Social media and ADHD: implications for clinical assessment and treatment

The interaction between social media use and mental health is complicated. The mental health information shared on these platforms is frequently of poor quality but has the potential to exert powerful influence on users. Social media trend peaks in some mental disorders have led to increases in illness behaviour through social contagion. There has been a marked upsurge in online interest in attention deficit hyperactivity disorder (ADHD) over the last number of years, which has been particularly noticeable since the onset of the COVID-19 pandemic. The exponential increase in online ADHD interest has the potential to contribute to overloading mental health services with referrals. Mental health professionals and organisations need to consider strategies to ensure that quality health information is disseminated to younger audiences.

Infections in the first year of life and development of beta cell autoimmunity and clinical type 1 diabetes in high-risk individuals: the TRIGR cohort

AIMS/HYPOTHESIS

Accumulated data suggest that infections in early life contribute to the development of type 1 diabetes. Using data from the Trial to Reduce IDDM in the Genetically at Risk (TRIGR), we set out to assess whether children who later developed diabetes-related autoantibodies and/or clinical type 1 diabetes had different exposure to infections early in life compared with those who did not.

METHODS

A cohort of 2159 children with an affected first-degree relative and HLA-conferred susceptibility to type 1 diabetes were recruited between 2002 and 2007 and followed until 2017. Infections were registered prospectively. The relationship between infections in the first year of life and the development of autoantibodies or clinical type 1 diabetes was analysed using univariable and multivariable Cox regression models. As this study was exploratory, no adjustment was made for multiple comparisons.

RESULTS

Adjusting for HLA, sex, breastfeeding duration and birth order, those who had seven or more infections during their first year of life were more likely to develop at least one positive type 1 diabetes-related autoantibody (p=0.028, HR 9.166 [95% CI 1.277, 65.81]) compared with those who had no infections. Those who had their first viral infection aged between 6 and 12 months were less likely to develop at least one positive type 1 diabetes-related antibody (p=0.043, HR 0.828 [95% CI 0.690, 0.994]) or multiple antibodies (p=0.0351, HR 0.664 [95% CI 0.453, 0.972]). Those who had ever had an unspecified bacterial infection were more likely to develop at least one positive type 1 diabetes-related autoantibody (p=0.013, HR 1.412 [95% CI 1.075, 1.854]), to develop multiple antibodies (p=0.037, HR 1.652 [95% CI 1.030, 2.649]) and to develop clinical type 1 diabetes (p=0.011, HR 2.066 [95% CI 1.182, 3.613]).

CONCLUSIONS/INTERPRETATION

We found weak support for the assumption that viral infections early in life may initiate the autoimmune process or later development of type 1 diabetes. In contrast, certain bacterial infections appeared to increase the risk of both multiple autoantibodies and clinical type 1 diabetes.

Practice variation in the diagnosis of acute rejection among pediatric heart transplant centers: An analysis of the pediatric heart transplant society (PHTS) registry

BACKGROUND

Freedom from rejection in pediatric heart transplant recipients is highly variable across centers. This study aimed to assess the center variation in methods used to diagnose rejection in the first-year post-transplant and determine the impact of this variation on patient outcomes.

METHODS

The PHTS registry was queried for all rejection episodes in the first-year post-transplant (2010-2019). The primary method for rejection diagnosis was determined for each event as surveillance biopsy, echo diagnosis, or clinical. The percentage of first-year rejection events diagnosed by surveillance biopsy was used to approximate the surveillance strategy across centers. Methods of rejection diagnosis were described and patient outcomes were assessed based on surveillance biopsy utilization among centers.

RESULTS

A total of 3985 patients from 56 centers were included. Of this group, 873 (22%) developed rejection within the first-year post-transplant. Surveillance biopsy was the most common method of rejection diagnosis (71.7%), but practices were highly variable across centers. The majority (73.6%) of first rejection events occurred within 3-months of transplantation. Diagnosis modality in the first-year was not independently associated with freedom from rejection, freedom from rejection with hemodynamic compromise, or overall graft survival.

CONCLUSIONS

Rejection in the first-year after pediatric heart transplant occurs in 22% of patients and most commonly in the first 3 months post-transplant. Significant variation exists across centers in the methods used to diagnose rejection in pediatric heart transplant recipients, however, these variable strategies are not independently associated with freedom from rejection, rejection with hemodynamic compromise, or overall graft survival.

Empowerment, Digital Literacy and Shared Digital Health Records: The Value of 'nothing about me without me'

People with complex chronic conditions (CCCs), particularly those living in rural locations, experience numerous challenges in engaging with quality integrated healthcare services. The deployment of shared digital health records (SDHRs) has been promoted to lessen these issues. However, the implementation of them has actually exacerbated the problems and inhibited SDHR adoption and use with this cohort as well as amongst rural health professionals. Based on a larger study conducted with a rural community, supported to adopt and use their SDHR, this paper highlights one finding, an empowerment gap. This needs to be overcome if vulnerable healthcare users and health professionals are to be able adopt and use SDHRs and realise some of their promised benefits. Critically, the finding highlights the importance of these users being empowered as active participants in SDHR adoption and use including by overcoming the digital literacy challenges faced. The research demonstrates that traditionally marginalised people living with CCCs in rural communities can be empowered and benefit more from an SDHR in ways comparable with users from less vulnerable groups.

Safety Outcomes During Pediatric GH Therapy: Final Results From the Prospective GeNeSIS Observational Program

Context

Safety concerns have been raised regarding premature mortality, diabetes, neoplasia, and cerebrovascular disease in association with GH therapy.

Objective

To assess incidence of key safety outcomes.

Design

Prospective, multinational, observational study (1999 to 2015).

Setting

A total of 22,311 GH-treated children from 827 investigative sites in 30 countries.

Patients

Children with growth disorders.

Interventions

GH treatment.

Main outcome measures

Standardized mortality ratio (SMR) and standardized incidence ratio (SIR) with 95% CIs for mortality, diabetes, and primary cancer using general population registries.

Results

Predominant short stature diagnoses were GH deficiency (63%), idiopathic short stature (13%), and Turner syndrome (8%), with mean ± SD follow-up of 4.2 ± 3.2 years (∼92,000 person-years [PY]). Forty-two deaths occurred in patients with follow-up, with an SMR (95% CI) of 0.61 (0.44, 0.82); the SMR was elevated for patients with cancer-related organic GH deficiency [5.87 (3.21, 9.85)]. Based on 18 cases, type 2 diabetes mellitus (T2DM) risk was elevated [SIR: 3.77 (2.24, 5.96)], but 72% had risk factors. In patients without cancer history, 14 primary cancers were observed [SIR: 0.71 (0.39, 1.20)]. Second neoplasms occurred in 31 of 622 cancer survivors [5.0%; 10.7 (7.5, 15.2) cases/1000 PY] and intracranial tumor recurrences in 67 of 823 tumor survivors [8.1%; 16.9 (13.3, 21.5) cases/1000 PY]. All three hemorrhagic stroke cases had risk factors.

Conclusions

GeNeSIS (Genetics and Neuroendocrinology of Short Stature International Study) data support the favorable safety profile of pediatric GH treatment. Overall risk of death or primary cancer was not elevated in GH-treated children, and no hemorrhagic strokes occurred in patients without risk factors. T2DM incidence was elevated compared with the general population, but most cases had diabetes risk factors.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Recommendations for Enhancing the Implementation and Utility of Shared Digital Health Records in Rural Australian Communities

Internationally, shared digital health records are becoming an important addition to improving contemporary healthcare provision. In 2012, Australia launched its version of a shared digital health record, My Health Record, but enrolment is slow and there remain challenges in its practical implementation. Further, people living with complex and chronic conditions in rural and remote communities often experience challenges in obtaining equitable access to contemporary healthcare provision, including eHealth services. This paper reports on research that explored the experience of and engagement with My Health Record, in a rural Australian community setting. Based on the key research findings, recommendations are presented for improving national roll out of My Health Record. The findings highlight, to understand and engage vulnerable communities and support their adoption and use of shared digital health records, there is a need to move away from traditional models of healthcare delivery toward person-centred care delivered from a digital complex adaptive systems perspective.

Avoiding Failure for Australia's Digital Health Record: The Findings from a Rural E-Health Participatory Research Project

Low adoption and use of Australia's digital health record has driven the Australian Government to trial 'opt-out' registration from mid-June 2016. The assumption that automatic registration will increase use and thereby deliver benefit requires further investigation especially amongst those sections of the population in rural, regional, remote Australia living with complex chronic conditions. This paper reports on findings from a community based participatory e-health research project based on an initiative where people with complex chronic conditions and their carers attended a rural health promotion and lifestyle modification program. Through co-operative enquiry, health promotion officers and their clients were actively supported to adopt and use Australia's digital health record as an intervention. Simultaneously they were encouraged to reflect on its design and their perceptions of its overall impact on their individual ability to self-manage complex chronic conditions. The findings, ultimately contributing to a conceptual implementation and evaluation framework for Australia's digital health record that could directly avoid failure of the new 'opt-out' approach being adopted.

Patient-Centred Coordinated Care in Times of Emerging Diseases and Epidemics. Contribution of the IMIA Working Group on Patient Safety

OBJECTIVES

In this paper the researchers describe how existing health information technologies (HIT) can be repurposed and new technologies can be innovated to provide patient-centered care to individuals affected by new and emerging diseases.

METHODS

The researchers conducted a focused review of the published literature describing how HIT can be used to support safe, patient-centred, coordinated care to patients who are affected by Ebola (an emerging disease).

RESULTS

New and emerging diseases present opportunities for repurposing existing technologies and for stimulating the development of new HIT innovation. Innovative technologies may be developed such as new software used for tracking patients during new or emerging disease outbreaks or by repurposing and extending existing technologies so they can be used to support patients, families and health professionals who may have been exposed to a disease. The paper describes the development of new technologies and the repurposing and extension of existing ones (such as electronic health records) using the most recent outbreak of Ebola as an example.

Effects of ZNF804A on auditory P300 response in schizophrenia

The common variant rs1344706 within the zinc-finger protein gene ZNF804A has been strongly implicated in schizophrenia (SZ) susceptibility by a series of recent genetic association studies. Although associated with a pattern of altered neural connectivity, evidence that increased risk is mediated by an effect on cognitive deficits associated with the disorder has been equivocal. This study investigated whether the same ZNF804A risk allele was associated with variation in the P300 auditory-evoked response, a cognitively relevant putative endophenotype for SZ. We compared P300 responses in carriers and noncarriers of the ZNF804A risk allele genotype groups in Irish patients and controls (n=97). P300 response was observed to vary according to genotype in this sample, such that risk allele carriers showed relatively higher P300 response compared with noncarriers. This finding accords with behavioural data reported by our group and others. It is also consistent with the idea that ZNF804A may have an impact on cortical efficiency, reflected in the higher levels of activations required to achieve comparable behavioural accuracy on the task used.

Australia's personally controlled electronic health record and primary healthcare: generating a framework for implementation and evaluation

The Australian Government launched a personally controlled electronic health record (PCEHR) system in July 2012 committing $466.7m. Currently Australia lacks a clearly articulated implementation and evaluation framework and there remains limited detail on how this system's success will be determined. These problems are especially visible in primary healthcare. The UK and US, have been advocated as models, however they have started to report points of failure arising from their approaches. Evidence suggests that alternatives need to be considered, if mistakes are not to be replicated. Insights from e-health record implementation and evaluation approaches in Denmark and the Netherlands provide Australia with other approaches. The PCEHR requires different and radical thinking around the delivery of health services. Drawing on a range of English language articles identified between 1996 and 2012, the paper generates a conceptual framework for implementation and evaluation of the PCEHR. The generation of a grounded implementation and evaluation framework in primary healthcare will reduce provider scepticism and facilitate complex changes associated with PCEHR uptake.

Mood congruent psychotic symptoms and specific cognitive deficits in carriers of the novel schizophrenia risk variant at MIR-137

OBJECTIVE

The Schizophrenia Psychiatric Genome-wide Association (GWAS) Consortium recently reported on five novel schizophrenia susceptibility loci. The most significant finding mapped to a micro-RNA, MIR-137, which may be involved in regulating the function of other schizophrenia and bipolar disorder susceptibility genes.

METHOD

We genotyped 821 patients with confirmed DSM-IV diagnoses of schizophrenia, bipolar affective disorder I and schizoaffective disorder for the risk SNP (rs1625579) and investigated the clinical profiles of risk allele carriers using a within-case design. We also assessed neurocognitive performance in a subset of cases (n=399) and controls (n=171).

RESULTS

Carriers of the risk allele had lower scores for an OPCRIT-derived positive symptom factor (p=0.04) and lower scores on a lifetime measure of psychosis incongruity (p=0.017). Risk allele carriers also had more cognitive deficits involving episodic memory and attentional control.

CONCLUSION

This is the first evidence that the MIR-137 risk variant may be associated with a specific subgroup of psychosis patients. Although the effect of this single SNP was not clinically relevant, investigation of the impact of carrying multiple risk SNPs in the MIR-137 regulatory network on diagnosis and illness profile may be warranted.

Preserved cognitive function is associated with suicidal ideation and single suicide attempts in schizophrenia

OBJECTIVE

Suicide is the leading cause of death in schizophrenia. An association between suicidal behavior and both higher and lower cognitive ability in schizophrenia has been reported. To clarify this relationship, we investigated whether the relationship between suicidality and neurocognition varied according to differences in suicidal ideation and behavior.

METHODS

Three hundred and ten patients with DSM-IV diagnoses of schizophrenia or schizoaffective disorder were categorized based on patient and staff interviews as either non-suicide attempters, non-attempters expressing suicidal ideation, single suicide attempters, or multiple suicide attempters. These groups were compared on a neuropsychological battery examining current general cognitive ability, episodic and working memory, and attentional control.

RESULTS

Neuropsychological performance in those with a history of suicidal ideation (n=63), and those who had made one suicide attempt (n=48) was comparable. Together, these groups outperformed patients with no history of either suicidal behavior or ideation (n=172) on measures of IQ, episodic memory and working memory. Only differences in global cognition remained significant after controlling for between-group differences in depressive symptoms. Those who had either expressed suicidal ideation and/or made a single suicide attempt demonstrated trend level advantages in neuropsychological tests over those that had made multiple suicide attempts.

DISCUSSION

These findings support earlier evidence of an association between suicidality and neurocognitive ability in schizophrenia. Specifically, these data suggest that patients who have contemplated suicide or made a single suicide attempt have better cognitive functioning than those who have not. Suicidality in multiple attempters, who do not perform better in neurocognitive tests than those who have neither contemplated nor attempted suicide, is likely to be influenced by factors other than neurocognitive ability.

The SM judgment and the Mental Health Act 2008

The Mental Health Act 2008 was subject to little debate. This Act ensured that the detentions of involuntary psychiatric patients under the Mental Health Act 2001 remained lawful. The direct costs of administering the Act are estimated at Euro 993,377, which could have provided 37 years of supported accommodation to the patient involved.

Beneficial effects and mechanism of action of Momordica charantia juice in the treatment of streptozotocin-induced diabetes mellitus in rat

This study investigated the beneficial effects and mechanism of action of the juice of Momordica charantia in streptozotocin (STZ)-induced diabetes mellitus in rats. Diabetes mellitus was associated with significant (p < 0.01) time course reductions in body weight, plasma insulin and the number of insulin positive cells per islet and significant (p < 0.01) time course elevation in blood glucose and osmolarity and systolic blood pressure compared to age-matched healthy controls. Oral intake of M. charantia juice by STZ-induced diabetic rats partially reversed all the diabetes-induced effects measured. Daily oral administration of M. charantia juice to STZ-induced diabetic rates significantly (p < 0.01) reduced the Na+- and K+-dependent absorptions of glucose by the brush border membrane vesicles of the jejunum compared to the responses obtained in STZ-induced diabetic rat. Either insulin (100 MM) or the fruit juice lyophilised extract (5 microg x ml(-1)) can stimulate 14C-D-glucose uptake in L6 myotubes. These effects were completely blocked by wortmannin, an inhibitor of phosphatidylinositol 3-kinase. High concentrations (10-200 microg x ml(-1)) of M. charantia juice extract inhibited 14C-D-glucose uptake in L6 myotubes compared to the control response. The effect of M. charantia treatment was also investigated on myelinated fibre abnormalities in the tibial nerve of STZ-induced diabetic and control rats. The results show that diabetes was associated with significant (p < 0.05) reduction in the mean cross-sectional myelinated nerve fibres, axonal area, myelin area and maximal fibre area compared to end controls. Treatment of STZ-induced diabetic rats with M. charantia juice normalised the structural abnormalities of peripheral nerves. The results indicate that M. charantia can exert marked beneficial effects in diabetic rats, and moreover, it can regulate glucose uptake into jejunum membrane brush border vesicles and stimulate glucose uptake into skeletal muscle cells similar to the response obtained with insulin.

Momordica charantia fruit juice stimulates glucose and amino acid uptakes in L6 myotubes

The fruit of Momordica charantia (family: Cucurbitacea) is used widely as a hypoglycaemic agent to treat diabetes mellitus (DM). The mechanism of the hypoglycaemic action of M. charantia in vitro is not fully understood. This study investigated the effect of M. charantia juice on either 3H-2-deoxyglucose or N-methyl-amino-a-isobutyric acid (14C-Me-AIB) uptake in L6 rat muscle cells cultured to the myotube stage. The fresh juice was centrifuged at 5000 rpm and the supernatant lyophilised. L6 myotubes were incubated with either insulin (100 nM), different concentrations (1-10 microg ml(-1)) of the juice or its chloroform extract or wortmannin (100 nM) over a period of 1- 6 h. The results were expressed as pmol min(-1) (mg cell protein)(-1), n = 6-8 for each value. Basal 3H-deoxyglucose and 14C-Me-AIB uptakes by L6 myotubes after 1 h of incubation were (means +/- S.E.M.) 32.14 +/- 1.34 and 13.48 +/- 1.86 pmol min(-1) (mg cell protein)(-1), respectively. Incubation of L6 myotubes with 100 nM insulin for 1 h resulted in significant (ANOVA, p < 0.05) increases in 3H-deoxyglucose and 14C-Me-AIB uptakes. Typically, 3H-deoxyglucose and 14C-Me-AIB uptakes in the presence of insulin were 58.57 +/- 4.49 and 29.52 +/- 3.41 pmol min(-1) (mg cell protein(-1)), respectively. Incubation of L6 myotubes with three different concentrations (1, 5 and 10 microg ml(-1)) of either the lyophilised juice or its chloroform extract resulted in time-dependent increases in 3H-deoxy-D-glucose and 14C-Me-AIB uptakes, with maximal uptakes occurring at a concentration of 5 microg ml(-1). Incubation of either insulin or the juice in the presence of wortmannin (a phosphatidylinositol 3-kinase inhibitor) resulted in a marked inhibition of 3H-deoxyglucose by L6 myotubes compared to the uptake obtained with either insulin or the juice alone. The results indicate that M. charantia fruit juice acts like insulin to exert its hypoglycaemic effect and moreover, it can stimulate amino acid uptake into skeletal muscle cells just like insulin.

Assessment of orientation: relationship between informant report and direct measures

Although informant reports of everyday functioning are often used in dementia assessments, the actual correspondence between such indirect reports of functioning and actual performance has not been examined. Orientation results on the Dementia Questionnaire for Mentally Retarded Persons were compared to those obtained in direct assessment of orientation of 138 adults with mental retardation. Fair to good agreement was found between informant report and direct assessment. However, for some orientation items, nonverbal IQ, cause of mental retardation, and age affected the level of agreement. Thus, both informant report and direct measures of orientation are necessary in dementia assessments, and further work is needed on informant scale validation.

Medical and health care needs of families providing in-home care for relatives with developmental disabilities

The purpose of this investigation was to attempt to describe the health care needs of families providing in-home care to members with developmental disabilities as well as the characteristics and demographics of families providing in-home care. The survey included 761 families who participated in a federal demonstration project in rural southern Georgia. The results indicated that impoverished families need increased assistance to provide adequate medical and health care when providing in-home care to relatives experiencing developmental disabilities. Implications for administration of programs and development of policies are discussed.

Fragile X premutation is a significant risk factor for premature ovarian failure: the International Collaborative POF in Fragile X study--preliminary data

The preliminary results of an international collaborative study examining premature menopause in fragile X carriers are presented. A total of 760 women from fragile X families was surveyed about their fragile X carrier status and their menstrual and reproductive histories. Among the subjects, 395 carried a premutation, 128 carried a full mutation, and 237 were noncarriers. Sixty-three (16%) of the premutation carriers had experienced menopause prior to the age of 40 compared with none of the full mutation carriers and one (0.4%) of the controls. Based on these preliminary data, there is a significant association between fragile X premutation carrier status and premature menopause.

Plasma concentrations of immunoreactive relaxin activity and progesterone in the pregnant Asian elephant (Elephas maximus)

Immunoreactive relaxin activity and progesterone concentrations in weekly plasma samples were measured throughout six pregnancies in five Asian elephants (Elephas maximus). One animal aborted, one delivered a stillborn calf at term and the remaining pregnancies concluded normally with living young. Immunoreactive relaxin activity increased by week 20 of pregnancy to reach a mean peak concentrations of > 6 ng/ml in the second trimester. This was followed by a slow decline beginning approximately at 30 weeks before term. A smaller, secondary relaxin rise was observed during the final eight weeks preceding parturition and circulating concentrations remained above pre-pregnancy baseline values for 72 h after birth. In contrast, progesterone concentrations increased immediately after mating and rose to a maximum of > 2 ng/ml by mid-gestation. As with relaxin, progesterone concentrations began to decline gradually approximately 30 weeks before birth. More frequently collected samples before, during and after parturition revealed a decline to pre-pregnancy levels between 2-5 days before parturition, in contrast to elevated relaxin levels (1 ng/ml) during this time. The aborted pregnancy at week 35 was accompanied by a precipitous decline in both immunoreactive relaxin and progesterone concentrations one week before the visible termination of the pregnancy. The delivery of the term stillborn calf occurred five weeks after both immunoreactive relaxin and progesterone concentrations had declined to pre-pregnancy values. Results suggest that immunoreactive relaxin may be important, along with progesterone, in the maintenance of pregnancy in the Asian elephant as well as playing a role in preparation for birth and possibly to indicate foetal well-being.

Dementia in adults with Down syndrome: diagnostic challenges

Although dementia associated with Down syndrome is often presumed to be progressive and irreversible, variations in disease course have been described. In addition, prevalence rates have varied widely among studies. This interim report is a description of the status of 70 adults with Down syndrome who are being followed for signs of dementia. Of the 70, 12 met all criteria for dementia, 40 met subsets of criteria, and 18 met no criteria. Information is provided on instruments used, rationale for choice and revision of instruments as well as criteria used to identify dementia and changes in the status of the participants. The results suggest that extreme care is needed when diagnosing dementia in adults with Down syndrome, for both clinical and research purposes.

Rate of decline of cortisol concentrations in ovarian follicles following ACTH treatment in the sow

The rates of decline in cortisol concentrations in blood and ovarian follicular fluid were assessed in cyclic sows (n = 30) after treatment with saline or a depot form of adrenocorticotrophic hormone (ACTH). After a single injection of ACTH (0.5 iu/kg, BW, i.m.), peak cortisol values were achieved in blood within 3 to 4 h followed by a half-life net clearance rate (t1/2 of 2.40 +/- 0.29 (SE) h. The same dose of ACTH was then given at 12 h intervals from days 9 to 13 of the estrous cycle. On day 14 the concentrations of cortisol in follicular fluid were higher (P < 0.05) in ACTH-injected sows than in saline-injected controls. A t1/2 value of 37.81 h was determined for cortisol based on the decline in concentrations in follicular fluid collected on days 14, 16 and 18. This relatively slow rate of removal from developing ovarian follicles may have implications for the previously observed detrimental effects of increased cortisol concentrations on follicular development.

Molecular fragile X screening in normal populations

In December, 1993, we initiated a pilot project in which DNA fragile X (fraX) testing was offered during routine prenatal or genetic counseling to all pregnant women seen at the Genetics & IVF Institute, most of whom were referred for the indication of advanced maternal age. A brochure on fragile X syndrome was sent to each patient prior to her appointment and was reviewed by a counselor or physician during the counseling session. As of June 1995, 3,345 patients were offered testing; 474 women with no identified family history of mental retardation or learning disability and 214 women with a positive family history accepted the test on a self-pay basis. The second population screened was 271 potential donors in our anonymous egg donor program. DNA from blood was tested by Southern blot using EcoRI/EagI and StB12.3. If an expansion was detected, CGG repeat number was determined by PCR-based analysis. Among the 474 patients with unremarkable family histories, three fraX carriers were identified (repeat sizes = 60+), whereas none were found in the 214 patients with a positive family history. Among the potential egg donors, two high borderline patients were identified (repeat sizes = between 50 and 59). Our ongoing study indicates that screening of pregnant or preconceptual populations for fraX carrier status using DNA testing is accepted by many patients and is an important addition to current medical practice.

Preliminary findings of altered follicular activity in Holstein cows with coagulation factor XI deficiency

Factor XI (F XI) deficiency is an autosomal recessive coagulopathy found in Holstein cattle. Affected animals have a 50% greater prevalence of repeat breeding. Therefore, several parameters describing ovarian function were studied. Daily blood sampling revealed that progesterone concentrations were slower to decline from a peak at day 16 (p < 0.01) to values less than 3 nmol/L in F XI-deficient cows (5.14 +/- 0.69 days (mean +/- SD) versus 4.05 +/- 0.63 days in control animals), resulting in an oestrous cycle length of 24.7 +/- 2.1 days compared to 22.9 +/- 3.0 days, respectively. This was not due to an alteration in the availability of prostaglandin F2 alpha (PGF2 alpha) or oxytocin (OT) involved in luteolysis. No significant differences (p > 0.05) were seen between normal (n = 7) and F XI-deficient (n = 7) cows in the peak values or the area under the curve for the pulse in 13,14-dihydro-15-keto PGF2 alpha in response to OT challenge or in the parameters describing the pulse of ovarian OT secretion after PGF2 alpha injection (n = 7 for each) between days 12 and 14. Ovulatory follicular development was assessed by ultrasound monitoring and plasma 17 beta-oestradiol values at 8-h intervals after a luteolytic injection of cloprostenol (n = 6 for each). Follicular diameter was smaller (p < 0.05) and accompanied by lower peak oestradiol values near the time of ovulation in F XI-deficient cows. The results suggest that the oestrous cycle in F XI-deficient cows is characterized by a slower process of luteolysis that may be associated with smaller follicular development.

Pediatric home healthcare: a paradox

Although parents may welcome having their ill child cared for at home, they are not prepared to compromise privacy and family rituals, nor share control of their child. The purpose of this article is to provide a snapshot of problems that parents have encountered with pediatric home healthcare. Home care parents offer suggestions for other parents and home healthcare nurses and agencies, encouraging them to be proactive in preventing potential problems.

Rifampin-induced immune thrombocytopenia. A case report

In this report, a case of rifampin-induced immune thrombocytopenia with the following characteristics is described: (a) thrombocytopenia follows intermittent drug administration; (b) onset occurs within hours of drug ingestion; (c) IgG antirifampin antibody binds in vitro to normal platelets only in the presence of rifampin; (d) thrombocytopenia resolves quickly in the absence of rifampin; (e) using immunofluorescence microscopy, IgG binding to normal platelets was seen with the patient's serum only in the presence of rifampin, and (f) using fluorescence spectrofluorometry, an absence of rifampin binding to normal platelets was demonstrated. Although the serological studies are not definitive, the mechanism of thrombocytopenia in the patient can best be explained by the formation of immune complexes composed of rifampin-antirifampin antibody binding to platelets causing their rapid clearance from the circulation.

Temporal changes in serum prostaglandin F2α and oxytocin in dairy cows with short luteal phases after the first postpartum ovulation

Luteolysis in the cow depends upon an interaction between prostaglandin F2alpha (PGF2alpha) and oxytocin. The objectives of our study were 1) to determine oxytocin concentrations in postpartum dairy cows and 2) to identify the temporal relationship between oxytocin and PGF2alpha release patterns during luteolysis in normal and abbreviated estrous cycles in the postpartum period. Serum oxytocin and PGF2alpha metabolite (PGFM) concentrations from nine cows which had short estrous cycles (<17 d) were compared with those of six cows which had normal estrous cycles. Serum basal oxytocin concentrations in short estrous cycle cows (23.7 to 31.1 pg/ml) were higher (P<0.05) than those of normal estrous cycle cows (14.6 to 19.8 pg/ml). Oxytocin concentrations increased to peak values in both short and normal cycle cows, during luteolysis. Basal PGFM concentrations (112.2 to 137.4 pg/ml) were higher in cows with short cycle (P<0.05) than in cows with normal cycles (62.9 to 87.5 pg/ml). The increase in PGFM concentrations during luteolysis was significant in both normal cycle and short cycle cows (P<0.05). Increases in serum PGFM concentrations were always associated with increases in serum oxytocin concentrations in normal cycle and short cycle cows and the levels decreased simultaneously before the subsequent estrus. Results support the idea of a positive relationship between PGF2alpha and oxytocin concentration during the estrous cycle as well as a possible synergistic action of these hormones in the induction of luteolysis in dairy cattle.

Prevalence of equine onchocerciasis in southeastern and midwestern United States

Of 664 horses reported to have originated in southeastern and midwestern United States, 341 (51.4%) were positive for Onchocerca cervicalis cutaneous microfilariasis. The highest prevalence of 68.8% was recorded for horses from Virginia. Horses with the highest concentrations of microfilariae (as high as 19,770 microfilariae/mg in 1 horse) were from the Southeast (Georgia, Florida, Tennessee, and Alabama). For horses from South Carolina, the prevalence of infection was 57.1%; from the Midwest (Kentucky, Illinois, Ohio, and Indiana), 54.4%; from North Carolina, 45.5%; from Pennsylvania, 7.7%; and from Minnesota, 5%. Histories and ages of the horses were not known, but most horses were approximately 15 years old. Compared with horses from other states, horses from Pennsylvania were younger, which may have accounted for their lower prevalence of infection.

Normal survival of Rh0 (D) negative, LW (a+) red cells in a patient with allo-anti LWa

The serum of an Rh0 (D)+ Caucasian female with a prior history of transfusions contained anti- LWa , reacting moderately with Rh0 (D)+ and weakly with Rh0 (D)- red cells at the antiglobulin phase. Since transfusions were required, Chromium (51Cr) survival studies and mononuclear phagocyte assays (MPA) were used to predict in vivo survival. The MPA value of 6% of the positive control predicted a low likelihood of clinically significant extravascular destruction and 51Cr survival studies indicated greater than 95% survival at 1 h and 78% survival at 20 h for rr erythrocytes. Transfusion of 4 units of Rh0 (D)-, serologically incompatible red cells increased the hemoglobin from 5.2 to 11.4 g/dl and the titer of anti- LWa against rr red cells from 4 to 1,024 7 days after the transfusion. A second 51Cr survival also indicated normal survival of rr erythrocytes. 3 additional Rh0 (D)- units were successfully transfused.

Epithelial-derived basal lamina regulation of mesenchymal cell differentiation

The mechanisms by which epithelial-mesenchymal interactions result in differentiation are not known. A number of recombinations between vertebrate tissues associated with epidermal organs (e.g. skin, feather, mammary gland, salivary gland, tooth organ) indicate that regional mesenchymal specificity is instructive for determination and differentiation of epithelial phenotypes. In epidermal organs within which mesenchyme becomes determined and differentiates into a unique phenotype, such as during tooth organogenesis and odontoblast differentiation. Does the epithelial-derived basal lamina regulate mesenchymal differentiation into odontoblasts and the expression of dentine extracellular matrix? Experiments were designed to test the hypothesis that murine or avian epithelial-derived basal lamina possess information which is instructive for determined dental mesenchyme to differentiate into odontoblasts. The strategy was to examine homologous and heterologous tissue recombinants between Theiler stage 25 C57BL/6 molar tooth organs and Hamburger-Hamilton equivalent stage 22-26 Japanese Pharoah quail mandibular processes. Trypsin-dissociated molar epithelium and mesenchyme, reconstituted, secreted a basal lamina within 8 hours and mesenchyme differentiated into odontoblasts and formed dentine matrix within 3 days. Isolated trypsin-dissociated mesenchyme did not differentiate in vitro, whereas heterologous recombinants between odontogenic mesenchyma and quail epithelia resulted in odontoblasts and dentine production. Mouse tooth or quail mandibular epithelia served to regulate odontogenic mesenchyme differentiation. EDTA-dissociated mouse molar mesenchyme, in the absence of epithelium but with adherent basal lamina, routinely differentiated into odontoblasts. Control tooth organs routinely formed both dentine and enamel extracellular matrices within 7-10 days in our serumless, chemically-defined organ culture system. Regulation of determined mesenchymal cells to differentiate into functional and highly specialized odontoblasts appears to be mediated by epithelial-derived basal lamina and is not species or organ-specific.

Initiation of quail and mouse mandibular chondrogenesis and osteogenesis in a serumless, chemically-defined medium

To evaluate the requirement of vascular and/or neurotrophic-derived factors on determination and differentiation of chondrogenic and osteogenic phenotypes, early embryonic quail and mouse mandibular processes were cultured using a modified Trowell method in a serumless, chemically-defined medium for 10 days. Quail HH stage 22 and mouse Theiler stage 16 mandibular processes formed cartilage and produced osteoid under these experimental conditions. Chondrogenic and osteogenic phenotypes were expressed without serum or other exogenous growth-promoting influences.

The usefulness of NOR and RFA banding in prenatal diagnosis: a case report

Prenatal chromosome analysis of amniotic cells showed a male fetus to carry an unusual marker D chromosome containing extra genetic material on the short arm, which could be interpreted as a possible t(D;G) or t(D;Fq) unbalanced translocation using non-branded preparations or a routine GTG band method. Analysis of this marker by NOR and RFA banding and parental chromosome studies showed the marker to be an unusual variant of the satellited area of chromosome 15, with no associated phenotypic anomalies. The usefulness of NOR and RFA banding as aids in chromosome identification in prenatal diagnosis is discussed.

Chemically-defined organ culture of embryonic mouse tooth organs: morphogenesis, dentinogenesis and amelogenesis

Chemically-defined in vitro conditions without serum have been identified which are permissive for embryonic mouse tooth organs to express morphogenesis and cytodifferentiation. In the absence of antibiotics, embryonic extracts, autologous and/or heterologous sera, molar tooth organs from Theiler stage 25 embryos (C57BL/6, A/Jax and Tabby mouse strains) routinely formed discrete dentin and enamel extracellular organic matrices within 10 days of continuous in vitro cultivation. Collagen and non-collagenous protein synthesis and secretion by differentiated cells within explants, between 9 and 10 days in vitro, were studied with light microscopic autoradiography. Finally, explants of embryonic mouse molar tooth organs have been maintained in organ culture for three week without serum supplementation.