"They just looked at me like I was human": The experiences of parenting women and providers with substance use disorder treatment

BACKGROUND

The current US addiction treatment system does not effectively meet the needs of pregnant and parenting women with substance use disorder (SUD). The aim of this research was to identify barriers and facilitators to engagement and retention in SUD residential treatment for pregnant and parenting women. This research was part of a co-design process to collaboratively create a more patient-centered long-term residential program.

DESIGN AND METHODS

The study conducted semi-structured individual interviews with both parenting women with lived experience (WWLE) in residential SUD treatment and SUD treatment providers. Interviews aimed to elicit participants' experiences either receiving or providing care. The study team analyzed data in NVivo-12 using a deductive codebook based on the six principles of trauma informed care (TIC).

RESULTS

We conducted a total of 32 interviews (WWLE =13, SUD providers =19). The study identified four major themes: 1) peer relationships provide inspiration and diminish shame; 2) providing individuals safe space to stumble in recovery creates opportunities for growth and builds self-efficacy; 3) reasonable, clear boundaries create a structured, protective environment for early recovery; 4) nonjudgmental connections facilitate engagement and build trust. We identified small pivotal moments along the continuum of care that showed how the elements in the four themes enhanced engagement and retention in treatment. These interactions, along the care continuum, are either structural (workflow process) or relational (interpersonal).

CONCLUSION

This research increases understanding of the interplay of the structural and relational barriers and facilitators to engagement and retention in treatment. These seemingly minor positive or negative interactions along the care continuum are pivotal to fully operationalizing TIC and optimizing women's engagement in treatment. Improvement strategies that integrate the voices of WWLE and collaboratively co-design a more patient-centered system are critical steps to improving engagement in SUD treatment and more equitable SUD treatment services.

International consensus statement on allergy and rhinology: Allergic rhinitis - 2023

BACKGROUND

In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document.

METHODS

ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work.

RESULTS

ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost.

CONCLUSION

The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

Role and Function of the Clinical Tutor in Mental Health Nursing in Ireland

The clinical tutor (CT) in mental health nursing is a role aimed at supporting the learning needs of mental health nursing students undertaking a 12-month post-registration programme. This paper aims to examine the role of the clinical tutor in mental health nursing in Ireland by describing the experience of nursing students and key service stakeholders. A qualitative descriptive design was employed using focus group discussions and semi-structured interviews. Two focus groups were conducted with 14 nursing students in the final week of their one-year programme. Semi-structured interviews were undertaken with seven service stakeholders and service leaders. Participants reported positive experiences of working with the clinical tutor and valued the role in terms of educational and pastoral support. Participants suggested the role strengthened the link between theory and practice and enhanced the relationship between the higher education institute and clinical sites. However, a lack of clarity existed in terms of role description. Participants suggested the CT role enhanced the link between the university and clinical areas providing benefits to both student and service stakeholders. Implementing similar roles may benefit post-registration mental health nursing students in other jurisdictions. Further investigation on how the role operates from the perspective of those in the post may provide more clarity and enhance the development of such roles in the future.

Assessment of florfenicol as a possible treatment for chlamydiosis in koalas (Phascolarctos cinereus)

OBJECTIVE

Because of limited availability of chloramphenicol to veterinary suppliers, a preliminary study was performed to predict whether an analogue, florfenicol, is an efficacious treatment for chlamydiosis in koalas.

METHODS

Florfenicol was administered to koalas with naturally occurring chlamydiosis at 20 mg/kg SC (n = 3) and at 5 mg/kg (n = 3) and 10 mg/kg (n = 3) IV. The estimated areas under the plasma concentration versus time curves (AUC) were compared with the minimum inhibitory concentration to inhibit Chlamydia pecorum. Clinical data were also examined from field trials conducted on koalas (n = 19) with naturally occurring chlamydiosis and treated with florfenicol at a range of dosages (5-20 mg/kg SC and 6-15 mg/kg IV). Florfenicol binding to proteins in plasma was also determined.

RESULTS

Florfenicol was not detectable in plasma 24 h post-administration at 20 mg/kg SC. The estimated AUC_0-24 h following administration at 10 mg/kg IV suggests florfenicol might be effective against Chlamydia spp. via this route. Florfenicol binding to plasma proteins was 13.0% (± 0.30 SEM). After treatment with florfenicol in field trials, 5 of 19 koalas (26%) were released without further treatment, 4 with no long-term follow-up; 6 (32%) required additional treatment with chloramphenicol to resolve chlamydiosis; 7 (36%) failed to clinically improve, of which 3 had clinical signs and/or necropsy findings suggestive of antibiotic-related gastrointestinal dysbiosis; another koala died within minutes of florfenicol administered IV at 7 mg/kg.

CONCLUSION

When administered at dosages tolerable in the field, florfenicol is a problematic treatment for chlamydiosis based on equivocal outcomes and plasma concentrations below those that inhibit the pathogen.

Population genetics of the koala (Phascolarctos cinereus) in north-eastern New South Wales and south-eastern Queensland

Habitat loss and fragmentation are key threats to local koala (Phascolarctos cinereus) populations. Broad-scale management is suboptimal for koalas because distribution models are not easily generalised across regions. Therefore, it is imperative that data relevant to local management bodies are available. Genetic data provides important information on gene flow and potential habitat barriers, including anthropogenic disturbances. Little genetic data are available for nationally significant koala populations in north-eastern New South Wales, despite reported declines due to urbanisation and habitat loss. In this study, we develop 14 novel microsatellite loci to investigate koala populations in north-eastern New South Wales (Port Macquarie, Coffs Harbour, Tyagarah, Ballina) and south-eastern Queensland (Coomera). All locations were significantly differentiated (FST = 0.096–0.213; FʹST = 0.282–0.582), and this pattern was not consistent with isolation by distance (R2 = 0.228, P = 0.058). Population assignment clustered the more northern populations (Ballina, Tyagarah and Coomera), suggesting contemporary gene flow among these sites. For all locations, low molecular variation among (16%) rather than within (84%) sites suggests historical connectivity. These results suggest that koala populations in north-eastern New South Wales and south-eastern Queensland are experiencing contemporary impediments to gene flow, and highlight the importance of maintaining habitat connectivity across this region.

Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease ? evidence from systematic reviews of randomized controlled trials (second update, January 2006)

AIM

To update dietetic guidelines based on systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention).

METHODS

The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to January 2005 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomized controlled trials relating to diet and secondary prevention of CVD. Each review was critically appraised by at least two members of the UK Heart Health and Thoracic Dietitians Group. The quality and results of each review were discussed and summarized at a group meeting.

RESULTS

Evidence-based strategies that reduce cardiovascular events in those with CVD include reduction in saturated fat and substitution with unsaturated fats. Individuals who have suffered a myocardial infarction may also benefit from adopting a Mediterranean type diet and increasing intake of omega 3 fats, but it is not clear whether they are beneficial for all patients with CVD. There is no systematic review evidence to support the use of antioxidant vitamins supplements, low glycaemic index diets, or homocysteine lowering therapies in this group.

CONCLUSION

There remains good evidence that reducing saturated fat reduces morbidity in patients with CVD. This advice is consistent for most manifestations of CVD, with the addition of Mediterranean dietary advice and increased omega 3 fats for those who have had a myocardial infarction.

Genome sequence of the plant pathogen and biotechnology agent Agrobacterium tumefaciens C58

Agrobacterium tumefaciens is a plant pathogen capable of transferring a defined segment of DNA to a host plant, generating a gall tumor. Replacing the transferred tumor-inducing genes with exogenous DNA allows the introduction of any desired gene into the plant. Thus, A. tumefaciens has been critical for the development of modern plant genetics and agricultural biotechnology. Here we describe the genome of A. tumefaciens strain C58, which has an unusual structure consisting of one circular and one linear chromosome. We discuss genome architecture and evolution and additional genes potentially involved in virulence and metabolic parasitism of host plants.

An optical fibre sensor for in situ measurement of external species in fluids based on artificial neural network pattern recognition

An optical fibre sensor system capable of detecting contaminants (e.g. particles, inorganic or organic species) in water and other fluids is reported. In this article experimental results are presented for a single optical fibre sensor located at a distance of 150 m from the transmitter/receiver of the system. The fibre is addressed using an optical time domain reflectometer (OTDR) in order to achieve the spatial resolution (along the fibre length) necessary for this investigation. Novel signal processing techniques involving artificial neural networks and pattern recognition have been applied to the signals arising from the sensor in order to allow cross-sensitivity effects, e.g. from fouling due to calcification, to be extracted from the real measurand, e.g. alcohol content.

Systematic analysis of oxidative degradation of polysaccharides using PAGE and HPLC--MS

Oxidation of polysaccharides yields hydroxyaldehydes and hydroxycarboxylic acids. Aldehydes and carboxylic acids were separately conjugated to 8-aminonaphthalene-1,3,6-trisulfonic acid (ANTS) or tyrosine t-butyl ester (TBT). The ANTS-labeled derivatives were separated by molecular size on PAGE gels and detected by fluorescence. TBT-labeled derivatives were separated by reverse phase chromatography on a C18-HPLC column and analyzed by positive ion electrospray mass spectroscopy (HPLC--MS). This combination of procedures allowed a systematic analysis of carbohydrate oxidation products.

A closed rebreathing system for dose maintenance during Partial Liquid Ventilation

Partial Liquid Ventilation (PLV), a treatment for acute respiratory failure in which the lungs are filled, either partially or to functional residual capacity (FRC), with perfluorochemical (PFC) liquid while the patient is on mechanical gas ventilation, has progressed to clinical trials using the PFC perflubron (PFB). Because gas expired during PLV is laden with PFB vapor, PFB is lost via evaporation, which increases dose consumption and necessitates periodic redosing. A device has been developed to minimize evaporative loss by confining PFC vapor to a gas volume breathed by the patient, which is isolated from the ventilator. This closed rebreathing system works with the ventilator such that after the lung is filled with PFB, the patient is connected to the rebreathing system, with breathing still "driven" by the ventilator. The rebreathing system consists of two gas circuits, or compartments, separated by a flexible bag (in a box) partition. One compartment is in gas communication with the lung, while the second communicates with the ventilator. The O2 level on the patient side is matched to that on the ventilator side by sensing gas concentrations and by feedback control of O2 introduction. Similarly, air is introduced into the patient side under pressure-based feedback control to maintain a constant gas volume. On inspiration, the ventilator delivers the tidal volume (breath) into the box surrounding the bag, which, in turn, is transmitted through the bag to the lung. On expiration, the process is reversed. Unidirectional circulation of gas in the rebreathing circuit is achieved via check valves, and expired CO2 is removed by a barium hydroxide lime cartridge. Airway humidification is maintained by captive water vapor in the system and water vapor from the CO2 absorber. It is recommended that flow, pressure, O2, and CO2 levels be monitored at the patient "Y," i.e., the proximal end of the endotracheal tube. Performance data from both in-vitro experiments and in-vivo PLV experiments in pigs are presented. The authors conclude that with the closed rebreathing system, the dose can be safely maintained with fewer redosing procedures, and an approximately 90% savings in dose is achieved.

Recent innovations in total liquid ventilation system and component design

In addition to partial liquid ventilation (PLV), total liquid ventilation (TLV) is being explored as a potential therapy to mitigate ventilator-associated lung injury and acute lung failure. TLV is ventilation of the completely liquid-filled lung using tidal flow of oxygenated perfluorochemical (PFC) liquid delivered by a "liquid ventilator." Most TLV research to date has focused on "small" lung (animals < 20 kg; vast majority < 5 kg), with primary relevance to its use in children. Recent investigations regarding TLV in larger lungs have helped define new design challenges for liquid ventilator systems to succeed as clinical products. Adult TLV requires the delivery of significantly higher liquid tidal volumes, with proportionately greater O2 and CO2 exchange. Although a simple scale-up of liquid ventilator components such as pumps, tubing, fittings, and gas and heat exchangers might be considered the most straightforward way to compensate for the increased demand, there are a number of practical problems with this approach. These include requirements to: 1) minimize priming volume, 2) minimize PFC evaporative loss, 3) suppress flow-induced cavitation in fittings and components, 4) monitor and control ventilation based on pressure signals exhibiting noise, 5) maintain ability and accuracy of delivered breaths in a fluid mechanical environment having higher inertial forces and pressure losses than for small lung systems, 6) use disposable or sterilizable fluid-contacting components, and 7) maintain PFC materials compatibility. TLV system and component innovations implemented on a new large-animal liquid ventilator prototype are presented. The advantages of new pumps, gas exchangers, and temperature-control components are discussed.

A prospective study of the effects of marital status and family relations on young children's adjustment among African American and European American families

The present study investigated the effects of divorce and family relations on young children's development prospectively, using an ethnically diverse sample of approximately 300 low-income families. We also were able to examine the moderating effects of ethnicity on child adjustment in always two-parent, to-be-divorced, already-divorced, and always single-parent families. Results indicated that to-be-divorced European American and African American families demonstrated higher rates of preschool-age behavior problems, and already-divorced families showed similar trends. Parental conflict and behavior problems accounted for predivorce differences in child behavior problems, whereas rejecting parenting accounted for differences in problem behavior between always single-parent and always two-parent families. The results are discussed in terms of the importance of ethnicity in influencing young, low-income children's adjustment to different family structures.

The effectiveness of individual versus group induction of depressed mood

This study is an investigation of the effectiveness of an individually administered mood induction procedure compared with an equivalent procedure administered to a group. Seventy-nine nondepressed individuals (25 men, 54 women) were randomly assigned to either a depressive or a neutral mood induction in an individual or a group setting. In each procedure, the mood induction involved the Velten self-statement procedure (E. Velten, 1968) enhanced by related mood music. Overall, both the individual and group induction procedures were effective in producing a depressed mood state, and their effectiveness was unrelated to social desirability or the sex of the participant. However, the group procedure was more vulnerable to individual differences in response, and its use in research on depression requires stringent criteria for mood change.

Clinical process improvement as a means of facilitating health care system integration

BACKGROUND

In recent years many health care providers, physicians, hospitals, and managed care organizations have undergone significant reorganization in both delivery and financing systems. This has created new organizations called integrated or organized delivery systems. Sentara Health System (Norfolk, Va), one of these new integrated entities, developed a unified strategy for clinical process improvement for the entire organization. This system-wide approach had unanticipated problems and benefits.

METHODS

The Sentara Health System created a team responsible for coordinating clinical process improvement activities across its hospitals and ambulatory physician sites. A steering committee directed this team to improve the organization and delivery of care for specific high-cost, high-volume, or problem-prone disease for physicians to manage. A standardized approach aimed at coordinating care across sites was the cornerstone of these activities.

RESULTS

Significant improvements in patient outcomes and a concomitant decrease in costs of care were accomplished for multiple diseases and procedures. These projects uncovered unanticipated barriers to implementing improvement projects in a complex health care system which make implementing these activities far more difficult than for an individual hospital with its medical staff.

CONCLUSION

Coordinating clinical improvement activities across multiple hospitals and other sites of care in a complex integrated delivery system serves important purposes in addition to improving patient care. These projects were an important cultural change agent to transform the individual components of the system into one that is capable of delivering care continuously across multiple sites. Standardization of care practices, policies, and procedures is considerably enhanced by coordinating these activities across the entire system.

Irreversible activation of the gonadotropin-releasing hormone receptor by photoaffinity cross-linking: localization of attachment site to Cys residue in N-terminal segment

Photoaffinity cross-linking with [azidobenzoyl-d-Lys6]GnRH leads to irreversible activation of the gonadotropin-releasing hormone (GnRH) receptor. In order to localize the cross-linking site, the disulfide bridge structure was initially probed by mutagenesis. A consistent pattern of changes in the ability of GnRH to stimulate signal transduction after Ser substitutions of extracellularly located Cys residues indicated that Cys14 in the N-terminal domain is connected to Cys200 in the second extracellular loop, while Cys196 in this loop is connected to the highly conserved Cys114 at the extracellular end of transmembrane helix 3. Protein chemical analysis of radioactive fragments of cross-linked GnRH receptor following deglycosylation and enzymatic digest with endoproteinase Glu-C and trypsin before and after introduction or elimination of potential protease cleavage sites indicated that 125I[azidobenzoyl-d-Lys6]GnRH cross-links to a segment comprising residues 12-18 of the N-terminal domain. The existence of the Cys114-Cys196 bridge was directly confirmed as a labeled fragment, including that Cys114 was resolvable only under reducing conditions. The observation that the cross-linked N-terminal enzymatic fragments had identical apparent size under non-reducing conditions shows that the cross-linking reaction disconnected the disulfide bridge between Cys14 and Cys200 and indicates that Cys14 is probably the residue involved in cross-linking of the ligand. It is concluded that covalent tethering of GnRH through a photoreactive side chain located at position 6 in the middle of the peptide leads to continued activation of the receptor presumably through covalent binding to Cys14 in the N-terminal domain of the receptor.

Biological assay for activity and molecular mechanism of retinoids in cervical tumor cells

The composition and response of the retinoid signaling pathway in a human cell line (CC-1), representative of a low grade cervical carcinoma, were evaluated. Reverse-transcriptase polymerase chain reaction (RT-PCR) analysis demonstrated expression of cytoplasmic retinol binding protein, CRBPI, cytoplasmic retinoic acid binding protein, CRABPII, and nuclear retinoic acid receptors, RAR alpha, RARgamma, RXR alpha, and RXRbeta, but not CRABPI or RARbeta. This pattern is similar to that of the ectocervix. Activation of endogenous nuclear receptors was evaluated in a reporter subline of CC-1, called CC-B, containing a reporter gene controlled by a retinoic acid responsive element (RARE) and thymidine kinase promoter. Retinoid treatment of CC-B resulted in dose-dependent increases in reporter gene expression. Retinoids inhibited growth at concentrations greater than 100 nM. 9-cis retinoic acid (1 nM) significantly stimulated growth. Immunohistochemical analysis of CC-B organotypic cultures demonstrated a high level of epidermal growth factor receptor (EGF-R) expression that was decreased by retinoids. The degree of RARE transactivation induced by retinoids significantly correlated with the degree of inhibition of growth (R = -0.96) and EGF-R expression (R = -0.92). The dose-dependent and retinoid-specific responses of CC-1 at the molecular and biological levels demonstrate the utility of this reporter cell line for evaluation of retinoid activities.

Seasons and depression: the influence of cigarette smoking

The seasonality of depressive illness has been documented since antiquity. A review of 611 patients, who were consecutively admitted to the adult inpatient psychiatric unit of a mid-Michigan general hospital, examined the influence of cigarette smoking and psychiatric diagnosis upon the seasonal variation of admissions. Among the smokers, admissions for depressive disorders (n = 151) peaked in the springtime (z = 2.1, p < .05) and declined in summer. Admissions for the nonsmokers failed to demonstrate a substantial seasonal rhythm. Admissions for smokers and nonsmokers in other diagnostic groups did not show any seasonal variation. These findings parallel numerous studies regarding the influence of seasons upon rates of hospitalization for depressive disorder, and completed suicide. Therapeutic implications related to the bidirectional relationship between cigarette smoking and depression are discussed.

Structural requirements for alpha-mating factor activity

The sexual hormone of S. cerevisiae, alpha-mating factor (alpha-MF, WHWLQLKPGQPMY) has structural homology with mammalian luteinizing hormone releasing hormone (LHRH, pEHWSYGLRPG-NH2) and has been shown to exhibit LHRH activity [Loumaye et al. (1982) Science 218, 1323-1325]. We have tested whether LHRH has alpha-MF activity in yeast and found that it does not. We therefore synthesized a series of hybrid peptides of alpha-MF and LHRH to study the structural features which determine alpha-MF and LHRH activities. A hybrid peptide consisting of the LHRH sequence with the C-terminal tetrapeptide (QPMY) of alpha-MF did not exhibit alpha-MF activity. Thus, the lack of alpha-MF activity of LHRH is not due solely to the absence of the C-terminal residues. Substitution of Lys7 in alpha-MF with Arg, as is found in LHRH, did not affect the alpha-MF activity, nor did an additional substitution of Trp1 with pGlu. However, the C-terminal four amino acids of alpha-MF were necessary for alpha-MF activity. Our results indicate that insertion of a Ser residue in position 4 as found in LHRH abolishes alpha-MF activity. These results suggest that, in addition to an intact C-terminus, correct spacing of the N-terminal His2 and the C-terminus is required for alpha-MF activity. The hybrid peptides all exhibited less LHRH activity than either LHRH or alpha-MF. These structure-function studies indicate that the structural homology between these two reproductive hormones may not reflect an evolutionary relationship between them.

Schools, families, and early adolescents: what are we doing wrong and what can we do instead?

Although most individuals pass through adolescence without excessively high levels of "storm and stress," many individuals experience difficulty during this period. Why? Is there something unique about this developmental period that puts individuals at greater risk for difficulty? This paper focuses on these questions and advances the hypothesis that some of the "negative" psychological and behavioral changes associated with adolescent development result from a mismatch between the needs of developing adolescents and their experiences at school and at home. It provides theoretical and empirical examples of how this mismatch develops, how it is linked to negative age-related changes in early adolescents' motivation, self-perceptions, self-evaluations, and psychological competence, and how we could provide more developmentally appropriate social environments, particularly at school.

A reciprocal mutation supports helix 2 and helix 7 proximity in the gonadotropin-releasing hormone receptor

Activation of the pituitary gonadotropin-releasing hormone receptor, a member of the seven-transmembrane G protein-coupled receptor (GPCR) family, triggers a cascade of events leading to gonadotropin release and stimulation of the reproductive system. An unusual feature of this receptor, observed in mice, rats, and humans, is the presence of Asn87 in the second putative transmembrane helix at the location of a highly conserved aspartate in the GPCR family and of Asp318 in the putative seventh transmembrane helix where nearly all other GPCRs have asparagine. The possibility that these residues interact was suggested by this reciprocal pattern and by a three-dimensional model of the gonadotropin-releasing hormone receptor and was investigated by site-directed mutagenesis. Replacing Asn87 in the second transmembrane domain by aspartate eliminated detectable ligand binding. A second mutation, generating the double-mutant receptor Asp87Asn318, recreated the arrangement found in other GPCRs and re-established high affinity agonist and antagonist binding. The restoration of binding by a reciprocal mutation indicates that these two specific residues in helices 2 and 7 are adjacent in space and provides an empirical basis to refine the model of the transmembrane helix bundle of the receptor.

Development during adolescence. The impact of stage-environment fit on young adolescents' experiences in schools and in families

Although most individuals pass through adolescence without excessively high levels of "storm and stress," many do experience difficulty. Why? Is there something unique about this developmental period that puts adolescents at risk for difficulty? This article focuses on this question and advances the hypothesis that some of the negative psychological changes associated with adolescent development result from a mismatch between the needs of developing adolescents and the opportunities afforded them by their social environments. It provides examples of how this mismatch develops in the school and in the home and how it is linked to negative age-related changes in early adolescents' motivation and self-perceptions. Ways in which more developmentally appropriate social environments can be created are discussed.

Cloning and characterization of the human GnRH receptor

A cDNA encoding the human GnRH receptor (GnRHR) has been cloned and functionally expressed in both Xenopus oocytes and COS-1 cells. The 2160 bp cDNA encodes a 328 amino acid protein with a predicted amino acid sequence that is 90% identical to that of the mouse GnRHR (Tsutsumi et al. (1992) Mol. Endocrinol. 6, 1163-1169). Injection of synthetic RNA transcript into oocytes led to the development of a depolarizing response to agonists when assayed by voltage-clamp electrophysiology. Consistent with the expression of a mammalian GnRHR, the response was blocked by GnRH antagonists. Following expression of the human GnRHR in COS-1 cells, agonists and an antagonist displaced [125I]GnRH agonist from membrane isolates with nanomolar range dissociation constants similar to those described for displacement from human pituitary membranes. Transfected COS-1 cells manifested a GnRH-stimulated increase in phosphoinositol turnover, with an EC50 of approximately 3 nM, which was inhibited by GnRH antagonists. Northern blot analysis revealed a single band of approximately 4.7 kb expressed in human pituitary which was not detected in testis. The predicted structure of the human GnRHR is similar to that previously reported for the mouse receptor. Although the mammalian GnRHR is a seven transmembrane domain receptor, it differs from other G-protein coupled receptors in several respects, most notably the lack of a cytoplasmic C-terminal domain. The present study demonstrates that the cDNA isolated encodes the human GnRHR and suggests that several unique features conserved among mammalian GnRHRs may be essential for receptor function and/or regulatory control.

The use of intraaortic balloon pumping as an adjunct to reperfusion therapy in acute myocardial infarction. The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group

To assess the risk and possible benefits of use of the percutaneous IABP in patients given thrombolytic therapy as treatment for acute myocardial infarction, we prospectively evaluated 810 consecutive patients entered into the TAMI trials. During hospitalization the 85 patients treated with the IABP had more cardiac risk factors, were slightly older (58 vs 56 years), and more often had anterior infarction (62% vs 38%). At acute cardiac catheterization, patients treated with the IABP also had more multivessel coronary disease (67% vs 43%), more frequent TIMI grade 0 or 1 flow (44% vs 28%), lower global ejection fraction (40% vs 52%), and worse regional infarct (-3.2 vs -2.5 SD/chord) and noninfarct (-0.67 vs +0.36 SD/chord) zone function. Although mortality rates (32% vs 4%) and in-hospital complications were greater in patients treated with the IABP, a greater improvement in global (delta ejection fraction: +1.9% vs +0.7%) and noninfarct zone (delta SD/chord: +0.11 vs -0.09) left ventricular function was observed in patients treated with the IABP at 1-week follow-up angiography. In addition, no reinfarction or reocclusion of the infarct-related artery occurred while patients were being treated with the IABP. These results suggest that the IABP may have a specific role after thrombolytic therapy in treating patients at high risk for reocclusion or at high risk for hemodynamic deterioration because of large infarction or critical stenoses in coronary vessels supplying the noninfarct zone.

Comparison of the activity of cefixime and activities of other oral antibiotics against adult clinical isolates of Moraxella (Branhamella) catarrhalis containing BRO-1 and BRO-2 and Haemophilus influenzae

MICs of 10 oral antibiotics were determined for 105 Moraxella catarrhalis and 96 Haemophilus influenzae isolates from adults. A two- to fourfold increase in MICs of oral cephalosporins was seen in the presence of BRO-1 but not with TEM-1 or BRO-2. The MICs of cefixime for 90% of strains of H. influenzae (0.125 microgram/ml) and M. catarrhalis (0.25 microgram/ml) were 8- to 64-fold lower than those of other oral cephalosporins.

Parents' and teachers' beliefs about adolescents: Effects of sex and experience

Three studies examine beliefs that parents and teachers have about adolescents. A distinction is made between category-based beliefs (concerning adolescents as a group) and target-based beliefs (concerning individual adoles cents). In Study 1, 90 late elementary and junior high school teachers indicated degree of agreement with a set of category-based statements about adolescents. Parents of early adolescents in Study 2 (N=1272) responded to category- and target-based statements. Study 3 compares the responses of teachers in Study 1 and parents in Study 2. Both teachers and parents endorsed beliefs that adolescence is difficult, and that adults can have an impact. Compared to fathers, mothers believed more in difficulty and in the negative effects of biological change on behavior. Parents of daughters believed adolescence is more difficult than parents of sons. Among teachers, amount of experience with adolescents was positively associated with the belief that adolescence is a difficult period of life. For parents, the effect of amount of experience was mixed. Experience had a greater impact on the category-based beliefs of teachers than parents. Possible influences on the origins and modification of beliefs are discussed.

BRO beta-lactamases of Branhamella catarrhalis and Moraxella subgenus Moraxella, including evidence for chromosomal beta-lactamase transfer by conjugation in B. catarrhalis, M. nonliquefaciens, and M. lacunata

Two closely related beta-lactamases, BRO-1 and BRO-2 (formerly called Ravasio and 1908), are found in Moraxella (Branhamella) catarrhalis. We screened strains of B. catarrhalis recovered in the United States since 1952 and identified the first beta-lactamase-positive isolate in August 1976. The prevalence of the enzymes among 394 clinical isolates from one Texas hospital has averaged 75% since testing began in 1983. Screening of isolates of Moraxella subgenus Moraxella revealed the BRO enzymes in two other human respiratory tract species, M. lacunata and M. nonliquefaciens, beginning in 1978. A different beta-lactamase with a pI of 6.4 predominated in other species of subgenus Moraxella. BRO-2 had a different isoelectric focusing pattern and was produced in lesser amounts than BRO-1, but the two enzymes were indistinguishable by substrate or inhibitor profile. BRO enzymes from B. catarrhalis, M. nonliquefaciens, and M. lacunata could be transferred by conjugation and, for B. catarrhalis, also by transformation to B. catarrhalis. Plasmid bands were demonstrated in 90% of M. nonliquefaciens and in one previously reported strain of B. catarrhalis, but no change in plasmid profiles was seen in beta-lactamase-positive recombinants, supporting previous studies that suggested the beta-lactamase genes are chromosomal.

Efficacy of Stenorol (halofuginone). III. for the control of coccidiosis in turkeys

Halofuginone at 3 ppm in the ration was tested against turkey coccidial infections caused by four species, in a series of eight battery trials of 16 days duration. The drug was evaluated against infections caused by Eimeria meleagrimitis, E. adenoeides, E. gallopavonis, and E. dispersa. As measured by livability, weight gain, feed efficiency, morbidity, dropping score, lesion score, and oocyst production the drug was highly effective in Beltsville Small White turkeys. The drug at 3 ppm appeared to be about equally effective against all four species and almost completely prevented infection or the effects of infection in some experiments, except when the challenge was too severe.

Efficacy of Stenorol (halofuginone). I. Against recent field isolates of six species of chicken coccidia

The efficacy of Stenorol (halofunginone) was tested against six species of chicken Eimeria in a series of four battery experiments utilizing 3- to 4 1/2-week-old Cobb color-sexed broiler chickens. There were five replicates of eight chickens per replicate for each treatment of an experiment or a total of 1080 birds used in the study. The isolates were predominantly E. tenella, E. maxima, E. acevulina, E. necatrix, E. brunetti, or E. mivati and had previously been proven partially to totally resistant to several commercially available anticoccidial drugs. Halofunginone, at 3 ppm in the ration, was highly effective (P less than .01) against all six isolates as measured by weight gain at D+6 or +7and D+12 or +14 postinoculation; feed efficiency at D-2 to D+12 or +14; morbidity; mortality; dropping score; lesion score (D+6 or +7); and oocyst production during 4 or 5 days postinoculation (D = day of inoculation). The drug was not as effective against E. acervulina as against the other species, and increasing halofuginone to 4 ppm failed to improve activity of the drug signif;cantly against this isolate. However, 3 ppm of drug was effective against two other isolates of E. acervulina (from Alabama and Mississippi); 4 ppm was quite effective (P less than .01) in reducing dropping and lesion scores, but not significantly better than 3 ppm as measureed by other parameters. No relapse occurred after drug withdrawal and halofuginone was found to be cidal rather than static.

Efficacy of Stenorol (halofuginone). II. Plus roxarsone or bacitracin MD against selected strains of chicken Eimeria

A total of 879 broiler strain chickens ranging from 2 1/2- to 7 1/2 weeks of age was utilized in four battery experiments to determine whether Roxarsone and/or bacitracin MD added to halofuginone were compatible and beneficial in reducing the effects of coccidial infections. The additives were generally beneficial as measured by weight gain and feed efficiency but not as measured by other parameters such as dropping score, lesion score, or oocyst production. The addition of 200 g of bacitracin/ton of feed did not give an additional response above that from 50 g/ton. Roxarsone in the ration was more effective in younger chickens (2 1/2 week old) than older ones (6 weeks, 2 days and 7 weeks, 3 days).

Activating and anesthetic effects of general depressants

The long-sleep (LS) and short-sleep (SS) lines of mice were derived by selective breeding with respect to ethanol sleep time. We found that in current generations LS mice also have longer sleep times than SS mice to trichloroethanol and paraldehyde. Two subsequent experiments tested our hypothesis that mice that are relatively insensitive to the hypnotic effects of depressant drugs might be relatively activated by low doses of these drugs. Both experiments failed to support the hypothesis. First, although SS mice were more activated than LS mice by subhypnotic doses of paraldehyde, the lines did not differ in the degree of activation produced by low doses of trichloroethanol. Second, among mice from a genetically heterogeneous population (HS), there was no relation between the degree of activation induced by a low dose of ethanol and sensitivity to the hypnotic effects of a higher dose.

In vitro adsorption of doxorubicin hydrochloride on insoluble calcium phosphate

The adsorption of doxorubicin hydrochloride, a potent antitumor agent, on solid tribasic calcium phosphate was studied in vitro. A Langmuir adsorption isotherm at pH 7.4 and the maximum adsorption capacity of tribasic calcium phosphate were established. Tribasic calcium phosphate was chosen as a model for solid bone samples, which are stained with doxorubicin in patients who have received long-term doxorubicin therapy.