Indices of drug misuse for prescription drugs

Few studies of prescription-drug misuse have taken into account the numbers of prescriptions dispensed for specific drugs. Using data from the Drug Abuse Warning Network (DAWN) and the National Prescription Audit, we calculated indices of drug misuse for specific prescription drugs that are used mainly in outpatient settings and are either benzodiazepines, barbiturates, other sedative-hypnotics, analgesics, or CNS stimulants. In 1983-1985 the drugs associated with the highest numbers of DAWN medical examiner-reported drug-misuse deaths were codeine, diazepam, propoxyphene, phenobarbital, and secobarbital. However, the drugs with the highest indices of DAWN medical examiner-reported drug-misuse deaths/100,000 dispensed prescriptions were methamphetamine, methaqualone, amobarbital, secobarbital, and glutethimide. An index of fatality risk, calculated as 100 x DAWN medical examiner-reported drug-misuse deaths/DAWN emergency room-reported drug-misuse episodes, suggested that the risk of death from a glutethimide-associated drug-misuse episode had increased 92% from 1975-1979 to 1983-1983 and in 1983-1985 was the highest for the drugs studied. These indices might assist public health authorities attempting to design effective strategies to efficiently address the problem of prescription-drug misuse.

A short form of the Mississippi Scale for Combat-Related PTSD

At the present time, The Mississippi Scale for Combat-Related PTSD (Mississippi Scale) is the best paper-and-pencil measure of this disorder. This study carried out a test-retest reliability on 52 chronic Vietnam veterans with PTSD and established three psychometric criteria for item retention in order to establish a short form of the Mississippi Scale. Ten items met these criteria and had a test-retest reliability coefficient of .66 (under the most stringent of conditions, treatment). This 10-item measure (Miss-10) then was applied to 95 new PTSD cases. This scale yielded two factors, guilt and numbing/anger. Discussion addressed its use as part of a screening battery or for monitoring change across time.

Child psychopathology and environmental influences: discrete life events versus ongoing adversity

Patterns of exposure to distinct types of life stressors were compared between 134 children attending a military child psychiatric clinic and a matched military community control sample. Compared with the community sample, clinic-referred children had experienced significantly higher levels of normative stressful events as well as events confounded with their own adjustment and events related to parental psychosocial functioning. Differences in levels of normative stressful events were no longer significant, however, when controlling for events related to parental functioning. Ratings of stressful events during the past year significantly underestimated the lifetime stress exposure differences between clinic and community control children. Although normative stressful events, parent-related events, and parent symptomatology ratings were significantly related to child behavior problem ratings, normative stressful events did not contribute to predictions of child behavior problems beyond the variance attributable to parent-related events and parent symptomatology. Implications of these findings for life stress and child maladjustment research are discussed.

Self-harming behavior in incarcerated male delinquent adolescents

This report describes self-harming behavior in males in a juvenile incarceration center. Three groups of adolescents were examined: self-harmers, those referred for a psychiatric examination, and the incarcerated general population. Compared to the general population, the youth in the two mental health groups were younger, had greater family needs, had more educational problems, were more likely to have escaped from a previous placement, and committed more rule violations. The self-harming group, when compared with the psychiatrically referred group, had a greater number of prior offenses, were more disruptive in school, performed worse on a problem-solving task, and committed more rule violations. Issues of psychopathology and treatment are discussed.

Effects of acyl-CoA: cholesterol O-acyltransferase inhibition on cholesterol absorption and plasma lipoprotein composition in hamsters

1. The ACAT inhibitors, CL 277082 and SA 58-035 were administered for 7 days to hamsters fed diets containing 0.5% cholesterol. 2. Both agents inhibited cholesterol absorption, decreased hepatic. VLDL and IDL cholesterol esters, plasma HDL and HDL apoE and A-I. 3. In addition, CL 277082 treatment produced significant decreases in plasma cholesterol, VLDL apoB and plasma IDL. 4. The cholesteryl esters in VLDL and LDL but not HDL were more polyunsaturated in CL 277082 treated animals. 5. These results support the hypothesis that ACAT inhibition in the cholesterol fed hamster results in an inhibition of dietary cholesterol absorption, thus limiting the cholesterol supply required for the hepatic production of triglyceride-rich lipoproteins.

A prospective analysis of intramuscular meperidine, promethazine, and chlorpromazine in pediatric emergency department patients

STUDY OBJECTIVE

To examine physiologic responses and efficacy of 2, 1, and 1 mg/kg IM meperidine, promethazine, and chlorpromazine (MPC), respectively, in children.

DESIGN

Prospective, unblinded trial.

SETTING

A university and community emergency department.

PATIENTS

Sixty-three hemodynamically and neurologically stable children.

INTERVENTION

Single dose of IM MPC.

MEASUREMENTS AND MAIN RESULTS

Serial respirations, heart rate, arterial systolic blood pressure, oxygen saturation, and Glasgow Coma Scale were measured at 30-minute intervals. Effectiveness was assessed by two independent observers using separate visual analog scales for cooperation and sedation. Times to sleep (27 +/- 24 minutes), sitting upright (103 +/- 87 minutes), ED discharge (4.7 +/- 2.4 hours), eating (11 +/- 7.9 hours), and normal behavior (19 +/- 15 hours) were acceptable. Minor, but statistically significant, changes in respiration rate (-1.9 +/- 0.4), heart rate (+4.5 +/- 1.8), oxygen saturation (-0.7 +/- 0.3%), and Glasgow Coma Scale (-2.5 +/- 0.6) occurred for 120 minutes after MPC. No serious complications or resuscitation were required. Mean visual analog scale scores were 5.0/10.4 or more in 71% of cases, with interobserver agreement very good (cooperation, r = .79; effectiveness, r = .80). Twenty-nine percent of children were judged insufficiently sedated.

CONCLUSION

IM MPC is a safe and generally effective agent for ED procedures in selected children.

Hidden PTSD in substance abuse inpatients among Vietnam veterans

Alcohol use patterns among Vietnam combat veterans is an area with little research. This study evaluated three groups of Vietnam subjects on a chemical dependency unit who had a current Axis I diagnosis of alcohol abuse. No subject possessed a PTSD diagnosis. Two groups involved in-country veterans divided by presence or absence of PTSD based on the MMPI-PTSD scale (In-country and PTSD). The third group did not experience combat and was below the mean on the MMPI-PTSD scale (Noncombat). These groups were compared on the MMPI and the Alcohol Use Inventory (AUI), a measure of alcohol use patterns. Results showed that the PTSD Group had significantly higher scores on the MMPI and AUI reflective of deteriorated and binge drinking patterns. Discussion focused on the "hidden" dimension of PTSD among chemically dependent Vietnam veteran inpatients. The Relapse Prevention model was endorsed.

Diplopia following head injury

Two cases of traumatic fourth cranial nerve palsy are described. The treatment is discussed.

Children at risk: II. Risk factors and clinic utilization

Using a strategy involving multiple raters and instruments, the authors compared 134 clinic subjects with controls matched on sex, age, and socioeconomic status to determine how various risk factors are related to clinic utilization apart from their effects on children's symptomatology. Parental psychopathology, family size, and marital status were most predictive of children's symptom levels, while stress levels, family size, and marital status were most predictive of clinic utilization. Although children's total symptom levels explained 27.6% of the variance in clinic utilization, other factors (family size, family history of divorce, stress, and parental psychopathology) explained an additional 13.2% of the variance. Findings indicate that clinicians and health care planners must carefully assess variables other than children's symptom levels in order to better understand children's mental health services utilization, develop more robust models of risk, and increase the effectiveness of our efforts directed towards prevention and intervention.

Force necessary to fracture the orbital floor

Current thought on the pathophysiology of orbital wall fractures postulates either a "hydraulic" or a "buckling" mechanism. Evidence from cadaver, dried skull, and theoretical model studies supports both theories. No in vivo data, human or nonhuman primate, are available that quantitate the force necessary to fracture the orbital floor by either of the two mechanisms. We developed an apparatus that delivers quantifiable force only to the globe, without occluding the orbital opening or striking the orbital rim. We used it on 11 anesthetized Macaca fascicularis monkeys. Following a single bilateral application, the orbits were exenterated, and the orbital walls and orbital contents were examined to determine the extent of injuries. Fractures were described, diagrammed, and photographed. Fracture of the orbital floor was consistently produced at and above a force of 2.08 J. Posterior ruptures of five eyes occurred over the same range. We provide the first accurate measurements of the force required to produce orbital blow-out fractures in a live primate model. We show that orbital floor fractures can occur at low energies with direct ocular trauma only ("pure" hydraulic mechanism). Orbital wall fractures failed to protect the globe from rupture in 23% of cases.

Plasma elevations of histamine and a prostaglandin metabolite in acute bronchiolitis

Acute bronchiolitis (AB) is a common lung disease in infants manifested clinically by dyspnea and wheezing. The purpose of this study was to measure simultaneous plasma levels of histamine and a stable prostaglandin F2 alpha metabolite [13,14-dihydro-15-keto-PGF2 alpha (PG metabolite)], by radioenzymatic and radioimmunoassays, respectively, during and after recovery from AB. Blood was obtained from 15 infants during AB and from 14 and 9 of these infants when re-evaluated 6 and 18 months later, respectively. Mean (+/- 1 SEM) pre- and posttherapy (inhaled isoetharine) histamine levels (pg/ml), 1,923 +/- 980 and 1,035 +/- 250 during AB, respectively, were markedly higher than those of the same nonwheezing subjects at 18 months, 360 +/- 125, but unexpectedly lower than those at 6 months, 9,210 +/- 5,242. Of the 14 infants evaluated at 6 months, 7 had elevated histamine levels along with histories of recurrent wheezing after AB. Similarly, pre- and posttherapy PG metabolite levels (pg/ml), 1,033 +/- 419 and 1,613 +/- 527, respectively, were significantly higher than those of the same children when asymptomatic at 6 (27 +/- 7) and 18 months (68 +/- 25). Pre- and posttherapy levels of histamine and PG metabolite were higher than those of normal and sick, nonwheezing infants. These data indicate that histamine and PG metabolite are detectable in plasma during AB and suggest a role for histamine and PGF2 alpha in the pathogenesis of airways inflammation in AB.

Dietary assessment instruments for preschool children: reliability of parental responses to the 24-hour recall and a food frequency questionnaire

Nutrient intakes of preschool-age children were assessed with a 24-hour dietary recall and a 3-month food frequency questionnaire (FFQ). Parents of 55 preschoolers (mean age = 4.25 +/- 0.59 years) completed the recall and FFQ on two occasions 1 week apart. The recalls and FFQs were analyzed for energy, cholesterol, protein, total carbohydrate, calcium, sodium, potassium, and saturated, polyunsaturated, and monounsaturated fats; each nutrient was expressed as raw value, value per kg body weight, and value per 1,000 kcal. Test-retest reliability estimates for the 24-hour recall indicated significant variability in reported total energy intake, but stable reports of intake were observed for one or all units of expression for polyunsaturated fats, cholesterol, protein, total carbohydrate, calcium, and potassium. The FFQ showed significant positive test-retest reliability estimates for all nutrients for all units of expression. Comparison of the recall and FFQ data showed similar percentages of intakes of energy from fat, carbohydrate, and protein and significant correlations for reported intakes of cholesterol, protein, calcium, and potassium. Comparison of the recall and FFQ data with recall data from a comparable cohort showed lower reported intakes for our sample, with the exception of protein, carbohydrate, calcium, and potassium. If validation studies are successful, the FFQ may be useful in epidemiological studies of preschoolers' intakes over extended periods. The recall may prove to be a useful tool in the assessment of day-to-day variations in macronutrient intakes.

Children at risk: I. Risk factors and child symptomatology

The authors compared 134 6- to 12-year-old children from a military psychiatric clinic with a control sample to determine the salience of various risk factors in predicting levels of child psychopathology. Parents provided demographic information and completed standardized questionnaires on themselves and their children, while children completed two self-report symptom inventories. Results indicated that all hypothesized risk factors mediated effects on child psychopathology, but the effects of various risk factors differed as a function of the rater and type of psychopathological construct being measured. Generally, parental psychopathology and life stress mediated the greatest effects on overall child symptoms levels. Furthermore, the clinical and community samples differed in the presence and extent of risk factors. Results indicate the need for caution in studies of child psychopathology using only clinical samples and may suggest the importance of therapies based on environmental manipulations for a substantial proportion of patients seeking child psychiatric assistance.

Prediction of early attrition from couple therapy

This study explored prediction of early attrition from couple therapy at a community agency. Using 16 therapist-derived predictors of failure to engage in therapy, multiple regression analysis suggested that common-law relationships and low nonmortgage debt predicted dropout among 45 couples. The results are discussed with reference to the literature on early termination.

Diagnosis and treatment of attention deficit disorder in two general hospital clinics

In two clinics in military general hospitals, the charts of all children with a presumptive diagnosis of attention deficit disorder who were prescribed psychostimulants (N = 68) were audited to assess the quality of the primary physicians' evaluation and treatment. The audit instrument, constructed by a multidisciplinary team, indicated high interrater reliabilities, high face and concurrent validity, and moderate internal consistency. The audit found that only 51.5 percent of the children being treated with psychostimulants met the audit criteria for attention deficit disorder. A school intervention plan was documented in only 16.2 percent of the cases, and a psychotherapy intervention in only 19.1 percent; low rates were also found for other treatment and follow-up criteria. Overall, the assessment, the follow-up care, and the overall quality of care were found to be inadequate or less than adequate in about two-thirds of the cases.

Validation of a heart rate monitor with children in laboratory and field settings

The validity of the Sport Tester PE 3000 portable heart rate monitor for use with children was assessed by comparing readings with simultaneously recorded ECG heart rates in three studies, two using laboratory tasks and one in a field setting. Study 1 examined the validity of the Sport Tester with a sample of ten 10-yr-olds performing a cycle ergometer exercise task. Sport Tester readings taken during three 3-min exercise loads were correlated from 0.97 to 0.99 with simultaneously recorded ECG heart rates. In study 2, 23 children from 4 to 6 yr of age performed treadmill exercise for three 1-min intervals while Sport Tester and ECG heart rate data were obtained. Correlations for the three intervals ranged from 0.94 to 0.99. Study 3 obtained ECG and Sport Tester heart rates in 14 7- to 9-yr-olds who engaged in 3-min periods of standing, walking, jogging, throwing a ball, batting a ball, and playing on a jungle gym. Significant correlations of at least 0.98 between Sport Tester and ECG heart rates were obtained during all six activities. For all three studies, standard errors of estimate were low, ranging from 1.1 to 3.7 beats.min-1. For individuals, maximum differences ranged from 0 to 12.4 beats.min-1. Collectively, these findings indicate that the Sport Tester provides valid readings of young children's heart rates across a wide range of exercise involving upper- and lower-body movements.

Critical carotid stenoses: morphologic and chemical similarity between symptomatic and asymptomatic plaques

To identify microanatomic and chemical features that may mark the transition from asymptomatic to symptomatic atherosclerotic carotid lesions, we evaluated 62 carotid artery bifurcation plaques including 45 high-grade stenoses removed at endarterectomy and 17 nonstenotic plaques recovered at autopsy. Morphologic features were evaluated on multiple-interval histologic sections and were graded for the presence of hemorrhage, ulceration, thrombosis, lumen surface irregularity, and calcification. Plaque hemorrhage, recent and remote, was found in most of the specimens, and did not discriminate between symptomatic and asymptomatic stenotic plaques. High-grade carotid stenotic plaques were associated with a significantly higher incidence of ulceration (53%), thrombosis (49%), and lumen irregularity (78%) when compared to nonstenotic asymptomatic plaques (6%, 0%, and 17%, respectively; p less than 0.01). Although these features were more prominent in lesions that produced symptoms, they were present in 80% of the stenotic bifurcations, and did not distinguish between symptomatic and asymptomatic endarterectomy plaques. No significant differences were found between symptomatic and asymptomatic high-grade lesions with respect to collagen, DNA, total cholesterol, fibrinogen, lipase, elastase, or collagenase content. We conclude that intraplaque hemorrhage is commonly seen in carotid plaques even without severe stenosis, and it does not appear to be a dominant determinant of symptoms. Ulceration and surface thrombi that may lead to cerebral embolization are prominent features in markedly stenotic plaques even when symptoms are absent. The disruptive processes that underlie plaque instability appear to be closely associated with plaque size and stenosis rather than plaque composition.

The accuracy of industry data from death certificates for workplace homicide victims

This study compared death certificate data on usual industry for workplace homicide victims in five urban Texas counties, with medical examiners' data on the industries where victims were working when injured. The overall positive predictive value of the death certificate data was 72 per cent. Death certificate data on usual industry underestimated the number of victims working in high-risk industries when injured, partly because of victims whose usual industry was recorded as student, housewife, or military personnel.

A shigellosis outbreak traced to commercially distributed shredded lettuce

In the period August 30-October 7, 1986, 347 persons in adjacent west Texas counties (Ector and Midland) contracted culture-confirmed Shigella sonnei gastroenteritis. A case-control study showed an increased risk of acquiring shigellosis in Ector County with eating at outlets of fast-food Restaurant A, and in Midland County with eating at Restaurant B or C. A second case-control study, of persons who had eaten at Ector County outlets of Restaurant A, showed an increased risk of acquiring shigellosis with eating foods containing shredded lettuce and tomatoes, which were served together (odds ratio = 68.8; 95% confidence interval 8.5-293.1). All implicated restaurants received shredded lettuce produced at one lettuce-shredding plant; two implicated restaurants did not receive tomatoes from the lot delivered to other implicated restaurants. The lettuce-shredding plant distributed shredded lettuce and intact lettuce; restaurants that received only intact lettuce were not involved in the outbreak. Investigation at the lettuce-shredding plant suggested that a food handler might have been the source of contamination and that the method of processing might have allowed cross-contamination to occur. In the laboratory, the outbreak strain of S. sonnei multiplied rapidly on shredded lettuce at 22 C and survived on refrigerated shredded lettuce for at least seven days. This outbreak, one of the largest outbreaks of Shigella infections in the United States in the last decade, indicates that a large, geographically widespread shigellosis outbreak can result from contaminated shredded lettuce that is distributed commercially.

Disposable hydrogel contact lenses for extended wear

Nine ophthalmologists and nine optometrists conducted a premarket study of the Acuvue disposable contact lens manufactured by Vistakon, Inc. Of the 812 patients offered the lens, 733 accepted it and were enrolled in the study. These patients were fitted with the lens and followed for a period of 8 months. Over 98% of these patients had 20/25 or better vision on initial fitting; and subjective ratings of lens comfort were very good. Only 3.7% (27 of 733) discontinued wearing their lenses during the study period. Thirty-four patients (5.6%) experienced a problem while wearing their contact lenses.

Maternal language environment of children with mental retardation

Maternal language directed towards children with mental retardation and children matched either for language ability or chronological age was compared in free-play and instruction situations. Results were consistent with the hypothesis that mothers of children with retardation match their verbal behavior to their children's language ability while at the same time adopting a more pervasive teaching role. Specifically, they were more directive, but only in free-play. When explicitly asked to instruct their child, they changed very little in comparison with control mothers, whose directive behavior altered to levels previously adopted in free-play by mothers of children with mental retardation.

A personal effectiveness and stress management course for community health workers: a pilot study

Since the role of a community health worker in an inner city area is potentially very stressful, there is a requirement to provide help, support and training to enable them to function successfully. An individual who has learned coping skills might also feel confident about teaching these skills to clients. This paper describes a short course intended to enable professionals such as health visitors, speech therapists, community nurses and physiotherapists to cope better with stress and to be more effective in their daily work with colleagues as well as in sharing skills with clients. The initial, actual knowledge of the participant and confidence in perceived knowledge and ability was assessed before and immediately after the training and at a 4-month follow-up and this was replicated in a second nurse. The preliminary results suggested that the course brought about highly significant changes which were generally maintained at follow-up.

Fetal lung maturity in diabetic pregnancies: relation among amniotic fluid insulin, prolactin, and lecithin

Insulin, prolactin, and lecithin phosphorus levels were measured in 97, 62, and 44 amniotic fluid samples from third trimester normal, gestational diabetic, and insulin-dependent diabetic patients, respectively. There was no difference in lecithin phosphorus concentration (index of fetal lung maturity) among the three groups. The amniotic fluid insulin level was significantly higher in insulin-dependent diabetic patients, whereas there was no difference in amniotic fluid prolactin levels among the groups. Correlations of amniotic fluid prolactin levels with both lecithin phosphorus and insulin levels were not statistically significant in any of the groups. This is probably because amniotic fluid prolactin is decidual, rather than fetal, in origin. Even though amniotic fluid insulin levels, which reflect fetal levels, were significantly higher in insulin-dependent diabetic patients, there was no difference in the amniotic fluid lecithin phosphorus concentration in diabetic pregnancies compared with that in normal pregnancies. Moreover, there was a positive, and not a negative, correlation between amniotic fluid insulin and amniotic fluid lecithin phosphorus levels in diabetic pregnancies. These results do not support the theory that fetal hyperinsulinemia results in delayed pulmonic maturation in diabetic pregnancies.

Working with families of children with special needs: the parent adviser scheme

This paper describes a project in which an attempt is made to provide regular, ongoing support and counselling for families of children with severe developmental delays and intellectual or physical impairments. This service is available to both English speaking and Bangladeshi families, and is concerned with the needs of the whole family, not just the child. Professionals already working in this field are trained in counselling skills and then work in partnership with the families, attempting to develop a respectful, open relationship based upon active listening.

Fatal occupational injuries of women, Texas 1975-84

A review of Texas death certificates for 1975-84 identified 348 cases of fatal occupational injuries of civilian females. Homicides accounted for 53 per cent and motor vehicle-related injuries accounted for 26 per cent of the deaths. Injuries from firearms caused 70 per cent of the homicides. One hundred thirty-three deaths occurred to women employed in the retail trade industry; of these, 77 per cent resulted from homicide. Women workers in gasoline service stations, food-bakery-and-dairy stores, and eating-and-drinking places had especially high risks of homicide. Texas female heavy-truck drivers had the highest fatal-injury rate, with motor-vehicle-related injuries causing 89 per cent of their deaths. These results indicate that effective strategies to prevent fatal occupational injuries of Texas women will need to address the problems of workplace violence and the hazards posed by motor vehicles.

Effect of neural crest ablation on development of the heart and arch arteries in the chick

Mesenchymal derivatives of the neural crest contribute to the connective tissues and blood vessels of the pharyngeal arches, and participate in the septation of the outflow tract of the heart. The present study was designed to determine the nature and timing of alterations in the development of the heart and arch arteries subsequent to diminished neural crest contributions. The neural crest contributing to the three caudalmost pharyngeal arches was ablated bilaterally in chick embryos and compared with sham or unoperated controls. Heart development was studied by scanning electron microscopy. Arch artery development was studied microscopically after intravascular injection of India ink and clearing of the specimen. Neural crest ablation caused morphological changes in most hearts. Hearts in experimental animals commonly were elongate and were subject to inappropriate development of ventricular and atrial areas. A surgical effect delayed the disappearance of arch arteries one and two, and removal of neural crest produced an additional delay. Neural crest ablation caused failure of arch arteries three, four (right), and six to develop to the proper size in some animals. Survival of those whose sixth arch arteries achieved the proper size caused group measurements to reach normal values again by stage 32. Closure of arch arteries in some animals and maintenance in others produced greater variability in experimental animals than in controls. It is significant that heart morphology was altered before septation of the outflow tract normally occurs. This indicates at the least that another factor, such as altered blood flow, contributes to the abnormal development. Altered flow may result from changes in pharyngeal arch mesenchyme and arch artery endothelium.

Workplace homicides of Texas males

A review of Texas death certificates for 1975-84 identified 779 civilian males whose deaths were homicides that occurred in the workplace. Injuries from firearms caused 81 per cent of the deaths. The overall rate of workplace homicide was 2.1/100,000 male workers/year. Males employed in taxicab service had the highest rate of workplace homicide. 78.2/100,000 male workers/year. Males employed in certain retail trade industries, law enforcement, and the private-security industry also had high rates of workplace homicide. Male workers greater than or equal to 65 years old were at especially high risk, with a workplace-homicide rate 3.5 times that of younger workers. A review of medical examiners' records in five urban counties indicated that 32 per cent of victims who had worked in eating-and-drinking places and 5 per cent of other workers had blood or cerebrospinal-fluid alcohol levels greater than or equal to 0.10 g/dl. These results provide a base for designing effective strategies to prevent workplace homicides.

Evidence for an immune response to HLA class I antigens in the vanishing-bileduct syndrome after liver transplantation

The relation between donor and recipient status for HLA class I and II antigens in 62 patients undergoing liver transplantation was examined with particular reference to a well-defined variant of chronic rejection, the vanishing-bileduct (VBD) syndrome. A complete mismatch for class I antigens was more common in those with the VBD syndrome than in those with normal graft function or chronic graft malfunction unrelated to the syndrome (p less than 0.025). In contrast, a complete mismatch for class II antigens was considerably less common in those with the VBD syndrome than in those without (p less than 0.02). The association of a complete mismatch for class I and a partial or complete match for class II antigens with the VBD syndrome was highly significant (p less than 0.0005). These findings support the hypothesis that in the VBD syndrome both class I antigen expression on bileduct epithelium and immunological interaction at the level of class II antigens are required for the rejection process to occur. In addition, high-titre donor-specific antibodies to class I antigen, which were present in 6 of 14 of those with the VBD syndrome but in none of those without (p less than 0.0005), may be involved in the pathogenesis of bileduct damage.

Effects of biofeedback and cognitive therapy on stress in patients with breast cancer

The effects of psychological intervention on multilevel stress responding in 25 patients newly diagnosed as having breast cancer were studied. Specifically, biofeedback and cognitive therapies were employed as treatments with 24-hr. urinary cortisol and state anxiety as dependent variables. The proportion of treated patients showing improvement exceeded that of non-treated patients on both variables. Most significantly, Cortisol levels among the 12 treated patients were reduced relative to those of control patients. These results are discussed for their relevance to psychoimmunology.

Retinal hemorrhage thresholds for Q-switched neodymium-Yag laser exposures

Thresholds for retinal vitreal and contained hemorrhages were determined for 1064 nm laser light at 30-nsec and 4-nsec pulsewidths. Rhesus monkeys received graded exposures from a neodymium-yag laser onto either the macular or extramacular region of the retina. Contained hemorrhages appeared as concentric ring structures with white punctate centers. The vitreal hemorrhage was characterized by the presence of choroidal blood in the vitreal chamber at the exposure site. The 30-nsec contained hemorrhage threshold (ED50) was 1.7 mJ on the macula and 2.1 mJ for an extramacular exposure. The 30-nsec vitreal hemorrhage macular threshold was 2.3 mJ, and the extramacular threshold was 6.6 mJ. The threshold for the 4-nsec pulsewidths to produce a hemorrhage (vitreal or contained) on the retina (macula or extramacular) was 340 microJ.

Sequential nonstress testing with use of each fetus as its own control

The sequential nonstress tests of 126 high-risk fetuses were assessed for baseline fetal heart rate, acceleration frequency, amplitude, and duration and the observance of fetal heart rate decelerations. In 108 fetuses (563 tests) with normal perinatal outcomes, no significant trends in these parameters were found. In 18 fetuses (104 tests) with perinatal compromise, 16 had significantly declining acceleration frequencies, 15 had decreasing acceleration duration, four had rising mean baseline rates, and seven, in their last test before delivery, had repetitive late or severe variable decelerations. The last tests of 11 of these 18 fetuses met institutional criteria for reactivity. When the nonstress tests of compromised fetuses were viewed sequentially, acceleration frequency declined by an average of 59% and acceleration duration by an average of 40%. Sequential assessment of the nonstress test, when compared with the use of standard reactivity criteria, improved test sensitivity from 39% to 89% and negative predictive value from 91% to 98%. We conclude that sequential nonstress test assessment in individual fetuses may improve the diagnostic value of this modality and lead to earlier recognition of fetal compromise.

Percent acceleration time: a new method of fetal assessment

The percent acceleration time (PAT) is a fetal heart rate parameter, which may be derived from the nonstress test (NST). It is based on measurement of the duration of individual movement-associated fetal heart rate accelerations (MAFAs), obtained during a nonstress test, and is calculated by the formula: (formula, see text) The authors studied 148 fetuses undergoing four or more serial nonstress tests who were delivered within one week of their last test. Percent acceleration time of fetuses with normal outcomes had a mean value of 15.5 +/- 10.0 (SD)%, correlated well with the frequency and amplitude of movement-associated fetal heart rate accelerations but was independent of gestational age and mean baseline fetal heart rate. No normal fetus had a percent acceleration time of less than 5% on its last nonstress test, while only one abnormal fetus had a percent acceleration time that exceeded the mean percent acceleration time of the normal group. All abnormal fetuses had a significant progressive decline in percent acceleration time (mean: 50.6%). Percent acceleration time values were more sensitive in identifying fetuses with perinatal compromise than were conventional criteria for nonstress test reactivity, and may provide a useful alternative to assessment of fetal status when other quantitative methods are unavailable (continuous ultrasound visualization) or less reliable (maternal perception, tokodynamometry, palpation).

The vulnerable child syndrome: fact and theory

Studies which have evaluated parent-child relationships following a life-threatening event indicate that parents and children have subsequent interactional difficulties. This study sampled a group of 17 mothers who gave birth to a low birth weight infant (mean weight 1260 grams) and compared them to 17 mothers of normal infants matched for age, education and marital status. The mothers were studied at the infant's adjusted chronological age of 12 to 18 months. At that time all infants were developing normally as determined by the Denver Prescreening Questionnaire. The results indicated that mothers of low birth weight infants did not demonstrate any greater degree of depression or over-protection than their matched controls. The findings of this preliminary study suggest the need for reassessing the relationship between prematurity and other life-threatening events and the psychological sequelae associated with the vulnerable child syndrome. Previous studies are reviewed, and their methodologies are discussed.

Training professionals in behaviour modification

This paper examines the general issues to be considered in training non-psychologists in the social, health and education services to use a behaviour modification approach in their work. The work in this area is considered in relation to the justification of such training, the personnel involved, the length and content of courses and the methods of teaching. Attention is also given to the evaluation of the effectiveness of the teaching methods including the problems of subsequent maintenance of the knowledge and skills taught. Though behavioural techniques have attracted enormous research efforts, relatively little has been directed at the problems of training personnel in their use.

Socialization, locus of control, and dogmatism as related to counsellors' office settings

Psychologists and social workers in geographically decentralized and sometimes isolated settings must often work autonomously and make independent decisions. It was predicted that staff who choose to work in these settings would be more internally directed and more dogmatic than staff who worked in a centralized office. Decentralized staff were also hypothesized to want less control by others and less social inclusion. On Rotter's (1966) Internal-External Scale, Rokeach's (1959) Dogmatism Scale and Shurz's FIRO-B measures for 29 social workers and psychologists there were differences on the FIRO-B but not in internality or dogmatism. The results are discussed in terms of the sample's characteristics and the implications for the decentralization of counselling services.

Disseminated cytomegalovirus disease in the guinea pig

Two guinea pigs (Cavia porcellus), which were housed conventionally in separate animal facilities and had not been experimentally manipulated, were found to have evidence of disseminated cytomegalovirus disease at necropsy. Microscopic examination revealed multiple focal areas of necrosis in numerous organs. The spleen, liver, kidney and lungs were affected particularly. These lesions contained numerous cells with large intranuclear and cytoplasmic inclusion bodies resembling cytomegalovirus inclusions. Characteristic cytomegalovirus virions were observed by electron microscopy in both cases. Antigens of guinea pig cytomegalovirus were detected in paraffin sections of lesions from both cases with an immunoperoxidase technique. Although subclinical infection is common, this is the only contemporary report of disseminated disease due to cytomegalovirus in guinea pigs.

Threshold sensitivity and frequency specificity in auditory brainstem response audiometry

Frequency-specific electric response audiometry can be performed on difficult to test young children if the child is sedated and proper choices are made of acoustic stimuli and recording parameters, although certain compromises are necessary. A very satisfactory sedative is secobarbital, administered intramuscularly in doses related to the weight of the child. As stimuli we recommend '2-1-2' tone bursts at 500, 1 000, 2 000, and 4 000 Hz: i.e., with a rise and fall of two periods and a plateau of one period of the modulated tone. A very robust and sensitive response that is not significantly modified by the sedation and is effective for all four frequencies is the P6-SN10 of the early brainstem sequence. To record this complex favorably requires a bandpass input filter of the Butterworth type with pass-band (at -3 dB) from 50 to 1 700 Hz and rejection rates of 24 dB/octave. With this combination, polarity of stimulus is unimportant and sweep time, rate of stimulation and number of responses averaged may be selected for convenience and simplicity. A routine that requires about an hour of testing time is described and the necessary correction factors are given for estimating a child's behavioral pure-tone thresholds. We believe that our threshold estimates are generally correct within 10 dB, and are sufficiently frequency-specific for proper selection of a hearing aid.

Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis

As part of a prospective study of acute bacterial meningitis in children, we studied for five years the hearing of 185 infants and children who had acute bacterial meningitis when they were more than one month of age. Nineteen (10.3 per cent) of the patients had persistent bilateral or unilateral sensorineural hearing loss. The incidence of hearing loss as determined by electric-response audiometry and conventional tests was 31 per cent with Streptococcus pneumoniae, 10.5 per cent with Neisseria meningitidis, and 6 per cent with Hemophilus influenzae infections. Transient conductive hearing impairment was found in 16 per cent of the sample, but in no case was there apparent improvement in a sensorineural deficit over time. The site of disease resulting in impaired hearing cannot be stated with certainty, but involvement of the inner ear or auditory nerve was suspected. The number of days of illness (symptoms) before hospitalization and institution of antibacterial treatment was not correlated with the development of sensorineural deafness.

Cardiac size and function in children with sickle cell anemia

Cardiac size and function were studied echocardiographically in 124 children with sickle cell anemia. A group of 78 healthy black children served as control subjects. Sickle cell patients exhibited progressive chamber enlargement and progressively increasing left ventricular mass. Although contractility indices were normal, when the opposing influences of volume overload due to anemia and ventricular dysfunction were separated, abnormalities of systolic time intervals were identified. Left ventricular systolic time interval ratio and left ventricular preejection period were higher in the sickle cell group and became increasingly abnormal with growth, suggesting that left ventricular function deteriorated with time.