Obesity in the global haemophilia population: prevalence, implications and expert opinions for weight management

Overweight and obesity may carry a significant disease burden for patients with haemophilia (PWH), who experience reduced mobility due to joint inflammation, muscle dysfunction and haemophilic arthropathy. This review aimed to define the prevalence and clinical impact of overweight/obesity in the global population of PWH. A detailed literature search pertaining to overweight/obesity in haemophilia in the last 15 years (2003-2018) was conducted, followed by a meta-analysis of epidemiological data. The estimated pooled prevalence of overweight/obesity in European and North American PWH was 31%. Excess weight in PWH is associated with a decreased range in motion of joints, accelerated loss of joint mobility and increase in chronic pain. Additionally, the cumulative disease burden of obesity and haemophilia may impact the requirement for joint surgery, occurrence of perioperative complications and the prevalence of anxiety and depression that associates with chronic illness. Best practice guidelines for obesity prevention and weight management, based on multidisciplinary expert perspectives, are considered for adult and paediatric PWH. Recommendations in the haemophilia context emphasize the importance of patient education and tailoring engagement in physical activity to avoid the risk of traumatic bleeding.

Age adjusted D-dimer in the Belfast Health and Social Care Trust: A retrospective study

D-dimers combined with clinical pre-test probability (PTP) scores are used to determine the likelihood of a venous thromboembolic event (VTE). It is recognised that with advancing age, d-dimer values increase, leading to a cohort of patients with a d-dimer above the standard cut-off of 500μg/L. A recent systemic review, examined the accuracy of an age-adjusted D-dimer in those aged > 50 years with a low clinical risk of a VTE. This showed an increase in specificity without loss of sensitivity. Our study, aimed to examine a population of patients, who between 2011 and 2014 underwent ultrasound Doppler studies of lower limbs. By applying a corresponding age-adjusted D-dimer, we determined the sensitivity and specificity and compared this to use of conventional D-dimer.

Safety and effectiveness of room temperature stable recombinant factor VIIa in patients with haemophilia A or B and inhibitors: Results of a multinational, prospective, observational study

INTRODUCTION

A room temperature stable formulation of recombinant activated factor VII (NovoSeven^® ), allowing convenient storage and therefore improved treatment access, has been developed. Bioequivalence to the previous NovoSeven^® was demonstrated in healthy humans, leading to European approval (2008). Although no confirmed cases of neutralising antibodies to rFVIIa in patients with haemophilia A or B have been observed with the original formulation, changes in formulation or storage condition may alter immunogenicity.

AIM

SMART-7™ was designed to investigate the safety of NovoSeven^® in a real-world setting in patients with haemophilia A or B with inhibitors.

METHODS

Study medication was not provided by the sponsor, and treatment was at the discretion of the treating physician, in accordance with the local label. Patient baseline information was collected at enrolment. Information on safety, drug exposure and bleeding episodes was collected and FVII antibody screening was encouraged at baseline and performed at the investigator's discretion.

RESULTS

Fifty-one patients were enrolled and 31 completed the study. Forty-one adverse events (AEs) were reported in 23 patients; 25 AEs in 14 patients were serious. No thromboembolic events were observed. Although four cases of reduced therapeutic response were reported, FVII antibody screening was negative. Forty-eight patients experienced 618 bleeding episodes and 93.4% of 609 evaluated bleeds were stopped by treatment. Of the 538 bleeding episodes treated with NovoSeven^® monotherapy, 94.2% stopped by end of treatment.

CONCLUSION

Data collected during the SMART-7™ study revealed no treatment-related safety issues and no FVII-binding antibodies for patients treated with NovoSeven^® under real-world conditions.

Intraosseous access to the circulatory system: An under-appreciated option for rapid access

In many emergency situations rapid vascular access is a priority, particularly in cases involving haemodynamic compromise. Traditional vascular access through the use of an intravenous cannula, although the preferred first line method, can in certain circumstances have a high rate of failure. A study by Minville et al (2006) showed that the success rate of first attempt venous cannulation can be as low as 76%. Repeated attempts at venous cannulation in patients with difficult vascular access wastes valuable time which in some situations could prove fatal.

Management of newly diagnosed chronic myeloid leukaemia during a twin pregnancy using leucapheresis: Case report and review of the literature

A case of chronic myeloid leukaemia diagnosed as an incidental finding in a 32-year-old woman, pregnant with twins at 11 weeks gestation, is presented. Management of the patient was with leucapheresis and supportive care until spontaneous delivery of two morphologically normal infants (one male, one female) at 37 weeks gestation. Special considerations while employing leucapheresis in pregnant patients are discussed.

Rotational thromboelastometry and its use in directing the management of coagulopathy in the battle injured trauma patient

The military hospital at camp bastion Afghanistan is reputed to be the world's busiest trauma centre. Much has been learnt there in the field of managing massive haemorrhage, the protocols used by the military show a significantly higher survival rate than might be expected of such injuries. This article aims to explain the use of rotational thromboelastometry (ROTEM) monitoring and its role in reducing mortality in battle injured trauma patients.

Agglutinins and cardiac surgery: a web based survey of cardiac anaesthetic practice; questions raised and possible solutions

INTRODUCTION

Cardiac surgery involves cardiopulmonary bypass during which the core temperature is generally lowered to hypothermic levels. Patients presenting for cardiac surgery are sometimes reported to have cold or warm autoantibodies at the time of blood screening. It is known that cold agglutinins may cause potentially life-threatening haemolysis, intracoronary haemagglutination leading to inadequate cardioplegia distribution, thrombosis, embolism, ischaemia or infarction. The risk (if any) posed by warm autoantibodies is less clear. Because of the absence of hospital policies and of clear UK guidelines that explain how to manage such cases, we decided to conduct a web-based survey regarding standard anaesthesia practice in patients with both cold and warm autoantibodies presenting for cardiac surgery.

METHODS

We devised a short electronic survey asking for responses to 8 questions on cold auto-antibodies and 2 on warm auto-antibodies. This was sent to all members of the Association of Cardiothoracic Anaesthetists. Responses were collated and expressed as percentages. Free text responses were analysed for trend or reported verbatim.

RESULTS

The results of our survey demonstrate that there is no consensus on the appropriate management of such patients, with responses ranging from cancelling surgery to proceeding without additional precautions.

CONCLUSIONS

In collaboration with haematologists and taking into account the available evidence, our institution has now developed a management strategy for cardiac patients with cold autoantibodies. Further studies will be required to determine the usefulness of our algorithm in daily practice.

Novel coagulation factor concentrates: issues relating to their clinical implementation and pharmacokinetic assessment for optimal prophylaxis in haemophilia patients

Prophylaxis is considered the optimal treatment regimen for patients with severe haemophilia, and may be especially important in the prevention of joint disease. Novel coagulation factor concentrates with prolonged half-lives promise to improve patient treatment by enabling prophylaxis with less frequent dosing. With the call to individualize therapy in haemophilia, there is growing awareness of the need to use pharmacokinetic (PK) assessments to tailor prophylaxis. However, for new factor concentrates, it is not yet known which PK values will be most informative for optimizing prophylaxis. This topic was explored at the Eighth Zurich Haemophilia Forum. On the basis of our clinical experience and a discussion of the literature, we report key issues relating to the PK assessment of new coagulation factors and include suggestions on the implementation of PK data to optimize therapy. As both inter- and intra-individual variability in factor half-life have been reported, we suggest that frequent PK assessments should be conducted. However, to diminish the burden of more frequent sampling, sparser sampling strategies and the use of population modelling should be considered. Guidelines on how to assay new factor concentrates, and which PK parameters should be measured, are needed. Concerns were raised regarding the possibility of breakthrough bleeding, and current thinking on how to prevent breakthrough bleeding may no longer be appropriate. Finally, as treatment adherence may be more important to ensure that a therapeutic level of a new coagulation factor concentrate is maintained, behavioural techniques could be implemented to help to improve treatment adherence.

Appraisal of the Glasgow assessment and management of alcohol guideline: a comprehensive alcohol management protocol for use in general hospitals

BACKGROUND

Guidelines exist for the management of alcohol withdrawal syndrome (AWS) but few have been assessed as to their suitability for general hospitals. The Glasgow Assessment and Management guideline for alcohol has been specifically developed for use in this context.

AIM

To determine if this alcohol assessment guideline aids the management of AWS in general hospitals.

DESIGN

The four components of the Glasgow Assessment and Management of Alcohol guideline were evaluated. This included the use of the Fast Alcohol Screening Test (FAST) to identify at risk patients, a risk stratification strategy to indicate fixed dose or symptom-triggered benzodiazepine treatment, the Glasgow Modified Alcohol Withdrawal Scale (GMAWS) for symptom-triggered treatment and a clear recommendation for vitamin prophylaxis of Wernicke's encephalopathy.

METHODS

FAST scores were assessed along with the CAGE (cut down, annoyed, guilty and eye-opener) screening tool to ascertain if a single screening tool could identify hazardous and dependent drinking. The GMAWS and Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) were compared between two medical units. A staff survey of the two AWS tools was also carried out.

RESULTS

FAST was able to identify both probable hazardous and dependent drinking. The GMAWS was reliable and gauged both physical and cognitive aspects of AWS. Staff generally preferred the GMAWS-based treatment as opposed to CIWA-Ar management and welcomed the Guideline as a whole.

CONCLUSION

The Glasgow Guideline aids the management of patients with AWS in an acute hospital setting. It allows early identification of at risk patients and directs effective therapeutic intervention.

Multicentre comparison of the Glasgow Blatchford and Rockall Scores in the prediction of clinical end-points after upper gastrointestinal haemorrhage

BACKGROUND

The Glasgow Blatchford Score (GBS) is increasingly being used to predict intervention and outcome following upper gastrointestinal haemorrhage (UGIH).

AIM

To compare the GBS with both the admission and full Rockall scores in predicting specific clinical end-points following UGIH.

PATIENTS AND METHODS

Data on consecutive patients presenting to four UK hospitals were collected. Admission history, clinical and laboratory data, endoscopic findings, treatment and clinical follow-up were recorded. Using ROC curves, we compared the three scores in the prediction of death, endoscopic or surgical intervention and transfusion. Results  A total of 1555 patients (mean age 56.7years) presented with UGIH during the study period. Seventy-four (4.8%) died, 223 (14.3%) had endoscopic or surgical intervention and 363 (23.3%) required transfusion. The GBS was similar at predicting death compared with both the admission Rockall (area under ROC curve 0.804 vs. 0.801) and full Rockall score (AUROC 0.741 vs. 0.790). In predicting endo-surgical intervention, the GBS was superior to the admission Rockall (AUROC 0.858 vs. 0.705; P<0.00005) and similar to the full Rockall score (AUROC 0.822 vs. 0.797). The GBS was superior to both admission Rockall (AUROC 0.944 vs. 0.756; P<0.00005) and full Rockall scores (AUROC 0.935 vs. 0.792; P<0.00005) in predicting need for transfusion.

CONCLUSIONS

Despite not incorporating age, the GBS is as effective as the admission and full Rockall scores in predicting death after UGIH. It is superior to both the admission and full Rockall scores in predicting need for transfusion, and superior to the admission Rockall score in predicting endoscopic or surgical intervention.

Outpatient management of patients with low-risk upper-gastrointestinal haemorrhage: multicentre validation and prospective evaluation

BACKGROUND

Upper-gastrointestinal haemorrhage is a frequent reason for hospital admission. Although most risk scoring systems for this disorder incorporate endoscopic findings, the Glasgow-Blatchford bleeding score (GBS) is based on simple clinical and laboratory variables; a score of 0 identifies low-risk patients who might be suitable for outpatient management. We aimed to evaluate the GBS then assess the effect of a protocol based on this score for non-admission of low-risk individuals.

METHODS

Our study was undertaken at four hospitals in the UK. We calculated GBS and admission (pre-endoscopy) and full (post-endoscopy) Rockall scores for consecutive patients presenting with upper-gastrointestinal haemorrhage. With receiver-operating characteristic (ROC) curves, we compared the ability of these scores to predict either need for clinical intervention or death. We then prospectively assessed at two hospitals the introduction of GBS scoring to avoid admission of low-risk patients.

FINDINGS

Of 676 people presenting with upper-gastrointestinal haemorrhage, we identified 105 (16%) who scored 0 on the GBS. For prediction of need for intervention or death, GBS (area under ROC curve 0.90 [95% CI 0.88-0.93]) was superior to full Rockall score (0.81 [0.77-0.84]), which in turn was better than the admission Rockall score (0.70 [0.65-0.75]). When introduced into clinical practice, 123 patients (22%) with upper-gastrointestinal haemorrhage were classified as low risk, of whom 84 (68%) were managed as outpatients without adverse events. The proportion of individuals with this condition admitted to hospital also fell (96% to 71%, p<0.00001).

INTERPRETATION

The GBS identifies many patients presenting to general hospitals with upper-gastrointestinal haemorrhage who can be managed safely as outpatients. This score reduces admissions for this condition, allowing more appropriate use of in-patient resources.

Relationship between theory of mind and language ability in children and adolescents with intellectual disability

BACKGROUND

The present study was designed to evaluate the validity of the false belief task as a measure of theory of mind development in individuals with intellectual disability (ID). In most if it variants, the false belief task is linguistically demanding. This raises the possibility that the finding that individuals with ID do poorly on it might reflect language difficulties rather than theory of mind difficulties. Complicating matters further, however, is the fact that there are theoretical reasons to suppose that there might be a relationship between some dimensions of language ability and theory of mind development in individuals with ID (as well as in other populations).

METHOD

In the present study, children and adolescents with ID and typically developing (non-verbal) mental age matches completed a standard false belief task and several tasks designed to measure language ability.

RESULTS

We reasoned that a pattern in which false belief performance was correlated with all measures of language ability would reflect an artefactual relationship, whereas a more highly circumscribed, theoretically sensible pattern of correlations that was similar across both groups would support the validity of the false belief task.

CONCLUSIONS

The results indicated that for individuals with ID who have limited narrative language skills, those limitations contribute substantially to their failure on the false belief task. For individuals with ID who have more highly developed narrative language skills (about 40% of the sample tested), however, the false belief task may provide a valid measure of their progress towards acquiring an adequate theory of mind. This latter conclusion was suggested by the fact screening out individuals who failed to meet linguistic and cognitive prerequisites for dealing with the performance demands of the false belief task yielded non-significant correlations between false belief performance and the language measures for both the group with ID and the typically developing comparison group.

Reconstructing the duplication history of a tandem repeat

One of the less well understood mutational transformations that act upon DNA is tandem duplication. In this process, a stretch of DNA is duplicated to produce two or more adjacent copies, resulting in a tandem repeat. Over time, the copies undergo additional mutations so that typically, multiple approximate tandem copies are present. An interesting feature of tandem repeats is that the duplicated copies are preserved together, making it possible to do "phylogenetic analysis" on a single sequence. This involves using the pattern of mutations among the copies to determine a minimal or a most likely history for the repeat. A history tries to describe the interwoven pattern of substitutions, indels, and duplication events in such a way as to minimize the number of identical mutations that arise independently. Because the copies are adjacent and ordered, the history problem can not be solved by standard phylogeny algorithms. In this paper, we introduce several versions of the tandem repeat history problem, develop algorithmic solutions and evaluate their performance. We also develop ways to visualize important features of a history with the goal of discovering properties of the duplication mechanism.

Friction in perspective

In the past, most frictional resistance studies have been conducted in a steady state condition that does not simulate the dynamics of the oral environment. Various oral functions as chewing, swallowing, speaking, etc, as well as the oral tissues contacting any orthodontic appliances, result in periodic, repetitive, minute relative motion at the bracket/arch wire interfaces several thousand times each day. This in turn affects the normal forces at the interfaces, and because frictional resistance is directly proportional to the normal force, a pilot study was undertaken to emulate the dynamic environment of the oral cavity and its effect on frictional resistance. Tests of a limited sample of stainless steel arch wires and brackets typically used in sliding mechanics revealed that frictional resistance was effectively reduced to zero each time minute relative movements occurred at the bracket/arch wire interfaces. Factors such as the degree of dental tipping, relative arch wire/slot clearances, and method of tying, did not have a measurable effect on frictional resistance in the simulated dynamics of the oral environment.

Tandem repeats finder: a program to analyze DNA sequences

A tandem repeat in DNA is two or more contiguous, approximate copies of a pattern of nucleotides. Tandem repeats have been shown to cause human disease, may play a variety of regulatory and evolutionary roles and are important laboratory and analytic tools. Extensive knowledge about pattern size, copy number, mutational history, etc. for tandem repeats has been limited by the inability to easily detect them in genomic sequence data. In this paper, we present a new algorithm for finding tandem repeats which works without the need to specify either the pattern or pattern size. We model tandem repeats by percent identity and frequency of indels between adjacent pattern copies and use statistically based recognition criteria. We demonstrate the algorithm's speed and its ability to detect tandem repeats that have undergone extensive mutational change by analyzing four sequences: the human frataxin gene, the human beta T cellreceptor locus sequence and two yeast chromosomes. These sequences range in size from 3 kb up to 700 kb. A World Wide Web server interface atc3.biomath.mssm.edu/trf.html has been established for automated use of the program.

Understanding referential expressions in context: use of common ground by children and adolescents with mental retardation

Listeners interpret utterances against the common ground, or network of presuppositions shared with the speaker. The first purpose of the study was to determine whether individuals with mental retardation use the major sources of common ground (i.e., physical copresence, linguistic copresence, and community membership) to resolve referential ambiguity. The second purpose was to determine whether they seek confirmation of their referent choices in accordance with the certainty of interpretation afforded by the common ground. The third purpose was to determine whether they signal noncomprehension when faced with ambiguity and common ground that is not informative. The final purpose was to evaluate the relationship between within-group variability in common ground use and measures of nonverbal cognition, receptive and expressive language, and social cognition. Participants were school-age individuals with mental retardation and typically developing children matched to them on nonverbal MA. Common ground use was examined in a role-playing task in which the participant responded to ambiguous utterances. Common ground was manipulated within participants. We determined whether referent selections were appropriate for the common ground, whether they were accompanied by confirmation requests, and whether noncomprehension was signaled. Both groups used all sources of common ground to resolve referential ambiguity at better than chance levels but were less successful in using community membership. Both groups also requested confirmation of their referent choices most often when the common ground was based on community membership. Both groups signaled noncomprehension when the common ground was not informative. Different aspects of common ground use were related to different predictors for the group with mental retardation.

On the distribution of k-tuple matches for sequence homology: a constant time exact calculation of the variance

We study the distribution of a statistic useful in calculating the significance of the number of k-tuple matches detected in biological sequence homology algorithms. The statistic is Rn,k, the total number of heads in head runs of length k or more in a sequence of iid Bernoulli trials of length n. Calculation of the mean is straightforward. Poisson approximation formulas have been used for the variance because they are simple and powerful. Unfortunately, when p = P(Head) is large, the Poisson approximation no longer works well. In our application, p is large, say .75, and we have turned instead to direct calculation of the variance. Surprisingly, we are able to show that the variance, which is based on the interactions of O(n2) random variables, can be computed in constant time, independent of the length of the sequence and probability p. This result can be used to calculate the mean and variance of a number of other head run statistics in constant time. Additionally, we show how to extend the result to sequences generated by a stationary Markov process where the variance can be calculated in O(n) time.

Pooling strategies for establishing physical genome maps using FISH

Often, in biological studies, it is necessary to identify an organism's chromosomes. In some organisms the individual chromosomes can be identified by staining procedures while many other species have a very large number of chromosomes, often of similar size, which defy identification by traditional staining methods. We have devised strategies, based on fluorescent in situ hybridization (FISH), which allow the assignment of a preset number of probes to each chromosome without prior chromosome identification. By hybridizing mixtures of probes labeled with different colored fluorescent molecules, the chromosomal origin of each probe can be determined.

Women and heart attack: a study of women's experiences

Cardiovascular disease in general, and myocardial infarction (MI) in particular, is the major health problem of females after 50 years of age. To date, heart disease research has focused primarily on males. The limited evidence suggests that the physical, psychological, and social ramifications of MI for women are significant, and different from those of men. Since the specific rehabilitation needs of women are not yet clear, this study was designed to explore the unique experiences and needs of women following a first MI. A phenomenological study using focus groups was used to explore the experiences, questions, concerns, and preferred interventions of women after a MI. Participants were female volunteers (n = 14) who had been hospitalized for a MI within the previous 6 months. Focus groups were audio taped and analysed by the investigators. Four major themes emerged: validation; perceived gender differences; role expectations/role tensions; and helps and hindrances to recovery.

Sequence alignment with tandem duplication

Algorithm development for comparing and aligning biological sequences has, until recently, been based on the SI model of mutational events which assumes that modification of sequences proceeds through any of the operations of substitution, insertion or deletion (the latter two collectively termed indels). While this model has worked fairly well, it has long been apparent that other mutational events occur. In this paper, we introduce a new model, the DSI model which includes another common mutational event, tandem duplication. Tandem duplication produces tandem repeats which are common in DNA, making up perhaps 10% of the human genome. They are responsible for some human diseases and may serve a multitude of functions in DNA regulation and evolution. Using the DSI model, we develop new exact and heuristic algorithms for comparing and aligning DNA sequences when they contain tandem repeats.

Signaling of noncomprehension by children and adolescents with mental retardation: effects of problem type and speaker identity

Previous research has demonstrated considerable within-individual and within-group variability in the signaling of noncomprehension by persons with mental retardation. The first purpose of this study was to determine whether within-individual variability in such signaling was related to differences in the nature of the inadequate message and the identity of the speaker. The second purpose was to evaluate the relationship between within-group variability in noncomprehension signaling and measures of cognition, receptive and excessive language ability, speech intelligibility, and social cognition. Participants were school-age individuals with mild mental retardation and typically developing children matched to them on nonverbal MA. Noncomprehension signaling was examined in a direction-following task in which inadequate message type and speaker were manipulated. It was found that message type, but not speaker, influenced noncomprehension signaling, with no difference between the two groups. We also found that performance on a test of receptive language ability was the best predictor of noncomprehension signaling for persons with mental retardation.

Circadian rest-activity disturbances in seasonal affective disorder

BACKGROUND

Previous studies hypothesized that seasonal affective disorder (SAD) was caused by a circadian rhythm abnormality. The purpose of this study was to ascertain whether rest-activity rhythms were phase delayed, diminished in amplitude, or more poorly entrained to the 24-hour day.

METHOD

Twenty healthy adult controls and 25 outpatients meeting Rosenthal-National Institute of Mental Health criteria for SAD and DSM-III-R criteria for major or bipolar depression with seasonal pattern had their levels of activity recorded for 72 hours (weekdays) using wrist-worn actigraphs.

RESULTS

Subjects with SAD had activity levels that were 11% lower than controls (P = .03), and their levels of activity were most attenuated during the first 2 hours after arising (P = .004). The relative amplitude of the circadian rhythm did not differ between groups. Patients with SAD were phase delayed by 50 minutes for the entire period (P = .02). Analysis of each individual day indicated that patients were delayed by up to 70 minutes (P = .007). Interdaily stability, an index of coupling between the rhythm and its zeitigeber was reduced in SAD (P = .01). Compared with controls, patients with SAD had best-fit circadian periods that were 92% more deviated from 24 hours (P = .007) and daily acrophase (time of the peak of the fit circadian rhythm) times that were 110% more variable between days (P < .001).

CONCLUSIONS

Patients with SAD have circadian rest-activity rhythms that are significantly phase delayed and more poorly entrained to the 24-hour day.

Effects of sampling context on the expressive language of children and adolescents with mental retardation

This study was designed to determine whether conversational samples of language should be supplemented with samples obtained in narrative, or storytelling, contexts when evaluating the expressive language skills of individuals with mental retardation. Language samples were elicited in both conversational and narrative contexts from 16 school-age individuals with mental retardation and 16 typically developing children matched to them on MA. An analysis of the samples demonstrated that both groups produced more syntactically complex language in narration than in conversation, whereas they were more talkative in conversation than in narration. These results suggest that conversational and narrative contexts should be used together when evaluating the expressive language performance of individuals with mental retardation.

Sexually dimorphic sterility phenotypes in Hoxa10-deficient mice

The Abdominal B (AbdB) genes constitute a distinct subfamily of homeobox genes that exhibit posterior domains of expression, including the genital imaginal disc in Drosophila and the developing urogenital system in vertebrates. We have mutated the AbdB gene Hoxa10 in mice. We report here that homozygotes are fully viable and show an anterior homeotic transformation of lumbar vertebrae. All male homozygotes manifest bilateral cryptorchidism resulting in severe defects in spermatogenesis and increasing sterility with age. Female homozygotes ovulate normally, but about 80% are sterile because of death of embryos between days 2.5 and 3.5 post coitum. This coincides spatially and temporally with expression of maternal Hoxa10 in distal oviductal and uterine epithelium. These results indicate a role for AbdB Hox genes in male and female fertility and suggest that maternal Hoxa10 is required to regulate the expression of a factor that affects the viability of preimplantation embryos.

A method for fast database search for all k-nucleotide repeats

A significant portion of DNA consists of repeating patterns of various sizes, from very small (one, two and three nucleotides) to very large (over 300 nucleotides). Although the functions of these repeating regions are not well understood, they appear important for understanding the expression, regulation and evolution of DNA. For example, increases in the number of trinucleotide repeats have been associated with human genetic disease, including Fragile-X mental retardation and Huntington's disease. Repeats are also useful as a tool in mapping and identifying DNA; the number of copies of a particular pattern at a site is often variable among individuals (polymorphic) and is therefore helpful in locating genes via linkage studies and also in providing DNA fingerprints of individuals. The number of repeating regions is unknown as is the distribution of pattern sizes. It would be useful to search for such regions in the DNA database in order that they may be studied more fully. The DNA database currently consists of approximately 150 million basepairs and is growing exponentially. Therefore, any program to look for repeats must be efficient and fast. In this paper, we present some new techniques that are useful in recognizing repeating patterns and describe a new program for rapidly detecting repeat regions in the DNA database where the basic unit of the repeat has size up to 32 nucleotides. It is our hope that the examples in this paper will illustrate the unrealized diversity of repeats in DNA and that the program we have developed will be a useful tool for locating new and interesting repeats.

Impact of parental substance use on adolescents: a test of a mediational model

Tested a mediational model of the relationship between parental substance use and adolescents' substance (tobacco, alcohol, marijuana) use with data from a sample of 1,775 adolescents, mean age 13.3 years, who completed a questionnaire including constructs from three theories of substance use. Mediational analyses identified five constructs involved in the relationship of parental and adolescent use. A structural model with latent constructs for substance use showed indirect effects of parental substance use through greater tolerance for deviance, lower behavioral control, greater perceived coping function of substance use, more negative life events, and more affiliation with peer users, plus a direct effect. Implications for the theory of transmission of risk are considered.

Development of a theory of mind in individuals with mental retardation

The ability of adolescents with mental retardation to reason about other people's mental states was examined. Subjects were asked questions about the knowledge and beliefs of characters in stories that they heard and saw enacted with props. The adolescents with mental retardation performed worse than did children without mental retardation matched for MA. The adolescents with mental retardation did better on questions requiring first-order reasoning than on those involving second-order reasoning; this pattern is similar to that found previously for children without mental retardation.

A quantitatively controlled method to study prospectively interstitial cystitis and demonstrate the efficacy of pentosanpolysulfate

A randomized, prospective, double-blind, placebo-controlled study was conducted at 7 clinical centers on 148 patients. Patients received orally either 100 mg. pentosanpolysulfate (a synthetic polysaccharide) 3 times per day or a placebo. Of the patients on drug therapy 32% showed significant improvement compared to 16% of those on placebo (p = 0.01). This study provides a model to assess this disease quantitatively in a prospective manner using a method whereby the patients globally assess their symptoms as either worse or improved by 0, 25, 50, 75 or 100%. Patients on drug therapy also experienced a significant decrease in pain and urgency (p = 0.04 and 0.01) on analogue scales when compared to placebo and also more drug patients showed an average increase of more than 20 ml. in voided volume than did placebo patients (p = 0.02). All adverse effects were minor, with 7 in the drug group and 10 in the placebo group. The results support the concept that some patients with the interstitial cystitis syndrome may have abnormal bladder surface glycosaminoglycans.

Swaledale sheep affected by natural scrapie differ significantly in PrP genotype frequencies from healthy sheep and those selected for reduced incidence of scrapie

PrP glycoprotein gene polymorphisms were examined in Swaledale sheep affected by natural scrapie, in healthy sheep and in Swaledales selected for low susceptibility to scrapie. The three groups differed significantly in frequencies of PrP genotypes detected by the restriction enzymes EcoRI, HindIII and BspHI, the latter being indicative of a PrP protein amino acid difference at codon 136. These frequency differences were confirmed in a single-flock study and present good evidence that scrapie susceptibility and resistance are associated with PrP gene variants in Swaledale sheep.

The Norrie disease gene maps to a 150 kb region on chromosome Xp11.3

Norrie disease is a human X-linked recessive disorder of unknown etiology characterized by congenital blindness, sensory neural deafness and mental retardation. This disease gene was previously linked to the DXS7 (L1.28) locus and the MAO genes in band Xp11.3. We report here fine physical mapping of the obligate region containing the Norrie disease gene (NDP) defined by a recombination and by the smallest submicroscopic chromosomal deletion associated with Norrie disease identified to date. Analysis, using in addition two overlapping YAC clones from this region, allowed orientation of the MAOA and MAOB genes in a 5'-3'-3'-5' configuration. A recombination event between a (GT)n polymorphism in intron 2 of the MAOB gene and the NDP locus, in a family previously reported to have a recombination between DXS7 and NDP, delineates a flanking marker telomeric to this disease gene. An anonymous DNA probe, dc12, present in one of the YACs and in a patient with a submicroscopic deletion which includes MAOA and MAOB but not L1.28, serves as a flanking marker centromeric to the disease gene. An Alu-PCR fragment from the right arm of the MAO YAC (YMAO.AluR) is not deleted in this patient and also delineates the centromeric extent of the obligate disease region. The apparent order of these loci is telomere ... DXS7-MAOA-MAOB-NDP-dc12-YMAO.AluR ... centromere. Together these data define the obligate region containing the NDP gene to a chromosomal segment less than 150 kb.

Different scrapie-associated fibril proteins (PrP) are encoded by lines of sheep selected for different alleles of the Sip gene

The incubation period of scrapie in sheep is controlled by the Sip gene which has two alleles (sA and pA). Following experimental challenge with SSBP/1 scrapie, a short incubation period is conferred by the partially dominant sA allele. Restriction fragment length polymorphisms of the scrapie-associated fibril protein (PrP) gene are associated with the Sip alleles. By sequencing the protein coding region of the PrP gene in Cheviot sheep selected for differing Sip genotypes, we have found four PrP protein variants which differ at three positions: amino acid 112 (Ala/Val), amino acid 130 (Arg/His) and amino acid 147 (Arg/Gln). The Val 112 variant can be distinguished at the DNA level by an RspXI restriction site which is not present in the Ala 112 form. Val 112 appears to be linked to a short incubation period of experimentally induced scrapie in the Cheviot sheep and therefore with the Sip sA allele. These results provide new evidence that the PrP protein may be a product of the Sip locus.

Restriction fragment length polymorphisms of the scrapie-associated fibril protein (PrP) gene and their association with susceptibility to natural scrapie in British sheep

We have investigated the correlation between restriction fragment length polymorphisms of the scrapie-associated fibril protein (PrP) gene and the incidence of natural scrapie in British sheep during the period from July 1988 to November 1990. Sixty percent of the scrapie-positive animals studied were homozygous for a 6.8 kb EcoRI fragment (e1) and a further 26% carried e1 as heterozygotes. This fragment is linked to susceptibility to experimental scrapie in a closed flock of Cheviot sheep. Twelve percent of cases were found to be homozygous for a 4.4 kb EcoRI fragment (e3) which in the Cheviot flock had been linked to relative resistance to scrapie. A third EcoRI fragment of 5.2 kb (e2) has also been found but is relatively rare and has not yet been associated with scrapie susceptibility. Four sets of flocks affected by natural outbreaks of scrapie divided into two groups. In three of these flocks, all scrapie cases carried e1 with high frequencies of e1e1 homozygotes. In the fourth, there were no e1e1 scrapie cases; all scrapie sheep carried e3 in approximately equal numbers of heterozygotes and homozygotes.

Course and outcome of drug abuse and medical and social conditions in selected young drug abusers

The course and outcome of drug abuse and medical and social conditions were investigated by following--in some aspects for up to 10 years--selected groups of young drug abusers who had had contact with health care and social welfare authorities in Gothenburg at the end of the 1960's. The follow-up was carried out by studying different registers and through interviews. The abusers were compared with a control group matched in terms of sex, age and daily sickness allowance. Abuse of cannabis predominated (2:1) over heavier drugs (primarily central stimulants i.v.) in the out-patient materials, while the reverse was the case in the in-patient material. About 40% of the drug users were interviewed and judged to be representative of their groups. After 4-6 years, 36-49% of the males and 23-48% of the females in the different materials were found registered as drug abusers; 22-38% of the men and 11-19% of the women were found after 8-10 years. According to the interviews, drug abuse persisted in 56-71% of the men and 26-60% of the women after 4-6 years and in 44-69% of the men and 13-36% of the women after 7-9 years. Abuse of cannabis persisted more often than abuse of heavier drugs, and had a lower mortality. Between 40 and 55% of drug abuse in the out-patient material, as well as among males in the social welfare material, was hidden during the follow-up period. The hidden abuse involved primarily cannabis; abuse of heavier drugs was generally known to the health care or social welfare authorities. Repeated or lengthy sick leave was more common than in the control group. In-patient adult psychiatric treatment was common among those in the health care material, although 40% of those in the social welfare material had also received such treatment. A diagnosis of drug abuse clearly predominated. Treatment of hepatitis was noted for 30-40%. More than 90% of drug abusers were registered with the social welfare authorities compared with less than half of the controls. Possession of driving licence was less common and the males had less often completed basic military training. The majority of those not registered for drug abuse after 4-6 years were employed or studying, and had considerably less need for social welfare and sick leave than those who were registered.(ABSTRACT TRUNCATED AT 400 WORDS)

Course and outcome of drug abuse in military conscripts

The course and outcome of drug abuse was studied by following a representative sample of military conscripts from Gothenburg who participated in a questionnaire survey concerning drug habits in 1969/70 in connection with registration for military service. Those with abuse registered in medical or social welfare files had, with few exceptions (11%), admitted to use of drugs in the questionnaire. However, 55% of those who in the questionnaire indicated high-frequency drug use and 89% of those who indicated low-frequency drug use were not registered. A large proportion of drug abuse was thus hidden. It was estimated that 6% of the whole population were registered for drug abuse up to the time of the questionnaire survey, and another 1% after that. In some cases registered drug abuse started as early as 9 years of age. For the under-fifteens solvents were the commonest first drug and for the over-fifteens cannabis. Few initiated drug abuse after the age of 20. In 30% of the registered men, the duration of abuse was less than or equal to 2 years, in 50% 2-10 years and in 20% less than or equal to 10 years. Distributed over the entire population, the proportions were 2%, 3% and 1%, respectively. Among high-frequency drugs users, 45% of the registered abuse remained after 5 years and 20% after 9 years. Compared with the drug-free "normal group" registered drug abusers had more often indicated running away from home, repeated truancy, nervous complaints, and had more often received child and youth psychiatric care and been registered with the Social Welfare Administration at an early age. Those who had long drug careers had lower intelligence levels than the normal group.

Validity of questionnaires in population studies on drug use

The concurrent validity of questionnaires in population studies on drug use was tested by comparing information from registers and interviews in two populations of young people from Gothenburg. The questionnaire items' sensitivity and specificity according to criteria and their capacity for prediction of drug use and no drug use and correct classification were calculated. Considering criteria weaknesses and other sources of errors, the validity of the questionnaire items was good. This conclusion is basic to longitudinal population studies which aim at clarifying the prognosis of drug abuse among young people.

Drug-related medical and social conditions in military conscripts

Drug-related medical and social conditions were investigated in a sample of military conscripts from Gothenburg. The men participated in a questionnaire study concerning drug abuse in 1969/70 and were traced in different registers for 5 to 7 years. Abusers demonstrated an over-consumption of psychiatric and social care. Of all military conscripts, 4% had received in-patient psychiatric care. A total of 18% of those who were high-frequency drug users received the same care. The predominant diagnosis at the time of psychiatric treatment was drug abuse. 42% of all military conscripts were registered with the Social Welfare Administration, while the figure was 71% for high-frequency drug users. The proportion of those with repeated or lengthy sick leave was greatest among those who indicated use of drugs in the questionnaire. The proportion who had driving licenses was lower among drug users and 39% of the high-frequency drug users were granted exemption from military service during the inspection proceedings compared with less than 10% among the remaining groups. Cumulative frequencies of registrations showed that a number of curves were high for groups of drug users at an early stage and that the curves had not leveled off at the end of the follow-up period.

Drug abuse in military conscripts. Prevalence and background

A questionnaire investigation in 1969/70 concerning drug use among military conscripts constitutes the basis for a study of the course and outcome of drug abuse and of drug-related medical and social conditions. 19% of military conscripts from Gothenburg indicated that they had at some time used drugs compared with 11% in the whole country. Between 4 and 5% of the men in Gothenburg indicated current drug use. Of those with some drug experience, more than 40% had used drugs more than 10 times. Cannabis smoking predominated. These figures are probably an underestimate because of the pattern of selection for military service. Those who had used drugs had more frequently used solvents and also had more advanced habits as regards alcohol consumption and tobacco smoking. Their intelligence level was somewhat higher than others' but they were less well-adjusted at home and at school. They had more frequently been in contact with the police or the Social Welfare Administration and more often had nervous problems.

Drug-related mortality in young people

Mortality in young drug users in Gothenburg was studied, by following up, for about a decade, two unselected groups (ninth grade pupils and military conscripts), and selected groups of abusers from the files of the health and social welfare authorities. In the unselected groups, cannabis smoking predominated. Solvents, LSD, and central stimulants taken orally or intravenously also occurred, particularly in the selected groups. Polydrug abuse including alcohol was common, opiate abuse was rare. Observed mortality was compared with expected mortality in the same age groups. The mortality rate was significantly increased in several of the selected groups, 2.4-6.9 times in men and 1.3-7.9 times in women. Among pupils with high-frequency drug use it was increased 5.5 times in boys and not significantly increased in girls. Among pupils with low-frequency drug use it was not significantly increased in boys and increased 4.7 times in girls. Among registered pupils the mortality was increased 4.2 and 8.2 times in boys and girls respectively. Military conscripts did not display an increased mortality. The proportion of unnatural deaths was over 90%, which was significantly higher than in the population. About half of the deaths were suicides and undetermined suicides. The proportion of undetermined suicides was high among men. Two of the male deaths were homicides. In about one third of the deaths alcohol was involved. Dextropropoxyphene was present in five of the 14 intoxications among men. Although mortality was increased it is lower than in other Scandinavian studies. This may be explained by the relative youth of the abusers and the rare occurrence of opiate abuse.

Drug-related criminality among young people

Drug-related criminality in Gothenburg, Sweden, was studied by following up criminal charges for stratified samples of unselected groups--ninth graders in 1968 and military conscripts in 1969/70--and selected groups--psychiatric patients and social welfare clients--of drug abusers. Cannabis was the predominant drug but central stimulants taken intravenously also occurred, particularly in the selected groups. During a follow-up period of 5-9 years cumulative criminality for men was twice as high among those who had stated high-frequency drug use in questionnaires, and four times as high among selected drug abusers, as the average in the unselected groups. Cumulative criminality was lower for women, but was nine times higher for women who had stated high-frequency drug use, and about 18 times higher for selected drug abusers, than was the average in the unselected groups. The most common drug-related crimes (in descending order) were crimes against property, against the Narcotics Drug Penal Act, and against the Road Traffic Offences Act. There was no significant increase in crimes against person. It is estimated that 25-50% of the criminals in the unselected groups of young men were drug abusers.