Cucumber mosaic virus RNA 5 is a mixed population derived from the conserved 3'-terminal regions of genomic RNAs 2 and 3

Analysis of encapsidated RNA from the Q strain of CMV (Q-CMV) has indicated the presence of a discreet population of molecules of approximately 300 nt termed RNA 5 (Peden, K.W.C., and Symons, R.H., Virology 53,487-492, 1973.). Q-CMV RNA 5 was isolated and the 5'-end sequence was determined by direct RNA sequencing. This sequence corresponded to the exact beginning of the imperfectly conserved 3'-terminal region of genomic RNAs 1, 2, and 3. A probe generated from RNA 3 consisting of the last 130 nt of this region hybridised to RNA 5. Oligonucleotides containing sequences from the 5'- and 3'-ends of the conserved region were used to generate RNA 5 cDNA clones by RT-PCR on gel-purified RNA 5. Sequencing of these clones and primer extension analysis of transcripts (derived from the cDNA clones) and purified RNA 5 indicated that RNA 5 consists of the conserved 3'-terminal region of genomic RNAs 2 and 3.

Results of an autologous tissue reconstruction for replacement of obstructed extracardiac conduits

Between May 1983 and March 1, 1995, 50 patients had replacement of an obstructed pulmonary ventricle-pulmonary artery conduit with an autologous tissue reconstruction in which a prosthetic roof was placed over the fibrous tissue bed of the explanted conduit. The roof was constructed with xenograft pericardium (most recently) (n = 42), homograft dura mater (n = 5), or Dacron fabric (n = 3). Patient ages ranged from 5 to 34 years (median 16 years). The explanted conduits were Hancock conduits (n = 33), Tascon conduits (n = 6), homograft (n = 4), Dacron tube (n = 3), and others (n = 4). Preoperative maximum systolic gradients ranged from 44 to 144 mm Hg (median 78 mm Hg). Thirty-seven concomitant cardiac procedures were done in 29 patients. When a valve was necessary (n = 15), it was possible to place a large-sized valve in the autologous tissue reconstructions (range 22 to 29 mm, median 26 mm). Cardiopulmonary bypass times ranged from 34 to 223 minutes (median 84 minutes), and aortic crossclamp times ranged from 0 (in 32 patients) to 109 minutes (median 0 minutes). Intraoperative postrepair peak systolic gradients from pulmonary ventricle to pulmonary artery ranged from 0 to 33 mm Hg (median 13 mm Hg). There was one early death (2%) in a patient who had additional cardiac procedures. Follow-up was complete in all patients and ranged from 1 month to 11.8 years (median 7.5 years). There were two sudden late deaths: conduits in both were known to be free from obstruction. Forty-four of the 47 surviving patients had evaluation of the gradient by echocardiography or cardiac catheterization 1 month to 11 years (median 7 years) after operation. The gradients ranged from 5 to 45 mm Hg (median 20 mm Hg). None of the conduits developed an obstructive peel, valve obstruction, or valve incompetence. At 10 years, the freedom from reoperation for conduit obstruction was 100%, and freedom from reoperation for any cause was 81%. This technique simplifies conduit replacement, allows for a generous-sized outflow tract, has a low risk, and yields late results that appear superior to those of cryopreserved homografts or other types of extracardiac conduits.

Restructuring of laboratory services at the Detroit Medical Center. Process and outcomes

Following an era of "do more, earn more," the health-care industry, including physicians and hospitals, has been faced with cost-containment measures. With this in mind, the Detroit Medical Center (DMC) embarked on a laboratory consolidation initiative to achieve this objective in 1985. The DMC entered into a partnership with Damon Clinical Laboratories, forming Damon Clinical Laboratories at the Detroit Medical Center. This partnership resulted in the consolidation of laboratory services within the DMC and the establishment of an outreach activity. In December 1992, it was decided that the partnership would be dissolved, with the DMC assuming full ownership and responsibility for the management of laboratory services. Thus, DMC University Laboratories was created and is currently in its third year of operation. This article presents how the decision to consolidate laboratory services within the DMC was made, along with the process and outcomes of consolidating the operations of seven hospital laboratories.

RNA 4 sequences from cucumber mosaic virus subgroups I and II

The complete sequences of RNA 4 from cucumber mosaic virus (CMV) strains Ny (subgroup I) and Sn (subgroup II) have been determined and compared to all other known complete CMV RNA 4 sequences. The identification of a unique EcoRI site, present only in subgroup-II RNA 4 sequences, provides the basis for a simple method of classifying CMV isolates.

Future directions for research on pediatric chronic disease management: lessons from diabetes

Discussed conceptual and methodological issues related to research on the management of pediatric chronic disease, focusing on diabetes. The quality of studies in this area has improved, but several problems remain. Recommendations include greater use of theory in planning studies; population-based samples; more sophisticated definitions of adherence; longitudinal designs; and analyses that control for demographic, developmental, and medical variables. Most needed are prevention and intervention studies that modify (rather than simply describe) contextual, behavioral, and psychological variables hypothesized to facilitate or impede adherence and adjustment. The questions asked and designs employed should match the state of knowledge regarding the conceptual issue(s) being studied. It is often not possible for a given study to incorporate all of the recommendations above, but it is hoped that more research studies will move toward these goals, and thereby enhance the contribution of pediatric psychology to chronic disease management.

Late results of pulmonary ventricle to pulmonary artery conduits

The development of the extracardiac conduit has been one of the greatest advances in cardiac surgery. Conduits have decreased the mortality rate of several standard operations and have made possible the correction of numerous complex congenital cardiac anomalies that previously were uncorrectable. However, the ideal conduit has not yet been developed. We have reviewed the long-term (16 to 29 years) results of our early experience with this technique.

Assessment of diabetes-related distress

OBJECTIVE

To describe a new measure of psychosocial adjustment specific to diabetes, the Problem Areas in Diabetes Survey (PAID), and to present initial information on its reliability and validity.

RESEARCH DESIGN AND METHODS

Before their routine clinic appointments, 451 female patients with type I and type II diabetes, all of whom required insulin, completed a self-report survey. Included in the survey was the PAID, a 20-item questionnaire in which each item represents a unique area of diabetes-related psychosocial distress. Each item is rated on a six-point Likert scale, reflecting the degree to which the item is perceived as currently problematic. A total scale score, hypothesized to reflect the overall level of diabetes-related emotional distress, is computed by summing the total item responses. To examine the concurrent validity of the PAID, the survey also included a series of standardized questionnaires assessing psychosocial functioning (general emotional distress, fear of hypoglycemia, and disordered eating), attitudes toward diabetes, and self-care behaviors. All subjects were assessed for HbA1, within 30 days of survey completion and again approximately 1-2 years later. Finally, long-term diabetic complications were determined through chart review.

RESULTS

Internal reliability of the PAID was high, with good item-to-total correlations. Approximately 60% of the subject sample reported at least one serious diabetes-related concern. As expected, the PAID was positively associated with relevant psychosocial measures of distress, including general emotional distress, disordered eating, and fear of hypoglycemia, short- and long-term diabetic complications, and HbA1, and negatively associated with reported self-care behaviors. The PAID accounted for approximately 9% of the variance in HbA1. Diabetes-related emotional distress, as measured by the PAID, was found to be a unique contributor to adherence to self-care behaviors after adjustment for age, diabetes duration, and general emotional distress. In addition, the PAID was associated with HbA1 even after adjustment for age, diabetes duration, general emotional distress, and adherence to self-care behaviors.

CONCLUSIONS

These findings suggest that the PAID, a brief, easy-to-administer instrument, may be valuable in assessing psychosocial adjustment to diabetes. In addition to high internal reliability, the consistent pattern of correlational findings indicates that the PAID is tapping into relevant aspects of emotional distress and that its particular feature, the measurement of diabetes-related emotional distress, is uniquely associated with diabetes-relevant outcomes. These data are also consistent with the hypothesis that diabetes-related emotional distress, separate from general emotional distress, is an independent and major contributor to poor adherence. Given that the study was limited to female patients using insulin, further examination of the clinical usefulness of the PAID will need to focus on more heterogeneous samples.

Risk of thromboembolism with the aortic Carpentier-Edwards bioprosthesis

Porcine bioprostheses provide an excellent alternative to mechanical prostheses for heart valve replacement in patients unable to comply with systemic anticoagulation and in the elderly. Long-term results of this prosthesis, however, demonstrated identical survival and parallel event-free status, albeit at a lower rate than the mechanical valves. Some discrepancy exists as to the need for and duration of systemic anticoagulation in the bioprosthesis, and some evidence exists to contraindicate anticoagulation due to a higher late mortality rate in patients with an aortic bioprosthesis. The records of 561 patients having the Carpentier-Edwards bioprosthesis in the aortic position as an isolated valve procedure were reviewed. The overall rate of bioprosthetic failure events was low (0.23%/patient year) and the survival (5 year, 74.8 +/- 2.4%; 10 year, 52.9 +/- 4.9%) and event-free statistics (5 year, 67.9 +/- 2.6%; 10 year, 42.4 +/- 5.1%) were excellent. No gender difference was present. A vulnerable period for neurologic events was identified by hazard function whereby the incidence of stroke was high; these were increased in the patient variables of compromised ejection fraction (0.54; p < or = 0.003), older age (< or = 73 years; p < or = 0.02), and preoperative atrial fibrillation or paced rhythm (p < or = 0.01). This pattern was similar for both transient ischemic events and strokes and rapidly decreased over the first few months of the first year and the first few years of the 12-year follow-up. These patients were not routinely anticoagulated.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics of rectal paracetamol after major surgery in children

Glycogelatin capsular suppositories containing a paracetamol slurry 40 mg.kg-1 were given PR to 20 children (12 months-17 yrs) after major orthopaedic surgery and plasma concentrations of paracetamol measured for up to 18 h. The mean maximum concentration (Cmax) was 0.115 (SD 0.049) mmol.l-1. Peak concentration occurred (Tmax) at 2.3 (SD 1.2) h. Mean concentration was 0.07 (SD 0.03) mmol.l-1 at six h. Apparent paracetamol clearance was 5.8 ml.min-1.kg-1. The plasma concentration of paracetamol associated with analgesic effectiveness in children is unknown, but antipyretic effects are seen in the range 0.066-0.130 mmol.l-1. Paracetamol suppositories 40 mg.kg-1 given perioperatively achieve effective therapeutic antipyretic plasma concentrations within 1-2 h. The timing is coincident with the recovery phase of short duration paediatric surgery. The coefficient of variance of Cmax was 43%. Some individual patients may not achieve a Cmax which is therapeutic.

The risk of stroke in the early postoperative period following mitral valve replacement

All patients (285) undergoing mitral valve replacement (MVR) with a Carpentier-Edwards (C-E) bioprosthesis +/- coronary bypass grafts (CABG) were reviewed (109 men and 176 women with a median age of 70 years). Overall, the 5-year survival rate was 58.9%, 62.7% for MVR (199 patients) and 50.1% for MVR+CABG (86 patients). Late survival was adversely affected by the operative time variables of NYHA class IV, older (> or = 70 years) age, low (> or = 56%) ejection fraction (EF), and the additional performance of associated procedures+CABG with MVR (P < or = 0.001). The 5-year freedom from stroke rate was 89.2%, 89.1% for MVR and 90.2% for MVR +/- CABG. Advanced heart class was the only significant variable associated with a greater risk of late stroke (P < or = 0.01). Neither chronic preoperative atrial fibrillation nor operative obliteration of the left atrial appendage increased or decreased the late risk of stroke in patients following MVR. Hazard function for stroke occurring in the first postoperative year (first 48 h excluded to discount intraoperative events) demonstrated the highest rate within the first month (40%), rapidly diminishing thereafter. This pattern was reproduced in the 12-year hazard function in that the rate of stroke occurrence was greatest in the first year (6.7%) following implantation. The mean stroke rate over 12 years was 2.5%. Strokes following MVR +/- CABG are more likely to occur in older and more compromised patients, and the higher early rate is not reflected in the mean rate. A more aggressive approach to early anticoagulation with IV heparin, Coumadin, and possibly antiplatelet therapy is advocated to reduce this complication rate.

Insulin omission in women with IDDM

OBJECTIVE

To describe the extent of intentional insulin omission in an outpatient population of women with insulin-dependent diabetes mellitus (IDDM) and examine its relationship to disordered eating, attitudes toward diabetes, other psychosocial factors, long-term complications, and glycemic control.

RESEARCH DESIGN AND METHODS

Before their routinely scheduled clinic appointments, female IDDM patients who were 13-60 years of age completed a self-report survey (final n = 341). The survey included standardized questionnaires assessing disordered eating attitudes and behaviors, psychological functioning (general distress, diabetes-specific distress, and hypoglycemic fear), attitudes toward diabetes, and self-care behaviors. All subjects were assessed for glycosylated hemoglobin within 30 days of survey completion. Long-term complications were determined through chart review.

RESULTS

Approximately 31% of the subject sample, representing women of all ages, reported intentional insulin omission, but only 8.8% reported frequent omission. Compared with non-omitters, omitters reported more disordered eating, greater psychological distress (general and diabetes-specific), more hypoglycemic fear, poorer regimen adherence, and greater fears concerning improved diabetes management (which may lead to weight gain). Omitters evidenced poorer glycemic control, more diabetes-related hospitalizations, and higher rates of retinopathy and neuropathy. Multivariate examination revealed only two variables that independently predicted omission: diabetes-specific distress and fear of improved glycemic control ("because I will gain weight"). Of the omitters, approximately half reported omitting insulin for weight-management purposes (weight-related omitters). These subjects evidenced significantly greater psychological distress, poorer regimen adherence (including more frequent omission), poorer glycemic control, and higher rates of complications than did non-weight-related omitters as well as non-omitters. Non-weight-related omitters tended to fall between weight-related omitters and non-omitters on most measures of psychological functioning, adherence, and glycemic control.

CONCLUSIONS

These findings suggest that insulin omission is common, that it is not limited to younger women, and that the medical consequences of omission, especially frequent omission, may be severe. Although a strong association between omission and disordered eating was observed, these data suggest that this link may be complicated by important diabetes-specific factors. Patients preoccupied with eating and weight concerns may also become emotionally overwhelmed by diabetes and/or fearful of normoglycemia (and the associated weight-related consequences), thus reinforcing the desire to omit insulin and maintain elevated blood glucose levels.

Cutaneous Blue Nevi: Classification and Malignant Degeneration

MM Al-Qattan, MF Stranc, BJ Anderson. Cutaneous blue nevi: classification and malignant degeneration. Can J Plast Surg 1994;2(3):130-132. A case of malignant melanoma arising in a congenital giant blue nevus on the arm of a 72-year-old male is reported. The literature is reviewed and a classification of cutaneous blue nevi presented. Malignant degeneration of different types of blue nevi is also discussed.

Cerebellar and brainstem circuits involved in classical eyeblink conditioning

Model systems are one useful strategy for the investigation of the mechanisms of learning. Whereas mammalian model systems generally do not offer the ease of identifying circuitry and exploring cellular mechanisms of learning that is realized with invertebrate preparations /37,97/, research involving the rabbit classical eyeblink conditioning paradigm has now reached the state at which much of the basic conditioning neural circuit appears to have been identified /9,65,66,85,89,91/. Despite a dispute as to precisely where in the circuitry convergence of the associated stimuli may occur, there is substantial evidence identifying the stimulus input pathways and motor output pathway. The present summary of this research details these paths. In addition, the proposed sites of convergence of the conditioning stimuli are discussed. Finally, a hypothesized neural circuit responsible for classical eyeblink conditioning is presented along with some suggestions for future research directions.

Glial hypertrophy is associated with synaptogenesis following motor-skill learning, but not with angiogenesis following exercise

Rats reared from weaning in a complex environment have an increase in 1) glial surface area, 2) capillary volume, and 3) the number of synapses, per neuron. In that paradigm it has not been possible to determine whether the glial increase more closely correlates with the increase in synaptic numbers or with angiogenesis. More recently we have found that rats that exercised had an increase in the density of capillaries without an increase in the synaptic numbers, whereas rats that learned new motor skills had a greater number of synapses per neuron without an increase in the density of capillaries. Those findings provided the opportunity to investigate whether changes in glial volume in the cerebellum correspond to changes in the number of synapses or in capillary volume. Glial area fraction estimates were obtained using point counts on electron micrographs from the previous studies. The skill learning group had a greater volume of molecular layer per Purkinje cell, and also a greater volume of glia per Purkinje cell, than rats in either an inactive group or rats in two exercise groups. No significant differences were found in glial volume per synapse and glial volume per capillary across groups, although there was a tendency for glial volume per capillary to be lower in the exercise groups. The data indicate that glial volume correlates with synaptic numbers and not with capillary density.

New overlapping gene encoded by the cucumber mosaic virus genome

Cucumber mosaic virus (CMV) contains three genomic RNAs (RNAs 1, 2, and 3) and a subgenomic RNA (RNA 4), a shared feature of the Bromoviridae family which includes cucumoviruses, bromoviruses, alfalfa mosaic virus, and ilarviruses. We describe in this paper the molecular characterization of a novel subgenomic RNA of the Q strain of CMV (Q-CMV), RNA 4A, which was first reported in 1973 (K. W. C. Peden and R. H. Symons, Virology 53, 487-492, 1973). RNA 4A is 682 nucleotides and is identical in sequence to the 3'-terminal 682 nucleotides of RNA 2. RNA 4A encodes a small open reading frame (ORF) of 100 codons, which, in RNA 2, overlaps the C-terminal portion of the major 2a gene; thus it is likely that RNA 4A functions as the mRNA for the in vivo expression of the ORF, called ORF 2b. Polyclonal antibodies raised against a 2b fusion protein expressed in Escherichia coli specifically detected the 2b gene product in Q-CMV-infected cucumber plants by Western immunoblotting. Examination of published viral RNA sequences revealed the conservation of ORF 2b in all of the four other cucumoviruses sequenced to date; however, it is absent from the rest of the Bromoviridae. We suggest that the proposed ORF 2b may be expressed in other cucumoviruses, most likely via 4A-like subgenomic RNAs, and that the predicted gene product may have a unique functional role in the infection process of cucumoviruses.

Propofol--contrasting effects in movement disorders

We report two patients presenting for thalamotomy in whom tremor was abolished for 8 h after propofol anaesthesia. Propofol has two contrasting actions. It may have an anti-Parkinsonion effect, abolishing abnormal limb movements. On other occasions, propofol is known to induce spontaneous abnormal limb movements, as well as epileptiform activity. Propofol is probably best avoided for stereotactic procedures. It is difficult to reconcile these two opposing actions.

Alcohol, personality traits, and high risk driving: a comparison of young, drinking driver groups

Four types of drinking driver groups were compared with each other and also with two nondrinking driver groups on sensation seeking, social responsibility, and hostility. Groups were also compared on traffic violations, accidents, alcohol consumption, frequency of driving after drinking, frequency of driving impaired, and perception of driving risk taking after drinking. Drivers under the influence apprehended in conjunction with an accident or moving violation had significantly greater alcohol consumption, frequency of driving after drinking, frequency of driving impaired, traffic violations, accidents, and self rating of risk taking after drinking in comparison with other groups.

Personality traits and behaviors of alcohol-impaired drivers: a comparison of first and multiple offenders

Using an interview and questionnaire format, 358 driving under the influence of alcohol (DUI) first offenders and 141 DUI multiple offenders were compared on measures of personality traits, drinking behavior and problems, and driving behavior and history. In addition, official driving records for the two groups were compared. Results indicated that multiple offenders were significantly higher in hostility, sensation seeking, psychopathic deviance, mania, and depression than first offenders. Multiple offenders were significantly lower in emotional adjustment and assertiveness. Multiple offenders had significantly more nontraffic arrests, accidents, and traffic tickets than first offenders. They also consumed significantly more alcohol, evidenced more alcohol problems, and had higher BACs at the time of arrest than first offenders. Results are discussed in terms of general problem behavior and implications for intervention and treatment.

Hyperglycaemia, hypoglycaemia, and blood glucose control in diabetes: symptom perceptions and treatment strategies

Recent research has suggested that patients with Type 1 diabetes who are in chronically poor blood glucose control perceive hyperglycaemia differently from those who are in good control. To extend these observations 181 insulin-treated patients with Type 1 or Type 2 diabetes were studied. Patients completed a self-report questionnaire which included items concerning feelings about high and low blood glucose levels and strategies for maintaining blood glucose control. Glycosylated haemoglobin levels were also measured. We hypothesized that level of blood glucose control would: (1) be associated with perceptions of hyperglycaemia and treatment strategies for managing hyperglycaemia and (2) not be associated with perceptions and strategies concerning hypoglycaemia. In comparison with those in 'acceptable' or 'poor' blood glucose control, those in 'good' control perceived symptoms of hyperglycaemia at lower blood glucose levels (p less than 0.001) and felt physically best at lower blood glucose levels (p less than 0.001). They, also began treatment for hyperglycaemia at lower glucose levels (p less than 0.05), set lower minimal (p less than 0.001) and maximal (p less than 0.001) glucose levels as treatment goals, and tested their blood glucose levels more frequently (p less than 0.05). Among Type 1 diabetic patients, those in 'good' control reported experiencing hypoglycaemia at lower glucose levels than those in 'acceptable' or 'poor' control (p less than 0.05). No differences in treatment strategies of hypoglycaemic symptoms were apparent. This study suggests an influence of patients' perceptions of symptoms and treatment in self-care of diabetes.

Correlates of hypoglycemic fear in Type I and Type II diabetes mellitus

We examined whether fear of hypoglycemia in insulin-dependent diabetes mellitus was associated with (a) higher levels of trait anxiety and general fearfulness, (b) difficulty in differentiating symptoms of anxiety and hypoglycemia, and (c) past experience with hypoglycemia. Joslin Diabetes Center outpatients with Type I and Type II diabetes (N = 232), all requiring insulin, were surveyed. Type I patients experienced significantly more fear of hypoglycemia than Type II patients. For the Type I and Type II groups, higher scores on the Worry subscale of the Hypoglycemia Fear Survey (HFS-W) were associated with higher levels of trait anxiety and fear. Higher scores on the Behavior subscale (HFS-B) were associated with higher levels of fear. Among Type I subjects only, HFS-W scores were also positively associated with past hypoglycemic experience and with difficulty in differentiating anxiety and hypoglycemic symptoms. These latter relations remained significant even after the variance resulting from trait anxiety and fear was removed. Other significant associations with HFS-B scores were not observed.

Exercise and the brain: angiogenesis in the adult rat cerebellum after vigorous physical activity and motor skill learning

This study compared the morphology of cerebellar cortex in adult female rats exposed for 1 month to repetitive exercise, motor learning, or an inactive condition. In the exercise conditions, rats that were run on a treadmill or housed with access to a running wheel had a shorter diffusion distance from blood vessels in the molecular layer of the paramedian lobule when compared to rats housed individually or rats that participated in a motor skill learning task. Rats taught complex motor skills substantially increased the volume of the molecular layer per Purkinje neuron and increased blood vessel number sufficiently to maintain the diffusion distance. These results dissociate angiogenesis associated with increased neuropil volume (as seen in the motor learning group) from angiogenesis associated with increased metabolic demands (as seen in the exercise groups). While the volume fraction of mitochondria did not differ among groups, the mitochondrial volume fraction per Purkinje cell was significantly increased in the motor skill rats. This appears to parallel the previously reported increase in synapses and associated neuropil volume change.

Biomechanical aspects of a fluid percussion model of brain injury

The fluid percussion model is in widespread use for the study of brain injury. However, the tissue deformation characteristics of the model have not been determined. Studies have suggested that at high levels of fluid percussion, the fluid percussion model is primarily a model of brainstem injury. It was proposed that this occurs as a direct result of the volume influx to the cranial vault at the moment of impact. This study examines the biomechanical deformation produced by the fluid percussion model. The purpose of this investigation was to describe the regional strain distribution in brain tissue at the moment of impact and to determine the effect of volume efflux produced by the percussion device. A cat skull was sectioned parasagittally and filled with an optically transparent gel. A grid pattern was painted in the midsagittal plane and was used to record the surrogate brain tissue deformation in response to fluid percussion loading. Motion of the grid pattern at low and high levels of fluid percussion loading was recorded using a high-speed camera, and a series of photographs developed from the high-speed film were analyzed to determine the intracranial strain distribution at these loading levels. The results of these studies indicated that the maximum site of strain was located in the region of the lower brainstem and that deformations were negligible in other regions of the brain. These studies provide an explanation for the pathophysiologic results obtained in a parallel series of experiments from which it was concluded that high-level fluid percussion is predominantly a model of lower brainstem injury.

Clinic attendance and glycemic control. Study of contrasting groups of patients with IDDM

OBJECTIVE

To assess factors associated with attendance at a specialized clinic for diabetes care.

RESEARCH DESIGN AND METHODS

Adults with insulin-dependent diabetes mellitus (IDDM) in poor (HbA1 greater than or equal to 12%) versus good (HbA1 less than or equal to 10%) control and with no known complications comprised the study group.

RESULTS

Infrequent attenders were in worse glycemic control than regular attenders (chi 2 = 6.60, P less than or equal to 0.01) and held health beliefs that downplayed the importance of getting advice from physicians (P less than or equal to 0.002) or providing opinions to physicians about what might be done to improve their health (P less than or equal to 0.001).

CONCLUSIONS

Because infrequent attenders are more likely to be in poor glycemic control and thus at greater risk for diabetic complications, engaging them in regularly supervised treatment has important personal and public health implications. Additional studies are needed to understand why some diabetic patients limit their contact with medical providers and to develop more effective strategies for reversing this process. Initial findings from this study suggest that patient beliefs about the doctor-patient relationship may influence clinic attendance.

Successful treatment of selected cases of abductor spasmodic dysphonia using botulinum toxin injection

Ten patients with abductor spasmodic dysphonia, who exhibited spasmodic bursts and heightened activity of the cricothyroid muscle during speech, were selected for participation. Between 5 and 20 U of botulinum toxin type A were injected into both right and left cricothyroid muscles. Six patients benefited substantially, whereas four did not. Acoustic analyses of voice patterns showed similar changes to the clinical impressions. Significant group improvements were found in sentence duration while selected patients improved in the proportion of their speech that was voiced and the duration of their voiceless consonants. Those patients with abductor spasmodic dysphonia and other muscle abnormalities in addition to the cricothyroid and with constant breathiness did not benefit.

Female DUI offenders: a comparison to male counterparts and an examination of the effects of intervention on women's recidivism rates

Female DUI offenders who participated in a controlled, random assignment DUI intervention study, the Mississippi DUI Probation Follow-Up Project, were compared to their male counterparts on demographic, drinker status and recidivism variables. In comparison to men, women in the project were less likely to be married, more likely to be between 30 and 50 years of age, less likely to have less than a 9th grade education, less likely to be screened as a high-problem-risk drinker, less likely to have prior DUI and public drunkenness arrests and less likely to recidivate. The effects of short-term rehabilitation, 1 year's probation and administration of the Life Activities Inventory-Current Status Questionnaire (LAI-CSQ) on the long-term recidivism rates of women were examined. The analysis for screened low-problem-risk women was inconclusive due to lack of statistical power. However, the repeated administration of the LAI-CSQ was detrimental for screened high-problem-risk women and tended to be detrimental for women with fewer than 12 years of education. Implications for intervening with female DUIs are discussed.

Gene sequences and comparison of the fimbrial subunits representative of Bacteroides nodosus serotypes A to I: class I and class II strains

We have determined the nucleotide sequences of the genes encoding the fimbrial subunits representative of the known Bacteroides nodosus serogroups. All of the genes are preceded by a highly conserved region which includes the likely promoter and transcriptional regulator sites as well as the ribosome-biding site, and are followed within a short but variable distance by a sequence with the characteristics of a transcription termination or attenuation signal. Based on sequence and organization, the subunits can be divided into two major classes called I (serogroups A, B, C, E, F, G, and I) and II (serogroups D and H). All contain the same seven-amino-acid positively charged leader sequence and conserved hydrophobic amino-terminal sequence typical of type 4 fibriae. Beyond this point the class II subunits are quite different from class I and share features more in common with those from other type 4 fimbriate bacteria, such as Moraxella bovis and Pseudomonas aeruginosa. The larger class I may be further subdivided into two subsets: (i) [A, E, F)(B, I)) and (ii) (C, G). These proteins exhibit three major clusters of variation, at either end of the presumptive disulphide loop which spans the central third of the protein, and near the carboxy-terimus, with dispersed changes in between. The length of the mature subunits varies from 152-156 amino acids, and the variation includes small insertions or deletions in the variable clusters between more conserved domains. The class II subunits are 149 amino acids in length and contain two pairs of cysteine residues: one is at the end of the amino-terminal conserved region, and the other is at the end of the protein. The major variation occurs in the central region of the molecule, and again small insertions or deletions are required to align adjacent conserved domains. There is also a striking absence of silent codon changes in the 5' coding region of all of these genes, indicating that these sequences have a secondary genetic function, probably in recombinational exchange.

Behavior and personality traits among DUI arrestees, nonarrested impaired drivers, and nonimpaired drivers

Eight types of drinking driver groups were compared on several personality and behavior traits. It was found that impaired drivers arrested after an accident or moving violation were significantly higher in hostility, psychopathic deviance, nontraffic arrests, frequency of impaired driving, accidents after drinking, and drinks consumed per week than impaired drivers caught in roadblocks. Neither impaired drivers stopped in roadblocks nor impaired drivers never arrested differed from nonimpaired drinking drivers or nondrinking drivers on most measures examined.

Caval thrombolysis in neonates using low doses of recombinant human tissue-type plasminogen activator

Four neonates suffered caval thrombosis secondary to indwelling central catheters. Dissolution of thrombus with recombinant tissue plasminogen activator (rt-PA) as a low-dose infusion (0.05 mg/kg/hr) directly into thrombus was successful in three patients. rt-PA was ceased after three days in the fourth patient because of catheter malposition. Thrombolysis was achieved between four and ten days. Rethrombosis occurred in one patient despite heparin prophylaxis. Plasminogen activator infusions were titrated to maintain fibrinogen levels above 100 mg/dl. One neonate suffered an intracranial haemorrhage. Regional rt-PA is an alternative to thrombectomy in critically ill neonates.

Problems of the National Practitioner Data Bank

After a two-year delay, the National Practitioner Data Bank, authorized by the Health Care Quality Improvement Act of 1986, has yet to begin its mission to collect and disseminate information concerning adverse actions affecting physicians' hospital privileges, licensure, and malpractice claims experience. This article discusses some of the problems that are likely to arise in the operation of the Data Bank.

Intellective functioning and strategy use in children with insulin-dependent diabetes mellitus

The cognitive development of children with either early or late onset insulin-dependent diabetes mellitus (IDDM) was investigated with tasks measuring intellectual ability, memory, and academic progress. In addition, children's perceptions of their competence and parents' perspectives on family functioning and their children's behavior were compared. It was found that children with IDDM scored within the normal range on standardized measures of intelligence and academic performance but evidenced some school difficulties, as reflected in subscale performance as well as in their need of remedial education services. Further, evidence was found to suggest deficiencies in children's use of strategies to organize and recall information, particularly for those with early onset of disease. Children's perceived self-competencies and parents' reports of family functioning were strikingly similar across groups. However, parents of those children whose illness began prior to age 5 reported their children to have poor attention spans and difficulty completing tasks.

Prothrombinex-induced thrombosis and its management with regional plasminogen activator in hepatic failure

Fulminant hepatic failure causes a bleeding diathesis as a result of impaired synthesis of hepatic clotting factors, thrombocytopenia, fibrinolysis and disseminated intravascular coagulation. Administration of clotting factor concentrates can cause thrombosis in patients with acute hepatic failure. Regional infusion of recombinant tissue-type plasminogen activator may be used to induce local thrombolysis. A case report of a five-year-old child is presented and the literature is reviewed.

Postoperative pain control with a continuous infusion of epidural sufentanil in the intensive care unit: a comparison with epidural morphine

A prospective, randomized, double-blind trial was conducted to compare the analgesic actions and side effects of sufentanil continuously infused (5 micrograms/h) into the lumbar epidural space (L2-3) with those of an infusion of lumbar epidural morphine (0.5 mg/h). Forty patients admitted to an intensive care unit after elective major abdominal surgery participated over a varying period of 24-40 h. Post-operative pain was treated with an epidural bolus of either sufentanil (50 micrograms) or morphine (5 mg), followed by a continuous infusion of the same opiate. The quality of pain relief was similar in each group. The sufentanil group had a more rapid onset of analgesia. The incidence of nausea and vomiting, pruritus, and drowsiness was similar in the two groups. In spontaneously breathing patients there were no respiratory complications requiring treatment. Forced vital capacities were statistically significantly better during the first 1-4 h with sufentanil.

Assessing family sharing of diabetes responsibilities

This study examined sharing of diabetes responsibilities between mothers and their diabetic children and the relationship between patterns of mother-child sharing of responsibility for diabetes tasks and demographic variables, adherence, and metabolic functioning in children with insulin-dependent diabetes mellitus (IDDM). A factor analysis of the Diabetes Family Responsibility Questionnaire (DFRQ), a 17-item questionnaire developed for the present study, resulted in a meaningful three-factor solution. Factors included responsibilities related to regimen tasks, General Health Maintenance, and Social Presentation of Diabetes. Analysis indicated that the DFRQ had adequate internal consistency and concurrent validity. One hundred and twenty-one children with IDDM, 6-21 years of age, and their mothers completed the DFRQ. Glycosylated hemoglobin (HbA1c) was used to index the child's level of metabolic control. Results of multiple regression analyses indicated that the child's age, disease duration, and sex are significant predictors of mother and child patterns of sharing diabetes responsibilities. Disagreements between mothers and children in perceptions of who is assuming responsibility and adherence level were significant predictors of HbA1c. Results indicated that children assume increasing responsibility with increasing age. Clinicians should not assume that mothers and children communicate about the sharing of diabetes responsibilities in the family or about changes in expectations of who is responsible as children develop. To foster better control and adherence in diabetic children, members of the health care team can help to identify diabetes tasks for which no one in the family takes responsibility.

Assessing family sharing of diabetes responsibilities

This study examined sharing of diabetes responsibilities between mothers and their diabetic children and the relationship between patterns of mother-child sharing of responsibility for diabetes tasks and demographic variables, adherence, and metabolic functioning in children with insulin-dependent diabetes mellitus (IDDM). A factor analysis of the Diabetes Family Responsibility Questionnaire (DFRQ), a 17-item questionnaire developed for the present study, resulted in a meaningful three-factor solution. Factors included responsibilities related to regimen tasks, General Health Maintenance, and Social Presentation of Diabetes. Analysis indicated that the DFRQ had adequate internal consistency and concurrent validity. One hundred and twenty-one children with IDDM, 6-21 years of age, and their mothers completed the DFRQ. Glycosylated hemoglobin (HbA1c) was used to index the child's level of metabolic control. Results of multiple regression analyses indicated that the child's age, disease duration, and sex are significant predictors of mother and child patterns of sharing diabetes responsibilities. Disagreements between mothers and children in perceptions of who is assuming responsibility and adherence level were significant predictors of HbA1c. Results indicated that children assume increasing responsibility with increasing age. Clinicians should not assume that mothers and children communicate about the sharing of diabetes responsibilities in the family or about changes in expectations of who is responsible as children develop. To foster better control and adherence in diabetic children, members of the health care team can help to identify diabetes tasks for which no one in the family takes responsibility.

Learning causes synaptogenesis, whereas motor activity causes angiogenesis, in cerebellar cortex of adult rats

The role of the cerebellar cortex in motor learning was investigated by comparing the paramedian lobule of adult rats given difficult acrobatic training to that of rats that had been given extensive physical exercise or had been inactive. The paramedian lobule is activated during limb movements used in both acrobatic training and physical exercise. Acrobatic animals had greater numbers of synapses per Purkinje cell than animals from the exercise or inactive groups. No significant difference in synapse number or size between the exercised and inactive groups was found. This indicates that motor learning required of the acrobatic animals, and not repetitive use of synapses during physical exercise, generates new synapses in cerebellar cortex. In contrast, exercise animals had a greater density of blood vessels in the molecular layer than did either the acrobatic or inactive animals, suggesting that increased synaptic activity elicited compensatory angiogenesis.

Learning causes synaptogenesis, whereas motor activity causes angiogenesis, in cerebellar cortex of adult rats

The role of the cerebellar cortex in motor learning was investigated by comparing the paramedian lobule of adult rats given difficult acrobatic training to that of rats that had been given extensive physical exercise or had been inactive. The paramedian lobule is activated during limb movements used in both acrobatic training and physical exercise. Acrobatic animals had greater numbers of synapses per Purkinje cell than animals from the exercise or inactive groups. No significant difference in synapse number or size between the exercised and inactive groups was found. This indicates that motor learning required of the acrobatic animals, and not repetitive use of synapses during physical exercise, generates new synapses in cerebellar cortex. In contrast, exercise animals had a greater density of blood vessels in the molecular layer than did either the acrobatic or inactive animals, suggesting that increased synaptic activity elicited compensatory angiogenesis.

Oral premedication in children: a comparison of chloral hydrate, diazepam, alprazolam, midazolam and placebo for day surgery

A double-blind study consisting of 339 randomly selected children investigated the effects of several premedicants on the preoperative and postoperative behaviour of children who underwent day-stay surgery. Patients were allocated into two groups. Group 1 consisted of 165 children aged between 6 and 47 months. Group 2 consisted of 174 children aged four years and older to a body weight of 50 kg. Each child received one premedicant. Both groups included alprazolam 0.005 mg/kg, midazolam 0.3 mg/kg and placebo. In addition Group 1 included chloral hydrate 40 mg/kg and Group 2 diazepam 0.25 mg/kg. Chloral hydrate produced superior conditions (more patients calm or asleep) at induction of anaesthesia. Postoperative behaviour and incidence of vomiting were similar for all drugs. No premedicant reduced anxiety in the older group. The time to awaken postoperatively with diazepam was longer than with placebo. Alprazolam and midazolam were unpalatable for children over four years and conferred no advantage over placebo.

Congenital myotonic dystrophy in children--a review of ten years' experience

A review of the anaesthetic management of children with congenital myotonic dystrophy anaesthetised at the Royal Children's Hospital over the past ten years is presented. Seven children underwent a total of fourteen anaesthetics. Anaesthetic considerations must include the degree of muscle weakness and hypotonia altering muscle relaxant requirements, aspiration risk due to palatopharyngeal dysfunction, and cardiomyopathy. Succinylcholine caused muscle contracture in a patient without clinical myotonia. This drug should be avoided. Although a low threshold to institute postoperative respiratory support must exist when treating neonates and infants, the older children did not clinically exhibit increased sensitivity to respiratory depressant drugs.

Thermal instability of germacrone: implications for gas chromatographic analysis of thermally unstable analytes

The rearrangement of germacrone (1) to β-elemenone (2) is common during gas chromatographic (GC) analysis, with the conversion taking place in the injector port at temperatures above 250 °C as well as on the column. While production of 2 in the injector is evident from the gas chromatographic trace, 2 produced from 1 during its migration down the column is difficult to detect because of the diffuse nature of the chromatographic peak produced by this process. A mathematical model and kinetic parameters (A = (1.35 ± 0.03) × 10−3s−1; Ea = 137 ± 4 kJ mol−1) determined from the reaction in solution can be used to estimate the degree of conversion of 1 to 2 for chromatographic runs (including temperature-programmed analyses). The results of these calculations verify that substantial amounts of 1 are converted to 2 under conditions that are commonly used for the analysis. The method for modeling thermally induced rearrangements in nonisothermal processes represents the first approach to quantitatively assessing their importance in GC analyses of thermally labile substances. Keywords: kinetics, gas chromatography, thermal rearrangement, germacrone, β-elemenone.

The "psychosomatic family" reconsidered ii: recalling a defective model and looking ahead

The notion of the "psychosomatic" family continues to enjoy uncritical acceptance in the absence of promised data and despite its dependence on an outmoded view of how psychosocial factors are involved in illness. We review the decline of psychosomatic models of illness that assume that arousal is the only or primary means by which psychosocial factors influence illness. Focusing on brittle diabetes, we note the potential for family theorists to develop more adequate models of poor self-care and medical crises as interactional tactics, as dynamic efforts to solve problems, define relationships, and influence others, even if they are costly and self-defeating. In an appendix, we note the inadequacy of Rosman and Baker's (1988) reanalyses of the Minuchin, Rosman and Baker (1978) data.

Interactions among DUI offender characteristics and traditional intervention modalities: a long-term recidivism follow-up

Using long-term DUI (Driving Under the Influence of Alcohol) arrest recidivism data from a controlled study of DUI intervention effectiveness, interactions among DUI interventions, age, race, education, and alcohol severity were estimated using logit analysis. Data were collected in a 9-year follow-up study of the Mississippi DUI Probation Project. The effects of short-term interventions (alcohol education schools for low alcohol severity offenders and structured group interventions for high alcohol severity offenders) were specified by educational level. Short-term rehabilitation was modestly effective for those with less than 12 years of education, but less effective or detrimental for the more highly educated. The effects of probation were specified by age and education, being more effective for those under 30 years and 55 years or older than for the middle age group. Probation was most effective for well-educated older (55+) offenders. An analysis of the under 30 years group also suggested that probation was especially effective for young well-educated Minority offenders.