Search for the CP forbidden decay eta-->4pi(0)

We report the first determination of the upper limit for the branching ratio of the CP forbidden decay eta-->4pi(0). No events were observed in a sample of 3.0x10(7) eta decays. The experiment was performed with the Crystal Ball multiphoton spectrometer installed in a separated pi(-) beam at the AGS (Alternating Gradient Synchrotron). At the 90% confidence limit, B(eta-->4pi(0))</=6. 9x10(-7).

Cognitive impairment among methadone maintenance patients

AIMS

To compare the cognitive performance of methadone maintenance patients (MMPs) and a matched sample of non-heroin-using control subjects, and to ascertain risk factors for poorer cognitive performance.

DESIGN

Matched control study.

SETTING

Sydney, Australia.

PARTICIPANTS

Thirty MMPs and 30 non-heroin using controls, matched for age, gender and education.

FINDINGS

The MMP group had significantly higher rates than controls of alcohol dependence, heroin overdose and head injury. There was no difference between the groups on pre-morbid functioning. The MMP group performed significantly poorer than controls on all of the neuropsychological domains measured: information processing, attention, short-term visual memory, delayed visual memory, short-term verbal memory, long-term verbal memory and problem solving. A life-time diagnosis of alcohol dependence and the number of non-fatal heroin overdoses were independent significant predictors of poorer cognitive performance.

CONCLUSIONS

In addition to high rates of psychiatric morbidity, MMPs also show cognitive deficits compared to matched controls. A history of alcohol dependence and repeated exposure to overdose increase the likelihood of cognitive impairment. The current study does not rule out the possibility of other factors, that were not measured, that may contribute to cognitive impairment among this MMPs.

Ligand responsiveness in human prostate cancer: structural analysis of mutant androgen receptors from LNCaP and CWR22 tumors

Androgen receptors (ARs) belong to the family of hormone receptors that are ligand-dependent transcription factors. Endocrine therapy provides effective treatment for prostate cancer until mutations arise that alter the ligand responsiveness of AR. In this study, structural models were developed for the functional domains of human AR by homology modeling from crystal structures of closely related nuclear receptors. These models were used to locate the sites of two frequently occurring mutations in prostate cancer. The substitutions that develop in LNCaP (threonine-->alanine at residue 877) and CWR22 (histidine-->tyrosine at residue 874) tumor cell lines are both located on helix 11 that forms part of the ligand-binding pocket. However, the results suggest that these mutations influence ligand responsiveness by completely different mechanisms. Residue 877 contacts the ligand directly, and substitution at this site alters the stereochemistry of the binding pocket. Thus, the LNCaP mutation apparently broadens the specificity of ligand recognition. In contrast, residue 874 is located down the helical axis, projects away from the ligand pocket, and does not contact ligand. The side chain of residue 874 lies in a cavity between helices 11 and 12. Substitution of tyrosine for histidine 874 in CWR22 tumors may affect a conformational change of helix 12 and, thus, influence binding of coactivator proteins and their regulatory effect on transcriptional activation.

Prophylactic syntometrine versus oxytocin for delivery of the placenta

BACKGROUND

The routine prophylactic administration of an oxytocic agent is an integral part of active management of the third stage of labour. These agents help prevent postpartum haemorrhage.

OBJECTIVES

The objective of this review was to assess the effects of ergometrine-oxytocin (syntometrine) with oxytocin alone in reducing the risk of postpartum haemorrhage (blood loss of equal to or greater than 500 millilitres) and other maternal and neonatal outcomes.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register.

SELECTION CRITERIA

Trials of oxytocic drugs (syntometrine or oxytocin) in women having the third stage of labour managed actively.

DATA COLLECTION AND ANALYSIS

Eligibility, trial quality assessment and data extraction were done independently by three reviewers. Study authors were contacted for additional information.

MAIN RESULTS

Six trials were included. Compared with oxytocin, ergometrine-oxytocin (syntometrine) was associated with a small reduction in the risk of postpartum haemorrhage (odds ratio 0.74, 95% confidence interval 0.65 to 0.85). This advantage was smaller but still significant when 10 international units of oxytocin was used. There was no difference seen between the groups using either five or 10 international units for blood loss equal to or greater than 1000 millilitres. Adverse effects of vomiting and hypertension were associated with the use of ergometrine-oxytocin. No significant differences were found in other maternal or neonatal outcomes.

REVIEWER'S CONCLUSIONS

The use of the combination preparation syntometrine (oxytocin and ergometrine) as part of the routine active management of the third stage of labour appears to be associated with a statistically significant reduction in the risk of postpartum haemorrhage when compared to oxytocin where blood loss is less than 1000ml. No difference was seen between the groups using either five or 10 international units for blood loss equal to or greater than 1000 millilitres. This needs to be weighed against the more common adverse effects associated with the use of syntometrine.

Active versus expectant management in the third stage of labour

BACKGROUND

Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic after delivery, early cord clamping and cutting, and controlled cord traction of the umbilical cord.

OBJECTIVES

The objective of this review was to assess the effects of active versus expectant management on blood loss, post partum haemorrhage and other maternal and perinatal complications of the third stage of labour.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register.

SELECTION CRITERIA

Randomised trials comparing active and expectant management of the third stage of labour in women with singleton pregnancies whose babies were presenting head first and who were expecting a vaginal delivery.

DATA COLLECTION AND ANALYSIS

Trial quality was assessed and data were extracted independently by the reviewers.

MAIN RESULTS

Four studies were included. Three of the trials were of good quality. Compared to expectant management, active management (in the setting of a maternity hospital) was associated with the following reduced risks: maternal blood loss (weighted mean difference -79.33 millilitres, 95% confidence interval -94.29 to -64. 37); post partum haemorrhage of more than 500 millilitres (odds ratio 0.34, 95% confidence interval 0.28 to 0.41); prolonged third stage of labour (weighted mean difference -3.40 minutes, 95% confidence interval -4.66 to -2.13). Active management was associated with an increased risk of maternal nausea (odds ratio 1. 95, 95% confidence interval 1.58 to 2.42), vomiting and raised blood pressure (probably due to the use of ergometrine). No advantages or disadvantages were apparent for the baby.

REVIEWER'S CONCLUSIONS

Routine 'active management' is superior to 'expectant management' in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active managment is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting a single baby by vaginal delivery in a maternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries).

Detection of Francisella tularensis in biological specimens using a capture enzyme-linked immunosorbent assay, an immunochromatographic handheld assay, and a PCR

The early detection of Francisella tularensis, the causative agent of tularemia, is important for adequate treatment by antibiotics and the outcome of the disease. Here we describe a new capture enzyme-linked immunosorbent assay (cELISA) based on monoclonal antibodies specific for lipopolysaccharide (LPS) of Francisella tularensis subsp. holarctica and Francisella tularensis subsp. tularensis. No cross-reactivity with Francisella tularensis subsp. novicida, Francisella philomiragia, and a panel of other possibly related bacteria, including Brucella spp., Yersinia spp., Escherichia coli, and Burkholderia spp., was observed. The detection limit of the assay was 10(3) to 10(4) bacteria/ml. This sensitivity was achieved by solubilization of the LPS prior to the cELISA. In addition, a novel immunochromatographic membrane-based handheld assay (HHA) and a PCR, targeting sequences of the 17-kDa protein (TUL4) gene of F. tularensis, were used in this study. Compared to the cELISA, the sensitivity of the HHA was about 100 times lower and that of the PCR was about 10 times higher. All three techniques were successfully applied to detect F. tularensis in tissue samples of European brown hares (Lepus europaeus). Whereas all infected samples were recognized by the cELISA, those with relatively low bacterial load were partially or not detected by PCR and HHA, probably due to inhibitors or lack of sensitivity. In conclusion, the HHA can be used as a very fast and simple approach to perform field diagnosis to obtain a first hint of an infection with F. tularensis, especially in emergent situations. In any suspect case, the diagnosis should be confirmed by more sensitive techniques, such as the cELISA and PCR.

Subcellular localisation of NS3 in HCV-infected hepatocytes

Hepatitis C virus (HCV) NS3 is a multifunctional protein with both protease and helicase activities and has been shown to interact with host cell proteins. It is shown that NS3 is present in the hepatocytes from patients with chronic HCV infection by using anti-NS3 antisera. NS3 is detectable in approximately 4% of the hepatocytes from these patients. In most infected cells, NS3 is present in the cytoplasm; however, in a minority of HCV-infected cells, both the cytoplasm and the nucleus or the nucleus on its own are positive for NS3. The presence of NS3 in the nuclei of hepatocytes in chronically infected patients indicates that the protein may play a role other than in virus replication, such as in persistence of HCV infection.

Whistle-blowing: effective and ineffective coping responses

How do nurses respond when they identify misconduct in patient care settings? The authors used a descriptive survey (N = 95) to identify effective coping strategies of whistle-blowers (n = 70) and non-whistle-blowers (n = 25). Results identified four effective coping strategies used by whistle-blowers. The authors offer recommendations to nurses who encounter misconduct in their workplace.

Searching the right database. A comparison of four databases for psychiatry journals

Journal coverage is one factor that affects the retrieval of relevant information from bibliographic databases. The aims of this study were to investigate the coverage of databases for psychiatry journals, and to assess the overlap between databases. Psychiatry journals were identified using Ulrich's International Periodicals Directory and then analysed to see which bibliographic databases indexed the most journals. A total of 213 abstracting and indexing services were listed as indexing at least one of the 977 psychiatry journals identified. The four most frequently cited databases (PSYCLIT, EMBASE, BIOSIS and MEDLINE) indexed 506 (52%) of the psychiatry journals. Of these 506 journals, PSYCLIT indexed 367 (73%), EMBASE 337 (67%), BIOSIS 243 (48%) and MEDLINE 236 (47%). Combining the databases with the highest yields (PSYCLIT and EMBASE) increased the number of journals indexed to 461 (91%). The four databases combined accounted for 90% of all psychiatry journals found to be indexed by at least one abstracting and indexing service. More than 400 journals were not indexed at all. Variations in the overlap between PSYCLIT, EMBASE, BIOSIS and MEDLINE, and the high proportion (35%) of journals indexed in only one of these four databases emphasize the importance of searching more than one or even two databases to ensure optimal coverage of the literature.

A model for a glutamate receptor agonist antibody-binding site

A combination of mutagenesis, computer modeling and immunoreactivity has been used to develop a structural model of a segment of the glutamate receptor (GluR), termed GluR3B, which is bound by receptor-activating autoantibodies. In this model, the GluR3B epitope is located in a reverse hairpin loop that places key residues important for antibody recognition and receptor activation in a linear arrangement on the solvent-exposed surface. The conformation of the loop is stabilized by a hydrophobic core which is critical for functional integrity of the epitope. The proximity of the amino- and carboxy-terminal residues suggested that the GluR3B peptide could be cyclized without diminishing immunoreactivity through replacement of these residues with cysteines and formation of a disulfide bond. This prediction was confirmed experimentally since the cyclized peptide retained full immunoreactivity. The model provides insight into GluR subunit-specific functional diversity and the role of autoantibodies to this region in neurological disease.

Exploring the process of inference generation in sarcasm: a review of normal and clinical studies

This article evaluates two theoretical accounts of how sarcasm is understood; the traditional model, which asserts that listeners derive a counterfactual inference from the sarcastic comment, and relevance theory, which asserts that listeners recognize sarcasm as a scornful echo of a previous assertion. Evidence from normal speakers provides only partial support for both theories. Evidence from brain-injured populations suggests that aspects of the pragmatic process can be arrested in ways not predicted by either theory. It is concluded that sarcasm is more effortful to process than nonsarcastic comments and that inferences about the facts of the situation and the mental state of the speaker (e.g., attitudes, knowledge, and intentions) are important to comprehending sarcasm. It is questioned whether inferences about mental state are relatively more difficult for brain-injured subjects and, if so, whether this is a continuum of difficulty or reflects reliance upon different cognitive processes.

Covert orienting and focusing of attention in children with attention deficit hyperactivity disorder

Performance on the covert visuo-spatial attentional functions of orienting and focusing by a group of ADHD children (n = 20) was compared to that of age and sex-matched control children. In Experiment 1, responses were given to cued targets at valid and invalid locations. In Experiment 2, responses were given to targets presented in small, medium-sized or large visual field locations. For both experiments, the hypotheses that reaction times of ADHD children would be greater than those of control children and that performance would be asymmetrical, were supported. For Experiment 1, ADHD children showed bilaterally greater 'benefits' from having directed attention to the cued location and greater 'costs' in having to relocate the attentional focus than controls. In Experiment 2, the hypothesis that the function of focusing attention by ADHD children may show breakdown in the usual pattern of an increase in reaction time with focus area was partly supported by the finding of similar reaction times to targets presented in medium-sized and large regions of the left visual hemifield. These results have been interpreted as reflecting a stronger anchorage of attention by ADHD children upon a cued location and an inability to shift covert attention easily to an alternative location. The breakdown of the focusing function suggests adoption of similar time response sets across focus area size by the more compromised right hemisphere.

Apparent bioaccumulation of Mn derived from paper-mill effluent by the freshwater crayfish Cherax destructor--the role of Mn oxidising bacteria

Bioaccumulation studies of wastewater from a thermo-mechanical paper mill using the freshwater crayfish (Cherax destructor) consistently demonstrated elevated levels of manganese. Most of the Mn appeared to be associated with the carapace of the animals. It is suggested that the elevated Mn levels are the result of Mn-oxidising bacteria forming biofilms on the carapace of the crayfish followed by Mn oxide precipitation rather than active uptake of Mn by the crayfish.

Prothrombotic changes in children with sickle cell disease: relationships to cerebrovascular disease and transfusion

Vascular occlusion has a central role in the pathophysiology of sickle cell disease (SCD) and, although there is little evidence that thrombosis alone is responsible, patients with sickle cell disease are known to have an ill-defined but increased thrombotic risk. The most serious complication of this in childhood is stroke which occurs in 7-10% of children and a further 14% have asymptomatic cerebrovascular disease (CVD) on imaging. We have performed a comprehensive profile of coagulation inhibitors and markers of thrombin generation in 96 children (83 nontransfused [NTx] and 13 transfused [Tx]) with steady-state SCD and 18 healthy sibling controls. The levels of protein S (free and total) and heparin cofactor II were reduced in both the NTx and Tx groups compared to controls and protein C and APC resistance ratios were reduced in the NTx group only. Antithrombin levels were not different from controls. Thrombin-antithrombin complexes and prothrombin fragment F1+2 were increased in both patient groups. In the NTx subgroups with or without CVD there were no differences for any of the parameters measured except for lower haemoglobin levels and higher white cell counts in those with asymptomatic CVD. We conclude that children with SCD have a reduction in levels of the majority of the coagulation inhibitors and increased thrombin generation in the steady-state and these are only partially reversed by transfusion. However, these abnormalities do not appear to play a primary role in the development of cerebrovascular disease.

Effects of the herbicide atrazine on Ambystoma tigrinum metamorphosis: duration, larval growth, and hormonal response

We exposed larval tiger salamanders (Ambystoma tigrinum) reared in the laboratory from eggs collected from a prairie wetland in North Dakota to three concentrations of atrazine (0, 75, and 250 micrograms/L) in a static renewal test to determine the pesticide's effect on (1) plasma corticosterone and thyroxine concentrations, (2) larval size, and (3) days-to-stage at stages 2 and 4 of metamorphic climax. We found significant effects of atrazine on each of these response variables. Plasma thyroxine was elevated in both atrazine-exposed groups compared with the control group; plasma corticosterone was depressed in the 75 micrograms/L treatment compared with both the control and 250 micrograms/L treatment. Larvae exposed to 75 micrograms/L atrazine reached stage 4 later but at a size and weight comparable to the control group. By contrast, larvae in the 250 micrograms/L treatment progressed to stage 4 at the same time but at a smaller size and lower weight than larvae in the control group. These results indicate that the herbicide has the potential to influence tiger salamander life history. We present a model consistent with our results, whereby corticosterone and thyroxine interact to regulate metamorphosis of tiger salamanders based on nutrient assimilation and adult fitness.

Interpreting ambiguous advertisements: the effect of frontal lobe damage

Despite intact primary language processes patients with frontal lobe deficits often have impaired communication skills including impaired capacity to understand conversational inference. This study examined the ability of three patients with demonstrated frontal lobe pathology to interpret lexically ambiguous advertisements. When compared to a nonbrain-damaged control group it was found that the frontal lobe patients were poorer at comprehending the abstract or inferred meanings inherent in the advertisements. The pattern of performance across the patients did, nevertheless, differ despite a similar end result. These findings are discussed in relation to theories concerning the contribution of the frontal lobes to language function.

Incidence of hospital-treated traumatic brain injury in an Australian community

This paper reports findings from an incidence study of head trauma in a defined population. In the North Coast Health Region of NSW, 1,259 subjects with head trauma were admitted to hospitals in a 12-month period in 1988. Direct examination of the medical records confirmed brain injury in only 413 of these cases, corresponding to an annual incidence of approximately 100/100,000 resident population. Although most injuries (62.2%) were mild, 38% were serious (either moderate, 20.3%, or severe, 13.6%; and 3.9% died after admission to hospital). Severe brain injury represented an annual incidence of 12/100,000 resident population. Road traffic accidents accounted for a higher proportion of injuries in the severe group in comparison with the other injury groups. Methodological issues involved in case ascertainment of brain injury are discussed.

Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center

OBJECTIVE

To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital.

DESIGN

Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections.

SETTING

A university referral center in Canada.

PATIENTS

Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991.

MEASUREMENTS

During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs.

RESULTS

We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%.

CONCLUSIONS

Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.

Requests that overcome listener reluctance: impairment associated with executive dysfunction in brain injury

Fifteen subjects with suspected executive impairment following brain injury and matched controls were tested on a request production task in which they were required to produce nonconventional requests that would overcome listener reluctance. In comparison to controls, the brain-injured subjects were less likely to produce requests that addressed the obstacle to listener compliance, less likely to produce "other" kinds of strategies, and more inclined to make requests encompassing counterproductive comments. These performances were correlated with independent neuropsychological measures of executive function. It was found that disinhibition was positively correlated to the ability to specify the source of listener reluctance in the request as well as to the tendency to use other kinds of strategies. It was surmised that the association between disinhibition and other strategies may reflect the broad nature of the categories used in which marginally appropriate strategies, categorized as "other," may actually have reflected mildly disinhibited behavior.