Quality as the driving force for cost-effective psychiatric managed care

The mental health profession is plagued by the perception that it is a vague, ambiguous, and sometimes ineffective field. A confluence of worldwide megatrends is affecting the mental health and substance abuse delivery system. Two different methods of providing psychiatric clinical care are addressed.

Enduringness and change in creative personality and the prediction of occupational creativity

Participants in a longitudinal study of women's adult development were scored at midlife on the Occupational Creativity Scale (OCS), which draws on J. L. Holland's (1985) model of vocational environments in the assessment of participants' creative achievement. College measures of cognitive-affective style and career aspirations predicted OCS scores at age 52, and consistency of creative temperament (H. G. Gough, 1992), motivation, and overall attributes of creative personality were demonstrated with both self-report and observer data over several times of testing. However, there was change along with this enduringness: Large fluctuations in creative temperament over one period of life or another were common in individuals, and OCS scores were associated with an increase in level of effective functioning over 30 years.

Effect of postmortem interval on in situ end-labeling of DNA oligonucleosomes

In situ end-labeling (ISEL) of DNA oligonucleosomes facilitates detection of apoptosis in tissue sections by binding labeled nucleotides to the oligonucleosomal fragments. Although ISEL is used in postmortem material, the effect of autolysis is not specifically known. Accordingly, normal rat brain and intestine were immersed in formalin after postmortem intervals (PMI) from 0 to 72 hours (h) or were fixed by perfusion with ethanol or paraformaldehyde-glutaraldehyde (PF-G). Omission of the binding enzymes or pretreatment with DNAase served as negative and positive controls. With DNA polymerase, material fixed by perfusion or by formalin immersion with PMI of O contained ISEL-positive nuclei only in apical intestinal cells and rare intravascular blood cells in brain. Postmortem intervals from 8 to 72 h did not alter this staining pattern although false-positive ISEL developed at section edges as a result of tissue drying. Terminal deoxynucleotidyl transferase gave similar results in the formalin-fixed material with PMI from 0-48 h but nonspecific nuclear labeling was increased with a PMI of 72 h and was widespread in the PF-G and ethanol-perfused material. This study shows that PMI of at least 72 h do not affect the sensitivity or the specificity of ISEL and confirm the reliability of this procedure in postmortem material. The results also indicate that false-positive ISEL occurs if the tissue is allowed to dry or if certain combinations of fixatives and binding enzymes are used.

A live attenuated vaccine for the control of avian coccidiosis: trials in broiler breeders and replacement layer flocks in the United Kingdom

Losses caused by coccidiosis are a significant problem in the rearing of breeder and layer flocks. A live vaccine has been developed that contains attenuated lines of the seven species of Eimeria that infect the chicken. The attenuated lines were derived from virulent strains by selection for earlier development in chickens. In 11 field trials, the performance of vaccinated chicks was compared with that of matched controls receiving conventional drug prophylaxis. The vaccine was given in the drinking water to 116,600 young chickens and provided excellent control of coccidiosis. The occurrence of coccidial oocysts in the litter, coccidial lesions post mortem and overt coccidiosis was markedly lower in the vaccinated birds than in the controls.

Relation between human T-lymphotropic virus type I and neurologic diseases in Panama: 1985-1990

Human T-cell lymphotropic virus type I (HTLV-I) is endemic in the Caribbean basin and in Japan. HTLV-II, a closely related virus, is endemic in several groups of native Americans, including Panamanian Guaymi. In Panama, a nationwide HTLV-I/II seroprevalence of 1-2% has been reported. We evaluated the frequency of HTLV-I/II infection in patients with neurologic diseases admitted to state tertiary hospitals in Panama City between 1985 and 1990. Nineteen of 322 patients with eligible diagnoses had antibodies to HTLV-I/II, 17 with HTLV-I and 2 with HTLV-II. HTLV-I was associated with spastic paraparesis (13 of 23, 56.5% versus 4 of 299, 1.3%, p < 0.001) and with cerebellar syndrome (2 of 13, 15.4%) and multiple sclerosis (2 of 54, 3.7%) (p < 0.05 for both diseases compared with subject with none of these diagnoses). The two HTLV-I infected patients with cerebellar syndrome later developed spastic paraparesis. HTLV-II infection was noted in one patient with cerebellar syndrome and one with amyotrophic lateral sclerosis. All patients with other diagnoses were seronegative. Among patients with spastic paraparesis, HTLV-I-infected patients were clinically indistinguishable from seronegative subjects. There is apparently an overlapping clinical spectrum of neurologic diseases associated with HTLV-I and HTLV-II infection.

A locking endurance test for hinged sections of removable partial dentures

In this study an apparatus is described that will open and close a hinged section of a removable partial denture. A metal framework based on a "swinglock" type of hinge and latch design was constructed. An electric motor provided the drive for the opening and closing mechanism, which when operated set the device in motion. The device and results of a test run of 12,000 opening and closing operations are discussed.

Evidence of apoptotic cell death in HIV encephalitis

The mechanism of cell death in the brains of patients with acquired immune deficiency syndrome was examined in 15 cases, 8 of whom had human immunodeficiency virus (HIV) encephalitis, and in 8 control cases. Postmortem formalin-fixed, paraffin-embedded sections were prepared for routine histology and immunohistochemistry to detect cell-specific antigens. Apoptosis was detected by its morphology and by in situ end labeling of its characteristic oligonucleosomal fragments. Combined in situ end labeling and immunohistochemistry identified specific cell types. Six acquired immune deficiency syndrome brains, 5 of which had HIV encephalitis, contained positive nuclei by in situ end labeling. Co-labeling studies identified the cells as neurons, reactive astrocytes, and, rarely, the multinucleated giant cells of HIV encephalitis. The only control with nuclei positive by in situ end labeling had hepatic encephalopathy and Alzheimer type II astrocytes; the location and absence of cell-specific markers suggested a glial origin for the labeled cells. These results demonstrate that at least some neuronal and astrocytic death in HIV infection occurs by apoptosis. Its stimuli are unknown, but likely candidates include tumor necrosis factor or HIV viral products. Additionally, we hypothesize that apoptotic death of reactive astrocytes may be a normal mechanism whereby the brain removes an excess number of astrocytes that have proliferated after certain types of brain injury.

Induction of human tissue plasminogen activator in the mammary gland of transgenic goats

Three transgenic females from a first generation transgenic male were induced to lactate between 11 and 12 months of age using a series of estrogen and progesterone injections. The milk contained human longer acting tissue plasminogen activator (LAtPA) at comparable concentrations (1-3 mg/ml) as occurred in the original founder female. In addition, the transgenic male was induced with a hormonal regime and was shown to produce 0.85 mg/ml of LAtPA. Milk protein gels indicated that the milk products (casein, IgG) were essentially normal. These experiments show that expression data for this vector can be evaluated in a shorter period of time in dairy goats than would be required through normal gestation and lactation schedules and can be used to identify the relative expression of transgenes in mammary tissue that would occur during normal lactation.

Prevalence of HTLV types I and II among drug users in King County, Washington

We investigated the prevalence of human T-cell lymphotropic virus (HTLV) types I and II among drug users entering treatment in King County, Washington, between 1988 and 1990. Of 762 injection-drug users, 81 (10.6%) were HTLV-positive; of 89 noninjection-drug users, 2 (2%) were HTLV-positive. Most (95.8%) of those typed) were HTLV-II-positive. The relationship between HTLV and demographic and behavioral characteristics was further evaluated among injection-drug users. The prevalence rates for HTLV increased 25-fold from the youngest age group (15 to 24 years) to the oldest (older than 45 years), after adjusting for race. After adjustment for age, American Indians or Alaska Natives were 7.9 times, blacks 6.2 times, Asians or Pacific Islanders 4.7 times, and Hispanics 4.1 times as likely as whites to be HTLV-positive. The prevalence of HTLV among heroin injectors was more than double that observed among injectors of other drugs after adjusting for age, although this association was only marginally significant. The strong association between HTLV prevalence and age suggests that HTLV-II (the predominant virus) has been endemic among King County injection-drug users for some time. Its relatively high prevalence indicates that there is both an opportunity and a need to further investigate the epidemiologic and clinical implications of HTLV-II infection.

Glutathione-linked detoxification pathway in normal and malignant human bladder tissue

This study compares the levels of glutathione (GSH) and GSH-dependent detoxification enzymes, which have been implicated in anti-cancer drug resistance, in paired normal and malignant human bladder tissues, a tumor with high incidence of inherent drug resistance. Although the mean GSH transferase (GST) activity did not differ significantly in normal and neoplastic bladder tissues, this enzyme activity was relatively higher in tumor tissues of five out of ten patients as compared with corresponding normal tissues. Similarly, the mean GSH content and GSH reductase activity did not differ significantly between normal and neoplastic bladder tissues. On the other hand, the mean GSH peroxidase activity towards cumene hydroperoxide and catalase activity in bladder tumors was higher by about 1.5 and 1.4 times, respectively (P < 0.05), compared with those of normal tissues. GST isoenzymes corresponding to the three major classes (alpha, mu and pi) were expressed in every normal bladder tissue examined in the present study. Overexpression of GST pi was observed in 60% of the bladder tumors, whereas alpha and mu type GST proteins in tumor tissues were lower at frequencies of 62.5% and 37.5%, respectively, compared with the corresponding normal tissues. These results suggest that (a) elevated levels of GSH peroxidase, catalase and GST pi in human bladder tumors may contribute, at least in part, to the intrinsic drug resistance of this neoplasm and (b) anti-oxidative enzymes GSH peroxidase and/or catalase may represent markers for this neoplasia, although a large number of tissue specimens must be analyzed to validate this hypothesis.

Comparison of live attenuated and inactivated influenza vaccines in cystic fibrosis patients and their families: results of a 3-year study

Forty-one cystic fibrosis (CF) patients and 89 family members were immunized in a double-blind randomized 3-year trial with either intranasal live cold-adapted (ca) influenza A vaccine or the recommended intramuscular trivalent inactivated (triv) influenza vaccine. Local, respiratory, and systemic symptoms after vaccine were infrequent and did not differ between vaccine groups. CF patients did not differ from family members in immune response to either vaccine. Although antibody responses tended to be higher after triv vaccine, > or = 85% of subjects had mean hemagglutination inhibition antibody titers > or = 1:32 to influenza H1N1 and H3N2 after the first dose of either vaccine. Infection with influenza H3N2 viruses circulating during this study occurred with comparable low frequency in CF patients after ca (14 infections/100 subject-years of observation) or triv vaccine (10 infections/100 subject-years of observation). Influenza A ca vaccines appear to be safe, immunogenic alternatives to influenza A inactivated vaccines for CF patients and their families.

Popliteal artery aneurysms: current management and outcome

PURPOSE

Thrombosis of popliteal artery aneurysms can produce limb-threatening ischemia. In this setting we have found preoperative thrombolytic therapy to be beneficial.

METHODS

Thirty-three patients with 54 popliteal artery aneurysms were studied (mean follow-up 62 months). Twenty-one patients (62%) had bilateral popliteal artery aneurysms, and 20 patients (61%) had extrapopliteal arterial aneurysms. Thirty-three (61%) aneurysms had symptoms of compression or ischemia, and 21 (39%) aneurysms had thrombosis. A trend toward thrombosis for larger aneurysms was noted (p < 0.068).

RESULTS

Forty-five aneurysms were treated with bypass grafting. Five-year graft patency and limb salvage rates were 71% and 90%, respectively. Factors favoring graft patency and limb salvage included presence of two- or three-vessel runoff compared with patients with single- or no-vessel runoff (p < 0.025 graft patency; p < 0.003 limb salvage) and presence of a patent aneurysm (p < 0.005 graft patency and limb salvage). Seven patients diagnosed with thrombosis of their aneurysm and all runoff vessels were treated with preoperative thrombolytic therapy. Complete clearing of thrombus from these arteries was achieved in six of these patients (and from two of these runoff vessels in the remaining patient). These patients had better graft patency (p < 0.005) and limb salvage (p < 0.01) than comparable patients treated with emergency operations. Six amputations were performed in the follow-up interval, none of which were performed in patients having undergone thrombolytic therapy.

CONCLUSIONS

It is concluded that popliteal aneurysms are managed best by elective repair of patent aneurysms with good runoff. In that difficult situation of the thrombosed popliteal artery aneurysm associated with acute leg ischemia, thrombolytic therapy safely and effectively provides patients with a more favorable alternative than emergency surgery.

Spectral pattern and the perceptual fusion of harmonics. II. A special status for added components?

A single even-numbered harmonic can be segregated from an odd-harmonic complex more easily than its odd-numbered neighbors, for low fundamentals [Roberts and Bregman, J.Acoust. Soc. Am. 90, 3050-3060 (1991)]. It has been proposed that this effect occurs because the even harmonic is inconsistent with the regular spectral pattern formed by the odd harmonics. However, in this study we evaluate some alternative accounts of the effect. The stimuli were harmonic complex tones for which one of the components was cued by a preceding pure tone. Subjects were required to listen for the cued component and either to rate its clarity (experiments 1 and 3) or to judge its pitch in relation to the preceding tone (experiment 2). It is argued that the weaker fusion of an added even harmonic depends on its status as an added component rather than as an even harmonic (experiment 1), and on its immediate perceptual salience rather than on auditory learning. An even-odd difference was also found when even and odd harmonics were tested in an identical spectral context (experiment 2), and when one of the neighboring odd harmonics was removed (experiment 3). These results are consistent with the proposal that it is easier to segregate a harmonic from a periodic complex tone when it does not form part of the regular pattern of spectral spacing defined by the other harmonics.

HIV gene expression enhances T cell susceptibility to hydrogen peroxide-induced apoptosis

A human T cell lineage was used to determine the possible effects of HIV infection on T cell antioxidant status. On inoculation into serum-free culture, 8E5, a constitutive HIV-expressing T cell line, underwent apoptosis whereas cell death was not observed with the uninfected A3.01 or latently HIV-infected 8E5L T cell lines. 8E5 survival was markedly prolonged by supplementing the serum-free medium with either A3.01-conditioned medium, catalase, vitamin E, or 2-mercaptoethanol, but supplementation with ascorbic acid, glutathione, or N-acetylcysteine had no effect. Consistent with their being in a state of oxidative stress, 8E5 cells displayed reduced levels of catalase activity, and were more susceptible to killing by exogenous hydrogen peroxide (H2O2) than A3.01 and 8E5L cells. These results demonstrate an inverse correlation between HIV gene expression and antioxidant status in human T cells. Enhanced cytotoxicity of HIV-infected, antioxidant-deficient CD4 T cells following exposure to H2O2 in lymphoid tissues responding to opportunistic pathogens may contribute to the depletion of CD4 T cells in AIDS.

Identification and quantification of juvenile hormone biosynthesized by larval and adult Australian sheep blowfly Lucilia cuprina (Diptera: Calliphoridae)

Recent evidence indicates that higher dipterans biosynthesize predominantly the novel juvenile hormone (JH) bisepoxide, methyl (2E,6trans)-6,7,10,11-bisepoxy-3,7,11-trimethyl-2-dodecen oate (JHB3), together with a small proportion of methyl (2E,6E)-10,11-epoxy-3,7,11-trimethyl-2,6-dodecadienoate (JHIII) and possibly its 6,7-epoxy isomer. A strategy of gas chromatography-mass spectrometry (GC-MS) involving cool on-column GC and negative-ion chemical ionization MS has enabled the selective analysis of underivatized JH-like products released in vitro by ring glands and corpora allata of Lucilia cuprina. JHB3 is released to the exclusion of mono-epoxidized and unepoxidized esters. The rate of JHB3 release in adult females increases dramatically after protein feeding from 0.2 to 5.2 pmol/h/gland. Values agree well with the rate of JH biosynthesis determined by radiochemical assay. As revealed by thin-layer chromatography, the radiolabel is predominantly incorporated into JHB3, of which only 2% is retained in the corpus allatum indicating almost immediate release from the gland. Approximately 5% of radioactive material retained in the glands co-migrates with JHIII and may be an intermediate in JHB3 synthesis. We conclude that JHB3 is the only juvenile hormone biosynthesized in vitro by L. cuprina. The data suggest that JHB3 may be the exclusive JH synthesized by higher dipterans.

Cloning of the goat beta-casein-encoding gene and expression in transgenic mice

The goat beta-casein-encoding gene (CSN2), which encodes the most abundant protein of goat milk, has been cloned and sequenced. The intron/exon organization of the 9.0-kb goat CSN2 gene is similar to that of other CSN2 genes. Expression of the goat gene was principally restricted to the mammary gland of lactating transgenic animals. A low level of expression was also observed in skeletal muscle and skin. In contrast to a rat CSN2 transgene [Lee et al., Nucleic Acids Res. 16 (1988) 1027-1041], the goat gene was expressed to a high degree in the lactating mammary gland. Differences in the content or context of regulatory elements may account for the enhanced performance of the goat relative to the rat CSN2 gene in transgenic mice.

Persistent pulmonary interstitial fibrosis, induced by immune response to TNP, is associated with altered mRNA procollagen type I:III ratio

Pulmonary interstitial fibrosis is characterized by a progressive increase in connective tissue in the lung parenchyma. Fibrosis is associated with conditions that result as a consequence of cell mediated responses including graft versus host disease, delayed type hypersensitivity reactions, and granulomas. The hapten-immune animal model for pulmonary interstitial fibrosis correlates the nonresolving fibrosis observed in the lung parenchyma directly with the animal's prior immunization to the hapten. Because the model is patterned after the well studied contact hypersensitivity assay in the skin, the immune response can be directly correlated with a cell-mediated (T-lymphocyte) immune mechanism. Previously, we reported that hapten-immune animals showed increased collagen deposition as identified on routine paraffin fixed slides that were stained with Masson's trichome. In this report, morphometric procedures were used to quantitate the fibrotic lesion. Fibroblasts were harvested from lungs of all treatment groups, cultured, and assayed for collagen production. Once it was determined that collagen production by fibroblasts was similar to that recorded in assays using fresh lung tissue, the fibroblasts were used as a homogeneous cell source for RNA. Total RNA from various treatment groups was used to assess the ratio of mRNA for procollagen I:III using slot and northern blot hybridization procedures. An increased ratio in the procollagen type I:III mRNA was observed in total RNA isolated from fibroblasts from immune and challenged hamsters, and not in samples from all other groups. These results support the hypothesis that the activated T lymphocytes involved in "contact" hypersensitivity-like reactions in the lung regulate not only the quantity, but also the quality of collagen produced by the fibroblasts in the lungs of the hamsters that develop nonresolving fibrosis. The model may be important for the study of skin and pulmonary disease induced by exposure to environmental haptens.