 60+ years, who reported fear of falling and associated activity restriction, was recruited from 40 senior housing sites in the Boston metropolitan area. Data were collected at baseline, and at 6-week, 6-month, and 12-month follow-ups. Compared with contact control subjects, intervention subjects reported increased levels of intended activity (p < .05) and greater mobility control (p < .05) immediately after the intervention. Effects at 12 months included improved social function (p < .05) and mobility range (p < .05). The intervention had immediate but modest beneficial effects that diminished over time in the setting with no booster intervention.

Phosphorylation of farnesol in rat liver microsomes: properties of farnesol kinase and farnesyl phosphate kinase

As farnesol may serve as a nonsterol endogenous regulator of the mevalonate pathway, the possibility that a kinase specific for its phosphorylation is present in the rat liver was investigated. In the 10,000 g supernatant of rat liver, farnesyl monophosphate was synthesized in the presence of ATP. The Km value for farnesol was 2.3 microM. Various detergents inhibited the activity of the enzyme. The farnesol kinase was present in rough and in smooth I microsomes, but not in smooth II microsomes, mitochondria, peroxisomes, Golgi, or plasma membranes. The enzyme was associated with the inner, luminal surface of the vesicles. Further analyses have demonstrated that an enzymatic mechanism exists which catalyzes the phosphorylation of farnesyl-P to farnesyl-PP. Activity of the farnesyl phosphate kinase resulted in the phosphorylation of the monophosphate by CTP but not by ATP, GTP, or UTP. This enzyme is activated by low concentrations of detergents. Treatment with proteases and chemical probes indicate that this second phosphorylation reaction probably takes place on the outer, cytoplasmic surface of microsomal vesicles. These results demonstrate that rat liver microsomes contain two enzymes for the consecutive phosphorylation of farnesol to farnesyl-PP.

Negotiation Teamwork: The Impact of Information Distribution and Accountability on Performance Depends on the Relationship among Team Members

We examined how the distribution of information among team members and accountability pressures affected the quality of negotiated settlements reached among teams of friends negotiating against teams of strangers. The main conclusions of the experiment may be summarized by the following findings: (1) Teams of strangers reaped a greater share of the joint profit than did teams of friends when teammates were accountable to a supervisor as opposed to negotiating strictly on their own behalf. (2) Teams of strangers also reaped a marginally greater share of the joint profit than did teams of friends when teammates possessed unique, as opposed to common, information about their own team's preferences. (3) Not surprisingly, teams of friends were more cohesive than were teams of strangers; however, teams of friends were also more concerned about maintaining their relationship than were teams of strangers. (4) Teams of friends felt least cohesive when they were accountable to a supervisor, whereas teams of strangers felt most cohesive when they were accountable. Similarly, friends indicated greater relationship concerns when having to deal with distributed information, whereas information distribution had no effect on the relationship concerns of strangers. (5) For teams of strangers, greater team cohesiveness was positively correlated with better performance. (6) Moreover, when teams of strangers felt more cohesive than their opponents, they earned more than teams of strangers who felt less cohesive. Copyright 1997 Academic Press.

Evidence for heteromeric gap junction channels formed from rat connexin43 and human connexin37

Homomeric gap junction channels are composed solely of one connexin type, whereas heterotypic forms contain two homomeric hemichannels but the six identical connexins of each are different from each other. A heteromeric gap junction channel is one that contains different connexins within either or both hemichannels. The existence of heteromeric forms has been suggested, and many cell types are known to coexpress connexins. To determine if coexpressed connexins would form heteromers, we cotransfected rat connexin43 (rCx43) and human connexin37 (hCx37) into a cell line normally devoid of any connexin expression and used dual whole cell patch clamp to compare the observed gap junction channel activity with that seen in cells transfected only with rCx43 or hCx37. We also cocultured cells transfected with hCx37 or rCx43, in which one population was tagged with a fluorescent marker to monitor heterotypic channel activity. The cotransfected cells possessed channel types unlike the homotypic forms of rCx43 or hCx37 or the heterotypic forms. In addition, the noninstantaneous transjunctional conductance-transjunctional voltage (Gj/Vj) relationship for cotransfected cell pairs showed a large range of variability that was unlike that of the homotypic or heterotypic form. The heterotypic cell pairs displayed asymmetric voltage dependence. The results from the heteromeric cell pairs are inconsistent with summed behavior of two independent homotypic populations or mixed populations of homotypic and heterotypic channels types. The Gj/Vj data imply that the connexin-to-connexin interactions are significantly altered in cotransfected cell pairs relative to the homotypic and heterotypic forms. Heteromeric channels are a population of channels whose characteristics could well impact differently from their homotypic counterparts with regard to multicellular coordinated responses.

Modification of amino acids at shock pressures of 3.5 to 32 GPa

Amino acids were subjected to shock impact over a pressure range of 3.5 to 32 GPa both within and without meteoritic mineral matrices. The extent of amino acid destruction, racemization, and conversion to secondary amino acids was examined. Abundances of parent compounds decreased by a factor of 10(3) over this pressure range. Racemization also occurred, but some residual optical activity remained in the amino acids surviving shocks up to 32 GPa. Secondary amino acids formed in the high peak pressure range; those identified were beta-alanine, glycine, alanine, gamma-aminobutyric acid, and beta-aminoisobutyric acid. At 30 GPa, the abundances of these daughter compounds exceeded those of the remaining initial amino acids. As the concomitant effects of high mechanical stress and temperature accompanying shocks cannot be separated in this work, their relative contribution to the observed transformations cannot be estimated. The survival of amino acids in shock experiments suggests that, after formation or emplacement of amino acids in carbonaceous chondrite parent bodies, these objects never experienced impact velocities greater than 5 km/s, which suffices to generate 30 GPa for typical silicate/silicate impacts. These results also provide guidelines for choosing appropriate capture media for interplanetary dust particles on Earth-orbiting platforms.

Voltage sensitivity of gap junction currents in rat osteoblast-like cells

The dependence of macroscopic gap junctional conductance (g(j)) upon transjunctional voltage (Vj) was examined in 39 paired osteoblast-like (OB) cells from primary cultures using the double whole cell patch clamp technique. OB cells were derived from calvarial explants of new-born rats. Instantaneous current-voltage (Ij-Vj) relationships of OB cell pairs (n = 6) were linear in the entire voltage range (-150 < Vj < 150 mV) examined. The steady-state Ij-Vj relationship was non-linear for V > or = +/-60 mV. The curve for the normalised steady-state junctional conductance-voltage relationship (Gss/G0-Vj) was bell-shaped, and was fitted with a two-state Boltzmann equation with a minimum conductance (Gmin) of 0.2-0.3, and a half deactivation voltage (Vo) of +/-83 mV. In two recordings unitary gap junction channel activity was observable. The linear I-V relationships revealed a single channel conductance of approximately 100 pS. Application of parathyroid hormone (10(-8) M) had no effect on the voltage dependence nor the magnitude of macroscopic currents (n = 7).

How Do Logical Inference Rules Help Construct Social Mental Models?

Starting from recent approaches in mental model research, it is argued that (1) logical inference rules are used in order to construct mental cliques from learned sentiment relations, and (2) social context cues (operationalized as primes) play a crucial role in activating such rules. Transitivity and antitransitivity are taken as examples, and are shown as core constituents of such models. In a first experiment, priming was achieved by announcing the sorting of fictitious persons in either two or three cliques. Thirty-one subjects studied eight sets of sentiment relations among these persons that either did or did not satisfy their primed clique expectations. They showed longer study times and more requests for additional information in the case of inconsistent fits between prime and set. Their sorting solutions also showed clear priming effects. A second experiment (n = 30) showed that when undergoing a recognition test after seeing the relation sets, subjects tended to confuse model-consistent distractors with information they had actually seen. In a third experiment (n = 30) the results from Experiment 1 were replicated using more realistic learning materials.

Giving peace a push. Interview by Judith Gips

Lifelong peace and justice activists Dave Dellinger and Elizabeth Peterson have been inspirations to many, including myself, over the last fifty or more years. Dave's collection of essays, Revolutionary Nonviolence, spanning thirty years of committed and loving resistance to injustice in all its forms, is an illuminating glimpse into how things could be if more of us shared such willingness to examine our assumptions and our privileges. Here they tell us of birthing their five children, three at home. They have eleven grandchildren and two great-grandchildren.

Temporal Adjustments in the Evaluation of Events: The "Rosy View"

In a series of three investigations we examined people's anticipation of, actual experiences in, and subsequent recollection of meaningful life events: a trip to Europe, a Thanksgiving vacation, and a 3-week bicycle trip in California. The results of all three studies supported the hypothesis that people's expectations of personal events are more positive than their actual experience during the event itself, and their subsequent recollection of that event is more positive than the actual experience. The "rosy view" phenomenon is associated with an increase in the number of negative thoughts during the event which seem to be caused by distractions, disappointment, and a less positive view of the self. However, these effects are short-lived; within days after the event, people have much more positive evaluations of the event. We discuss alternative interpretations for our findings and implications for group and organizational settings.

Gregarina triboliorum (Eugregarinida: Gregarinidae) n. sp. from Tribolium confusum and resolution of the confused taxonomic history of Gregarina minuta Ishii, 1914

The septate gregarine parasites of flour beetles (Tribolium spp.) include Gregarina minuta Ishii, 1914, a relatively small species in which both primite and satellite possess an obvious protomerite, and a larger species that lacks the satellite protomerite. The latter species has been placed in the genera Didymophyes and Hirmocystis by various authors, but studies reported here demonstrate that this species, herein described as Gregarina triboliorum, exhibits early pairing and produces oocyst chains, both characteristics of the genus Gregarina. The oocysts of this new species are described for the first time. In addition, experimental infections using oocyst from single gametocysts reveal that oocyst chain number is variable but is typically 1, 2, or 4. Prior experiments involving a related beetle, Tenebrio molitor, demonstrated extreme host specificity within the 4 Gregarina species parasitizing larval and adult hosts. However, G. triboliorum is not limited either stadially or specially, infecting both adults and larvae of Tribolium confusum and Tribolium castaneum.

Effects of angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists in rats with heart failure. Role of kinins and angiotensin II type 2 receptors

Angiotensin-converting enzyme inhibitors (ACEi) improve cardiac function and remodeling and prolong survival in patients with heart failure (HF). Blockade of the renin-angiotensin system (RAS) with an angiotensin II type 1 receptor antagonist (AT1-ant) may have a similar beneficial effect. In addition to inhibition of the RAS, ACEi may also act by inhibiting kinin destruction, whereas AT1-ant may block the RAS at the level of the AT1 receptor and activate the angiotensin II type 2 (AT2) receptor. Using a model of HF induced by myocardial infarction (MI) in rats, we studied the role of kinins in the cardioprotective effect of ACEi. We also investigated whether an AT1-ant has a similar effect and whether these effects are partly due to activation of the AT2 receptor. Two months after MI, rats were treated for 2 mo with: (a) vehicle; (b) the ACEi ramipril, with and without the B2 receptor antagonist icatibant (B2-ant); or (c) an AT1-ant with and without an AT2-antagonist (AT2-ant) or B2-ant. Vehicle-treated rats had a significant increase in left ventricular end-diastolic (LVEDV) and end-systolic volume (LVESV) as well as interstitial collagen deposition and cardiomyocyte size, whereas ejection fraction was decreased. Left ventricular remodeling and cardiac function were improved by the ACEi and AT1-ant. The B2-ant blocked most of the cardioprotective effect of the ACEi, whereas the effect of the AT1-ant was blocked by the AT2-ant. The decreases in LVEDV and LVESV caused by the AT1-ant were also partially blocked by the B2-ant. We concluded that (a) in HF both ACEi and AT1-ant have a cardioprotective effect, which could be due to either a direct action on the heart or secondary to altered hemodynamics, or both; and (b) the effect of the ACEi is mediated in part by kinins, whereas that of the AT1-ant is triggered by activation of the AT2 receptor and is also mediated in part by kinins. We speculate that in HF, blockade of AT1 receptors increases both renin and angiotensins; these angiotensins stimulate the AT2 receptor, which in turn may play an important role in the therapeutic effect of the AT1-ant via kinins and other autacoids.

A prospective, randomized, controlled evaluation of peripheral nerve stimulation versus standard clinical dosing of neuromuscular blocking agents in critically ill patients

OBJECTIVES

To determine if vecuronium doses individualized by peripheral nerve stimulation are lower than those doses chosen by standard clinical techniques; and to determine whether patients monitored by peripheral nerve stimulation exhibit shorter recovery times and less prolonged neuromuscular blockade after discontinuation of vecuronium than control patients.

DESIGN

A prospective, randomized, controlled, single-blind trial.

SETTING

Two ten-bed medical intensive care units of a 937-bed tertiary care, not-for-profit, teaching hospital and health system.

PATIENTS

Mechanically ventilated patients requiring continuous neuromuscular blockade as part of their therapy.

INTERVENTIONS

After obtaining written, informed consent and baseline neurologic examinations, patients were randomized to treatment, where dosing was individualized by peripheral nerve stimulation or standard clinical assessment. Doses in the peripheral nerve stimulation group were adjusted to 90% blockade (Train-of-Four of 1/4). The standard clinical dosing group received doses individualized to clinical response by the medical team (blinded to Train-of-Four). Differences between groups were evaluated by Wilcoxon matched-pairs signed rank test.

MEASUREMENTS AND MAIN RESULTS

A total of 77 patients (35 standard clinical patients vs. 42 peripheral nerve stimulation patients) were enrolled in the study. Despite no difference in initial doses and time to reach 90% blockade or clinical response between groups, the peripheral nerve stimulation group used less drug than the standard clinical group (0.040 +/- 0.028 vs. 0.070 +/- 0.030 mg/kg/hr, respectively, p = .001). The total cumulative amount of vecuronium for the episode of paralysis was greater in the control group (285.8 +/- 246.6 vs. 137.1 +/- 106.4 mg, p = .001). The peripheral nerve stimulation group recovered neuromuscular function (relative risk of 1.85, with 95% confidence interval [CI] of 1.02-3.35, p = .039) and spontaneous ventilation (relative risk of 1.86, 95% CI 1.00-3.45, p = .047) faster than the control group. In patients, adjusting for renal dysfunction, the likelihood of a faster recovery in the peripheral nerve stimulation group increased for neuromuscular function (relative risk of 1.89, 95% CI of 1.07-3.32, p = .018) and spontaneous ventilation (relative risk of 2.27, 95% CI of 1.23-4.21, p = .019). Patients with combined renal and liver failure similarly demonstrated a faster recovery in the peripheral nerve stimulation group. The recovery was affected to a lesser extent by adjusting for concurrent aminoglycoside and corticosteroid administration.

CONCLUSIONS

Use of peripheral nerve stimulation for monitoring the degree of blockade and adjusting drug doses in continuously paralyzed critically ill medical patients results in lower doses of vecuronium to maintain a desired depth of paralysis, and allows a faster recovery of neuromuscular function and spontaneous ventilation.