The Timing of High Sea Levels Over the Past 200,000 Years

The (230)Th ages and (234)U/(238)U ratios were determined for Barbados corals that grew during periods of high sea level within the last 200,000 years. The similarity of the initial (234)U/(238)U ratios of some of the corals to the modern marine value suggests that these samples are pristine and that the marine (234)U/(238)U ratio 83,000 and 200,000 years ago was within 2 per mil of the modern value. The accuracies of the (230)Th ages are evaluated on the basis of the (234)U/(238)U values and a model of the behavior of uranium and thorium isotopes during diagenesis. For the last three interglacial and two intervening interstadial periods, sea level peaked at or after peaks in summer insolation in the Northern Hemisphere. This overall pattern supports the idea that glacial-interglacial cycles are caused by changes in Earth's orbital geometry. The sea-level drop at the end of the penultimate interglacial, the last interglacial, and a subsequent interstadial period lagged behind the decrease in insolation by 5,000 to 10,000 years.

Meeting the change challenge: managing growth in the nonprofit and public human services sectors

The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector leaders, need to concern themselves with the concurrent management of two agendas: Running the Shop and Meeting the Change Challenge. This can be done effectively through the use of strategic issue management, which is a set of techniques that represents a blend of traditional strategic management and change management approaches.

Foster care and adoption policy in Romania: suggestions for international intervention

Building an effective child welfare system is a monumental task facing postrevolution Romania. Following revelations on American and Western European television about the large number of "orphans" in Romania, many couples flocked to that country to adopt children. A significant number of adopted Romanian children were brought to the United States. Some of these children are now evidencing problems that are bringing them to the attention of health and social service agencies. This article examines the macroeconomic policies that led to the institutionalization of a large number of children in Romania. Although institutional care is the current norm, a legal basis exists for building family foster care as an alternative. Romania's new adoption law replaces private adoptions with agency-based work. International adoption agencies are involved in developing community-based foster care and permanency planning as part of their work. This article challenges international adoption agencies to use clinical assessments of developmental delays and more rigorous health examinations for children released for adoption.

A Large Drop in Atmospheric 14C/12C and Reduced Melting in the Younger Dryas, Documented with 230Th Ages of Corals

Paired carbon-14 ((14)C) and thorium-230((230)Th) ages were determined on fossil corals from the Huon Peninsula, Papua New Guinea. The ages were used to calibrate part of the (14)C time scale and to estimate rates of sea-level rise during the last deglaciation. An abrupt offset between the (14)C and (230)Th ages suggests that the atmospheric (14)C/(12)C ratio dropped by 15 percent during the latter part of and after the Younger Dryas (YD). This prominent drop coincides with greatly reduced rates of sea-level rise. Reduction of melting because of cooler conditions during the YD may have caused an increase in the rate of ocean ventilation, which caused the atmospheric (14)C/(12)C ratio to fall. The record of sea-level rise also shows that globally averaged rates of melting were relatively high at the beginning of the YD. Thus, these measurements satisfy one of the conditions required by the hypothesis that the diversion of meltwater from the Mississippi to the St. Lawrence River triggered the YD event.

Hemostatic alterations in cancer patients

Nearly all patients with cancer manifest laboratory evidence of hypercoagulability and some develop clinical thromboembolic disease (TED). Routine laboratory studies of blood coagulation have been performed in several large, prospective trials of the use of anticoagulant drugs in cancer treatment. The results of these studies, as well as data from several smaller studies of more sensitive tests of hypercoagulability [e.g. fibrinopeptide A (FPA); thrombin-antithrombin (TAT) complexes; prothrombin fragment F1 + 2)], indicate that the levels of some clotting proteins parallel disease activity. However, no studies of sound methodologic design have yet been performed to indicate that any of these tests of blood coagulation can serve as adequate predictors of TED in patients with cancer. In addition to the important role played by tumor-related procoagulants, several other mechanisms may be involved in the pathogenesis of thromboembolic events in patients with cancer, including stasis and endothelial damage. Considerable variability in the relative importance of these mechanisms in the pathogenesis of TED may exist among patients with different types of cancer. The risk for TED associated with surgical procedures in cancer patients is substantial and prophylactic antithrombotic therapy should be considered for most of these patients. Chemotherapy and hormonal therapy of cancer probably increases the likelihood of TED, particularly in those subjects with indwelling venous catheters. This risk has been particularly well-studied in patients with breast cancer treated with tamoxifen plus cytotoxic drugs. The pathogenic mechanisms may be complex but vascular injury is likely as a proximate cause of venous access catheter thrombosis and can be prevented with low dose coumadin therapy. The utility of low dose coumadin anticoagulation in reducing the risk for TED during breast cancer treatment is unknown but is currently being tested in a large, multiinstitutional study. Since chronic coumadin anticoagulation of cancer patients, and single pulse dose heparin prior to intravenous chemotherapy, both prevent thrombin generation, these agents may be of use in reducing the risk of chemotherapy-associated thrombosis. Prophylactic anticoagulation should be considered for high risk patients.

Prognostic significance of blood coagulation tests in carcinoma of the lung and colon

Blood coagulation test results were collected prospectively in patients with previously untreated, advanced lung or colon cancer who entered into a clinical trial. In patients with colon cancer, reduced survival was associated (in univariate analysis) with higher values obtained at entry to the study for fibrinogen, fibrin(ogen) split products, antiplasmin, and fibrinopeptide A and accelerated euglobulin lysis times. In patients with non-small cell lung cancer, reduced survival was associated (in univariate analysis) with higher fibrinogen and fibrin(ogen) split products, platelet counts and activated partial thromboplastin times. In patients with small cell carcinoma of the lung, only higher activated partial thromboplastin times were associated (in univariate analysis) with reduced survival in patients with disseminated disease. In multivariate analysis, higher activated partial thromboplastin times were a significant independent predictor of survival for patients with non-small cell lung cancer limited to one hemithorax and with disseminated small cell carcinoma of the lung. Fibrin(ogen) split product levels were an independent predictor of survival for patients with disseminated non-small cell lung cancer as were both the fibrinogen and fibrinopeptide A levels for patients with disseminated colon cancer. These results suggest that certain tests of blood coagulation may be indicative of prognosis in lung and colon cancer. The heterogeneity of these results suggests that the mechanism(s), intensity, and pathophysiological significance of coagulation activation in cancer may differ between tumour types.

Multisite microprobes for neural recordings

Multisite, passive microprobes have been developed to allow simultaneous recording of action potential activity from multiple neurons at different locations in the brain. The microprobes were fabricated using standard integrated circuit techniques. The probe is a planar structure that consists of gold electrodes sandwiched between two polyimide dielectric layers and bonded to a molybdenum structural support. Windows in the top dielectric layer expose the electrode sites and bonding pads. In two distinct versions of the probe four or six recordings sites, respectively, of approximately 25 microns 2 are arranged on a dagger-shaped structure which can penetrate the pia. The bonding pads and interconnect wires at the probe head are entirely encapsulated in a tubular fixture that is packed with silicone RTV and sealed with epoxy to protect the interconnections from contact with body fluids. The site impedances at 1 kHz are typically between 2 and 4 M omega. Probe lifetimes for continuous immersion in physiological saline solution, as measured by impedance, have exceeded 750 h. The failure mechanism is believed to be due to moisture and ion absorption in the top dielectric layer. In acute neurophysiological experiments using the four site probes, action potential activity was recorded from physiologically identified neurons in the dorsal column nuclei of anesthetized rat.

The platelet count in carcinoma of the lung and colon

Platelet counts were evaluated in 714 patients with advanced non-small cell lung cancer (N-SCLC), small cell carcinoma of the lung (SCCL), and colon cancer entered to a clinical trial. Patients had not received prior chemotherapy. Platelet counts were not different in patients who had received radiation therapy prior to entry to the study. In comparison to the other tumor types, patients with N-SCLC demonstrated an increased prevalence of thrombocytosis (counts greater than 400,000/mm3), higher platelet counts at the time of entry to the study, higher over all mean platelet counts, relative preservation of high platelet levels during disease progression, and no relationship between platelet numbers and the amount of chemotherapy given. By contrast, platelet counts in patients with SCCL were negatively correlated with the absolute amount of cyclophosphamide and adriamycin given, and declined most dramatically with disease progression and death. Platelet numbers did not correlate with fibrinopeptide A or fibrin split product levels suggesting that disseminated intravascular coagulation or fibrinolysis may have had less influence on platelet numbers than certain other factors. By contrast, significant correlations were found for all three tumor types between platelet numbers and other indicators of bone marrow function including anemia, total leukocyte count, and absolute neutrophil count; and the fibrinogen level. Based upon these findings, we postulate that the host response to malignancy, possibly in the form of production of bone marrow-stimulating cytokines, may play a prominent role in regulation of platelet counts in these (and perhaps other) neoplasms, and that a particularly prominent and persistent degree of marrow stimulation exists in patients with N-SCLC.

Heparin abolishes the chemotherapy-induced increase in plasma fibrinopeptide A levels

PURPOSE, PATIENTS, AND METHODS

Blood coagulation abnormalities are common in patients with cancer, particularly after treatment with chemotherapeutic agents. Chemotherapy has been associated with an increased incidence of thromboembolic events, and patients treated with chemotherapy often develop evidence of local phlebitis, which may lead to loss of venous access. We have utilized the radioimmunoassay for plasma fibrinopeptide A (FPA) and in vitro FPA generation to assess the rate of in vivo blood coagulation and the level of plasma thrombin activity in 16 cancer patients treated with chemotherapy. Eight patients were treated twice, once with chemotherapy alone and once with chemotherapy after an intravenous infusion of heparin (5,000 U).

RESULTS

Our results confirm that FPA levels are elevated in most cancer patients. Following chemotherapy, FPA levels were further increased within 45 minutes (mean FPA = 5.2 ng/mL before chemotherapy versus 8.3 ng/mL after chemotherapy, p less than 0.01) and were accompanied by an increase in the FPA generation rate. Infusion of heparin prior to chemotherapy significantly lowered plasma FPA levels and abolished post-chemotherapy FPA generation.

CONCLUSION

These data suggest that patients receiving chemotherapy express thrombin-like activity in plasma and, therefore, may be at risk for clinically significant intravascular activation of coagulation. Heparin diminished the laboratory evidence of this chemotherapy-related coagulopathy and may have a role in the prevention of thromboembolic disorders in some cancer patients undergoing cytotoxic therapy.

Effect of mopidamol on survival in carcinoma of the lung and colon: final report of Veterans Administration Cooperative Study No. 188

Mopidamol (RA-233), a derivative of dipyridamole, is a phosphodiesterase inhibitor that has been shown previously to limit progression of malignancy in certain experimental animal models and in a pilot study in humans. RA-233 plus chemotherapy was compared with chemotherapy alone in a 5-year double-blind trial involving 719 patients with advanced carcinomas of the lung and of the colon. RA-233 treatment was associated with a statistically significant prolongation of survival in patients with non-small cell lung cancer (N-SCLC) limited to one hemithorax and with reduction in mean plasma fibrogen concentration. RA-233 was not toxic. The favorable effects on survival could not be explained by any factor other than the RA-233 treatment. In other tumor categories tested, no differences in survival were observed. These results suggest that RA-233 is useful in the treatment of N-SCLC of limited extent. They also suggest that therapeutic intervention aimed at modified intracellular pathways might constitute a novel investigative approach to the treatment of cancer.

Monocyte procoagulant activity as a peripheral marker of clotting activation in cancer patients

Peripheral blood monocytes generate the procoagulant tissue factor in vitro and in vivo in response to stimulation by a variety of agents. Monocytes from cancer patients generate significantly increased tissue factor and a quantitative relationship exists between the levels of monocyte tissue factor (MTF) and levels of circulating fibrinopeptide A (FPA), a marker of in vivo clotting activation. Furthermore, monocytes from cancer patients have a greater procoagulant response to stimulation by endotoxin in vitro, which appears independent of lymphocyte regulation. These findings suggest a priming process in vivo, and may reflect exposure of monocytes to tumor antigen(s) or components of the immune response to tumors.

Abnormalities of blood coagulation tests in patients with cancer

Routine blood coagulation tests were performed on 431 consecutive patients enrolled in a study of the role of anticoagulation in cancer treatment (VA Cooperative Study #75). Two hundred sixteen control patients were treated with standard therapy, and 215 patients were treated with standard therapy plus sodium warfarin. At the time of entry into the study, the most common abnormalities were elevated fibrinogen levels, platelet counts, and fibrinopeptide A levels. Serial studies demonstrated a steady increase in platelet count and fibrinogen levels before death. Anticoagulation lowered FPA levels but had no significant effect on fibrinogen levels, platelet counts, or euglobulin clot lysis times. An unexpected finding was a dramatic increase in fibrin split product levels after institution of anticoagulation (means +/- SEM = 42.6 +/- 116.4 vs. 2.9 +/- 7.0 mg/L in control subjects; P less than 0.02). This study supports the presence of subclinical activation of blood coagulation in most patients with cancer. Moreover, the preferential activation of fibrinolysis in anticoagulated patients suggests a role for a vitamin K-dependent factor(s) in the regulation of fibrinolysis in patients with cancer.

Precise Timing of the Last Interglacial Period from Mass Spectrometric Determination of Thorium-230 in Corals

The development of mass spectrometric techniques for determination of (230)Th abundance has made it possible to reduce analytical errors in (238)U-(234)U-(230)Th dating of corals even with very small samples. Samples of 6 x 10(8) atoms of (230)Th can be measured to an accuracy of +/-3 percent (2sigma) and 3 x 10(10) atoms of (230)Th can be measured to an accuracy of +/-0.2 percent. The time range over which useful age data on corals can be obtained now ranges from about 50 to about 500,000 years. For young corals, this approach may be preferable to (14)C dating. The precision with which the age of a coral can now be determined should make it possible to critically test the Milankovitch hypothesis concerning Pleistocene climate fluctuations. Analyses of a number of corals that grew during the last interglacial period yield ages of 122,000 to 130,000 years. The ages coincide with, or slightly postdate, the summer solar insolation high at 65 degrees N latitude which occurred 128,000 years ago. This supports the idea that changes in Pleistocene climate can be the result of variations in the distribution of solar insolation caused by changes in the geometry of the earth's orbit and rotation axis.

Activation of blood coagulation in Crohn's disease. Increased plasma fibrinopeptide A levels and enhanced generation of monocyte tissue factor activity

We have examined the relationships among activation of blood coagulation, generation of monocyte procoagulant activity, and clinical activity in patients with Crohn's disease. Subclinical activation of blood coagulation was measured using a radioimmunoassay for fibrinopeptide A. Fibrinopeptide A levels were strongly correlated with the level of disease activity as measured by the Crohn's disease activity index. Patients with active disease who were successfully treated either medically or surgically demonstrated a reduction of fibrinopeptide A levels. Failure of fibrinopeptide A to return to the normal range predicted an early relapse. Monocyte tissue factor generation was assessed in both unstimulated and lipopolysaccharide-stimulated mononuclear cell cultures obtained from the peripheral blood of patients with Crohn's disease. A strong correlation (r = 0.89) was observed between plasma fibrinopeptide A levels and monocyte tissue factor generation. These results suggest that monocyte procoagulant generation may contribute to the activation of blood coagulation in this inflammatory bowel disease. Moreover, fibrinopeptide A levels in Crohn's disease may provide a useful quantitative measure of inflammatory activity.

The effect of sodium warfarin on rabbit monocyte tissue factor expression

A rabbit model was developed to examine the effect of sodium warfarin on peripheral blood monocyte tissue factor (MTF) activity. After three days of treatment with sodium warfarin, MTF expression was significantly impaired (p less than 0.003). Vitamin K reversed this inhibition despite continued treatment with warfarin. Animals resistant to warfarin did not become anticoagulated and failed to demonstrate inhibition of MTF expression. Cells grown in plasma from warfarin-treated animals expressed reduced amounts of MTF activity, while cells grown in normal rabbit plasma demonstrated procoagulant activity in assays using both normal and factor VII-deficient substrate plasmas. These studies suggest that normal factor VII binds to monocytes during the culture period. Moreover, a plasma component in warfarin-treated animals, possibly abnormal factor VII, may bind to monocytes and block expression of MTF activity. This may represent another mechanism for warfarin-mediated inhibition of cell-mediated coagulation reactions in vivo.