The reasons for, and lessons learned from, the closure of the Canterbury GP After-Hours Service

This paper describes a trial of the Canterbury GP After-Hours Service (CGPAHS), a GP staffed after-hours service within the Canterbury Hospital Emergency Department. It was decided not to continue the service beyond the twelve-month trial phase because the opportunity cost to do this was greater than existing alternative services. The efficiency of the service might have been improved had greater numbers of patients been referred to it, either from the adjacent emergency department or the local community. Reasons why the trial was not able to realise these efficiencies are explored.

Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors

The blockade of serotonin (5-HT) and norepinephrine (NE) transporters in vitro and in vivo by the dual 5-HT/NE reuptake inhibitors duloxetine and venlafaxine was compared. Duloxetine inhibited binding to the human NE and 5-HT transporters with K(i) values of 7.5 and 0.8 nM, respectively, and with a K(i) ratio of 9. Venlafaxine inhibited binding to the human NE and 5-HT transporters with K(i) values of 2480 and 82 nM, respectively, and with a K(i) ratio of 30. Duloxetine inhibited ex vivo binding to rat 5-HT transporters and NE transporters with ED(50) values of 0.03 and 0.7 mg/kg, respectively, whereas venlafaxine had ED(50) values of 2 and 54 mg/kg, respectively. The depletion of rat brain 5-HT by p-chloramphetamine and depletion of rat hypothalamic NE by 6-hydroxydopamine was blocked by duloxetine with ED(50) values of 2.3 and 12 mg/kg, respectively. Venlafaxine had ED(50) values of 5.9 and 94 mg/kg for blocking p-chloramphetamine- and 6-hydroxydopamine-induced monoamine depletion, respectively. Thus, duloxetine more potently blocks 5-HT and NE transporters in vitro and in vivo than venlafaxine.

Preventing transmission of Sarcoptes scabiei var. suis from infested sows to nursing piglets by a prefarrowing treatment with doramectin injectable solution

Studies were conducted at swine facilities in Illinois and North Carolina to evaluate the effect of treatment with doramectin injectable solution on transmission prevention of Sarcoptes scabiei var. suis from sows to nursing piglets. Approximately 42 days prefarrowing, 58 mange-free sows were experimentally infested with 200 S. scabiei in each ear. Seven to fourteen days prior to farrowing, 22 sows were given doramectin injectable intramuscularly at a dose of 300 microg/kg of body weight. A total of 21 sows served as untreated controls. Skin scrapings for mite counts and lesion scoring were performed on sows before treatment on day 21, and on either day 35 or 42. Each sow was observed on days 0, 7, 14, 21, 28, and 35 or 42 for the incidence of scratching/rubbing. Skin scrapings, lesion scoring, and observation of scratching/rubbing were performed on the piglets after weaning and at the end of the nursery stage. Geometric mean mite counts of the untreated sows were 0.70 and 0.26 on days 21 and 35 or 42, respectively, and 0.00 for doramectin-treated sows over the same time periods (P<0.05). Lesions scores and the incidence of scratching/rubbing were both higher in the untreated sows as compared to the doramectin-treated sows during the same time periods (P<0.05). Geometric mean mite counts of piglets farrowed by untreated sows were 0.50 and 0.60 after weaning and at the end of the nursery stage, respectively, and 0.00 for piglets from doramectin-treated sows over the same time periods (P>0.05). Lesion scores and the incidence of scratching/rubbing were both higher in piglets from untreated sows as compared to those piglets from doramectin-treated sows (P<0.05). Treating S. scabiei-infested sows with doramectin injectable solution before farrowing eliminated mite infestation and prevented the transmission of S. scabiei to piglets.

Antifungal susceptibilities, varieties, and electrophoretic karyotypes of clinical isolates of Cryptococcus neoformans from Brazil, Chile, and Venezuela

One hundred clinical isolates of Cryptococcus neoformans from human immunodeficiency virus (HIV)-infected and non-HIV-infected patients from Brazil, Chile, and Venezuela were separated according to varieties and tested for antifungal susceptibility. A high susceptibility to antifungal agents was observed among all the isolates. The electrophoretic karyotyping of 51 strains revealed good discrimination among Cryptococcus neoformans var. neoformans strains.

Speech disorder in children with Down's syndrome

The speech of children with Down's syndrome (DS) is often unintelligible, unlike many other children who have an intellectual disability. However, the nature of their speech disorder is controversial. The speech error patterns of children with DS were compared to those of intellectually average children with phonological disorder whose errors were characterized by inconsistency. The groups were matched for percentages of consonants produced in error. The data revealed no differences between the groups in terms of the number of words which were produced inconsistently on repeated productions in a picture-naming task. However, further analyses revealed differences in the type of errors made by the groups in that the children with phonological disorder characterized by inconsistent errors made more changes to words on repeated production than the group with DS. The deficits underlying inconsistent pronunciation of words in the two groups of children under investigation would appear to differ. Intervention strategies should target the deficits identified.

Battle of the sexes: gender stereotype confirmation and reactance in negotiations

The authors examined how gender stereotypes affect negotiation performance. Men outperformed women when the negotiation was perceived as diagnostic of ability (Experiment 1) or the negotiation was linked to gender-specific traits (Experiment 2), suggesting the threat of negative stereotype confirmation hurt women's performance relative to men. The authors hypothesized that men and women confirm gender stereotypes when they are activated implicitly, but when stereotypes are explicitly activated, people exhibit stereotype reactance, or the tendency to behave in a manner inconsistent with a stereotype. Experiment 3 confirmed this hypothesis. In Experiment 4, the authors examined the cognitive processes involved in stereotype reactance and the conditions under which cooperative behaviors between men and women can be promoted at the bargaining table (by activating a shared identity that transcends gender).

A comparison of patients with different types of syndactyly

We performed a retrospective review of finger syndactyly releases at Shriners Hospital for Children, Houston Unit, between January 1983 and January 1993. This study was performed in an attempt to compare the long-term postoperative function in patients after release of syndactyly resulting from Poland's syndrome with that in patients with idiopathic forms of syndactyly. Only patients with one involved hand were included in this study. The contralateral hand was used as a control. Twenty-seven patients with only one hand involved underwent syndactyly release during this period. Of these, 13 patients who underwent a total of 30 syndactyly releases were available for evaluation. For each patient, the type of syndactyly was determined. Each patient was subjected to a detailed physical examination and participated in occupational-therapy modalities. We noted statistically significant differences in function between operated-on and control hands in the Poland's group, whereas operated-on hands affected with idiopathic forms of syndactyly did not demonstrate significantly different function compared with contralateral controls. These data suggest that functional deficits in hands affected by Poland's syndrome are attributable to more than the syndactyly alone. Hands affected by idiopathic forms of syndactyly are likely to have little postoperative functional deficit.

Analysis of a natural immune response against tumor antigens in a melanoma survivor: lessons applicable to clinical trial evaluations

The long-term survival of some patients with metastatic melanoma may be attributable in part to cellular immune responses to melanoma antigens. However, little is known about the level of CTL reactivity in vivo that is required for immunological control of tumor progression. In the present report, T-cell responses were evaluated with lymphocytes obtained from tumor-involved nodes and peripheral blood of a long-term melanoma survivor. Using an ELISPOT assay, naturally occurring functional T cells, which recognize the peptide ALLAVGATK (gp100(17-25)) plus two other HLA-A3 restricted peptides, were detected in a tumor-involved lymph node. The ALLAVGATK-reactive T cells were also evaluated by MHC-tetramers staining and were found to be CD8+ CD45RO+ L-selectin(-) CD11a+, suggesting that they are antigen experienced and have a memory phenotype. Unstimulated peripheral blood lymphocytes from the same patient demonstrated no detectable T-cell responses; however, a single stimulation with ALLAVGATK peptide in vitro resulted in a dramatic expansion of peptide-reactive CTLs. This patient, with evidence of tumor-reactive CTLs targeted to several tumor antigens in a tumor-involved lymph node and with evidence of a circulating memory T-cell response, has remained disease-free for 6 years, despite prior bulky nodal metastasis. In contrast, three HLA-A3+ patients with rapidly progressive metastatic melanoma had no detectable T-cell response in tumor-involved nodes or peripheral blood lymphocytes, even after peptide stimulation ex vivo. The presented data are consistent with a systemic polyvalent immune response against tumor in this long-term survivor. These data provide an estimate of the level of CTL response that may be associated with protection from tumor recurrence.

Congenital syphilis surveillance and newborn evaluation in a low-incidence state

OBJECTIVES

To evaluate congenital syphilis surveillance in Minnesota, to assess the evaluation and management of newborns at risk for congenital syphilis, and to assess prenatal syphilis screening.

DESIGN

Case ascertainment and medical record review.

SETTING

The 7-county Minneapolis-St Paul metropolitan area.

PATIENTS

Newborns at risk for congenital syphilis during a 3-year period (1992-1994).

MAIN OUTCOME MEASURES

The completeness of congenital syphilis case ascertainment, maternal demographic data, maternal syphilis management, newborn evaluation for and management of congenital syphilis, and hospital syphilis screening practices at delivery.

RESULTS

Eighty mother-infant pairs who were at risk for congenital syphilis were identified from 3 sources. Using the Centers for Disease Control and Prevention's congenital syphilis case definition, 36 infants (45%) were classified as probable cases, 42 (53%) were classified as noncases, and 2 (3%) were syphilitic stillbirths. Forty-seven women (59%) had syphilis serologic tests performed in the third trimester; only 37 (46%) had syphilis screening at delivery. Conditions of the mothers of 8 probable cases (22%) were diagnosed at delivery. Most probable cases (86%) were evaluated; only 56% were evaluated adequately. Twenty-five probable cases (69%) were treated. Most hospitals did not have formal policies for syphilis screening at delivery. The Minnesota Department of Health's congenital syphilis registry lacked sensitivity (39%) as a case ascertainment method.

CONCLUSIONS

Clinicians should adhere to standardized protocols in the evaluation and management of at-risk newborns. Vigilant screening prenatally and at delivery and adequate follow-up are critical to reduce congenital syphilis. Improved surveillance data and resources are needed for the identification and follow-up of newborns at risk for congenital syphilis.

Multiple cellular phenotypes in an insertional mutation in mouse affecting bone development

The 6093 line of transgenic mice exhibits altered bone development as a result of an insertional mutation by the transgene. Female transgenic mice show a marked kyphosis as early as 2 weeks of age. Vertebrae from female mice have lower total bone area and mineral content than age-matched, gender-matched controls, although the bone mineral density is not changed. The femur and tibia exhibit the opposite effect-increased bone area and mineral content. Fluorescent bone label experiments indicated an increased rate of bone mineral deposition in the femur during the early postnatal growth period, and bone marrow from femurs of 6093 females had increased numbers of fibroblast colony-forming units. Transgenic females also are obese and have altered thymocyte development, suggesting that the insertional mutation affects multiple cell populations. We hypothesize that these phenotypes arise as a result of an alteration in the function or developmental potential of a stromal cell or mesenchymal stem cell.

Comparison of fluoroquinolone pharmacokinetic parameters after treatment with marbofloxacin, enrofloxacin, and difloxacin in dogs

Plasma, urine, and skin drug concentrations were determined for dogs (n=12) given five daily oral doses of marbofloxacin (MAR) (2.75 mg/kg), enrofloxacin (ENR) (5.0 mg/kg) or difloxacin (DIF) (5.0 mg/kg). Concentrations of the active metabolite of ENR, ciprofloxacin (CIP), were also determined. The three-period, three-treatment crossover experimental design included a 21-day washout period between treatments. Area under the plasma drug concentration vs. time curve (AUC0-last, microg/mLxh of MAR was greater than for ENR, CIP, ENR/CIP combined, and DIF. Maximum concentration (Cmax) of MAR was greater than ENR, CIP, and DIF. Time of maximum plasma concentration (Tmax) was similar for MAR and DIF; Tmax occurred earlier for ENR and later for CIP. Plasma half-life (t1/2) of MAR was longer than for ENR, CIP, and DIF. Urine concentrations of DIF were less than MAR or ENR/CIP combined, but urine concentrations of MAR and ENR/CIP combined did not differ. DIF skin concentrations were less than the concentrations of MAR or ENR/CIP combined 2 h after dosing, but skin concentrations of MAR and ENR/CIP combined did not differ.

Functional changes in persons aging with spinal cord injury

Declines in general physical function and the effect of these changes on activities of daily living and needs for assistance were assessed in 150 individuals with spinal cord injury (SCI). The sample consisted of outpatients returning for follow-up at the spinal cord injury clinic at Rancho Los Amigos National Rehabilitation Center in Downey, CA. The average duration of injury of the sample was 13 years (range 1-37), and average age was 38 years (range 18-64). Twenty-four percent of those sampled experienced a decline or change in their physical function within the last 5 years. Individuals experiencing declines were significantly older than those without changes, averaging 45 years versus 36 years. The group with change also had a longer duration of injury, averaging 18 years versus 11 years compared to the group reporting no declines. Fatigue was the most frequently reported problem, followed by pain and weakness. Over half of the group with changes required additional assistance with activities of daily living (ADLs). Family members were the primary helpers for both ADLs and instrumental activities of daily living (IADLs) for those persons experiencing changes. The use of assistive technology, primarily equipment for bathing, toileting, and low technology devices, increased with time. The increased vulnerability to loss of function in persons with advancing age and duration of injury in this population with SCI suggests the need for early preventative measures, routine assessments to detect changes, and access to health care and supportive services to alleviate or minimize the effect of these changes.

How the quality of third parties' settlement solutions is affected by the relationship between negotiators

Observers watched videotapes of people negotiating. In half of the videotapes, the negotiators had a negative relationship; in the other half, the negotiators had a positive relationship. Some observers believed that the relationship was a genuine reflection of how the parties felt about one another; others were told that the behavior of negotiators was strategic (i.e., used by parties to gain advantage). Following the tape, observers recommended a settlement. Observers' suggestions were most efficient when the negotiators' relationship was positive and genuine; observers proposed significantly worse solutions when negotiators' relationships were negative and genuine. The authors advise mediators to focus on the issues rather than the emotional tone and to avoid the correspondence bias when observing conflicts among parties with negative relationships.

The effectiveness of doramectin pour-on in the control of gastrointestinal nematode infections in cow-calf herds

Two field studies were conducted in the USA to determine the efficacy of a single strategically-timed dose of doramectin pour-on in the control of gastrointestinal nematodosis in beef cow-calf herds and the resultant effects on calf productivity. One study was carried out between May and October 1996 in a spring-calving herd at a site located in Idaho (ID) and the other between January and July 1997 in a fall-calving herd at a site located in Mississippi (MS). In each study, cow-calf pairs were randomly allotted by sex of calf to pastures and one of two treatment groups (doramectin pour-on at the recommended dose rate of 500 microg/kg body weight or untreated control). There were four pasture replicates per treatment at each site. Each pasture contained 12 cow-calf pairs at the ID site and 15 cow-calf pairs at the MS site. Treatment was administered to cows and calves on 21 May 1996 (ID) or 23 January 1997 (MS). Following treatment, cow-calf pairs were assigned to their designated pastures where they remained until the calves were weaned 140 (ID) or 168 (MS) days later. Cow and calf fecal egg counts and calf body weights were recorded on treatment day and then at monthly intervals until study termination. Doramectin treatment reduced nematode egg output in cows and calves over the entire grazing season compared to untreated controls and resulted in calf weight gain improvements of 9.8kg (p=0.295) at the ID site and 17.4kg (p=0.0002) at the MS site.

Treatment of patients with recurrent and primary refractory acute myelogenous leukemia using mitoxantrone and intermediate-dose cytarabine: a pharmacologically based regimen

BACKGROUND

Although chemotherapy can achieve a high rate of disease remission induction in patients with newly diagnosed acute myelogenous leukemia (AML), patients with recurrent or refractory AML generally have a poorer rate of response. This study assessed the utility of mitoxantrone and intermediate-dose cytarabine (Ara-C) in the treatment of patients with recurrent or refractory AML.

METHODS

Forty-seven patients with recurrent or refractory AML were treated with Ara-C, 0.5 gm/m2, intravenously (i.v.) every 12 hours x 12 doses on Days 1-6 and mitoxantrone, 5 mg/m2, i.v. on Days 1-5.

RESULTS

Twenty-nine of the 47 patients (62%) achieved a complete response. The median duration of disease remission was 112 days (range, 29 days- 8 years). Of the 25 patients age > or = 60 years, 19 (76%) had a complete disease remission and the median duration of disease remission in this group was 114 days (range, 33-370 days), although all patients subsequently developed a disease recurrence. The chemotherapy generally was well tolerated, with a mean duration of neutropenia of 31 days and a mean duration of thrombocytopenia of 33 days. Three patients died of infectious complications between 23-26 days after the initiation of chemotherapy, 1 patient died of sudden cardiac arrest 13 days after the initiation of chemotherapy, and 1 patient developed cutaneous desquamation. Three patients developed acute cerebellar dysfunction.

CONCLUSIONS

The use of mitoxantrone and Ara-C is effective in the treatment of patients with recurrent and refractory AML. The subgroup of patients age > or = 60 years also had a high rate of disease remission induction with this regimen, and the regimen generally was well tolerated.

How the quality of third parties' settlement solutions is affected by the relationship between negotiators

Observers watched videotapes of people negotiating. In half of the videotapes, the negotiators had a negative relationship; in the other half, the negotiators had a positive relationship. Some observers believed that the relationship was a genuine reflection of how the parties felt about one another; others were told that the behavior of negotiators was strategic (i.e., used by parties to gain advantage). Following the tape, observers recommended a settlement. Observers' suggestions were most efficient when the negotiators' relationship was positive and genuine; observers proposed significantly worse solutions when negotiators' relationships were negative and genuine. The authors advise mediators to focus on the issues rather than the emotional tone and to avoid the correspondence bias when observing conflicts among parties with negative relationships.

Aortic laceration secondary to palmaz stent placement for treatment of superior vena cava syndrome

Aortic laceration secondary to Palmaz Stent placement for treatment of superior vena cava syndrome is reported. This potentially life-threatening complication should be considered when rigid balloon expandable stents are used to treat superior vena cava syndrome of benign origin. Cathet. Cardiovasc. Intervent. 49:160-162, 2000.

The effectiveness of a single dose of doramectin pour-on in the control of gastrointestinal nematodes in yearling stocker cattle

Three field studies were conducted to determine the efficacy of a single dose of doramectin pour-on in the control of gastrointestinal nematode infections in yearling stocker calves on pasture. These 140-day studies were carried out between October 1995 and March 1996 in Tennessee (TN), between January and June 1997 in Louisiana (LA), and between May and September 1997 in Wisconsin (WI). Calves with patent nematode infections were equally allocated to treatments (doramectin pour-on, at 500 microg/kg body weight or untreated control) and pastures as randomized complete-block designs (LA and TN studies) or completely at random (WI study). There were six pasture replicates per treatment at each site, with each pasture replicate accommodating six calves at the TN site (36 calves per treatment), five calves at the LA site (30 calves per treatment), and seven calves at the WI site (42 calves per treatment). Fecal samples for nematode egg counts were collected on Day 0, and at 28-day intervals thereafter. Body weights were recorded on Day 0 and at 28-day intervals until study termination. Nematode egg output of the doramectin-treated groups was reduced over the entire grazing period compared to those in the untreated control groups, resulting in average daily weight-gain advantages of 0.055 kg (p < or = 0.05) for the TN study, 0.208 kg (p < or = 0.05) for the LA study, and 0.116 kg (p < or = 0.05) for the WI study.