Changes in understandings and perceptions of individuals, significant others and community supporters involved in a theatre company for adults with intellectual disabilities

BACKGROUND

Theatre companies to show positive capabilities and identities of people with intellectual disabilities have been established. Existing research focuses upon sole theatre performances and rarely includes the impacts on those in the immediate and wider contexts of people with intellectual disabilities.

METHODS

The impacts of a theatre company on understandings and perceptions of intellectual disabilities from multiple perspectives were explored. Interviews with members with intellectual disabilities (n = 14), and focus groups with significant people in their lives (n = 11) and community supporters (n = 10) were conducted and analysed using thematic analysis.

RESULTS

Four superordinate and nine subordinate themes were identified. The theatre company increased members' connectivity, allowed them to experience parts of life they are often excluded from, and enabled growth for all participants, leading to a desire to extend the theatre company's ethos elsewhere.

CONCLUSIONS

The importance of such organisations to improve perceptions of people with intellectual disabilities is emphasized.

GWAS meta-analysis reveals novel loci and genetic correlates for general cognitive function: a report from the COGENT consortium

This corrects the article DOI: 10.1038/mp.2016.244.

GWAS meta-analysis reveals novel loci and genetic correlates for general cognitive function: a report from the COGENT consortium

The complex nature of human cognition has resulted in cognitive genomics lagging behind many other fields in terms of gene discovery using genome-wide association study (GWAS) methods. In an attempt to overcome these barriers, the current study utilized GWAS meta-analysis to examine the association of common genetic variation (~8M single-nucleotide polymorphisms (SNP) with minor allele frequency ⩾1%) to general cognitive function in a sample of 35 298 healthy individuals of European ancestry across 24 cohorts in the Cognitive Genomics Consortium (COGENT). In addition, we utilized individual SNP lookups and polygenic score analyses to identify genetic overlap with other relevant neurobehavioral phenotypes. Our primary GWAS meta-analysis identified two novel SNP loci (top SNPs: rs76114856 in the CENPO gene on chromosome 2 and rs6669072 near LOC105378853 on chromosome 1) associated with cognitive performance at the genome-wide significance level (P<5 × 10^-8). Gene-based analysis identified an additional three Bonferroni-corrected significant loci at chromosomes 17q21.31, 17p13.1 and 1p13.3. Altogether, common variation across the genome resulted in a conservatively estimated SNP heritability of 21.5% (s.e.=0.01%) for general cognitive function. Integration with prior GWAS of cognitive performance and educational attainment yielded several additional significant loci. Finally, we found robust polygenic correlations between cognitive performance and educational attainment, several psychiatric disorders, birth length/weight and smoking behavior, as well as a novel genetic association to the personality trait of openness. These data provide new insight into the genetics of neurocognitive function with relevance to understanding the pathophysiology of neuropsychiatric illness.

Variation in the Williams syndrome GTF2I gene and anxiety proneness interactively affect prefrontal cortical response to aversive stimuli

Characterizing the molecular mechanisms underlying the heritability of complex behavioral traits such as human anxiety remains a challenging endeavor for behavioral neuroscience. Copy-number variation (CNV) in the general transcription factor gene, GTF2I, located in the 7q11.23 chromosomal region that is hemideleted in Williams syndrome and duplicated in the 7q11.23 duplication syndrome (Dup7), is associated with gene-dose-dependent anxiety in mouse models and in both Williams syndrome and Dup7. Because of this recent preclinical and clinical identification of a genetic influence on anxiety, we examined whether sequence variation in GTF2I, specifically the single-nucleotide polymorphism rs2527367, interacts with trait and state anxiety to collectively impact neural response to anxiety-laden social stimuli. Two hundred and sixty healthy adults completed the Tridimensional Personality Questionnaire Harm Avoidance (HA) subscale, a trait measure of anxiety proneness, and underwent functional magnetic resonance imaging (fMRI) while matching aversive (fearful or angry) facial identity. We found an interaction between GTF2I allelic variations and HA that affects brain response: in individuals homozygous for the major allele, there was no correlation between HA and whole-brain response to aversive cues, whereas in heterozygotes and individuals homozygous for the minor allele, there was a positive correlation between HA sub-scores and a selective dorsolateral prefrontal cortex (DLPFC) responsivity during the processing of aversive stimuli. These results demonstrate that sequence variation in the GTF2I gene influences the relationship between trait anxiety and brain response to aversive social cues in healthy individuals, supporting a role for this neurogenetic mechanism in anxiety.

Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia

Although the developers of the Positive and Negative Syndrome Scale (PANSS) grouped items into three subscales, factor analyses indicate that a five-factor model better characterizes PANSS data. However, lack of consensus on which model to use limits the comparability of PANSS variables across studies. We counted "votes" from published factor analyses to derive consensus models. One of these combined superior fit in our Caucasian sample (n=458, CFI=.970), and in distinct Japanese sample (n=164, CFI=.964), relative to the original three-subscale model, with a sorting of items into factors that was highly consistent across the studies reviewed.

Kinetic instabilities that limit β in the edge of a tokamak plasma: a picture of an H-mode pedestal

Plasma equilibria reconstructed from the Mega-Amp Spherical Tokamak have sufficient resolution to capture plasma evolution during the short period between edge-localized modes (ELMs). Immediately after the ELM, steep gradients in pressure, P, and density, n(e), form pedestals close to the separatrix, and they then expand into the core. Local gyrokinetic analysis over the ELM cycle reveals the dominant microinstabilities at perpendicular wavelengths of the order of the ion Larmor radius. These are kinetic ballooning modes in the pedestal and microtearing modes in the core close to the pedestal top. The evolving growth rate spectra, supported by gyrokinetic analysis using artificial local equilibrium scans, suggest a new physical picture for the formation and arrest of this pedestal.

Tuberculosis in HIV programmes in lower-income countries: practices and risk factors

BACKGROUND

Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART).

OBJECTIVE

To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART.

METHODS

Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models.

RESULTS

Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥ 16 years contributed 13,227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33-0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68-0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19-0.31, P < 0.0001).

CONCLUSIONS

Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.

Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings

Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely.

Genes, cognition and brain through a COMT lens

Various genes are known to modulate the delicate balance of dopamine in prefrontal cortex and influence cortical information processing. Catechol-O-methyltransferase (COMT) on chromosome 22q11 is the most widely studied of these genes. Val158Met, a common, functional variant in the coding sequence that increases or decreases the enzymatic activity of the gene has been shown to impact the efficiency of prefrontally-mediated cognition, specifically executive functioning, working memory, fluid intelligence and attentional control. We review the rapidly evolving literature exploring the association between COMT genotype and cognitive performance, and illustrate how this polymorphism has served a pivotal role in characterizing various interacting dimensions of complexity in the relationship between genes and cognition. We review how Val158Met has been used to help develop and validate behavioral and neurophysiological phenotypes, as a critical tool in dissecting overlapping neural functional systems and exploring interactions within and between genes, and in exploring how gene effects on cognition are modulated by environmental, demographic and developmental factors. Despite the impressive range of findings, the COMT story is also a bracing reminder of how much work remains to translate this knowledge into practical clinical applications.

Bacillus cereus strains fall into two clusters (one closely and one more distantly related) to Bacillus anthracis according to amino acid substitutions in small acid-soluble proteins as determined by tandem mass spectrometry

Small acid-soluble proteins (SASPs) are located in the core region of Bacillus spores and have been previously demonstrated as reliable biomarkers for differentiating Bacillus anthracis and Bacillus cereus. Using MS and MS-MS analysis of SASPs further phylogenetic correlations among B. anthracis and B. cereus strains are described here. ESI was demonstrated to be a more comprehensive method, allowing for the analysis of intact proteins in both MS and MS-MS mode, thus providing molecular weight (MW) and sequence information in a single analysis, and requiring almost no sample preparation. MALDI MS was used for determination of MW of intact proteins; however, MS-MS analysis can only be achieved after enzymatic digestion of these proteins. It was demonstrated that the combination of the two different approaches provides confirmatory and complementary information, allowing for unambiguous protein characterization and sequencing. This study established that B. cereus strains fall into two clusters (one closely and one more distantly related) to B. anthracis as exhibited by amino acid substitutions. The closely related cluster was characterized by a beta-SASP with a single amino acid substitution, localized either close to the C terminus (phenylalanine-->tyrosine, 16 masses change) or close to the N terminus (serine-->alanine serine, also 16 masses change). The more distantly related cluster displayed both amino acid substitutions (32 masses change). One strain of B. cereus isolated from a patient with severe pneumonia (an anthrax-like disease) fell into the more distantly related cluster implying that pathogenicity and phylogenicity are not necessarily correlated features. Unlike PCR and DNA sequencing, protein sequence variation assessed by ESI MS-MS, essentially occurs in real-time, and involves simply extracting the protein and injecting into the instrument for analysis.

A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines

OBJECTIVES

To establish the role and value of written information available to patients about individual medicines from the perspective of patients, carers and professionals. To determine how effective this information is in improving patients' knowledge and understanding of treatment and health outcomes.

DATA SOURCES

Electronic databases searched to late 2004, experts in information design, and stakeholder workshops (including patients and patient organisations).

REVIEW METHODS

Data from selected studies were tabulated and the results were qualitatively synthesised along with findings from the information design and stakeholder workshop strands.

RESULTS

Most people do not value the written information they receive. They had concerns about the use of complex language and poor visual presentation and in most cases the research showed that the information did not increase knowledge. The research showed that patients valued written information that was tailored to their individual circumstances and illness, and that contained a balance of harm and benefit information. Most patients wanted to know about any adverse effects that could arise. Patients require information to help decision-making about whether to take a medicine or not and (once taking a medicine) with ongoing decisions about the management of the medicine and interpreting symptoms. Patients did not want written information to be a substitute for spoken information from their prescriber. While not everyone wanted written information, those who did wanted sufficient detail to meet their need. Some health professionals thought that written information for patients should be brief and simple, with concerns about providing side-effect information. They saw increasing compliance as a prime function, in contrast to patients who saw an informed decision not to take a medicine as an acceptable outcome.

CONCLUSIONS

The combination of a quantitative and qualitative review, an exploration of best practice in information design, plus the input of patients at stakeholder workshops, allowed this review to look at all perspectives. There is a gap between currently provided leaflets and information which patients would value and find more useful. The challenge is to develop methods of provision flexible enough to allow uptake of varying amounts and types of information, depending on needs at different times in an illness. This review has identified a number of areas where future research could be improved in terms of the robustness of its design and conduct, and the use of patient-focused outcomes. The scope for this research includes determining the content, delivery and layout of statutory leaflets that best meet patients' needs, and providing individualised information, which includes both benefit and harm information. In particular, studies of the effectiveness and role and value of Internet-based medicines information are needed.

Survival of spacecraft-associated microorganisms under simulated martian UV irradiation

Spore-forming microbes recovered from spacecraft surfaces and assembly facilities were exposed to simulated Martian UV irradiation. The effects of UVA (315 to 400 nm), UVA+B (280 to 400 nm), and the full UV spectrum (200 to 400 nm) on the survival of microorganisms were studied at UV intensities expected to strike the surfaces of Mars. Microbial species isolated from the surfaces of several spacecraft, including Mars Odyssey, X-2000 (avionics), and the International Space Station, and their assembly facilities were identified using 16S rRNA gene sequencing. Forty-three Bacillus spore lines were screened, and 19 isolates showed resistance to UVC irradiation (200 to 280 nm) after exposure to 1,000 J m(-2) of UVC irradiation at 254 nm using a low-pressure mercury lamp. Spores of Bacillus species isolated from spacecraft-associated surfaces were more resistant than a standard dosimetric strain, Bacillus subtilis 168. In addition, the exposure time required for UVA+B irradiation to reduce the viable spore numbers by 90% was 35-fold longer than the exposure time required for the full UV spectrum to do this, confirming that UVC is the primary biocidal bandwidth. Among the Bacillus species tested, spores of a Bacillus pumilus strain showed the greatest resistance to all three UV bandwidths, as well as the total spectrum. The resistance to simulated Mars UV irradiation was strain specific; B. pumilus SAFR-032 exhibited greater resistance than all other strains tested. The isolation of organisms like B. pumilus SAFR-032 and the greater survival of this organism (sixfold) than of the standard dosimetric strains should be considered when the sanitation capabilities of UV irradiation are determined.

Understanding the response of large South African companies to HIV/AIDS

This paper provides a framework analysing the response of South African companies to HIV/AIDS. Drawing on three case studies of companies, each with over 20,000 South African-based employees, we identify six 'drivers' that influence corporate behaviour regarding HIV/AIDS: legal requirements, voluntary regulation, business costs, social pressures, visibility of the disease, and individuals within companies. We suggest that costs calculations, while possibly underestimating indirect and macro-implications, are not key in driving company responses to HIV/AIDS. The law and voluntary regulation have influenced, but not determined, the response of companies to HIV/AIDS. Social pressures on companies are of importance, but the scale and complexity of need in South Africa has seen the deflecting of this driver. Of greater reference in determining responses has been the social pressure of other companies' responses. The general visibility of the AIDS epidemic is also a significant factor in explaining companies' responses to HIV/AIDS. Moreover, the visibility of HIV/AIDS within companies has influenced the responses of often relatively weak, internal agents who have been attempting to drive companies' HIV/AIDS programmes. We conclude that external drivers--legal requirements, economic performance, and social pressures--have framed corporate responses to HIV/AIDS to a degree, but have generally been weak. Moreover, there has been relatively little synergy between these external drivers and the internal drivers--voluntary regulation, visibility, and company HIV/AIDS 'champions'--that could propel companies into pro-active, bold responses to HIV/AIDS.

A case control study to examine the pharmacological factors underlying ventricular septal defects in the North of England

BACKGROUND

Amphetamine exposure is associated with congenital cardiac abnormalities in animals. We previously reported an association between recreational use of 2,4-methylenedioxymethamphetamine (ecstasy, MDMA) and ventricular septal defect in babies born to users. We have carried out a case control study to investigate risks in the occurrence of ventricular septal defect in a cohort of babies born in the North East of England.

METHODS

Cases were identified from paediatric cardiology units in Newcastle upon Tyne and Leeds, and controls were recruited from the mothers of babies born in the same hospital as the index case. Research nurses carried out interviews using a structured questionnaire.

RESULTS

A total of 296 case control pairs were studied. There was insufficient exposure to ecstasy to test the primary hypothesis. Increased risk of ventricular septal defect was found to be associated with consumption of cough and cold remedies [pre-conception OR 2.2, 95% CI 1.41, 3.51; pregnancy OR 5.1, 95% CI 2.56, 11.27; exposure in either OR 2.83, 95% CI 1.85, 4.45; P<0.005] and in the case of non-steroidals for exposures in pregnancy (OR 4.2, 95% CI 1.54, 14.26; P<0.005).

CONCLUSIONS

These findings suggest that ventricular septal defect is associated with consuming the medications identified. They are also compatible with the hypothesis that sympathomimetics (pseudoephedrine, phenylephrine and phenylpropanolamine) present in cough mixtures cause the increased risk, and with our original hypothesis that sympathomimetics and amphetamines are potentially cardiotoxic in utero.

Can parents who smoke socialise their children against smoking? Results from the Smoke-free Kids intervention trial

OBJECTIVE

To evaluate Smoke-free Kids, a new home based programme to assist parents who smoke in socializing their children against smoking.

DESIGN

Two year randomised controlled trial.

PARTICIPANTS

At baseline, 887 adult smokers who had an abstinent child in the third grade (ages 7-8 years); 671 adults and children were retained through the 24 month follow up.

INTERVENTION

Programme modules, newsletters, incentives, support calls.

OUTCOMES

Anti-smoking socialisation; susceptibility to smoking.

RESULTS

Of 327 parents randomised to treatment, 210 obtained adequate treatment by using at least three of five core modules. Programme efficacy analyses, which compared these parents with controls (n = 344), showed that exposure to adequate treatment predicted significantly higher levels in nearly all categories of anti-smoking socialisation three months post-intervention. Two years post-baseline, children of parents who reported adequate treatment scored significantly higher than controls on attributes that reduce susceptibility to smoking, and they scored significantly lower than controls on attributes that raise susceptibility to smoking. Programme effectiveness analyses compared all parents randomised to treatment (n = 327) with controls (n = 344). Treatment effects were evident for several socialisation outcomes; however, these effects were smaller and less consistent than those from the efficacy analyses. Similarly, although treated children scored higher than controls on attributes that reduce susceptibility and lower than controls on attributes that raise susceptibility, several of these between-group differences were not significant.

CONCLUSIONS

Given adequate exposure to the Smoke-free Kids programme, significant beneficial effects were observed on anti-smoking socialisation in households where parents smoke cigarettes, and significant beneficial effects were observed on children's susceptibility to smoking after two years. Improving programme acceptance and utilisation is necessary before programme effectiveness can be demonstrated.

Social network and social support characteristics amongst individuals recently discharged from acute psychiatric units

This study compares the social support network of a diagnostically heterogeneous group of community mental health service users recently discharged from acute inpatient units, with that of a mental health service user comparison group with no history of hospital admission. Social data were elicited by a structured interview schedule (the Social Network Schedule). It was observed that the study group was characterized by smaller overall social networks, particularly within the primary network, but conversely the group had a greater proportion of service user peer contact. Few differences in perceived social support between groups were observed, although the study group reported fewer confidants. The implications of the study for nursing staff are discussed.

cDNA and genomic cloning of lacritin, a novel secretion enhancing factor from the human lacrimal gland

Multiple extracellular factors are hypothesized to promote the differentiation of unstimulated and/or stimulated secretory pathways in exocrine secretory cells, but the identity of differentiation factors, particularly those organ-specific, remain largely unknown. Here, we report on the identification of a novel secreted glycoprotein, lacritin, that enhances exocrine secretion in overnight cultures of lacrimal acinar cells which otherwise display loss of secretory function. Lacritin mRNA and protein are highly expressed in human lacrimal gland, moderately in major and minor salivary glands and slightly in thyroid. No lacritin message or protein is detected elsewhere among more than 50 human tissues examined. Lacritin displays partial similarity to the glycosaminoglycan-binding region of brain-specific neuroglycan C (32 % identity over 102 amino acid residues) and to the possibly mucin-like amino globular region of fibulin-2 (30 % identity over 81 amino acid residues), and localizes primarily to secretory granules and secretory fluid. The lacritin gene consists of five exons, displays no alternative splicing and maps to 12q13. Recombinant lacritin augments unstimulated but not stimulated acinar cell secretion, promotes ductal cell proliferation, and stimulates signaling through tyrosine phosphorylation and release of calcium. It binds collagen IV, laminin-1, entactin/nidogen-1, fibronectin and vitronectin, but not collagen I, heparin or EGF. As an autocrine/paracrine enhancer of the lacrimal constitutive secretory pathway, ductal cell mitogen and stimulator of corneal epithelial cells, lacritin may play a key role in the function of the lacrimal gland-corneal axis.

Patient information leaflets for medicines: using consumer testing to determine the most effective design

Comprehensive medicine information leaflets for patients are now mandatory across the European Union. In 1997, the European Commission (EC) proposed a prescriptive 'model' for the leaflets and a method for consumer testing. This exploratory study compared consumers' ability to use a leaflet based on the EC model leaflet and an alternative leaflet based on best practice in information design (Mark II). The leaflets were tested in two matched groups of 20 consumers, who were required to find, and understand, 15 pieces of information in the leaflets. The target that each question should be answered correctly by 16 out of 20 consumers, was achieved for three of the 15 points in the EC leaflet, compared with eight in the Mark II leaflet. Open questioning confirmed the problems with the EC leaflet, including a failure to understand key concepts about medicine interactions and contraindications. This research demonstrates the benefits of consumer testing, ensuring that leaflets are patient-orientated. A rigid model leaflet would prevent these benefits from being utilised.

New tools for learning

In the last twenty-five years more has been learned about the human brain than in the past history of mankind. Through the use of new technologies such as PET and CAT scans and functional MRI's, it is now possible to see and learn much about the human brain while it is in the process of thinking. The research of neuroscientists, such as Marian Diamond, has demonstrated that the brain changes physiologically as a result of learning and experience--for better or worse--and that plasticity can continue throughout the lifespan. It appears that there are particular kinds of environments that are most conducive to the development of good mental equipment. They are positive, nurturing, stimulating, and encourage action and interaction. Many of the most effective schools and training programs have created such high-challenge low-threat environments. It is also very clear that intelligence is not a static structure, but an open, dynamic system that can continue to develop throughout life. This understanding is being utilized not only in school systems but in the workplace, where training programs show that even at the adult level people are able to develop their intelligence more fully. Corporations such as Motorola have implemented programs in which they are training their employees, managers, and executives to think, problem-solve and create more effectively using strategies developed by such educational innovators as Reuven Feurstein, J.P. Guilford, and Edward de Bono. A most recent development is in the new kinds of technology that make it possible for people to take responsibility for their own learning as they access and process information through the internet, communicate with experts anywhere in the world, and use software that facilitate higher order thinking and problem-solving. Computers are in no way replacing teachers, but rather these new tools allow them to spend more time being facilitators, mentors, and guides. As a result, teachers and students are able more often to collaborate on creating new knowledge as well as mastering the basics. As technology becomes more ubiquitous, there is growing recognition of the importance of the arts in humanizing the curriculum. "More high-tech, more need for high-touch" is becoming the by-word of many schools. They recognize that the arts are not only culturally important and civilizing influences, but they can facilitate the learning of almost any subject. I believe that these four concepts--the plasticity of the brain, the modifiability of intelligence, the use of technology as a powerful new tool for learning, and the renaissance of the arts in education--have major implications specifically for educational systems and generally for the future of our world. In this time of rapid change, leading-edge educational systems are equipping people with the ability to learn, unlearn, and relearn continually. They are giving students meaningful opportunities to apply what they have learned in order to turn information into knowledge. And--of critical importance if any of this is to lead to a healthy future--they are helping students to learn to use knowledge responsibly, ethically, and with integrity. Furthermore, they are involving students in experiences that develop compassion and altruism in the process of their education. Our complex world urgently needs more people who have developed their fullest potential in mind, body, and spirit.

Alcohol-specific socialization, parenting behaviors and alcohol use by children

OBJECTIVE

This panel study examined the relations between alcohol-specific socialization by parents (monitoring of alcohol use by children, allowing alcohol use by children at home, communicating against alcohol use and setting rules against alcohol use), general dimensions of parenting behavior (responsiveness and demandingness) and alcohol use by children.

METHOD

A sample of 488 fifth-grade children reported their perceptions of alcohol-specific socialization by parents, parental responsiveness and parental demandingness. These variables were used to predict alcohol use when children in the panel were in seventh grade.

RESULTS

Nineteen percent of seventh-grade children reported alcohol use in the past 30 days. Logistic regression analyses indicated that, after accounting for children's age, sex, single parent status, prior use of alcohol and exposure to parental modeling of alcohol use, the odds of alcohol use were significantly greater among children who perceived no parental monitoring of alcohol use, who had been allowed by parents to have a drink with alcohol at home and who perceived relatively low levels of parental demandingness. Rules against alcohol use, parental communication against alcohol use and parental responsiveness were unrelated to the study outcome.

CONCLUSIONS

Parental monitoring of alcohol use by children, family norms regarding alcohol use by children at home and parental ability to set and enforce behavioral rules merit consideration as factors that should be modified by prevention programs. There is a need, however, for additional research that further examines the relations between exposure to such parenting behaviors during childhood and alcohol use during adolescence.

Methanotrophs, Methylosinus trichosporium OB3b, sMMO, and their application to bioremediation

One of the most problematic groups of the USEPA and EU priority pollutants are the halogenated organic compounds. These substances have a wide range of industrial applications, such as solvents and cleaners. Inadequate disposal techniques and accidental spillages have led to their detection in soil, groundwater, and river sediments. Persistence of these compounds in the environment has resulted from low levels of biodegradation due to chemical structural features that preclude or retard biological attack. Research has indicated the idea that treatment systems based on methanotrophic co-metabolic transformation may be a cost-effective and efficient alternative to physical methods because of the potential for high transformation rates, the possibility of complete compound degradation without the formation of toxic metabolites, applicability to a broad spectrum of compounds, and the use of a widely available and inexpensive growth substrate. A substantial amount of work concerning methanotrophic cometabolic transformations has been carried out using the soluble form of methane monooxygenase (sMMO) from the obligate methanotroph Methylosinus trichosporium OB3b. This NADH-dependent monooxygenase is derepressed when cells are grown under copper stress. sMMO has a wider specificity than the particulate form. sMMO has been shown to degrade trichloroethylene (TCE) at a rate of at least one order of magnitude faster than obtained with other mixed and pure cultures, suggesting it has a wider application to bioremediation. Furthermore, sMMO catalyzes an unusually wide range of oxidation reactions, including the hydroxylation of alkanes, epoxidation of alkenes, ethers, halogenated methanes, cyclic and aromatic compounds including compounds, that are resistant to degradation in the environment. However, the practical application of methantrophs and Methylosinus trichosporium OB3b to the treatment of chlorinated organics has met with mixed success. Although oxidation rates are rapid, compound oxidation with M. trichosporium OB3b is difficult. This fastidious organism grows relatively slowly, which limits the speed with which sMMO expressing biomass can be generated. Furthermore, product toxicity toward the cell, affecting the stability of the enzyme when transforming certain compounds has been observed, for example, by the products of 1,2,3 trichlorobenzene hydroxylation (2,3,4- and 3,4,5-trichlorophenol) and of TCE degradation (chloral hydrate). Because of this toxicity and the inability of sMMO to further oxidize its own hydroxylation products, the ability of methane monoxygenase to carry out the monooxygenation of a wide variety of substituted aromatics and polyaromatics cannot be fully exploited in M. trichosporium OB3b. Many of these problems could be overcome by the use of either a mixed downstream heterotrophic population of organisms that could accommodate the products of hydroxylation or to express sMMO in an organism that could metabolize the products of hydroxylation. The latter of these two approaches would have several advantages. The main benefit would be the removal of the need for methane, which is required to induce sMMO in M. trichosporium OB3b, and supply carbon and energy to the cells that continuously oxidise the target compound, but also acts as a competitive inhibitor of sMMO. Instead, the recombinant could utilize the products of sMMO-mediated hydroxylation as a carbon source.

Creating a new environment of ambulatory care: community health centers and the Planetree philosophy

This article provides an overview of the approach, programming, and methodology for the renovation of the Peekskill Area Health Center, an urban based non-profit community health center in the Hudson Valley. The impetus of the renovation is in response to changes in the health care environment and overcrowding of the existing facility. The model development, which is reflected in the physical renovation, employees key elements of the Planetree approach to patient-centered care. Consistent with the national Community Health Center philosophy, the project is dedicated to vitalizing an economically depressed area through construction opportunities and links with local commercial businesses.

A longitudinal study predicting patterns of cigarette smoking in late childhood

Early initiation of cigarette smoking so strongly predicts future smoking that several investigators have advocated delaying the age of initiation as a prevention strategy. To complement retrospective studies of early initiation, this study assessed prospectively patterns of smoking behavior in a sample of 401 children who were surveyed in the fifth, sixth, and seventh grades. The principal findings were (1) modeling of smoking by parents and friends is sufficient to influence children to initiate smoking, particularly when children also have low behavioral self-control, and (2) when modeling occurs in combination with poor adjustment to school, low parental monitoring, easy access to cigarettes, and other risk attributes, early initiators are significantly more likely to continue smoking. The results suggest that delaying initiation of smoking without also modifying child attributes and socialization factors that predict early initiation and persistent smoking is unlikely to reduce the proportion of children who become habitual smokers.

Extension of Drosophila lifespan by overexpression of human SOD1 in motorneurons

Reactive oxygen (RO) has been identified as an important effector in ageing and lifespan determination. The specific cell types, however, in which oxidative damage acts to limit lifespan of the whole organism have not been explicitly identified. The association between mutations in the gene encoding the oxygen radical metabolizing enzyme CuZn superoxide dismutase (SOD1) and loss of motorneurons in the brain and spinal cord that occurs in the life-shortening paralytic disease, Familial Amyotrophic Lateral Sclerosis (FALS; ref. 4), suggests that chronic and unrepaired oxidative damage occurring specifically in motor neurons could be a critical causative factor in ageing. To test this hypothesis, we generated transgenic Drosophila which express human SOD1 specifically in adult motorneurons. We show that overexpression of a single gene, SOD1, in a single cell type, the motorneuron, extends normal lifespan by up to 40% and rescues the lifespan of a short-lived Sod null mutant. Elevated resistance to oxidative stress suggests that the lifespan extension observed in these flies is due to enhanced RO metabolism. These results show that SOD activity in motorneurons is an important factor in ageing and lifespan determination in Drosophila.

Residual and recurrent shunts after implantation of Cook detachable duct occlusion coils

OBJECTIVE

To assess the presence and outcome of Doppler detectable shunts following implantation of the Cook detachable PDA coil.

DESIGN

Prospective study.

SETTING

Tertiary paediatric cardiac centre.

PATIENTS

76 consecutive patients undergoing coil implantation (80 procedures).

MAIN OUTCOME MEASURES

Detection and colour Doppler echocardiographic appearance of residual or recurrent shunts, the timing of the appearance of recurrent shunts, and the time taken for spontaneous resolution of these shunts.

RESULTS

Immediate occlusion was achieved in 52 patients. At one month 63 patients had complete occlusion and after three months the duct was completely occluded in 67 patients. In 27 cases small residual shunts were detected on echocardiography 10 minutes after the completion of the implantation procedure; 15 of these had resolved by 24 hours and 20 had resolved by three months. Recurrent shunts were detected after apparent initial complete occlusion in 11 cases 24 hours after coil implantation and in two cases one month after the procedure. Six recurrent shunts resolved on later follow up. Residual shunts appeared as single jets after implantation of a single coil, but up to three separate jets were detected after implantation of multiple coils.

CONCLUSIONS

Spontaneous resolution of small residual shunts occurs in most patients. The recurrence of small shunts after apparent complete occlusion suggests that recanalisation of the duct may occur in a small percentage of patients up to one month after occlusion. Residual shunts may take the form of multiple residual jets that may require implantation of further coils to achieve complete duct occlusion.

TGF-beta1 is essential for the homeostasis of the dentin-pulp complex

Among the complex network of cytokines that influence odontoblast function during development and repair, TGF-beta1 is unique in its dual abilities to function as a potent immunosuppressant and as an inducer of extracellular matrix production. These properties underscore the importance of this molecule in maintaining the homeostasis of the dentin-pulp complex after injury. The purpose of this paper is to describe new findings of our phenotypic analysis of dentition in mice in which the TGF-beta1 gene has been disrupted. The major phenotype of TGF-beta1(-/-) offspring is one of diffuse immune system activation with progressive inflammation, wasting and death. Our studies of adult TGF-beta1(-/-) dentition show widespread pulpal and periapical inflammation and necroses. In addition, the coronal surfaces of occluding molars show marked attrition. To determine whether the phenotypic changes in TGF-beta1(-/-) dentition are directly linked to the loss of TGF-beta1 rather than the inflammatory process itself, we studied adult dentition in TGF-beta1(-/-) mice backcrossed into immunodeficient backgrounds. Results of our histopathologic and radiographic analyses show that teeth of TGF-beta1(-/-) immunodeficient mice retain vitality in pulpal and periapical regions but show excessive wear of occlusal surfaces.

The early use of alcohol and tobacco: its relation to children's competence and parents' behavior

OBJECTIVES

Use of tobacco and alcohol during childhood predicts heavy use of these substances and use of illicit drugs during adolescence. This study aims to identify developmental correlates of tobacco and alcohol use among elementary-school children.

METHODS

Cross-sectional surveys were used to measure tobacco and alcohol use, multiple indicators of child competence, parenting behaviors, and parental modeling of tobacco and alcohol use in a sample of 1470 third- and fifth-grade children. Both self-report and teacher-rated assessments were obtained, which allowed collateral testing of study hypotheses.

RESULTS

Children's tobacco and alcohol use was strongly related to low scores on several measures of child competence, both self-reported and teacher rated. Children's tobacco and alcohol use was also associated with less effective parenting behaviors and with parental use of tobacco and alcohol.

CONCLUSIONS

Children's early experience with tobacco and alcohol is associated with weak competence development and exposure to socialization factors that promote risk taking. Interventions to prevent early use of tobacco and alcohol are needed.

Can elderly residents with memory problems be prepared for relocation?

Relocation of elderly clients between residential establishments can be unsettling, although good preparation can help reduce negative effects and contribute to successful transfer. However, it is less clear whether preparation is feasible for residents with cognitive deficits and clarification of this issue was the objective of the study. Results indicated that with the exception of those with severe cognitive deterioration, residents generally retained awareness of impending relocation and reported feelings appropriate to the situation. Implications for the types of preparation are discussed.

Does hospital rundown affect long-stay clients?

In order to examine what happens to long-stay clients who remain in hospital, a retrospective analysis of annual surveys between 1984 and 1992 was undertaken. Data were derived from the REHAB scale, which provides measures of patient Total General Behaviour (TGB) and Deviant Behaviour (DB), together with data from the Supplementary Information Questionnaire (SIQ). Results indicate that skills and behaviour, as measured by TGB, do not deteriorate as a function of continuous length of stay or increasing age. However, TGB for certain clients is adversely affected by a reduction in the level of structured activity occurring during major episodes of contraction leading up to closure. In contrast, DB, which is relatively high for this group, fluctuates independently of rundown. The implications for hospital services in transition are discussed.

Dexamethasone vs. placebo for cisplatin-induced emesis. A randomized cross-over trial

A randomized cross-over trial of dexamethasone (10 mg I.V. before therapy, and 4 mg I.V. q 4 h X 6 doses) vs. placebo as antiemetic therapy was conducted in 19 patients receiving high-dose cisplatin. Sixteen patients and 32 treatment courses were fully evaluable. There was no significant difference between regimens in the number of emesis-free patients or the number of emetic episodes, though the duration of nausea symptoms may have been reduced. We conclude that dexamethasone as used in our trial is not an effective antiemetic in patients receiving cisplatin.

A prospective evaluation of indirect methods for detecting carotid atherosclerosis

The statistical efficacy of three indirect techniques for noninvasive diagnosis of carotid artery disease was assessed in a prospective, blind study of 103 persons. Oculoplethysmography-carotid phonoangiography, periorbital Doppler examination and supraorbital photoplethysmography were acceptably sensitive only to carotid artery occlusions and preocclusive carotid artery stenoses exceeding a 75 per cent diameter reduction. Less pronounced lesions could not be reliably detected by any of the techniques used either singly or in combination. Supraorbital photoplethysmography proved inferior to the other methods because of its poor specificity rate.

Pelvic disruption in the polytraumatized patient: a management protocol

This article reviews the experience with the management of 79 polytraumatized patients with pelvic fractures. The incidence of involvement of other systems was measured by the injury severity score. The average severity score was 33.5, and the mortality was 19%. Patients with a posterior disruption of the pelvis had a higher mortality, a higher "injury severity score," and required greater resuscitation efforts. Resuscitation of these patients requires efficient effective action. Adherence to our management algorithm, based on assessment of the patient's response, should help achieve that end.

Conducting tissues in univentricular heart of right ventricular type with double or common inlet

Four specimens of univentricular hearts of the right ventricular type, three with two atrioventricular valves and one with a common valve, have been examined histologically to identify the atrioventricular conduction system. Three of the specimens were initially thought to have only one chamber within the ventricular mass, a chamber which had a right ventricular trabecular pattern. On detailed examination and with removal of blocks of tissue for histologic study, a second, rudimentary chamber was found in the posterior ventricular wall. This chamber had a trabecular zone of the left ventricular type and was connected with the main chamber only via a small defect in the septum which separated the two chambers. In all four cases the connecting atrioventricular node was dound in normal relationship to atrial markers and the penetrating bundle descended onto the posterior wall of the main chamber. In three cases it ran along the crest of the septum between the main chamber and rudimentary chamber, in relation to the septal defect. In two cases left bundle branch tissue was identified running into the rudimentary chamber. This pattern of conducting system is different from that previously identified in other varieties of univentricular heart and again underlines the importance of intraoperative mapping of the conduction system during surgery of the univentricular heart.