The effect of switch control site on computer skills of infants and toddlers

OBJECTIVE

The purpose of this study was to determine whether switch control site (hand vs. head) affects the age at which children can successfully activate a computer to play a cause-and-effect game.

METHOD

The sample consisted of 72 participants randomly divided into two groups (head switch and hand switch), with stratification for gender and age (9-11 months, 12-14 months, 15-17 months). All participants were typically developing. After a maximum of 5 min of training, each participant was given five opportunities to activate a Jelly Bean switch to play a computer game. Competency was defined as four to five successful switch activations.

RESULTS

Most participants in the 9-month to 11-month age group could successfully use a hand switch to activate a computer, and for the 15-month to 17-month age group, 100% of the participants met with success. By contrast, in the head switch condition, approximately one third of the participants in each of the three age ranges were successful in activating the computer to play a cause-and-effect game.

CONCLUSION

The findings from this study provide developmental guidelines for using switches (head vs. hand) to activate computers to play cause-and-effect games and suggest that the clinician may consider introducing basic computer and switch skills to children as young as 9 months of age. However, the clinician is cautioned that the head switch may be more difficult to master than the hand switch and that additional research involving children with motor impairments is needed.

Advice about management of skin conditions in the community: who are the providers?

A survey was undertaken in the central Victorian city of Maryborough to investigate the use of pharmacies and general practitioners as sources of advice about skin problems. In a 2 week period consumers purchasing either prescription or over the counter (OTC) products for skin, hair and nails in pharmacies were approached for interview. Simultaneously, each of the city's general practitioners (GP) completed questionnaires on all patients presenting with conditions of skin, hair and nails. Seventy per cent of the 315 consumers interviewed were purchasing OTC products and 50% prescription items. Of the OTC products, 42% were originally recommended by pharmacy staff and 18% by doctors. Over one-third of consumers buying OTC products described symptoms to pharmacy staff and in about half of the cases it was to the pharmacy assistant. One-third of people describing symptoms had already seen a doctor. Problems most frequently reported were dermatitis, skin dryness, acne and tinea. General practitioners recorded 265 conditions (of which 54% were new) in patients. The most common condition treated was solar keratosis, and GP wrote a prescription for 45% and recommended OTC products for 7% of conditions. People in Maryborough are seeking advice for their skin conditions from a variety of sources including GP, pharmacies and others.

Structure of a secreted aspartic protease from C. albicans complexed with a potent inhibitor: implications for the design of antifungal agents

The three-dimensional structure of a secreted aspartic protease from Candida albicans complexed with a potent inhibitor reveals variations on the classical aspartic protease theme that dramatically alter the specificity of this class of enzymes. The structure presents: (1) an 8-residue insertion near the first disulfide (Cys 45-Cys 50, pepsin numbering) that results in a broad flap extending toward the active site; (2) a 7-residue deletion replacing helix hN2 (Ser 110-Tyr 114), which enlarges the S3 pocket; (3) a short polar connection between the two rigid body domains that alters their relative orientation and provides certain specificity; and (4) an ordered 11-residue addition at the carboxy terminus. The inhibitor binds in an extended conformation and presents a branched structure at the P3 position. The implications of these findings for the design of potent antifungal agents are discussed.

When can elderly patients be excluded from discussing resuscitation?

Case notes of elderly medical patients were surveyed to determine when "do not resuscitate' (DNR) decisions could legitimately be made without consulting them. Patients were thought to be suitable for exclusion from decisions if morbidity scores indicated that they were unlikely to survive cardiopulmonary resuscitation (CPR) or if they were mentally incompetent. Thirty per cent of all patients were predicted not to survive CPR; another 28% were deemed incompetent. Of those with DNR decisions, 59% were predicted not to survive and a further 24% were incompetent. Discussing resuscitation would have been appropriate with 17% of those with DNR decisions.

Parvovirus B19 outbreak in a developmental center

Of 49 employees serving developmentally disabled persons, 13 (27%) were found to have parvovirus B19 infection on the basis of serum positivity for parvovirus B19 IgM by enzyme-linked immunosorbent assay. Two employees had severe peripheral symmetric polyarthropathy lasting longer than 6 months. Infection control measures are described.

Resuscitation decisions--when should we talk to patients?

This paper attempts to summarise the results of recent British studies in the area of resuscitation decisions, and to explain the ethical and legal framework for the use of 'do not resuscitate' decisions and to give clear guidance about involving patients and relatives.

Discussing cardiopulmonary resuscitation with patients and relatives

This paper aims to give clear guidance for doctors working in the UK about their responsibilities when discussing cardiopulmonary resuscitation with patients and their relatives. The ethical and legal framework for making decisions is outlined and the commonly encountered dilemmas are discussed.

From research to practice: the effects of the jointly sponsored dissemination of an arthritis self-care nursing intervention

Various educational programs have been developed and found to be effective in the self-management of arthritis. This study reexamined the effectiveness of one such program, "Bone Up On Arthritis" (BUOA), when the program was delivered by a community-based service organization to a sample of persons (N = 154) who differed widely in disease type and demographic characteristics. Arthritis Foundation staff implemented BUOA at four national sites; data were collected and analyzed by University of Michigan nurse researchers. Investigators found improved scores on all outcome measures (self-care behavior, helplessness, pain, dysfunction, and depression). These findings suggest that "Bone Up" is an effective nursing intervention in multiple organizational and community environments and for diverse patient populations.

Criteria-based antimicrobial i.v. to oral conversion program

Collaborative efforts among several departments and the P & T Committee resulted in an IV to oral conversion program for select antimicrobials in our 580-bed county teaching hospital. This criteria-based program was designed to monitor and educate physicians on the appropriateness of parenteral antimicrobial prescribing, ensure rapid transition from IV to oral therapy, and contain costs. In the first 2 months of the program, 78 patients were converted from IV to oral administration with an estimated savings of $12,935. Of the ordering physicians, 66 (84.6%) accepted the interventions. All patients who switched administration routes were successfully treated with an oral agent. This program also has had a positive effect on patient outcomes and physician prescribing habits.

To resuscitate or not?

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A middle stone age worked bone industry from Katanda, Upper Semliki Valley, Zaire

Three archaeological sites at Katanda on the Upper Semliki River in the Western Rift Valley of Zaire have provided evidence for a well-developed bone industry in a Middle Stone Age context. Artifacts include both barbed and unbarbed points as well as a daggerlike object. Dating by both direct and indirect means indicate an age of approximately 90,000 years or older. Together with abundant fish (primarily catfish) remains, the bone technology indicates that a complex subsistence specialization had developed in Africa by this time. The level of behavioral competence required is consistent with that of upper Paleolithic Homo sapiens sapiens. These data support an African origin of behaviorally as well as biologically modern humans.

Cardiopulmonary resuscitation: doctors and nurses expect too much

Doctors and nurses in the UK and US have an over-optimistic view of patients' chances of surviving an attempt at cardiopulmonary resuscitation (CPR). If medical staff are to follow the recommendation that they should discuss the pros and cons of CPR with patients and their relatives, they should at least be able to give them realistic expectations of survival; otherwise inappropriate decisions may be made. Resuscitation training programmes should routinely include data on survival from CPR in differing circumstances.

Does audit improve DNR decision making?

The use of 'do not resuscitate' (DNR) orders in hospitals has been the subject of considerable comment in both the medical and the lay press. Guidelines have been produced to help make DNR decisions but, as yet, there have been no published accounts of these in practice. We have used audit to accounts of these in practice. We have used audit to develop DNR policy in our hospital, and have reviewed practice after the introduction of guidelines. This led to early consultant involvement in making decisions in 55 of 80 patients (69%) who were assessed as DNR at the time of death or discharge, documentation of reasons for DNR in all 55 of these and documentation of discussion with nurses in 49 (89%). Consultants agreed with DNR decisions made by their juniors in 31 of 34 cases (91%) and changed 'for CPR' decisions to DNR in 24 of 108 (22%). We have demonstrated that audit is an appropriate way to change and develop practice in sensitive areas such as this.

Diagnostic and treatment results from a southeastern academic center-based premenstrual syndrome clinic: the first year

OBJECTIVES

We attempted to ascertain the following: (1) the yield of a structured workup in a premenstrual syndrome clinic coordinated by a university-based gynecology department in the southeast, (2) referral patterns and care provided before consultation, and (3) therapeutic outcomes.

STUDY DESIGN

The first 100 women seen prospectively entered a uniform diagnostic and treatment protocol. Data analysis was performed with analysis of variance and confidence interval for a population proportion.

RESULTS

Thirty-eight women (95% confidence interval 28% to 48%) had premenstrual syndrome, 24 had premenstrual magnification syndrome (95% confidence interval 16% to 32%), 13 had an affective or other psychiatric disorder (95% confidence interval 6% to 20%). Only 44% of women previously given a diagnosis of premenstrual syndrome were found to have premenstrual syndrome. Overall, 84% of women with premenstrual syndrome and premenstrual magnification syndrome responded to treatment.

CONCLUSIONS

Too many women are still given the diagnosis of premenstrual syndrome without appropriate prospective documentation. Premenstrual magnification represents an important diagnostic category. Therapeutic responses to present treatments are encouraging.

Complement-mediated binding of naturally glycosylated and glycosylation-modified human immunodeficiency virus type 1 to human CR2 (CD21)

Particulate glycoproteins lacking sialic acid, such as desialylated enveloped viruses, readily activate complement through the alternative pathway. Human immunodeficiency virus type 1 (HIV-1) contains two heavily glycosylated and partially sialylated envelope glycoproteins: a surface gp120 and a transmembrane gp41. The abilities of naturally glycosylated HIV-1 and glycosylation-modified HIV-1 to interact with the complement system were examined with a biological assay which measured the binding of whole virus particles to cells expressing CR2 (CD21), the complement receptor found naturally in abundance on follicular dendritic cells and immature B cells. HIV-1 IIIB was synthesized in the presence or absence of the mannosidase II inhibitor, swainsonine, to give rise to high-mannose-type, nonsialylated, nonfucosylated carbohydrate moieties. The virus also was treated with neuraminidase or endo-beta-galactosidase to remove terminal sialic acids. An enzyme immunoassay specific for HIV-1 p24 core protein was used to quantitate the amount of virus bound to cell surfaces. Virus particles incubated with 1:3-diluted, fresh HIV-1-negative human serum as a source of complement readily bound to MT-2 (CD4+ CR2+) and Raji-3 (CD4- CR2+) cells but not to CEM (CD4+ CR2-) cells, suggesting that the virus bound to CR2 independently of CD4. Compared with heat-inactivated or C3-deficient sera, fresh complement increased binding by as much as 62 times for naturally glycosylated virus, and 5 times more than this for glycosylation-modified virus. Similar observations were made with freshly isolated, non-mitogen-stimulated peripheral blood mononuclear cells. Additional evidence that HIV-1 bound to CR2 independently of CD4 was provided by the fact that binding was blocked by monoclonal antibody OKB7 (anti-CR2) but not by OKT4a (anti-CD4). Also, the virus bound to transfected K562 cells (CD4-) which expressed recombinant human CR2 but did not bind to untransfected K562 cells. Results obtained with complement component-deficient sera indicated that binding required the alternative complement pathway. Raji-3 and transfected K562 cells could not be infected with HIV-1 in the presence of complement, suggesting that utilization of CR2 as a receptor in the absence of CD4 does not allow virus entry. The demonstration of CR2 as a receptor for HIV-1 in the presence of complement, together with the ability to enhance binding by desialylation, provides new insights into mechanisms of HIV-1-induced immunity and immunopathogenesis.

The Albrecht Nursing Model for Home Healthcare. Predictors of satisfaction with a self-care intervention program

Satisfaction with a self-care intervention program was evaluated through this quantitative study of arthritis clients at home. The results indicate that the clients were highly satisfied with the intervention. In this era of consumer satisfaction with their care, nurse administrator's knowledge of which interventions are satisfying is important for staff development and case management in the community.

Oral dapsone versus nebulized pentamidine for Pneumocystis carinii pneumonia prophylaxis: an open randomized prospective trial to assess efficacy and haematological toxicity

OBJECTIVE

To compare the haematological toxicity and efficacy of oral dapsone and nebulized pentamidine as Pneumocystis carinii pneumonia (PCP) prophylaxis in HIV-infected patients receiving zidovudine.

DESIGN

Randomized, prospective.

SETTING

Infectious diseases hospital with participants drawn from both inpatient and outpatient departments.

PATIENTS

Those eligible were starting treatment with zidovudine, needed PCP prophylaxis (CD4+ count < 200 x 10(6)/l or < 20% total lymphocyte count or previous episode of PCP), and had a normal glucose-6-phosphate dehydrogenase screen. Of the 98 patients enrolled, 96 returned for follow-up.

INTERVENTIONS

Fifty patients received dapsone (100mg orally twice weekly) and 46 pentamidine (400 mg nebulized monthly). Follow-up was for a median of 18 months.

MAIN OUTCOME MEASURES

The development of PCP, transfusion requirements, monthly complete blood cell counts, serious adverse reactions and death were recorded.

RESULTS

Nine (18%) dapsone and eight (17%) pentamidine recipients developed PCP. There was no significant difference in number of patients transfused (12 dapsone and nine pentamidine recipients) or transfusion-free survival. At exit from the study, mean haemoglobin (11.7 versus 12.4 g/dl), white blood cell (3.9 versus 3.7 x 10(9)/l) and platelet (195 versus 184 x 10(9)/l) counts did not differ for the dapsone and pentamidine arms, respectively. There was no significant difference in the occurrence of serious adverse reactions (six in the dapsone and eight in the pentamidine arm).

CONCLUSIONS

Dapsone can be recommended in preference to pentamidine as PCP prophylaxis on the basis of equivalent efficacy, absence of excessive haematological toxicity, low cost and ease of administration.

Studies in a kindred with parathyroid carcinoma

We report a family with primary hyperparathyroidism in four patients in two generations with apparent autosomal dominant transmission. A fifth member was probably affected. Two cases had definite parathyroid carcinoma (PC), and two had parathyroid adenoma with atypical features that could represent an early stage of cancer. In each of our patients, one parathyroid gland was abnormal. Five other parathyroid glands (in two patients) were normal in histology and size. There was no evidence of neoplasia in other tissues. Constitutional karyotypes were normal in all four patients. We identified three chromosomal abnormalities (a reciprocal translocation between chromosomes 3 and 4, trisomy 7, and a pericentric inversion in chromosome 9) in cultured PC tissue from one patient. These chromosomal changes are of unclear significance. Analyses on tumor DNA from one case of PC and one of atypical adenoma showed no evidence of ras gene mutations, PTH gene rearrangement, or allelic loss from chromosome 11q13 (locus of the gene for multiple endocrine neoplasia type 1). This family shows susceptibility to cancer without antecedent hyperplasia in all parathyroids. It could help identify a novel tumor susceptibility gene.

Lack of therapeutic efficacy of vitamin A for non-cholera, watery diarrhoea in Bangladeshi children

Vitamin A deficiency has been postulated to increase childhood mortality, possibly through increasing the severity and case-fatality of infectious diseases like diarrhoea. A clinical trial was conducted to measure the effect of vitamin A therapy on the severity and duration of acute episodes of non-cholera, watery diarrhoea; 83 children with less than 48 h of illness were randomized to receive vitamin A (200,000 IU of retinyl palmitate) orally or placebo during hospitalization at the International Centre for Diarrhoeal Disease Research in Bangladesh. The patients were similar initially with regard to age, nutritional status and severity of diarrhoea prior to admission. No adverse effects of vitamin A were detected. During hospitalization there were no differences between groups in duration of illness or stool output. Thus, vitamin A can be given safely during diarrhoeal illness to augment hepatic reserves and possibly provide a beneficial effect in regard to subsequent episodes of diarrhoea and other infections, but this supplementation should not be expected to have a therapeutic effect on a current episode.

Mechanism of physiologic and pathologic S3 gallop sounds

Although the S3 gallop sound has long been used clinically as an indicator of left ventricular systolic dysfunction, the mechanism responsible for its production remains controversial. The same sound is often found in young healthy individuals, and whether a similar mechanism is responsible is also unknown. The relationship of the S3 gallop sound to the dynamics of left ventricular filling was compared in 18 healthy young triathletes and 15 older subjects with cardiac disease. Twenty healthy normal subjects without an S3 were included as controls. Phonocardiographic, two-dimensional echocardiographic, and Doppler echocardiographic analysis of left ventricular inflow were evaluated. The S3 in both groups always occurred close to peak early filling velocity (E), during early flow deceleration. Mean E deceleration rate was higher in the subjects with S3 (726 +/- 153 cm/sec2 in the triathletes and 819 +/- 274 cm/sec2 in those with cardiac disease) than in control subjects (563 +/- 131 cm/sec2, p less than 0.001 in both cases). Ten triathletes underwent examination both before and immediately after 30 degrees head-up tilt. E deceleration rate dropped significantly with head-up tilt (720 +/- 137 vs 590 +/- 174 cm/sec2, p less than 0.01), while concurrently the S3 disappeared or was diminished in amplitude. Similar changes were seen in subjects with cardiac disease. We conclude that both the "pathologic" and "physiologic" S3 are related to abnormally rapid deceleration of early diastolic left ventricular inflow. Although the presence of the S3 is not dependent on the state of left ventricular systolic function, diastolic filling is characterized by a predominance of early inflow with a rapid flow deceleration rate.

Purinergic receptor activation of Cl- secretion in T84 cells

The regulation by ATP of Cl- secretion in T84 cells grown on filters was investigated by measuring short-circuit current (Isc = net Cl- secretion). ATP (greater than or equal to 10 microM) added to the basolateral side markedly stimulated Isc both in the presence and absence of forskolin-activated Isc. Fluorescence microscopy of cells loaded with the Ca2+ indicator fura-2 showed that ATP stimulated a transient increase in intracellular free Ca2+ concentration [Ca2+]i. The augmentation of forskolin-stimulated Isc by ATP was at least partly caused by mobilization of Ca2+ from an internal store because prior depletion of the store using ionomycin prevented the response. The activity sequence for stimulation of Isc in the presence of forskolin was adenosine 5'-O-(3-thiotriphosphate) = 5'-adenylylimidodiphosphate (AMP-PNP) greater than ATP greater than ADP greater than AMP, suggesting the presence of a P2 purinergic receptor. Neither beta, gamma-methyleneadenosine 5'-triphosphate nor alpha, beta-methyleneadenosine 5'-triphosphate increased the Isc. Stimulation of Isc by ATP in the absence of forskolin was at least partly due to the breakdown of ATP to AMP and adenosine, which act at P1 receptors to stimulate Isc, since 1) inhibition of the ecto-phosphohydrolase 5'-nucleotidase by alpha, beta-methylene-ADP partially inhibited stimulation of Isc by ATP, 2) the adenosine receptor antagonists caffeine and 8-phenyltheophylline markedly inhibited the ATP-stimulated Isc, and 3) AMP-PNP, a weakly hydrolyzable analogue of ATP, caused a much smaller increase in Isc compared with ATP. Adenosine had no effect on [Ca2+]i.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect on mortality of community-based maternity-care programme in rural Bangladesh

Various community-based interventions have been proposed to improve maternity care, but hardly any studies have reported the effect of these measures on maternal mortality. In this study, the efficacy of a maternity-care programme to reduce maternal mortality has been evaluated in the context of a primary health-care project in rural Bangladesh. Trained midwives were posted in villages, and asked to attend as many home-deliveries as possible, detect and manage obstetric complications at onset, and accompany patients requiring referral for higher-level care to the project central maternity clinic. The effect of the programme was evaluated by comparison of direct obstetric maternal mortality ratios between the programme area and a neighbouring control area without midwives. Random assignment of the intervention was not possible but potentially confounding characteristics, including coverage and use of other health and family planning services, were similar in both areas. Maternal mortality ratios due to obstetric complications were similar in both areas during the 3 years preceding the start of the programme. By contrast, during the following 3 years, the ratio was significantly lower in the programme than in the control area (1.4 vs 3.8 per 1000 live births, p = 0.02). The findings suggest that maternal survival can be improved by the posting of midwives at village level, if they are given proper training, means, supervision, and back-up. The inputs for such a programme to succeed and the constraints of its replication on a large scale should not be underestimated.

The pharmacokinetics of cefuroxime axetil in the sick elderly patient

The pharmacokinetics of cefuroxime axetil (RS3 formulation) were studied in 20 elderly patients following admission for lower respiratory or urinary tract infection. The mean age was 83.9 years. A 12-hourly dose of 250 mg was given for five days. The mean time to attain maximum serum concentration was 3.2 h with a mean peak concentration of 8.5 mg/l. The mean serum elimination half-life was 3.5 h and the AUC0-infinity 60.4 mg/h.l. There was no accumulation of the drug in the patients studied after five days treatment. The data suggest that the standard dosage regimen is adequate in the sick elderly patient.

Assessment of anomalous sentences repetition test

Use of Anomalous Sentences Repetition Test (ASRT) in 16 patients with diagnosis of dementia of Alzheimer's type, 16 normal elderly and 18 patients with depression revealed no difference in the age adjusted scores between the three groups, suggesting that it is not a good test for diagnosing dementia or differentiating dementia from depression.

Neutrophilic myelofibrosis presenting as Philadelphia chromosome negative BCR non-rearranged chronic myeloid leukemia

Chronic myeloid leukemia consists of Philadelphia chromosome positive disease in 90% of cases, and a further 5%, although Philadelphia chromosome negative, exhibit bcr gene rearrangements consistent with the disease. The remaining 5% of cases have a heterogeneous clinical picture with a course unlike that of classical chronic myeloid leukemia, and may belong to different pathologic entities. We report five cases belonging to the latter group, initially identified as Philadelphia chromosome negative, bcr non-rearranged chronic myeloid leukemia, that developed progressive leucocytosis, absolute monocytosis, myelodysplasia, extramedullary hematopoiesis, and had evidence of myelofibrosis. These cases may represent a distinct clinical entity characterized by neutrophilic myelofibrosis, which can be identified prospectively by clinical and pathologic criteria. Standard therapy for treating chronic myeloid leukemia or idiopathic myelofibrosis may not be appropriate for this group.