Public interest in medical assistance in dying and palliative care

OBJECTIVES

Medical assistance in dying (MAiD) is legal in an increasing number of countries, but there are concerns that its availability may compromise access to palliative care. We assessed public interest in MAiD, palliative care, both, or neither, and examined characteristics associated with this interest.

METHODS

We surveyed a representative sample of the adult Canadian public, accessed through a panel from May to June 2019. Weighted generalised multinomial logistic regression analyses were used to determine characteristics associated with interest in referral to palliative care, MAiD, or both, in the event of diagnosis with a serious illness.

RESULTS

Of 1362 participants who had heard of palliative care, 611 (44.8% weighted (95% CI 42.1% to 47.5%)) would be interested in both MAiD and palliative care, 322 (23.9% (95% CI 21.5% to 26.2%)) palliative care alone, 171 (12.3% (95% CI 10.5% to 14.1%)) MAiD alone and 258 (19.0% (95% CI 16.9% to 21.2%)) neither. In weighted multinomial logistic regression analyses, interest in both MAiD and palliative care (compared with neither) was associated with better knowledge of the definition of palliative care, older age, female gender, higher education and less religiosity; interest in palliative care alone was associated with better knowledge of the definition of palliative care, older age, female gender and being married/common law; interest in MAiD alone was associated with less religiosity (all p<0.05).

CONCLUSIONS

There is substantial public interest in potential referral to both MAiD and palliative care. Simultaneous availability of palliative care should be ensured in jurisdictions where MAiD is legal, and education about palliative care should be a public health priority.

Public knowledge and attitudes concerning palliative care

OBJECTIVE

WHO recommends early integration of palliative care alongside usual care to improve quality of life, although misunderstanding of palliative care may impede this. We compared the public's perceived and actual knowledge of palliative care, and examined the relationship of this knowledge to attitudes concerning palliative care.

METHODS

We analysed data from a survey of a representative sample of the Canadian public, accessed through a survey panel in May-June 2019. We compared high perceived knowledge ('know what palliative care is and could explain it') with actual knowledge of the WHO definition (knew ≥5/8 components, including that palliative care can be provided early in the illness and together with life-prolonging treatments), and examined their associations with attitudes to palliative care.

RESULTS

Of 1518 adult participants residing in Canada, 45% had high perceived knowledge, of whom 46% had high actual knowledge. Participants with high (vs low) perceived knowledge were more likely to associate palliative care with end-of-life care (adjusted OR 2.15 (95% CI 1.66 to 2.79), p<0.0001) and less likely to believe it offered hope (0.62 (95% CI 0.47 to 0.81), p=0.0004). Conversely, participants with high (vs low) actual knowledge were less likely to find palliative care fearful (0.67 (95% CI 0.52 to 0.86), p=0.002) or depressing (0.72 (95% CI 0.56 to 0.93), p=0.01) and more likely to believe it offered hope (1.88 (95% CI 1.46 to 2.43), p<0.0001).

CONCLUSIONS

Stigma regarding palliative care may be perpetuated by those who falsely believe they understand its meaning. Public health education is needed to increase knowledge about palliative care, promote its early integration and counter false assumptions.

Low prevalence of Staphylococcus aureus colonization among dental students in a teaching hospital in Malaysia

Staphylococcus aureus is an important microorganism which is associated with infections in the hospital setting. It is spread mainly through contaminated hands of the healthcare worker or through the underlying colonization of this microorganism in the nasal cavity of the healthcare worker. Apart from the healthcare worker, medical and dental students also can be source of the transmission because they are also engaged with the patients during their training period. The objective of this study was to determine the prevalence and risk of S. aureus colonization among dental students. Cross sectional study was conducted in the month of May 2014 involving a total of 205 dental students (104 pre-clinical years and 101 clinical years) from School of Dental Sciences, Universiti Sains Malaysia. The questionnaires were distributed and nasal swabs were collected. A total of 205 dental students participated in this study which comprises 50.7% pre-clinical year and 49.3% clinical year students. Their age ranged from 20 to 26 years old, with a mean (standard deviation) of 22.29 (1.73) years. The male to female ratio was 1:2.5. Eighteen percent of dental students had S. aureus colonized in their nasal cavity. No colonization of Methicillin resistant S. aureus strain was found in their nasal cavity. A carriage of S. aureus was significantly associated with the presence of health care worker among their family member. Healthcare worker may acquire S. aureus from the hospital, colonized in their nasal cavity and spread it to other family members via inhalation and close contact, however further study on this area is recommended to find out their relationship. S. aureus carrier among dental students worth screening to look whether the carry resistant strain i.e. MRSA to prevent spread to other patients. This is because they also involved in the clinical management during their clinical year study.

Tuberculosis in adults

Tuberculosis (TB) in Malaysia is rising due to multiple factors and issues related to its management are addressed in the updated evidence-based clinical practice guidelines. Screening for active TB should be considered in high risk groups. Light emitting diode-based fluorescence microscopy and nucleic acid amplification tests are recommended investigations. Health education and standardised 6-month daily antituberculosis (antiTB) regimen are among important elements for successful treatment. Latent TB infection screening should only be performed on high risk individuals. AntiTB regimen offered to HIV-positive adults should be the same as for HIV-negative adults and timing to initiate highly active antiretroviral therapy in patients with TB is based on CD4 count. All patients on antiTB treatment should be monitored to assess their response to treatment and to identify problems associated with it.

Back to basic: bio-burden on hands of health care personnel in tertiary teaching hospital in Malaysia

Hands of Health Care Personnel (HCP) are one of the most common vehicles for the transmission of infection. Microorganisms can survive well on the hands of HCP for a certain duration. Therefore, the purpose of this study is to bring awareness to HCP that their hands can actually be contaminated with many microorganisms. These microbes on the hands of HCP can potentially infect their patients if they do not comply with the proper hand hygiene practice. This cross-sectional study was conducted at a randomly selected Intensive Care Unit (ICU) and general ward in a hospital. Twenty five HCP from each ward were randomly selected and their hands were imprinted on blood culture plates. Microorganism growth were quantified and identified. Data were analyzed and presented as descriptive analysis. One hundred blood agar plates were processed and analyzed. Majority (71%) of the samples had more than 50 colony-forming units (CFU) and only 17% of the samples had less than 25 CFU. Microorganisms identified include Staphylococcus spp., Acinetobacter spp., Enterobacteriaceae, Pseudomonas spp., Moraxella, Delftiaacidovorans and fungi. All isolated microorganisms were antibiotic sensitive strain. This study showed that the hands of HCP were contaminated with many microorganisms. Therefore, it is imperative that HCP must practice proper hand hygiene when taking care of their patients in the wards.

A Case of Recurrent Respiratory Papillomatosis Successfully Removed Via Endoscopic Argon Plasma Coagulation (APC) With No Evidence of Recurrence

Recurrent respiratory papillomatosis (RRP) is a benign disease caused by the human papilloma virus (HPV), characterized by the formation of recurrent, epithelial neoplastic lesions in the airways. While benign, they can cause significant airway obstruction in some cases. Difficulties in treatment arise from the recurrent nature of the lesions despite repeated procedures. Other known procedures that result in deep tissue damage also cause unacceptable collateral damage to the underlying airway mucosa. We describe a case of recurrent papillomatosis that was successfully treated with argon plasma coagulation ( APC) when laser and electrocautery ablation had failed in the past. After the papillomatasis was treated with APC, there is no recurrence on repeat scope at 4 months and 9 months after the initial procedure. The procedure was done as a day case and there is no complication from the procedure. The property of the APC that allows it to cause only superficial thermal damage to the tissue makes it a suitable adjunct therapy to the treatment of papillomas, which are usually superficial lesions.

Methacholine challenge test as an adjunctive investigative tool in patients with asthma-like symptoms: the Sabah experience

INTRODUCTION

Patients with asthma-like symptoms pose a diagnostic dilemma when physical examination is normal. The usual practice in Malaysia would be to give empirical asthma treatment. Bronchial challenge test (BCT) is widely used in many countries to diagnose asthma objectively but it is not widely available in Malaysia.

OBJECTIVE

To describe our experience with BCT using methacholine at Queen Elizabeth Hospital as a supporting tool in the investigation of patients with asthma-like symptoms.

METHODOLOGY

Review of case notes of patients who underwent BCT from July 2008 till April 2009. BCT was performed via dosimeter technique. Results were classified as high hyper responsiveness if the provocative dose of methacholine required to achieve 20% fall in FEV1 (PD20) was less than or equal to 0.125 micromol, moderate hyper responsiveness if PD20 was between 0.125 to 1.99 micromol or mild hyper responsiveness if PD20 was between 2.00 to 6.6 micromol. PD20 of more than 6.6 micromol constitutes a negative MCT.

RESULTS

29 patients had BCT during the study period. 19 cases were included in this review. The age ranged from 13 to 70 years old. There were 12 males and 7 females. Duration of symptoms ranged from 2 weeks to 23 years. BCT was positive (mild or moderate hyper responsiveness) in 10 out of 19 patients. No patient had high bronchial hyper responsiveness.

CONCLUSIONS

BCT is a useful adjunctive tool in the investigation of patients presenting with asthma-like symptoms. This test obviates empirical asthma treatment. BCT should be made available in all major hospitals in Malaysia.

Encapsulation in sub-micron species: A short review and alternate strategy for dye encapsulation

The encapsulation of molecular species has received considerable attention in recent years. Polymers, dendrimers and microemulsions along with other systems have been used as precursors for the synthesis of encapsulating agents. Especially important in this field is the core-shell architecture. This structure offers the encapsulated species an extra level of protection due to the presence of a shell, covering the interior of a capsule. Dyes, porphyrines, drugs, cells and other active agents have been successfully encapsulated, and the host-guest interaction has been studied by various experimental techniques. A review is new provided of the progress made in this field in the last several years is presented. Different classes of synthetic approaches are presented and resulting encapsulation studies are summarised. An approach to the encapsulation of dansyl chloride dye in core-shell nanoparticles is also presented.

Lysine conjugate of acrylonitrile as antigenic sites in hemoglobin adducts

For biomonitoring environmental exposure to acrylonitrile (AN), a monoclonal antibody (mAb) A2D1, was developed to recognize specifically the hemoglobin (Hb) adduct, Hb-AN, but not Hb itself. This appears to be the first example that a small molecule-like AN may introduce new antigenicity into hemoglobin, which already exhibits multiple antigenic determinants. This report addresses the localization of the newly formed antigenic sites in human Hb-AN. As antigenic probes, the AN conjugates of 10 amino acids, six dipeptides, and four tripeptides were prepared as monitored by 1H NMR, and their antigenicity was evaluated by competitive inhibition immunoassay. A Lys-epsilonNH-AN was found essential to inhibiting activity. The potent peptide-AN inhibitors, containing a sequence of His and Lys, showed IC50 at the micromolar concentration, thus implicating human Hbalpha-89,90 and Hbbeta-143,144 in the distal heme pocket region as the new antigenic sites.

Subspeciation of nickel disulfide by carbon paste electrode voltammetry catalyzed by Ni 2+

In subspeciation of sulfidic nickel, carbon paste electrode voltammetry was developed for the specific determination of Ni3S2 or NiS, but NiS2 was found to be unreactive. Ni2+ in pH 7.2 acetate solution was able to catalyze NiS2 to undergo redox reactions. The cyclic voltammogram showed two anodic peaks at -0.3 and +0.7 V and a cathodic peak at -0.6 V. The first anodic peak at -0.3 V and the cathodic peak were common among the three nickel sulfides, but the second anodic peak at +0.7 V was unique to NiS2. This peak current gave a linear dose response to NiS2 from 40 to 610 microg, with a correlation coefficient of 0.994, and a detection limit of 40 microg.

Nickel speciation of residual oil fly ash and ambient particulate matter using X-ray absorption spectroscopy

The chemical speciation of Ni in fly ash produced from approximately 0.85 wt % S residual (no. 6 fuel) oils in laboratory (7 kW)- and utility (400 MW)-scale combustion systems was investigated using X-ray absorption fine structure (XAFS) spectroscopy, X-ray diffraction (XRD), and acetate extraction [1 M NaOAc-0.5 M HOAc (pH 5) at 25 degrees C]-anodic stripping voltammetry (ASV). XAFS was also used to determine the Ni speciation of ambient particulate matter (PM) sampled near the 400-MW system. Based on XAFS analyses of bulk fly ash and their corresponding acetate extraction residue, it is estimated that > 99% of the total Ni (0.38 wt %) in the experimentally produced fly ash occurs as NiSO4.xH2O, whereas > 95% of the total Ni (1.70 and 2.25 wt %) in two fly ash samples from the 400-MW system occurs as NiSO4.xH2O and Ni-bearing spinel, possibly NiFe2O4. Spinel was also detected using XRD. Acetate extracts most of the NiSO4.xH2O and concentrates insoluble NiFe2O4 in extraction residue. Similar to fly ash, ambient PM contains NiSO4.xH2O and NiFe2O4; however, the proportion of NiSO4.xH2O relative to NiFe2O4 is much greater in the PM. Results from this and previous investigations indicate that residual oil ash produced in the 7-kW combustion system lack insoluble Ni (e.g., NiFe2O4) but are enriched in soluble NiSO4.xH2O relative to fly ash from utility-scale systems. This difference in Ni speciation is most likely related to the lack of additive [e.g., Mg(OH)2] injection and residence time in the 7-kW combustion system.

Chemical speciation of nickel in fly ash by phase separation and carbon paste electrode voltammetry

In a risk-based approach to cost-effective management of power plant emissions, chemical speciation of fly ash is required. A quantitative but indirect separation of nickel phases by sequential extraction was undertaken in conjunction with direct analysis of the sulfidic nickel phase by carbon paste electrode voltammetry (CPEV). Four ash samples produced in a laboratory combustion system from burning high- and low-sulfur residual oil at excess O(2) of 1 and 2-3 mol% were studied. The extractions yielded five phases of nickel. The CPEV analysis of sulfidic nickel in the ash and extraction residues was performed in pH 5 acetate. The anodic peak (-0.1 V) unique to Ni(3)S(2), distinguishing it from NiS and NiS(2), was found to be absent from these ash samples. The CPEV method was consistent with phase extraction, which showed NiSO(4) being predominant with very low proportions of sulfidic nickel.

Sex differences on the MMPI-2 substance abuse scales in psychiatric inpatients

Sex differences on the MMPI-2 addiction scales (MacAndrew Alcoholism Scale-Revised, Addiction Acknowledgement Scale, Addiction Potential Scale) and their ability to distinguish between substance-abusing and nonabusing psychiatric inpatients were examined. Men obtained higher mean raw scores than women on the MacAndrew Alcoholism Scale-Revised and the Addiction Acknowledgement Scale, and substance abusers scored higher on all three scales. Even relatively low cutoff scores, however, on the MacAndrew Alcoholism Scale-Revised resulted in false negative rates of 37 to 39%. The results support the utility of the MMPI-2 substance abuse scales; however, lower cutoff scores should be used with women and within a psychiatric population.

Cognitive and affective improvement in brain dysfunctional patients who achieve inpatient rehabilitation goals

OBJECTIVE

To evaluate whether improvements in specific cognitive and affective functions are associated with achieving inpatient rehabilitation goals after the acute onset of brain dysfunction.

DESIGN

Retrospective analysis of data obtained in a prospective inception cohort study.

STUDY SETTING

Medical center and neurological institute.

SUBJECTS

Ninety-five heterogeneous brain dysfunctional patients who participated in an interdisciplinary inpatient neurorehabilitation program. Subjects were classified as having achieved their rehabilitation goals (Group 1) or not (Group 2) at time of discharge.

MAIN OUTCOME MEASURE

Number of treatment goals attained.

RESULTS

Although overall level of performance on the BNI Screen (BNIS) for Higher Cerebral Functions distinguished patients who later achieved their inpatient rehabilitation goals, on admission only performance on the visual spatial subtest was associated with later goal attainment. In contrast, at discharge, patients who showed greater improvement in awareness, affect, visual spatial skills, memory, and attention/concentration were likely to obtain their rehabilitation goals. This was true when the initial level of performance was taken into account.

CONCLUSIONS

Measurement of overall neuropsychological status and specific visual spatial abilities at time of admission may help determine which brain dysfunctional patients will obtain inpatient rehabilitation goals. Improvement in a variety of cognitive and affective functions was associated with goal attainment. Early cognitive rehabilitation should focus on both cognitive and affective disturbances to facilitate recovery and rehabilitation outcome.

Antisense knockdown of inducible nitric oxide synthase inhibits induction of experimental autoimmune encephalomyelitis in SJL/J mice

We used an antisense oligodeoxynucleotide (ODN) complementary to inducible nitric oxide synthase (iNOS) to inhibit experimental autoimmune encephalomyelitis (EAE) in female SJL/J mice, an animal model for multiple sclerosis. The antisense ODN was administered intraventricularly to mice daily for 10 days beginning at the time of adoptive transfer of myelin basic protein-specific T lymphocytes. The antisense ODN treatment significantly reduced the clinical score of EAE and blocked iNOS mRNA and protein synthesis, as well as iNOS enzyme activity within the central nervous system. The levels of nitric oxide and cyclic guanosine monophosphate were also significantly reduced by the antisense ODN treatment. Neither sense nor random ODN affected clinical EAE or iNOS expression. Moreover, the protein and enzyme activity level of constitutive neuronal nitric oxide synthase was not affected by the antisense ODN. Thus, we have shown that the iNOS antisense ODN specifically blocked iNOS expression and ameliorated the induction of EAE.

Speed of finger tapping and goal attainment after unilateral cerebral vascular accident

OBJECTIVE

To determine (1) if speed of finger tapping is bilaterally slow after an acute unilateral cerebral vascular accident (CVA) and (2) if speed of finger tapping and grip strength are related to achieving rehabilitation goals during the first few weeks after stroke.

DESIGN

Prospective inception cohort study.

STUDY SETTING

Medical center and neurological institute.

PARTICIPANTS

Fifty-one patients with unilateral CVAs.

MAIN OUTCOME MEASURES

Documentation of goal attainment at discharge and bilateral measures of speed of finger tapping and grip strength.

RESULTS

Speed of finger tapping and grip strength were often bilaterally below normal limits after an acute unilateral CVA, with the contralateral hand most affected. Speed of finger tapping, but not grip strength, in the ipsilateral hand was associated with achieving rehabilitation goals. Speed of finger tapping in the contralateral hand as well as bilateral grip strength was not related to achievement of rehabilitation goals.

CONCLUSIONS

Motor findings suggest that bilateral cerebral dysfunction may be common after an acute unilateral CVA. The speed of finger movement in the hand ipsilateral to the lesion may reflect the degree to which the so-called "unaffected" cerebral hemisphere has in fact maintained its functional integrity. As such, it may be a useful behavioral marker for predicting goal attainment during early stages of neurorehabilitation.

Gender differences of inducible nitric oxide production in SJL/J mice with experimental autoimmune encephalomyelitis

We identified gender related differences of inducible nitric oxide synthase (iNOS) expression and NO production in mice with experimental autoimmune encephalomyelitis (EAE). When myelin basic protein-specific T-lymphocytes derived from female mice were transferred, the female recipients developed more severe EAE and expressed higher levels of iNOS and NO than male recipients. When the T-lymphocytes derived from males were transferred, severe EAE was induced in neither female or male recipients and neither iNOS nor NO were detectable. These data show an association between No production and EAE severity, suggesting a possible role of NO in the pathogenesis of EAE.

Prescribed versus actual length of stay and inpatient neurorehabilitation outcome for brain dysfunctional patients

OBJECTIVE

To determine (1) whether brain dysfunctional patients have better rehabilitation outcomes if they receive prescribed length of stay (LOS) versus less than prescribed and (2) if LOS and cognitive status relate to goal attainment.

DESIGN

Prospective inception cohort study.

STUDY SETTING

Medical center and a neurological institute.

PARTICIPANTS

One hundred six patients with acute static brain lesions.

MAIN OUTCOME MEASURES

Documentation of goal attainment at discharge and maintenance of goals 6 months after discharge. All subjects also received neuropsychological tests at admission and discharge.

RESULTS

Patients who received prescribed LOS achieved their rehabilitation goals at discharge more frequently than patients who received less than prescribed LOS. There was, however, no difference between groups as to maintenance of rehabilitation goals 6 months after discharge. There was no relation between number of days spent in neurorehabilitation and number of goals achieved at discharge. Cognitive status at discharge was strongly related to achieving rehabilitation goals.

CONCLUSION

Although LOS may not specifically relate to goal attainment in a heterogeneous group of brain dysfunctional patients, patients who receive the prescribed LOS and who show notable improvement in cognitive status tend to achieve rehabilitation goals, compared with patients who do not.

Inducible nitric-oxide synthase and nitric oxide production in human fetal astrocytes and microglia. A kinetic analysis

The understanding of the induction and regulation of inducible nitric-oxide synthase (iNOS) in human cells may be important in developing therapeutic interventions for inflammatory diseases. In the present study, we not only demonstrated that human fetal mixed glial cultures, as well as enriched microglial cultures, synthesize iNOS and nitric oxide (NO) in response to cytokine stimulation, but also assessed the kinetics of iNOS and NO synthesis in human fetal mixed glial cultures. The iNOS mRNA was expressed within 2 h after stimulation and decreased to base line by 2 days. Significant levels of iNOS protein appeared within 24 h after stimulation and remained elevated during the culture period. A dramatic increase in NO production and NO-mediated events, such as the induction of cyclic guanosine monophosphate (cGMP), NADPH diaphorase activity, and nitrotyrosine occurred 3 days after stimulation, a delay of 48 h from the time of the first expression of iNOS enzyme. This delay of NO production was altered by the addition of tetrahydrobiopterin, but not by the addition of L-arginine, heme, flavin adenine dinucleotide (FAD), flavin mononucleotide (FMN), or NADPH. These findings suggest that a post-translational regulatory event might be involved in iNOS-mediated NO production in human glia.

Antisense blockade of inducible nitric oxide synthase in glial cells derived from adult SJL mice

Increasing evidence suggests a correlation between cytokine-induced nitric oxide synthase (iNOS) and demyelination in Multiple sclerosis (MS). Inhibition of iNOS may therefore be a novel therapeutic approach in MS. To test an antisense oligodeoxynucleotide (ODN) knockdown strategy for inhibiting iNOS, we used lipopolysaccharide (LPS) together with gamma-interferon (IFN-gamma) to induce iNOS in adult mouse mixed glial cell cultures. We administered an iNOS-derived antisense phosphorothiorate oligodeoxynucleotide (S-ODN) to block the induction. The antisense ODN treatment resulted in significant inhibition of LPS and IFN-gamma induced iNOS mRNA and protein expression. It also inhibited nitric oxide (NO) and cyclic GMP (cGMP) production in a dose dependent fashion. Sense and random S-oligo had no effect in any of these studies. These data indicate the efficacy and specificity of the antisense oligodeoxynucleotide approach in inhibiting iNOS in glial cells.

Base rate and simulated symptoms of mild head injury among normals

This study examined the vulnerability of several self-report instruments commonly used in neuropsychological evaluation - the Iowa Interview for Partial Seiwre-Like Symptoms, Postconcussion Checklist (PCL). Postconcussion Syndrome Checklist (PCSC), and Beck Depression Inventory (BDI) - to exaggerated or feigned complaints. Two hundred twenty-nine college student volunteers completed the instruments under one of three conditions: I) Base Rate/Control; simulated Head Injured, but 2) without or 3) with prospect of financial gain for the injury. Although the simulated Head Injured groups did not differ significantly from one another, both groups endorsed more symptoms than the Base Rate group, suggesting that the instruments are vulnerable, to simulation. Base rates of head injury symptoms in the normal population, laypersons' knowledge about the sequelae of mild head injury, and implications of using symptom checklists in medicolegal evaluations were discussed, as was the desirability of replicating this study with noncollege student populations.

The stability and prediction of depressive mood states in college students

Objective criteria for predicting dysphoric mood states in college students from measures of stress and cognitive and personality variables were developed and cross-validated. Contrary to Beck's diathesis-stress model of depression, although dysfunctional attitudes, together with the number and impact of life events, self-esteem problems, and level of traditional feminine personality characteristics, predicted concurrent levels of depressive symptoms, initial level of depression was the best predictor of future depression. Cross-validation of the criteria resulted in accuracy rates of 86 to 87%. Implications of these results and some secondary findings were discussed.

Lay theories of psychotherapy and perceptions of therapists: a replication and extension of Furnham and Wardley

This study examined laypersons' perceptions of psychotherapy, the experience of psychotherapy clients, and therapist credibility. Most of Furnham and Wardley's recent findings of positive and realistic lay views on psychotherapy and therapists were replicated. Age, sex, and psychological experience mediated some beliefs about therapy and clients' experience. Although positive views were associated with higher ratings on some aspects of therapist credibility, only the modality of the therapy (behavior vs. client-centered vs. rational-emotive individual therapy) influenced perceptions of overall credibility. Neither the fee charged nor the participant's sex had any effect on perceptions of therapist credibility.

Verbal vs. visual categories on the Wechsler Memory Scale-revised: how meaningful a distinction?

This study investigated whether the a priori classification of Wechsler Memory Scale-Revised (WMS-R) subtests into separate Verbal and Visual categories is warranted. Correlational and hierarchical clustering analyses found that (a) memory test performance correlated significantly with performance on subtests of Form II of the Luria-Nebraska Neuropsychological Battery (LNNB-II) that measure substrates of particular memory processes; and (b) subtests that appeared a priori to involve verbal skills clustered separately from those that appeared to involve nonverbal (visual) skills. However, the WMS-R Visual Paired Associates subtest did not cluster with the nonverbal scales as expected, and the LNNB-II Memory Scale appeared to be predominantly a test of verbal memory. Practical consequences of these findings were discussed.

Depressive mood states and their cognitive and personality correlates in college students: they improve over time

About 30% of 171 college student respondents reported at least mild dysphoria. Depressed mood states were associated with dysfunctional attitudes and self-esteem problems, but not with gender or self-reported problem-solving ability. Findings about sex role orientation were mixed. The freshmen reported the highest levels of dysphoria, problem-solving difficulties, and dysfunctional attitudes, but there appeared to be consistent, gradual improvements, such that by the senior year students reported significantly less dysphoria. However, a 2-month follow-up found no significant changes in these areas, which suggests that the observed improvements may occur more gradually or may be an artifact of selective attrition from college. Implications of the results and directions for future research were discussed.

Comparison of empirically derived and predicted standard scores for Form II of the Luria-Nebraska Neuropsychological Battery

Until Wong, Schefft, and Moses published norms for Form II of the Luria-Nebraska Neuropsychological Battery in 1990, Golden, Purisch, and Hammeke's 1985 regression equations were the only procedure available to interpret scores on Form II of the battery. In the present study comparison of the empirically based norms with standard scores obtained via the regression equations showed that (1) the scale means and standard deviations used in the development of the regression equations indicated substantially more impairment than those obtained by Wong, et al. and (2) the standard (T) scores predicted by the regression equations consistently underestimated impairment relative to the T scores obtained directly from Wong, et al.'s empirically derived norms. Reasons for, and implications of, these findings were discussed.

Revised norms and decision rules for the Luria-Nebraska Neuropsychological Battery, Form II

All control subjects from a previous Luria-Nebraska Neuropsychological Battery, Form II (LNNB2) normative study were combined with a considerably larger normative sample to produce a composite normative sample of 392 subjects with a mean high school educational level. Revised norms for the LNNB2 were developed based on this sample and were scaled with uniform T-scores to make scale elevations comparable across LNNB2 measures. Differences between the scalewise LNNB2 normative values and published alternatives were highly significant. A critical level and actuarial decision rules for differentiation of normal from neurologically impaired performance level were developed for the LNNB2 using the current empirical norms (86% accuracy with current sample empirical critical level; 89% accuracy with LNNB1 critical level). The normative prediction values of Golden, Purisch, and Hammeke for the LNNB2 were not satisfactory (69% overall, with 45% accuracy among brain damaged sample). There was no significant effect of sex of subject on LNNB2 performance level among the control subjects.

Intravenous double-dose contrast computed tomography in the diagnosis of spinal arteriovenous malformations: report of four cases

Spinal IV double-dose computed tomography (DCT) followed by reformation imagings was performed on 4 patients. Three cases received double-dose contrast injections, one case received a conventional single dose contrast material. 'Dots' enhancement on axial CT scanning and 'vasculature-like' hyperdense enhancement on sagittal and coronal reformation imagings were found in four cases of spinal arteriovenous malformation (AVM). Two were at the cervical region and two at the thoracic level. Typical serpentine filling defects were noted in the myelogram of three cases of spinal AVM. One patient suffered from acute onset of paraplegia (case 2), requiring that she received immediate surgical intervention after DCT scanning without myelography. Time for the whole procedure lasted approximately 20 minutes. In addition DCT followed by reformation imaging may be used as a noninvasive preliminary screening procedure for spinal AVMs.

Effects of speed vs accuracy instructions and field dependence on college students' digit-symbol matching performance

Correct digit-symbol matches of 68 women were significantly higher than those of 26 men. Speed instructions led to higher scores than those for accuracy or a neutral approach. Field dependence (Group Embedded Figures Test scores) interacted with instructions and field independent subjects scored higher when instructed to be accurate.

Inactivity of acrylonitrile epoxide to modify a Ha-ras DNA in a non-focus transfection-transformation assay

The transforming potential of acrylonitrile epoxide (ANO) was tested in a modified NIH3T3 transfection-transformation assay. This involves a new ras construct obtained by ligating a human c-Ha-ras-1 proto-oncogene to the pSV2neo mammalian vector. The new plasmid was allowed to react with ANO or an established carcinogen in vitro, and the modified ras DNA transfected into NIH 3T3 cells. The transfectants are subjected to triple selections: G418 (neomycin) resistance, low serum growth, and limit dilutions. The end points are scored by cell growth kinetics and monolayer saturation density. In using this protocol, the EJ tumor ras plasmid was the positive control, and anti-benzo[a]pyrene-7,8- dihydrodiol-9,10-epoxide (anti-BPDE) and N-methyl-N-nitrosourea were found to be positive in yielding transformants. Although ANO-modified ras gave rise to two G418R clones, both were scored negative due to their normal growth rate and monolayer density similar to the negative controls. Southern blot analysis of anti-BPDE transformant DNA revealed a fragment of 411 bp, indicating a ras mutation at codon 11 or 12. However, both the ANO clones showed the wild-type band of 355 bp by the same method.

Evidence for two conductance/exchange pathways for chloride in rat parotid secretory granules

Electron probe x-ray microanalysis was used to determine that bromide is localized to rat parotid secretory granules at early stages of an in situ Cl/Br washout experiment. Chloride efflux and bromide influx across the secretory granule membrane occurred with a time order of minutes. Since the Cl washout data indicated minimal Cl binding within the granule, and therefore minimal Br binding, the Br localization results suggest the presence of two or more anion conductance/exchange pathways in the granule membrane for the Cl (Br) ion.

S1 nuclease mapping of viral RNAs from a temperature-sensitive transformation mutant of murine sarcoma virus

The structures of murine sarcoma virus (MuSV) ts110 viral RNA and intracellular RNA present in MuSV ts110-infected cells (6m2 cells) have been examined by S1 nuclease analysis. A previous study involving heteroduplex analysis of MuSV ts110 viral RNAs hybridized to wild-type DNA revealed the presence of two MuSV ts110 RNAs, 4.0 and 3.5 kilobases (kb) in length, containing overlapping central deletions relative to wild-type MuSV 124 viral RNA (Junghans et al., J. Mol. Biol. 161:229-255, 1982). Here we show that the deletion (termed delta 1) in the 4.0-kb RNA has a 5' border located at about nucleotide 2409 (using the numbering system of Van Beveren et al., Cell 27:97-108, 1981), a position 63 bases upstream of the junction of the p30 and p10 coding sequences. The 3' border of the delta 1 deletion is found 1,473 bases downstream at approximately nucleotide 3883, 10 nucleotides downstream of the first mos gene initiation codon. In the 3.5-kb MuSV ts110 RNA, the 5' border of the deleted central region (termed delta 2) is located in a splice consensus donor site at approximately nucleotide 2017, 330 bases downstream from the junction of the p12 and p30 coding sequences, and extends about 1,915 bases in the downstream direction to nucleotide 3935, found in a splice consensus acceptor site about 55 nucleotides downstream of the first mos gene initiation codon and 30 bases upstream of the second initiation codon. No alteration of polyadenylate addition sites was observed in either MuSV ts110 RNA species, as compared with MuSV 349 RNA. The observation that the 5' and 3' borders of the deletion in the 3.5-kb RNA are within in-frame splice donor and acceptor sites suggests strongly that the 3.5-kb RNA is derived from the 4.0-kb RNA by a temperature-sensitive splice mechanism. Data presented here show unequivocally that formation of the 3.5-kb MuSV ts110 RNA from which the P85gag-mos polypeptide is translated is temperature sensitive. At 33 degrees C, with S1 analysis, the 3.5-kb RNA is found readily in 6m2 cells. Within 4 h of a shift to 39 degrees C, however, only trace amounts of this RNA can be found. Moreover, reshifting 6m2 cells to 33 degrees C permits the reappearance of the 3.5-kb RNA at its original level.

The etiology of nongonococcal urethritis in men attending a venereal disease clinic

Nongonococcal urethritis was identified as a major reason that men attended our Venereal Disease Clinic. The prevalence of several agents that might cause nongonococcal urethritis was determined. Attempts were made to isolate gonococci; chlamydiae, Ureaplasms urealyticum, trichmonads, Candida sp., and Corynebacterium vaginale from urethral swabs from 307 men. Chlamydiae were recovered from 31% of the 67 men with nongonococcal urethritis compared to only 4% of 86 asymptomatic men without pyuria. Unexpectedly, cultures from only 4% of the 99 men with gonorrhea also yielded chlamydiae. Ureaplasma urealyticum was recovered from 9 of 27 asymptomatic men (33%), 16 of 30 men with nongonococcal urethritis (53%) and 16 of 68 men with gonorrhea (42%). These differences were not statistically significant. However, when chlamydiae-positive men were excluded from the analysis urethritis. Twelve of 18 (76%) men with nononchlamdial nongonococcal urethritis yielded the organism compared to 8 of 26 (31%) men without urethritis. The other organisms sought were recovered infrequently and could not be associated with nongonococcal urethritis.

Vinyl chloride mutagenicity via the metabolites chlorooxirane and chloroacetaldehyde monomer hydrate

Mutagenicity tester strains of Bacillus and Salmonella were used to assay vinyl chloride in nutrient broth at a practical concentration level. Also screened without exogenous activation were seven potential metabolites of vinyl chloride in their pure forms as well as the related epichlorohydrin. Chlorooxirane, chloroacetaldehyde, chloroacetaldehyde monomer hydrate, chloroacetaldehyde dimer hydrate, chloroacetaldehyde trimer, and epichlorohydrin produced significant mutagenic acitivity in Salmonella typhimurium strains sensitive to base-pair mutation. A recombination repair deficient strain of Bacillus subtilis was inhibited in growth by these compounds, whereas excision repair deficient and wild type strains of Bacillus subtilis were relatively unaffected. On the basis of these assays a working hypothesis for the vinyl chloride carcinogenesis mechanism is proposed which involves chlorooxirane and chloroacetaldehyde monomer hydrate as the ultimate carcinogenic metabolites of vinyl chloride.