Bidirectional influence of heroin and cocaine escalation in persons with dual opioid and cocaine dependence diagnoses

Persons with dual severe opioid and cocaine use disorders are at risk of considerable morbidity, and the bidirectional relationship of escalation of mu-opioid agonists and cocaine use is not well understood. The aim of this study was to examine the bidirectional relationship between escalation of heroin and cocaine use in volunteers dually diagnosed with opioid and cocaine dependence (OD + CD). Volunteers from New York with OD + CD (total n = 295; male = 182, female = 113; age ≥ 18 years) were interviewed with the Structured Clinical Interview for the DSM-IV Axis I Disorders and Kreek-McHugh-Schluger-Kellogg scales for dimensional measures of drug exposure, which also collect ages of 1st use and onset of heaviest use. Time of escalation was defined as age of onset of heaviest use minus age of 1st use in whole years. Times of escalation of heroin and cocaine were positively correlated in both men (Spearman r = .34, 95% confidence interval [CI: .17, .48], p < .0001) and women (Spearman r = .51, [.27, .50], p < .0001) volunteers. After we adjusted for demographic variables, a Cox regression showed that time of cocaine escalation was a predictor of time of heroin escalation (hazard ratio [HR] = 0.97, 95% CI [0.95, 0.99], p = .003). Another Cox regression showed that this relationship is bidirectional, because time of heroin escalation was also a predictor of time of cocaine escalation (HR = 0.98, [0.96-0.99], p = .016). In these adjusted models, gender was not a significant predictor of time of escalation of either heroin or cocaine. Therefore, escalation did not differ robustly by gender when adjusting for demographics and other major variables. Overall, rapid escalation of cocaine use was a predictor of rapid escalation of heroin use, and vice versa, in persons with dual severe opioid and cocaine use disorders. These findings suggest a shared vulnerability to rapid escalation of these 2 drugs in persons with dual severe opioid and cocaine use disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Has the United States Reached a Plateau in Overdoses Caused by Synthetic Opioids After the Onset of the COVID-19 Pandemic? Examination of Centers for Disease Control and Prevention Data to November 2021

BACKGROUND

Overdoses caused by synthetic mu-opioid receptor (MOR) agonists such as fentanyl are causing increasing mortality in the United States. The COVID-19 pandemic continues to have complex effects on public health, including opioid use disorders (OUD). It is unclear whether recent increases in mortality caused by synthetic opioids have reached a plateau (i.e., a stable period), after the onset of the COVID-19 pandemic.

METHOD

This study examined provisional overdose mortality data from the Centers for Disease Control and Prevention, for synthetic opioids excluding methadone (code T40.4; monthly data available from 39 States, plus New York City and Washington DC), for June 2019-November 2021. Data were first examined as crude mortality rates. The presence of a maximum plateau was analyzed for the last 4 months of available data. For authorities in which a plateau in mortality was detected, sigmoidal Boltzmann equations were used to model parameters of this phenomenon (e.g., level of the plateau).

RESULTS

At the end of the study period, all but one authority (New Hampshire) reported increases in mortality rates for synthetic opioids, compared to the baseline month of June 2019 (range: 111-745% of baseline). A plateau was observed over the last 4 months of the study period (Aug 2021-Nov 2021) in 29 of the authorities. Ten other authorities had not reached a stable plateau at the end of the study period. For the authorities where a plateau was detected, a sigmoidal Boltzmann model revealed a fitted maximum of 262% rise in mortality over the study period, from the baseline month. The midpoint in the rise in mortality was fitted in September 2020. After separation of data into census regions, the highest plateau was observed in the West region, followed by South, Midwest, and Northeast (fitted plateau values were 409, 262, 204, and 149% of baseline, respectively).

DISCUSSION

There were increases in overdose mortality due to synthetic opioids across most states, ranging considerably in magnitude. A plateau in overdose mortality was detected at the end of the study period in most of these authorities. The reasons for these plateaus should be explored, in order to develop optimized public health interventions.

Age of onset of heaviest use of cannabis or alcohol in persons with severe opioid or cocaine use disorders

BACKGROUND

Persons with severe opioid or cocaine use disorders are particularly vulnerable to morbidity and mortality. Heaviest use of mu-opioid receptor agonists and cocaine typically commences in early adulthood and is preceded by substantial adolescent exposure to cannabis and/or alcohol. Little information exists on the age trajectories of exposure to cannabis or alcohol in persons diagnosed with severe opioid or cocaine use disorders, compared to persons diagnosed with other substance use disorders (unrelated to opioids or cocaine).

METHOD

This observational study had n = 854 volunteers (male = 581, female = 273; ≥18 years of age at the time of interview) and examined the ages of onset of heaviest use of cannabis and alcohol in persons diagnosed by DSM-IV criteria with opioid dependence (OD), both opioid and cocaine dependence (OD + CD) and cocaine dependence (CD). These age trajectory measures were compared to persons with other substance use disorders (primarily cannabis and alcohol use disorders, termed "Any Other Diagnoses").

RESULTS

Unadjusted survival analyses showed persons diagnosed with either OD + CD or CD had earlier onset of heaviest use of cannabis (mean ages of 16.2 and 17.8, respectively) compared to the "Any Other Diagnoses" reference group (mean age = 19.5). A multivariate logistic regression showed that later onset of heaviest use of cannabis was associated with lower odds of being in the OD + CD or CD groups, when compared to the reference group.

CONCLUSIONS

Persons diagnosed with severe cocaine use disorders or dual opioid and cocaine use disorders exhibit a pattern of heavy and especially early adolescent exposure to cannabis, compared to persons with other substance use disorders.

Are trait impulsivity and exposure to cannabis or alcohol associated with the age of trajectory of cocaine use? A gender-specific dimensional analysis in humans with cocaine dependence diagnosis

Cocaine use disorders (CUD) cause major morbidity and optimized prevention efforts are critical. It is unclear if trait impulsivity and exposure to cannabis or alcohol are associated with age trajectory of cocaine use (e.g., age of onset of heaviest use, or time of escalation), or with vulnerability to develop a CUD. This is an observational study with volunteers (≥ 18 years old), from a metropolitan area. The sample (n = 1,010) included: n = 360 normal volunteers, n = 438 with cocaine dependence (CD) diagnoses, and n = 212 with other addictive diseases. Trait impulsivity was examined with BIS-11 scores. Maximal self-exposure to cannabis, alcohol, and cocaine were characterized dimensionally with Kreek-McHugh-Schluger-Kellogg (KMSK) scales. Time of escalation was defined as the interval between age of first use and age of onset of heaviest use. Onset of maximal use of cannabis (median age = 17) and alcohol (median age = 21) preceded that of cocaine (median age = 27), in volunteers with CD. Multivariate Cox regressions in volunteers with CD show that increasing self-exposure to cannabis was a predictor of earlier onset of heaviest use of cocaine. Also, more rapid time of escalation of alcohol was a predictor of more rapid time of escalation of cocaine. A multiple logistic regression shows that increasing self-exposure to cannabis or alcohol was a positive predictor of odds of CD diagnosis. Trait impulsivity and gender were not significant predictors in these multivariate analyses. This study shows that aspects of adolescent exposure to nonmedical cannabis and alcohol are predictors of early onset of CUD, and may be potentially targeted for prevention efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Escalation of drug use in persons dually diagnosed with opioid and cocaine dependence: Gender comparison and dimensional predictors

BACKGROUND

Persons dually diagnosed with opioid and cocaine dependence (OD + CD) present a clinical challenge and are at risk of morbidity and mortality. The time of escalation of heroin and cocaine exposure in persons with OD + CD remain understudied, and the influence of gender and other variables have not been examined. This observational study focused on the time of escalation of heroin and cocaine in volunteers with OD + CD, examining gender and exposure to other drugs (e.g., cannabis or alcohol) as predictors. Ages of first use and of onset of heaviest use of each drug were collected (in whole years). Time of escalation was defined as the interval between age of first use and onset of heaviest use.

VOLUNTEERS

sequentially ascertained adult volunteers recruited from the New York Metropolitan area, of which n = 297 were diagnosed with OD + CD.

METHODS

Instruments administered were the SCID-I diagnostic interview (DSM-IV criteria), BIS-11 impulsiveness scale, and KMSK scales, dimensional measures of maximal exposure to specific drugs.

RESULTS

In volunteers with OD + CD, ages of onset of heaviest use of cannabis (median age = 15) and alcohol (median age = 19) were in adolescence or emerging adulthood and preceded those for heroin and cocaine (median ages = 26 and 25, respectively). Maximal levels of cannabis and alcohol exposure were high, in volunteers with OD + CD. In adjusted Cox regressions, gender was not a significant predictor of time of heroin or cocaine escalation. However, more rapid time of alcohol escalation was a predictor of more rapid time of escalation of both heroin and cocaine, in volunteers with OD + CD.

Interaction between spent fuel components and carbonate rocks

Deep geological repository is considered the internationally accepted method for spent fuel (SF) disposal. In countries where salt, clay, tuff and granite are unavailable at geologically suitable area, other rock types may come into consideration. In Israel, carbonate rocks make up a significant portion of the surface and subsurface lithologies, thus, low permeability carbonates were evaluated as possible host rocks for a repository, and for an interim storage facility. Sorption and retardation capacity of SF components to low permeability carbonate rocks were evaluated using their chemical simulants. Strontium and Cs represent components that may leach during interim storage, while U and Ce (as a simulant for redox-active actinides) represent components that may leach under repository conditions. Rocks from the Upper Cretaceous Mount Scopus Group were sampled from boreholes at the Yamin Plateau, Israel. Single point batch experiments were conducted with synthetic rainwater spiked with tracers and interacted with five rock types of various particle sizes at 25 °C. Results were evaluated using the LeachXS™-ORCHESTRA geochemical speciation and data management program. Cerium removal was found to be related to the HCO₃^- concentration in solution, where Ce precipitated as Ce₂(CO₃)₃·XH₂O and as an amorphous carbonate phase. Removal of Cs and Sr was controlled by clays. No Sr co-precipitation as carbonate species was observed. Uranium was removed mainly by sorption onto solid organic matter, whereas clays had no significant role in U sorption. Iron-(hydr) oxides may have also played a role in U removal. Calculated partition coefficients for U, Cs, and Sr were in the order of 10¹-10² mL/g. Grain size had no significant effect on the retention capacity of the studied rocks due to similar effective surface area. The current study indicates that a repository or an interim storage facility within carbonate rocks, would provide only partial isolation of radionuclides from the environment, hence, additional engineered barriers may be required.

In vivo ultrasonic measurement of tissue vibration at a stenosis: a case study

It is known that bruits often can be heard downstream from stenoses. They are thought to be produced by disturbed blood flow and vessel wall vibrations. Our understanding of bruits has been limited, though, to analysis of sounds heard at the level of the skin. For direct measurements from the stenosis site, we developed an ultrasonic pulse-echo multigate system using quadrature phase demodulation. The system simultaneously measures tissue displacements and blood velocities at multiple depths. This paper presents a case study of a severe stenosis in a human infrainguinal vein bypass graft. During systole, nearly sinusoidal vessel wall vibrations were detected. Solid tissue vibration amplitudes measured up to 2 microm, with temporal durations of 100 ms and frequencies of roughly 145 Hz and its harmonics. Cross-axial oscillations were also found in the lumen that correlate with the wall vibrations, suggesting coupling between wall vibration and blood velocity oscillation.

Lung cancer and environmental tobacco smoke: occupational risk to nonsmokers

The principal epidemiologic evidence that environmental tobacco smoke (ETS) increases the risk of lung cancer in (lifelong) nonsmokers is from studies of nonsmoking women married to smokers. This article estimates exposure-response curves for 14 studies (1, 249+ cases, 7 countries) with data on lung cancer categorized by the number of cigarettes/day smoked by the husband. The pooled results from the five U.S. studies alone are extrapolated to ETS levels in the workplace using measures of serum cotinine and nicotine samples from personal monitors as markers of exposure to ETS. It is predicted that the increase in lung cancer risk for nonsmoking women from average ETS exposure at work (among those exposed at work) is on the order of 25% (95% confidence interval (CI) = 8, 41) relative to background risk (i.e., with no ETS exposure from any source). This compares to an estimate of 39% (95% CI = 5, 65) for nonsmoking women whose husbands smoke at the adult male smoker's average of 25 cigarettes/day. At the 95th percentiles of exposure, the estimate from spousal smoking is 85% (95% CI = 32, 156), compared to 91% (95% CI = 34, 167) from workplace ETS exposure. Subject to the validity of the assumptions required in this approach, the outcome supports the conclusion that there is a significant excess risk from occupational exposure to ETS. The excess risk from ETS at work is typically lower than that from spousal smoking, but may be higher at the 95th percentiles of exposure.

The effect of queuosine on tRNA structure and function

Computational modeling was performed to determine the potential function of the queuosine modification of tRNA found in wobble position 34 of tRNAasp, tRNAasn, tRNAhis, and tRNAtyr. Using the crystal structure of tRNAasp and a tRNA-tRNA-mRNA complex model, we show that the queuosine modification serves as a structurally restrictive base for tRNA anticodon loop flexibility. An extended intraresidue and intramolecular hydrogen bonding network is established by queuosine. The quaternary amine of the 7-aminomethyl side chain hydrogen bonds with the base's carbonyl oxygen. This positions the dihydroxycyclopentenediol ring of queuosine in proper orientation for hydrogen bonding with the backbone of the neighboring uridine 33 residue. The interresidue association stabilizes the formation of a cross-loop hydrogen bond between the uridine 33 base and the phosphoribosyl backbone of the cytosine at position 36. Additional interactions between RNAs in the translation complex were studied with regard to potential codon context and codon bias effects. Neither steric nor electrostatic interaction occurs between aminoacyl- and peptidyl-site tRNA anticodon loops that are modified with queuosine. However, there is a difference in the strength of anticodon/codon associations (codon bias) based on the presence or lack of queuosine in the wobble position of the tRNA. Unmodified (guanosine-containing) tRNAasp forms a very stable association with cytosine (GAC), but is much less stable in complex with a uridine-containing codon (GAU). Queuosine-modified tRNAasp exhibits no bias for either of cognate codons GAC or GAU and demonstrates a lower binding energy similar to the wobble pairing of guanosine-containing tRNA with a GAU codon. This is proposed to be due to the inflexibility of the queuosine-modified anticodon loop to accommodate proper positioning for optimal Watson-Crick type associations. A preliminary survey of codon usage patterns in oncodevelopmental versus housekeeping gene transcripts suggests a significant difference in bias for the queuosine-associated codons. Therefore, the queuosine modification may have the potential to influence cellular growth and differentiation by codon bias-based regulation of protein synthesis for discrete mRNA transcripts.

Inorganic arsenic: a need and an opportunity to improve risk assessment

This paper presents views on the current status of (inorganic) arsenic risk assessment in the United States and recommends research needed to set standards for drinking water. The opinions are those of the Arsenic Task Force of the Society for Environmental Geochemistry and Health, which has met periodically since 1991 to study issues related to arsenic risk assessment and has held workshops and international conferences on arsenic. The topic of this paper is made timely by current scientific interest in exposure to and adverse health effects of arsenic in the United States and passage of the Safe Drinking Water Act Amendment of 1996, which has provisions for a research program on arsenic and a schedule mandating the EPA to revise the maximum contaminant level of arsenic in drinking water by the year 2001. Our central premise and recommendations are straightforward: the risk of adverse health effects associated with arsenic in drinking water is unknown for low arsenic concentrations found in the United States, such as at the current interim maximum contaminant level of 50 microg/l and below. Arsenic-related research should be directed at answering that question. New epidemiological studies are needed to provide data for reliable dose-response assessments of arsenic and for skin cancer, bladder cancer, or other endpoints to be used by the EPA for regulation. Further toxicological research, along with the observational data from epidemiology, is needed to determine if the dose-response relationship at low levels is more consistent with the current assumption of low-dose linearity or the existence of a practical threshold. Other recommendations include adding foodborne arsenic to the calculation of total arsenic intake, calculation of total arsenic intake, and encouraging cooperative research within the United States and between the United States and affected countries.

Skin cancer and inorganic arsenic: uncertainty-status of risk

The current U.S. EPA standard for inorganic arsenic in drinking water is 50 ppb (microgram/L), dating to the National Interim Primary Drinking Water Regulation of 1976. The current EPA risk analysis predicts an increased lifetime skin cancer risk on the order of 3 or 4 per 1000 from chronic exposure at that concentration. Revision of the standard to only a few ppb, perhaps even less than 1 ppb, may be indicated by the EPA analysis to reduce the lifetime risk to an acceptable level. The cost to water utilities, and ultimately to their consumers, to conform to such a large reduction in the standard could easily reach several billion dollars, so it is particularly important to assess accurately the current risk and the risk reduction that would be achieved by a lower standard. This article addresses the major sources of uncertainty in the EPA analysis with respect to this objective. Specifically, it focuses on uncertainty and variability in the exposure estimates for the landmark study of Tseng and colleagues in Taiwan, analyzed using a reconstruction of the their exposure data. It is concluded that while the available dataset is suitable to establish the hazard of skin cancer, it is too highly summarized for reliable dose-response assessment. A new epidemiologic study is needed, designed for the requirements of dose-response assessment.

Gene disruptions indicate an essential function for the LmmCRK1 cdc2-related kinase of Leishmania mexicana

The generation of homozygous null mutants for the crk1 Cdc2-Related Kinase of Leishmania mexicana was attempted using targeted gene disruption. Promastigote mutants heterozygous for crk1 were readily isolated with a hyg-targeting fragment, but attempts to create null mutants by second-round transfections with a bie-targeting fragment yielded two classes of mutant, neither of which was null. First, the transfected fragment formed an episome; second, the cloned transfectants were found to contain wild-type crk1 alleles as well as hyg and ble integrations. DNA-content analysis revealed that these mutants were triploid or tetraploid. Plasticity in chromosome number following targeting has been proposed as a means by which Leishmania avoids deletion of essential genes. These data support this theory and implicate crk1 as an essential gene, validating CRK1 as a potential drug target. L mexicana transfected with a Trypanosoma brucel homologue, tbcrk1, was shown to be viable in an immcrk1 null background, thus showing complementation of function between these trypanosomatid genes. The expression of crk1 was further manipulated by engineering a six-histidine tag at the C-terminus of the kinase, allowing purification of the active complex by affinity selection on Nl(2+)-nitriloacetic acid (NTA) agarose.

Does self-regulation require cognitive resources? Evaluation of resource allocation models of goal setting

The resource allocation model of goal setting (R. Kanfer & P.L. Ackerman, 1989) maintains that self-regulation initiated through goal setting requires attentional resources that could be more productively applied to skill acquisition and complex task performance. The current study questioned this hypothesis because attentional resources had not been directly manipulated or measured in studies supporting the model. Thus, alternative explanations that are based on other complex task goal-setting models cannot be excluded. As a direct test of the resource allocation hypothesis, dual task methodology was used to measure the attentional resource requirements of self-regulation. Even at the limits of human information processing, participants who were assigned difficult, specific goals performed at least as well on the secondary task as did individuals with do-your-best goals. These findings suggest that self-regulation does not necessarily require attentional resources. Implications for theory and practice are discussed.

Significance of exposure assessment to analysis of cancer risk from inorganic arsenic in drinking water in Taiwan

The primary source of evidence that inorganic arsenic in drinking water is associated with increased mortality from cancer at internal sites (bladder, liver, lung, and other organs) is a large ecologic study conducted in regions of Southwest Taiwan endemic to Blackfoot disease. The dose-response patterns for lung, liver, and bladder cancers display a nonlinear dose-response relationship with arsenic exposure. The data do not appear suitable, however, for the more refined task of dose-response assessment, particularly for inference of risk at the low arsenic concentrations found in some U.S. water supplies. The problem lies in variable arsenic concentrations between the wells within a village, largely due to a mix of shallow wells and deep artesian wells, and in having only one well test for 24 (40%) of the 60 villages. The current analysis identifies 14 villages where the exposure appears most questionable, based on criteria described in the text. The exposure values were then changed for seven of the villages, from the median well test being used as a default to some other point in the village's range of well tests that would contribute to smoothing the appearance of a dose-response curve. The remaining seven villages, six of which had only one well test, were deleted as outliers. The resultant dose-response patterns showed no evidence of excess risk below arsenic concentrations of 0.1 mg/l. Of course, that outcome is dependent on manipulation of the data, as described. Inclusion of the seven deleted villages would make estimates of risk much higher at low doses. In those seven villages, the cancer mortality rates are significantly high for their exposure levels, suggesting that their exposure values may be too low or that other etiological factors need to be taken into account.

Statistical issues on the no-observed-adverse-effect level in categorical response

The determination of the value of the no-observed-adverse-effect level (NOAEL) when observed responses can be categorized by severity (categorical data) and sample sizes are small is discussed. The common situation of only two categories, where only the presence or absence of an effect is observed, is addressed first (dichotomous data). Three tests for dichotomous data are critically examined, including the Brown-La Vange test, a modified version of that test, and Dunnett's multiple comparison test. Although the modified test is an improvement, all three procedures have shortcomings in determining the value of the NOAEL, particularly when the sample size is small. An alternative method is suggested, based on the Akaike information criterion (AIC), which performs well. This method is extended to severity data with an arbitrary number of categories. Use of a dose-response curve for the NOAEL is discussed.

Cyclical disturbance of diabetic control in girls before the menarche

Seven diabetic girls who presented with cyclical disturbance of diabetic control before the menarche are described. In six girls cyclical hyperglycaemia occurred and in one cyclical hypoglycaemia. The index case is described in detail, and is then included in a description of the main clinical features of all seven cases. Cyclical disturbance of diabetic control may present in diabetic girls from age 9 years onwards. Home blood glucose monitoring records may reveal cyclical disturbance, usually hyperglycaemia, and usually occurring at 21-34 day intervals and lasting for two to five days. Serious illnesses and hospital admission can be averted by educating parents to make appropriate changes to insulin regimen or diet. Our hypothesis is that the disturbance of diabetic control is caused by the onset of cyclical hormonal changes, a 'menstrual' cycle before menstruation. The precise mechanism for the changes in carbohydrate tolerance is unknown.

A dose-response analysis of skin cancer from inorganic arsenic in drinking water

A study of the prevalence of skin cancer among 40,421 persons consuming arsenic-contaminated drinking water in Taiwan was used for a cancer dose-response assessment of ingested arsenic. The numbers of persons at risk over three dose intervals and four exposure durations were estimated from the data in order to apply the method of maximum likelihood to a multistage-Weibull time/dose-response model. A constant exposure level since birth for each of the exposure categories was assumed. It was found that the cumulative hazard increases as a power of three in age, and is linear or quadratic (with a linear coefficient) in dose. Observations from a smaller epidemiologic survey in Mexico were similar to what would be predicted from the model of the Taiwan data. Assuming that the skin cancer risk from ingested arsenic in the American population would also be similar to the Taiwan population, an American male would have a lifetime risk of developing skin cancer of 1.3 x 10(-3) (3.0 x 10(-3] if exposed to 1 microgram/kg/day for a 76-year lifespan (median lifespan in the U.S.).

Statistical uncertainty in the no-observed-adverse-effect level

The no-observed-adverse-effect level (NOAEL) is a dose value that U.S. EPA reduces by uncertainty factors (UF) and modifying factors (MF) to obtain a reference dose (RfD) for input to regulatory decision making. Whether the true added risk at the NOAEL is below an acceptable level, however, is a source of statistical uncertainty itself. As several authors have previously noted, the probability that added risk at the NOAEL is not negligibly small increases as sample sizes decrease. This is because the definition of the NOAEL statistically controls for the chance of a false-positive error, but not for a false-negative error. The false-positive rate is the test level set by the user in testing for a statistically significant dose effect, typically 0.05. When it is held fixed, the increase in statistical uncertainty as sample size decreases produces an increase in the false-negative rate. Hence, the fewer data available for statistical inference, the higher the expected value of the NOAEL and the less toxic an agent is likely to appear. The solution lies in calculating the probability that a statistical procedure used will detect the maximum added risk acceptable for health regulation (the "power" at that added risk). If the observed response in a dose group is not significantly elevated relative to the control group, and the power for detecting a difference is low as well, then the statistical evidence is inconclusive. In such a case, additional data or other sources of information are needed for evaluating added risk. These concepts are illustrated for examples from the literature with dichotomous (quantal response) data and categorical (severity) data, using a new statistical procedure.

Altitude, radiation, and mortality from cancer and heart disease

The variation in background radiation levels is an important source of information for estimating human risks associated with low-level exposure to ionizing radiation. Several studies conducted in the United States, correlating mortality rates for cancer with estimated background radiation levels, found an unexpected inverse relationship. Such results have been interpreted as suggesting that low levels of ionizing radiation may actually confer some benefit. An environmental factor strongly correlated with background radiation is altitude. Since there are important physiological adaptations associated with breathing thinner air, such changes may themselves influence risk. We therefore fit models that simultaneously incorporated altitude and background radiation as predictors of mortality. The negative correlations with background radiation seen for mortality from arteriosclerotic heart disease and cancers of the lung, the intestine, and the breast disappeared or became positive once altitude was included in the models. By contrast, the significant negative correlations with altitude persisted with adjustment for radiation. Interpretation of these results is problematic, but recent evidence implicating reactive forms of oxygen in carcinogenesis and atherosclerosis may be relevant. We conclude that the cancer correlational studies carried out in the United States using vital statistics data do not in themselves demonstrate a lack of carcinogenic effect of low radiation levels, and that reduced oxygen pressure of inspired air may be protective against certain causes of death.

Effect of vitamin D supplementation during pregnancy on the vitamin D status of ewes and their lambs

Pregnant ewes were injected intramuscularly with 300,000 iu of vitamin D3 in a water miscible vehicle either 10, seven or four weeks before the expected lambing date and the effects on plasma concentrations of 25-hydroxyvitamin D3 were monitored. The concentrations increased quickly and remained high at parturition but at no time were they outside the normal physiological range. The concentrations in the plasma of the newborn lambs were higher than in uninjected controls and were well correlated with the concentrations in their mothers. Dosing pregnant ewes with 300,000 iu of vitamin D3 in a rapidly available form, approximately two months before lambing, provided a safe means of increasing the vitamin D status of the ewe and the newborn lamb by preventing the seasonally low concentrations of 25-hydroxyvitamin D3.

Atomic and Raman spectroscopy of the dipalmitoylphosphatidic acid-calcium complex and phase transitions

Calcium binding measurements by atomic absorption spectroscopy and temperature-dependent phase transitions studies by Raman spectroscopy were combined in order to investigate the effect of Ca2+ binding on dipalmitoylphosphatidic acid (DPPA) dispersed in CaCl2 solutions of varying concentration at pH 7. The peak heights for the Raman CH stretch bands observed at 2885 cm-1 and 2935 cm-1 were used as a measure of hydrocarbon chain randomization and aggregate ultrastructure. Two transitions were observed for both pure DPPA and DPPA-Ca2+ mixtures. Ca2+ binding caused greatly increased DPPA chain rigidity in the melted state above Tm, but had much less effect on the solid phases below Tm. The increase in rigidity in the fluid state was observed to vary linearly with the molar ratio of bound Ca2+ to total DPPA throughout the range 0 to 1. The results of the Raman and Ca2+ binding measurements are explained by a model in which two populations of DPPA co-exist in the fluid state when Ca2+ binding has not reached saturation. One population consists of the Ca2+-bound DPPA complex with stoichiometric 1:1 binding ratio (determined from an atomic absorption Ca2+ binding study), and the second population is free DPPA. We propose that Ca2+-induced clustering and separation of the two components occurs chiefly because of differences in chain fluidity of the two components.

Phase transitions in combined rabbit muscle sarcoplasmic reticulum lipids by Raman spectroscopy

Using Raman spectroscopy, we found that the sarcoplasmic reticulum lipids of combined muscles from rabbit leg undergo at least two reversible temperature phase changes, centered at about -15 and 13 degrees C. Below the first transition, the lipid Raman CH st region is characteristic of the hexagonal lamellar gel phase. Above the second transition, the Raman CH stretch region is that of a "melted" lamellar phase, somewhat more rigid than a monophasic lipid system. The composition of the lipids was determined and the possibility of a relation between the major head group types and the phase transitions is discussed. Since SR Ca2+ATPase activity is enhanced at about 14-19 degrees C, the Raman studies suggest that ATPase activity is enhanced when the 13 degrees C transition is complete.

Modeling time-to-tumor data: analysis of the ED01 study

The ED01 study is an experiment conducted by the National Center for Toxicological Research (NCTR) of the FDA in which over 24,000 mice were exposed to the known carcinogen 2-acetylaminofluorene. The details of the experiment and analysis of the results by NCTR are documented in Staffa and Mehlman (1979). The analysis by the ED01 task force of the Society of Toxicology is in disagreement with NCTR on several issues, and is reported in Fundam. Appl. Toxicol. 1:26-128. The results given in this paper are from a separate analysis aimed at adequately and parsimoniously representing the functional relationship of dose and time to the carcinogenic response. A very general non-parametric approach is applied to the data on sacrificed animals, which eliminates any complications due to a change in protocol and avoids the difficulties in combining sacrifice and non-sacrifice data. It is shown that for either liver neoplasms or bladder neoplasms as the toxicological endpoint, any model which has a factorable hazard function (one that can be factored into the product of a function of dose exclusively and a function of time exclusively) is too simplistic to accurately describe the response over the entire experimental range of dose and time. The lack of fit of the liver neoplasm data to a time-dose product model is due to data at the highest time (month 33). If these data are excluded then a factorable hazard function fits the data well, with the function of dose following a J-shaped curve and the function of time being either a simple power of time or a polynomial in time. For a power of time, the resultant probability distribution is Weibull over time with dose affecting the scale parameter, and this result is consistent with the empirical equation of Druckrey (1967). Both of the functional forms described fit the data significantly better than the previously suggested Hartley-Sielken model which utilized polynomials in both dose and time. The lack of fit of bladder neoplasms to a model with a factorable hazard function is not due to just the data at month 33 or the data at months 24 and 33 combined. Unfortunately, from the viewpoint of model fitting, the response of bladder neoplasms is fairly insensitive to changes in time and dose, except at the high extremes. This leaves only a small number of observations which are actually very useful in model validation and comparison, which means that one could only hope to discriminate between gross differences of fit.(ABSTRACT TRUNCATED AT 400 WORDS)

Multistage prediction of cancer in serially dosed animals with application to the ED01 study

The ED01 study is a large-scale experiment in which mice were exposed to the known carcinogen 2-acetylaminofluorene (2-AAF). The dosing was continuous until time of death for most of the mice. However, for some mice, dosing was terminated at specified intervals prior to sacrifice time. Exploratory model fitting of the continuous dosing data of sacrificed mice using liver neoplasms as the endpoint was conducted by Brown and Hoel (1982). They report that the multistage model of Armitage and Doll (1954) fits the data moderately well, however a much improved fit with fewer parameters is attainable by a modified multistage model. These two models, with parameter estimates obtained from the data on continuous dosing, are referred to in this paper as Model 1 and Model 2, respectively. Models 1 and 2 are extended to provide for termination of dosing prior to time of sacrifice. The resultant equations are used to predict cancer responses in the serial dosing part of the ED01 study, and then are compared to the actual observed tumor frequencies. The objective is to evaluate the change in cancer risk over time after dosing is terminated, and to establish which stages in the multistage process are affected by dose. The predictive capabilities of the two models are compared and contrasted. Model 1, which presumes four stages of which two are affected by dose, predicts only moderately well and is inconclusive as to which two of the stages are the ones affected. Model 2, which differs from the multistage model by using a "J-shaped" curve instead of a polynomial for the dose metameter, provides an improvement over Model 1.(ABSTRACT TRUNCATED AT 250 WORDS)

The nephrotic syndrome in Malawian blacks

This study deals with the nephrotic syndrome in 34 Malawian Blacks, Plasmodium malariae infection and the use of mercury-containing skin lightening creams (Butone 3) must be included among the usual causes of nephrotic syndrome in the Malawian Black.

Cardiac disease in Malawi

A prospective clinical study of 114 Malawian patients with cardiac disease seen at Queen Elizabeth Central Hospital, Blantyre, is presented. Rheumatic and hypertensive heart disease, cardiorenal failure and severe anaemia were the most common causes. Pericardial disease, mainly due to tuberculosis, was an important treatable cause of cardiac disease. Endomyocardial fibrosis was not diagnosed with certainty and cardiomyopathy was relatively uncommon. Ischaemic heart disease was not seen.

Conformationally dependent low-frequency motions of proteins by laser Raman spectroscopy

Low-frequency Raman bands (lower than 50 cm(-1)) exist in certain proteins. They are dependent upon the conformation of the protein molecule, but are relatively independent of the form of the sample, i.e., whether it is a film or a crystal.Low-frequency Raman spectra were obtained from samples of alpha-chymotrypsin that had been prepared in several ways. A peak at about 29 cm(-1) was found for all samples except the one that had been denatured with sodium dodecyl sulfate. Such low frequency motions must arise from vibrations that involve all, or very large portions, of the protein molecule.

Vessel dimensions in premature altheromatous disease of aortic bifurcation

The area ratio of the abdominal aortic bifurcation is defined as the ratio of the sum of the cross-sectional areas of the common iliac arteries to the cross-sectional area of the aorta. Abnormality of the area ratio is associated with initiation of atheroma of the lower aorta. Hypoplasia of the abdominal aorta predisposes to early occlusion as the atheromatous process advances.In five out of six women with thrombosis at the aortic bifurcation the area ratio was low. Hypoplasia of the abdominal aorta was present in two of these patients. All six patients were successfully treated by aortoiliac disobliteration and reconstruction.

Tachyarrhythmia in severe imipramine overdose controlled by practolol

A 2½-year-old boy, comatose and having fits after an overdose of imipramine, suffered a respiratory and cardiac arrest from which he was successfully resuscitated. A severe tachyarrhythmia was well controlled by intravenous practolol, and it is suggested that practolol is the drug of choice in this situation.

Respiratory failure in neuromuscular diseases

A series is reported of five patients with acute respiratory failure complicating neuromuscular diseases, three of whom required assisted ventilation. Initially the arterial carbon dioxide tension fell to levels below the normal range in all the patients and this change reflects alveolar hyperventilation which is probably produced by a combination of fear, small airway collapse, and reflex tachypnoea. It is only late in the development of respiratory weakness that alveolar ventilation falls and carbon dioxide tension rises to normal and then elevated levels. Several factors contribute to the reduction in arterial oxygen tension, including airway collapse and infection, and it is important to try to prevent these by correct posture, vibration, and passive deep breathing. We think that objective measurements of respiratory function are essential in the management of these patients and that the most valuable are serial measurements of vital capacity and carbon dioxide tension and the least helpful is the arterial oxygen tension. Assisted ventilation will probably be required if the vital capacity falls below 30% of that predicted for the patient or if the carbon dioxide tension rises from low to normal levels as vital capacity is falling.