The COVID-19 pandemic and food assistance organizations' responses in New York's Capital District

This research examines the impact of COVID-19 on food security in New York state and the innovative approaches employed by food assistance organizations to help address the changing and increasing demand for their services from March 2020 to May 2021. We examine the case study of New York's Capital District region through a qualitative approach. We find that there was a sharp increase in utilization of emergency services during spring of 2020, which tapered off in the summer and fall of 2020 but remained above the levels of need seen the previous year. Food assistance organizations quickly adapted to the increased demand for their services and changing conditions to reduce gaps in local food distribution chains: They reorganized and tapped into new sources for volunteers, networked with public and private organizations, and coordinated work with other regional food pantries for maximum impact. The flexibility of food assistance organizations to address the disruptions brought about by the COVID-19 pandemic highlights their critical roles in the U.S. food security environment. While organizations are aware of their shortcomings, constraints, and overall role in the American food system, the majority also expressed that the pandemic presented an opportunity to treat a complex problem together and to enact change. Several stakeholders also shared their hope that strengthening their networks and innovations may facilitate post-pandemic recovery, bring about systemic changes to address root causes of food insecurity, and better serve the communities most vulnerable to hunger and service disruptions.

Superimposed non-stationary renewal processes

For superposition of independent, stationary renewal processes, it is well known that the distribution of waiting time between events for the superimposed process is approximately exponential if the number of processes involved is sufficiently large, (see Khintchine (1960), Ososkov (1956)). We assume that all component processes have the same age t, and we generalize the classical result to show that even for t finite (non-stationary case), the limiting waiting time distribution (as the number of processes increases) is exponential with a scale parameter which depends on t through the average of the individual process renewal densities.

[Assisted suicide in Germany: medical diagnoses and personal reasons of 117 decedents]

BACKGROUND

In Germany both scientific and public debates on physician assisted suicide often focus on patients with unbearable suffering in terminal condition. Proponents of physician assisted suicide bring forward the argument that there are end-of-life situations where only assisted suicide can bring relief from intolerable pain, dyspnea or other symptoms. But does focusing on unbearable symptoms in terminal condition reflect the reality of assisted suicide? Our data from 117 assisted suicides in Germany indicates that the reasons for assisted suicide are more complex than the current debate in Germany suggests.

METHODS

We analyzed diagnoses and reasons that prompted patients to suicide with the help of the German right-to-die organization "Sterbehilfe Deutschland" (StHD) between 2010 and 2013. 118 case reports of assisted suicide published by StHD were evaluated retrospectively.

RESULTS

Between 2010 and 2013 StHD provided assistance in 118 suicides. 71 % of the deceased were women. 67 % were aged 70 years or older. 25,6 % suffered from metastasized cancer, 20,5 % had a severe neurological disease. 23 % suffered from age-associated diseases or disability. 14,5 % of the decedents had a predominant psychiatric diagnose, 7,7 % were physically and mentally healthy. The main reasons for suicide were loss of life perspective in the face of a severe disease (29 %), fear of care dependency (23,9 %), weariness of life without any severe disease (20,5 %). Only 12,8 % named non-treatable symptoms as a reason.

CONCLUSION

Loss of life perspective in the face of a severe disease, fear of long-term care and weariness of life without any severe disease rather than unbearable suffering of non-treatable symptoms seem to be the most common reasons for members of StHD to commit suicide. These empirical findings should be mentioned in future debates on assisted suicide in Germany.

Effects of early and late diabetic neuropathy on sciatic nerve block duration and neurotoxicity in Zucker diabetic fatty rats

BACKGROUND

The neuropathy of type II diabetes mellitus (DM) is increasing in prevalence worldwide. We aimed to test the hypothesis that in a rodent model of type II DM, neuropathy would lead to increased neurotoxicity and block duration after lidocaine-induced sciatic nerve block when compared with control animals.

METHODS

Experiments were carried out in Zucker diabetic fatty rats aged 10 weeks (early diabetic) or 18 weeks (late diabetic, with or without insulin 3 units per day), and age-matched healthy controls. Left sciatic nerve block was performed using 0.2 ml lidocaine 2%. Nerve conduction velocity (NCV) and F-wave latency were used to quantify nerve function before, and 1 week after nerve block, after which sciatic nerves were used for neurohistopathology.

RESULTS

Early diabetic animals did not show increased signs of nerve dysfunction after nerve block. In late diabetic animals without insulin vs control animals, NCV was 34.8 (5.0) vs 41.1 (4.1) ms s(-1) (P<0.01), and F-wave latency was 7.7 (0.5) vs 7.0 (0.2) ms (P<0.01), respectively. Motor nerve block duration was prolonged in late diabetic animals, but neurotoxicity was not. Late diabetic animals receiving insulin showed intermediate results.

CONCLUSIONS

In a rodent type II DM model, nerves have increased sensitivity for short-acting local anaesthetics without adjuvants in vivo, as evidenced by prolonged block duration. This sensitivity appears to increase with the progression of neuropathy. Our results do not support the hypothesis that neuropathy due to type II DM increases the risk of nerve injury after nerve block.

Sedation and regional anaesthesia in the adult patient

This review discusses sedation for regional anaesthesia in the adult population. The first section deals with general aspects of sedation and shows that the majority of patients receiving sedation for regional anaesthesia are satisfied and would choose it again. Methods of assessing the level of sedation are discussed with emphasis on clinical measures. The pharmacology of the drugs involved in sedation is discussed, with propofol and remifentanil appearing to be the combination of choice for sedation in regional anaesthesia. The techniques for administering sedation are discussed and replacement of the traditional repeated boluses or continuous infusion with pharmacokinetic and patient-controlled systems is supported. Patient satisfaction studies suggest that patient-controlled systems are preferred.

Postconditioning with a volatile anaesthetic in alveolar epithelial cells in vitro

Acute lung injury is a common complication in critically ill patients. The present study examined possible immunomodulating effects of the volatile anaesthetic sevoflurane on lipopolysaccharide (LPS)-stimulated alveolar epithelial cells (AEC) in vitro. Sevoflurane was applied after the onset of injury, simulating a "postconditioning" scenario. Rat AEC were stimulated with LPS for 2 h, followed by a 4-h co-exposure to a CO(2)/air mixture with sevoflurane 2.2 volume %; control cells were exposed to the CO(2)/air mixture only. Cytokine-induced neutrophil chemoattractant-1, monocyte chemoattractant protein-1, intercellular adhesion molecule-1, as well as the potential protective mediators inducible nitric oxide synthase (iNOS)2 and heat shock protein (HSP)-32, were analysed. Additionally, functional assays (chemotaxis, adherence and cytotoxicity assay) were performed. A significant reduction of inflammatory mediators in LPS-stimulated, sevoflurane-exposed AEC was found, leading to reduced chemotaxis, neutrophil adherence and neutrophil-induced AEC killing. While iNOS2 was increased in the sevoflurane group, blocking experiments with iNOS2 inhibitor did not affect sevoflurane-induced decrease of inflammatory mediators and AEC killing. Interestingly, sevoflurane treatment also resulted in an enhanced expression of HSP-32. The data presented in the current study provide strong evidence that anaesthetic postconditioning with sevoflurane mediates cytoprotection in the respiratory compartment in an in vitro model of acute lung injury.

Hypoxia attenuates effector-target cell interaction in the airway and pulmonary vascular compartment

Leucocyte infiltration is known to play an important role in hypoxia-induced tissue damage. However, little information is available about hypoxia and interaction of effector (neutrophils) with target cells (alveolar epithelial cells, AEC; rat pulmonary artery endothelial cells, RPAEC). The goal of this study was to elucidate hypoxia-induced changes of effector-target cell interaction. AEC and RPAEC were exposed to 5% oxygen for 2-6 h. Intercellular adhesion molecule-1 (ICAM-1) expression was determined and cell adherence as well as cytotoxicity assays were performed. Nitric oxide and heat shock protein 70 (HSP70) production was assessed in target cells. Under hypoxic conditions enhanced ICAM-1 production was found in both cell types. This resulted in an increase of adherent neutrophils to AEC and RPAEC. The death rate of hypoxia-exposed target cells decreased significantly in comparison to control cells. Nitric oxide (NO) concentration was enhanced, as was production of HSP70 in AEC. Blocking NO production in target cells resulted in increased cytotoxicity in AEC and RPAEC. This study shows for the first time that target cells are more resistant to effector cells under hypoxia, suggesting hypoxia-induced cell protection. An underlying mechanism for this phenomenon might be the protective effect of increased levels of NO in target cells.

Inflammation and infection complications of 2285 perineural catheters: a prospective study

BACKGROUND

Perineural catheters (PNCs) are increasingly being used. Few data are available on the infectious complications of PNCs. The incidence and localization of local inflammation and infection associated with PNCs were assessed.

METHODS

PNCs placed under sterile conditions for regional anesthesia and post-operative analgesia were evaluated prospectively. Local inflammation was defined as redness, swelling or pain on pressure at the catheter insertion site. Infection was defined as purulent material at the catheter insertion site with or without the need for surgical intervention.

RESULTS

In total, 2285 PNCs were evaluated: 600 axillary, 303 interscalene, 92 infraclavicular, 65 psoas compartment, 574 femoral, 296 sciatic and 355 popliteal. Local inflammation occurred in 4.2% and infection in 3.2%. The duration of PNC placement was a risk factor (P < 0.05). Surgical intervention was necessary in 0.9%. No late complications occurred in any patient. Interscalene catheters were associated with an increased risk of infection (4.3%; P < 0.05). Anterior proximal sciatic catheters were associated with a lower risk of local inflammation (1.7%; P < 0.05) and infection (0.4%; P < 0.05). Staphylococcus epidermidis and Staphylococcus aureus were isolated in 42% and 58% of catheter tip cultures, respectively.

CONCLUSION

In the present study population, infection of PNCs was a rare occurrence, but the incidence increased with the duration of PNC placement, and close clinical monitoring is required.

Remission of nephrotic syndrome in type 1 diabetes: long-term follow-up of patients in the Captopril Study

In 1994, we reported a 3.4 +/- 0.8 year follow-up of the eight patients who experienced remission of nephrotic syndrome during the Collaborative Study Group-sponsored, multicenter trial of captopril therapy in patients with type 1 diabetes with nephropathy (Captopril Study). Of the 409 patients randomized to treatment on the Captopril Study, 108 had nephrotic syndrome (24-hour proteinuria >/= 3.5 g of protein) at baseline. Of these 108 patients, 8 experienced remission of nephrotic syndrome (proteinuria </= 1.0 g/24 h of protein). Remission was significantly associated with captopril therapy and control of systolic blood pressure. The present study describes the status of these eight patients during a follow-up of 7.7 +/- 0.3 years. Since our previous report, one patient has been lost to follow-up and one patient progressed to end-stage renal disease (ESRD) 3.7 years after completion of the Captopril Study. The remaining six patients remain in remission of nephrotic syndrome (mean 24-hour proteinuria, 1.03 +/- 0.3 g of protein) and have stable serum creatinine levels (mean, 1.58 +/- 0.3 mg/dL) and body weights (mean, 69.8 +/- 5.3 kg). Of the six patients, one has discontinued angiotensin-converting enzyme inhibitor (ACEi) therapy because of hypotension. Excluding the patient who progressed to ESRD, the current mean systolic blood pressure is 135 +/- 6 mm Hg and mean diastolic blood pressure is 78 +/- 4 mm Hg. We conclude that long-term remission of nephrotic syndrome and preservation of renal function is achievable in some patients with type 1 diabetes. Control of blood pressure and ACEi therapy appear to be important in achieving long-term remission.

Large-pore hemodialysis in acute endotoxin shock

OBJECTIVE

This study was undertaken to test the hypothesis that hemodialysis with a large-pore membrane would improve heart function during acute endotoxin shock.

SETTING

Large animal laboratory.

DESIGN

Eighteen mongrel dogs were instrumented to measure left ventricular maximum end-systolic elastance (left ventricular maximum elastance at end systole), cardiac output, circumflex artery blood flow, and myocardial mechanical efficiency (CO x MAP/MVO2, where CO is cardiac output, MAP is mean arterial pressure, and MVO2 is myocardial oxygen consumption). Plasma catecholamine concentrations were determined by high-performance liquid chromatography. Endotoxin shock was induced by infusing 5.0 microg/kg/min of Escherichia col 0127:B8 endotoxin in the portal vein for 60 mins, followed by 2.0 microg/kg/min of constant infusion. Control dogs (n = 6) received 4.0 mL/kg/min of saline; hemodialysis dogs (n = 6) underwent venovenous hemodialysis in 50-min intervals using a polysulfone filter (1.2 m2; mean pore size, 0.50 nm; blood flow rate, 400 mL/min; ultrafiltrate, "zero-balanced"); shams (n = 5) were treated identically to hemodialysis dogs, except that no convective dialysis was performed. A fourth group (n = 6) was treated with dopamine (5.0-7.0 microg/kg/min, optimal dose for contractile increase based on dose-response studies).

MEASUREMENTS AND MAIN RESULTS

After 2 hrs of treatment, left ventricular maximum elastance at end systole increased and was unchanged in controls (30 +/- 5 mm Hg/mm) and shams (24 +/- 6 mm Hg/mm) compared with basal control. Hemodialysis treatment increased contractility (53 +/- 4 mm Hg/mm), as did dopamine treatment (54 +/- 7 mm Hg/mm). Endotoxin shock reduced mechanical efficiency to 45% of basal control; with hemodialysis treatment, left ventricular efficiency returned to 64% of basal control measurement, compared with 49% with dopamine treatment. During treatment, myocardial glucose uptake was increased with hemodialysis compared with other groups. No difference was observed among groups for left ventricular end-diastolic pressures or dimensions, or catecholamine concentrations.

CONCLUSIONS

Large-pore hemodialysis increased left ventricular contractility to a similar degree as dopamine and provided a marginal improvement in myocardial glucose uptake and mechanical efficiency.

Cognitive distortions and blame attribution in sex offenders against adults and children

OBJECTIVE

Sexual offenders tend to hold attitudes and beliefs which minimize and justify their offending behavior. It was hypothesized that distorted thinking supporting sexual offending and blame attribution would differ depending on the offence characteristics of different groups of sexual offenders.

METHOD

Two groups of sexual offenders separated on the basis of the age of their victims (sex offenders against children, 36; sex offenders against adults, 30) were compared on measures of cognitive distortions relating to sex with children and rape and a measure of blame attribution which assesses external, mental element, and guilt feeling attributions.

RESULTS

Child sexual offenders endorsed more cognitive distortions relating to sex with children, but there were no group differences in cognitive distortions relating to rape. Those who offended against adults reported more external attributions and child offenders reported more guilt feeling attributions. Mental element attribution related to alcohol intoxication and use of violence in the offence, but was not related to group differences.

CONCLUSIONS

Results are interpreted as suggesting that child sex offenders support their offending by more enduring distorted cognitions, while those who offend against adults use blame attributions associated with the particular offence.

Role clarity, perception of the organization and burnout amongst support workers in residential homes for people with intellectual disability: a comparison between a National Health Service trust and a charitable company

Changes in roles and responsibilities brought about by community care and the reorganization of the UK National Health Service (NHS) have resulted in higher levels of stress and insecurity amongst residential nursing staff working with people with intellectual disability. In the light of these organizational changes, questions have arisen about the relationship between role clarity, perception of the organization and occupational stress. A number of studies have investigated these issues amongst staff working with people with intellectual disability, although there have been few investigations in the UK. The present study examines the relationship between these variables in the context of the differences between the employees of an NHS trust and a charitable organization. The present study involved constructing a measure of role clarity and perception of the organization, and the use of the Maslach Burnout Inventory (MBI). The results indicated that most support workers regarded their role as being clear and their levels of burnout to be comparable with UK nursing norms. Charity staff were more likely to view their organization positively and rated their emotional exhaustion as significantly lower than NHS trust staff. A within-service comparison of homes revealed differences amongst NHS trust and charity homes on sub-scales of the MBI. The results are discussed in the context of previous research and changes in working practices in the field.

Light regulation of the abundance of mRNA encoding a nucleolin-like protein localized in the nucleoli of pea nuclei

A cDNA encoding a nucleolar protein was selected from a pea (Pisum sativum) plumule library, cloned, and sequenced. The translated sequence of the cDNA has significant percent identity to Xenopus laevis nucleolin (31%), the alfalfa (Medicago sativa) nucleolin homolog (66%), and the yeast (Saccharomyces cerevisiae) nucleolin homolog (NSR1) (28%). It also has sequence patterns in its primary structure that are characteristic of all nucleolins, including an N-terminal acidic motif, RNA recognition motifs, and a C-terminal Gly- and Arg-rich domain. By immunoblot analysis, the polyclonal antibodies used to select the cDNA bind selectively to a 90-kD protein in purified pea nuclei and nucleoli and to an 88-kD protein in extracts of Escherichia coli expressing the cDNA. In immunolocalization assays of pea plumule cells, the antibodies stained primarily a region surrounding the fibrillar center of nucleoli, where animal nucleolins are typically found. Southern analysis indicated that the pea nucleolin-like protein is encoded by a single gene, and northern analysis showed that the labeled cDNA binds to a single band of RNA, approximately the same size and the cDNA. After irradiation of etiolated pea seedlings by red light, the mRNA level in plumules decreased during the 1st hour and then increased to a peak of six times the 0-h level at 12 h. Far-red light reversed this effect of red light, and the mRNA accumulation from red/far-red light irradiation was equal to that found in the dark control. This indicates that phytochrome may regulate the expression of this gene.

Effective lowering of plasma, LDL, and esterified cholesterol in LDL receptor-knockout mice by adenovirus-mediated gene delivery of ApoB mRNA editing enzyme (Apobec1)

Adenovirus-mediated gene delivery of apolipoprotein (apo)B mRNA editing enzyme (AvApobec1) was used to study the effect of apoB mRNA editing on apoB production in homozygous LDL receptor-deficient (LDLR-/-) mice. Intravenous injection of AvApobec1 into these mice resulted in a >80% decrease in plasma apoB-100 with a concomitant increase in plasma apoB-48 level. The plasma apoE level also increased. In all cases, total plasma apoB (apoB-100 + apoB-48) decreased by 60% at day 5 and remained approximately 40% lower in AvApobec1-treated compared with control vector Av1LacZ4-treated animals at day 12. On day 12, total plasma cholesterol decreased by 29% in male mice and 18% in female mice that were transduced with AvApobec1. This was reflected in a reduction in apoB-containing lipoprotein cholesterol, which decreased by 34% and 27% in male and female mice, respectively. Apobec1 gene transfer also decreased the cholesteryl ester contents in the LDL fraction, which were 16%, 22%, and 22% in female and 20%, 20%, and 15% in male animals on days 5, 7, and 12, respectively, compared with Av1LacZ controls with 29%, 32%, and 33%, respectively, in female and 29%, 38%, and 36%, respectively, in male animals. Nondenaturing gradient gel electrophoresis indicated almost complete elimination of LDL particles of 29, 27, and 25 nm at days 7 and 12. We conclude that in the absence of a functioning LDL receptor, hepatic overexpression of Apobec1 is highly efficient in lowering plasma apoB-100 levels, leading to the almost complete elimination of LDL particles and a reduction in LDL cholesterol and cholesteryl ester content.

Video-assisted thoracoscopic volume reduction surgery in patients with diffuse pulmonary emphysema: gas exchange and anesthesiological management

Arterial blood gases were studied prospectively using continuous intraarterial blood gas monitoring during thoracoscopic volume reduction surgery (VRS) in 24 patients with advanced diffuse pulmonary emphysema. Additionally, the early postoperative course (48 h) of arterial blood gases was studied retrospectively. Twenty-six operations were performed using a combination of thoracic epidural and general anesthesia with left-sided double-lumen intubation for one-lung ventilation (OLV). Arterial blood gases were determined awake, during two-lung ventilation prior to surgery, during OLV (extreme values), and after tracheal extubation. Additionally, the extremes during the whole procedure were determined: avoiding excessive peak inspiratory pressures (26.4 +/- 7.0 cm H2O), minimum PaO2 was 77 +/- 39 mm Hg (mean +/- SD), maximum PaCO2 65 +/- 14 mm Hg (P < 0.0001 versus preoperative values), and minimum pHa 7.22 +/- 0.08 (P < 0.0001). One tension pneumothorax occurred during OLV. Immediate postoperative extubation was performed in 25 of 26 cases, reintubation was necessary in two cases. One patient with coronary artery disease died 36 h after surgery. Hypercapnia (maximum PaCO2 49 +/- 8 mm Hg, minimum pHa 7.37 +/- 0.04, P < 0.01) was still observed 48 h after surgery. These results demonstrate that adequate oxygenation can be preserved during OLV for VRS, but CO2 elimination is impaired. However, intraoperative hypercapnia and immediate postoperative tracheal extubation are well tolerated.

Galactosamine-induced fulminant hepatic necrosis in unanesthetized canines

A large animal model of fulminant hepatic necrosis is necessary to test the efficacy of artificial liver support systems. A recent model was developed using D-galactosamine in anesthetized dogs. Because of the difficulties encountered with prolonged anesthesia, a similar protocol was used in 10 unanesthetized dogs. Intravenous infusions of D-galactosamine (1.0 to 1.5 gm/kg) did not result in uniform death of all animals at 72 hours or development of hypoglycemia. Severe hepatic necrosis was observed in all animals, but residual hepatocyte viability was evident in some. All animals developed severe consumption coagulopathy with histological evidence of disseminated intravascular coagulation (DIC) in four. A clinical picture characteristic of endotoxic shock was observed in most animals as a terminal event. The presence of endotoxin was confirmed in all dogs tested after 12 hours (7/10). The differences observed between this model and the anesthetized model are probably because of the toxic synergism between halothane and D-galactosamine. Neither model seems satisfactory for the testing of artificial liver support systems. The halothane model requires extremely long periods of anesthesia and mechanical ventilation. The present model does not cause uniform or universal death of the animals within 3 days. Foremost, both models result in DIC and endotoxic shock, neither of which is likely to respond to bioartificial liver support or treatment with conventional dialysis membranes.

Plasma exchange for dramatic gestational hyperlipidemic pancreatitis

We describe the response to plasma exchange in a woman with extreme gestational hyperlipidemia and severe pancreatitis. Her serum triglyceride reached an astounding level of 21,300 mg/dl-among the highest concentrations ever recorded. Two consecutive plasma exchanges led to a remarkable reduction in triglyceride levels of 73% and 82%, respectively. Plasma viscosity decreased by 50% after the first plasma exchange. This was associated with an equally dramatic and unexpectedly rapid resolution of severe pancreatitis. Plasma exchange can rapidly and safely resolve extreme hyperlipidemia and be associated with prompt resolution of pancreatitis in women with severe gestational hyperlipidemic pancreatitis.

Memory, attention, and executive function in chronic fatigue syndrome

OBJECTIVES

To examine cognitive function in chronic fatigue syndrome.

METHODS

Twenty patients with chronic fatigue syndrome recruited from primary care and 20 matched normal controls were given CANTAB computerised tests of visuospatial memory, attention, and executive function, and verbal tests of letter and category fluency and word association learning.

RESULTS

Patients with chronic fatigue syndrome were impaired, predominantly in the domain of memory but their pattern of performance was unlike that of patients with amnesic syndrome or dementia. They were normal on tests of spatial pattern recognition memory, simultaneous and delayed matching to sample, and pattern-location association learning. They were impaired on tests of spatial span, spatial working memory, and a selective reminding condition of the pattern-location association learning test. An executive test of planning was normal. In an attentional test, eight subjects with chronic fatigue syndrome were unable to learn a response set; the remainder exhibited no impairment in the executive set shifting phase of the test. Patients with chronic fatigue syndrome were also impaired on verbal tests of unrelated word association learning and letter fluency.

CONCLUSION

Patients with chronic fatigue syndrome have reduced attentional capacity resulting in impaired performance on effortful tasks requiring planned or self ordered generation of responses from memory.

Comparative effects of Cd2+ and Cd-metallothionein on cultured kidney tubule cells

The effects of Ca2(+) and Cd-metallothionein on two cultured cells with proximal tubule characteristics, mouse kidney cortical cells and pig kidney LLC-PK1 cells, have been compared. Cd2+ inhibits Na(+)-glucose cotransport in LLC-PK1 cells and in the process decreases the number of binding sites for [3H]phlorizin, a competitive inhibitor of glucose for the Na(+)-glucose cotransporter. During 24 hr incubation and over a range of concentrations in the two cell types, only Cd2+ inhibited Na(+)-glucose cotransport even when approximately equal concentrations of intracellular Cd resulted from these treatments. Indeed, at low concentrations of Cd-metallothionein in mouse cells, transporter activity was elevated. Extension of incubations to 72 hr in mouse cells led to increased Cd uptake and reduction in cell density with both sources of Cd but only a progressive decline in Na(+)-glucose cotransport activity with Cd2+. Zn-metallothionein was without effect under comparable conditions. Both forms of Cd were accumulated by these cells, with the large majority of the metal ion localizing in metallothionein as a Cd, Zn-protein in LLC-PK1 cells. Under equal exposure conditions, the net uptake of Cd from Cd-metallothionein in the two cell types. It is evident that the mechanisms of toxicity of Cd2+ and Cd-metallothionein as well as their modes of uptake differ in these two cell types.

Inhibition of Na(+)-glucose cotransport in kidney cortical cells by cadmium and copper: protection by zinc

Properties of the inhibition of Na(+)-glucose cotransport by Cd2+ in mouse kidney cortical cells have been determined. In no case was any inhibition observed before 3 hr. The extent of inhibition was dependent upon both the concentration of Cd2+ and the length of exposure. Kinetic studies showed that metallothionein mRNA induction by Cd2+ was initiated within 1 hr after incubation with Cd2+ began and peaked by 3-6 hr. Metallothionein protein increased more slowly, beginning at 3 hr and continuing for at least 9 hr. The protein had both Cd2+ and Zn2+ bound to it throughout this period. Nevertheless, a pool of nonmetallothionein Cd2+ appeared after 3 hr, coinciding with the onset of inhibition of Na(+)-glucose cotransport, and increased over the next 9 hr. Pretreatment of cells with Zn2+ protected them from the effects of Cd2+ on Na(+)-glucose cotransport. It delayed the onset of inhibition of transport as well as the extent of inhibition. Detailed analysis of the distribution of Cd2+ and Zn2+ in the soluble fraction of these cells showed that the concentration of non-metallothionein bound Cd2+ was not suppressed by the presence of Zn-metallothionein after the onset of exposure to Cd2+. Incubation of cells with larger concentration of Zn2+ and Cu2+ also inhibited Na(+)-glucose cotransport.

Adenovirus-mediated gene transfer of rat apolipoprotein B mRNA-editing protein in mice virtually eliminates apolipoprotein B-100 and normal low density lipoprotein production

Apolipoprotein (apo) B-100 is the major protein component in low density lipoprotein (LDL); it contains the binding domain for the LDL receptor and the attachment site for apolipoprotein(a) in lipoprotein(a). ApoB-48 is colinear with the amino-terminal half of apoB-100 and misses the part of the molecule required for LDL receptor interaction and lipoprotein(a) formation. ApoB-48 mRNA is produced by the editing of apoB-100 mRNA, a process by which the codon CAA for Gln-2153 is changed to UAA, an in-frame stop codon. We used the cloned catalytic component of the rat apoB mRNA-editing enzyme (REPR) to construct a replication-defective recombinant adenoviral vector containing REPR cDNA (AvREPR) and a control vector (Av1LacZ4) containing a beta-galactosidase cDNA to investigate the effect of REPR gene delivery in C57BL/6 mice. Intravenous injection of AvREPR in mice resulted in efficient transduction of liver cells, where REPR mRNA and protein were overexpressed, reaching a peak at 7 and 12 days, returning toward control levels at 39 days after AvREPR administration. ApoB mRNA editing activity in liver extracts showed changes parallel to those of REPR mRNA expression; the proportion of edited apoB mRNA in the total hepatic apoB mRNA increased from approximately 60% to more than 90% at the peak of REPR expression. The proportion of plasma apoB-100 in AvREPR-transduced animals decreased from approximately 50% to < 10% of total plasma apoB concentration. Plasma very low density lipoproteins were polydisperse in control animals with an average diameter of 54.9 +/- 20.6 nm (uninjected control) and 54.7 +/- 16.8 nm (Av1LacZ4-treated), respectively. They became much smaller (average diameter 39.3 +/- 12.7 nm) and more uniform in size at day 12 following AvREPR administration. On the same day, the normal plasma LDL (26.2-25.5 nm) was almost completely eliminated in treated animals. Adenovirus-mediated transfer of the REPR cDNA is an efficient method to reduce plasma apoB-100 and normal LDL production.

Total quality management: administrative and clinical applications in nursing homes

OBJECTIVE

Describe the application of the Total Quality Management (TQM) model to the unique work force, resident population, and regulatory issues that characterize long term care settings.

DESIGN

The key differences between TQM and current management and training practices in nursing homes are described. A specific data-based example is provided of a successful TQM application to health care involving clinical work processes related to incontinence care.

CONCLUSION

Significant organizational and clinical obstacles must be overcome if TQM is to improve the quality of life and satisfaction of nursing home residents and their families as it has improved the efficiency and product quality in hospital and non-health-care settings.

Complications of the Wiltse Pedicle Screw Fixation System

The purpose of the current study is to retrospectively review the incidence and types of complications occurring using a single pedicle screw fixation system for lumbar spine fusions. For a 3-year period beginning in July 1987, 470 patients underwent spinal fusion and instrumentation with the Wiltse Pedicle Screw Fixation System. Although multiple configurations of the Wiltse System were included, the predominant construct was that of segmental pedicle screw fixation. Complications occurred in a total of 29 patients, for an overall complication rate of 6%. Among the complications were 10 wound problems (2%) that included 2 seromas requiring drainage and 3 superficial wound infections. The remaining five wound complications were deep wound infections requiring irrigation and debridement. The overall deep wound infection rate was 1%. Neurologic complications occurred in two patients, one with temporary foot drop and one with persistent L5 nerve root irritation confirmed by electromyogram (EMG). Both of these patients underwent anatomic workup, which failed to reveal any evidence of impingement by either screw or other hard tissue. Two intraoperative complications occurred, both involving fracture of the L5 pedicle. No adverse sequela resulted. There were 15 hardware complications, for an overall rate of 3%. This included four patients with broken screws (a total of eight screws). There were three failures at the screw-bone interface, as well as four patients with uncoupling of the screw rod linkage. In addition, there were four broken rods encountered. A total of 122 Wiltse devices were removed, for an overall removal rate of 25%.(ABSTRACT TRUNCATED AT 250 WORDS)

National survey of current arrangements for diversion from custody in England and Wales

OBJECTIVES

To assess the extent and nature of psychiatric assessment schemes based at magistrates' courts in England and Wales for the early diversion of mentally disordered offenders from custody and to determine the response of the NHS to new initiatives concerning alternatives to custody for this group.

DESIGN

Postal survey of the probation service, petty sessional divisions, mental health provider units, and district purchasing authorities in England and Wales.

SUBJECTS

All chief probation officers (n = 55), clerks to the justices (n = 284), managers of mental health provider units (n = 190), and purchasers of mental health services (n = 190) in each of the district health authorities.

MAIN OUTCOME MEASURES

Number of psychiatric assessment schemes, practical difficulties in their operation, extent of regular liaison with health and social services; current and future intentions to purchase or provide services for diversion from custody.

RESULTS

Data were obtained from every magistrates' court. Forty eight psychiatric assessment schemes were identified with another 34 under development. Particular problems were lack of adequate transport arrangements, difficulties with hospital admissions, and overdependence on key people. There was little liaison between health, social services, and members of the criminal justice system. Twenty five of the 106 purchasers who responded had a policy dealing with diversion, and 39 had a scheme under development; 56 purchasers had no current or future plans about diversion. Sixty nine of the 150 providers who responded reported that diversion was included in their current or next business plan.

CONCLUSION

Schemes to divert mentally disordered offenders from the criminal justice system are often hampered by lack of adequate transport arrangements, difficulties in hospital admissions, and overdependence on key people.

NIH conference. Chronic fatigue syndrome research. Definition and medical outcome assessment

A workshop was held 18 to 19 March 1991 at the National Institutes of Health to address critical issues in research concerning the chronic fatigue syndrome (CFS). Case definition, confounding diagnoses, and medical outcome assessment by laboratory and other means were considered from the perspectives of key medical specialties involved in CFS research. It was recommended that published Centers for Disease Control (CDC) case-definition criteria be modified to exclude fewer patients from analysis because of a history of psychiatric disorder. Specific recommendations were made concerning the inclusion or exclusion of other major confounding diagnoses, and a standard panel of laboratory tests was specified for initial patient evaluation. The workshop emphasized the importance of recognizing other conditions that could explain the patient's symptoms and that may be treatable. It was viewed as essential for the investigator to screen for psychiatric disorder using a combination of self-report instruments followed by at least one structured interview to identify patients who should be excluded from studies or considered as a separate subgroup in data analysis. Because CFS is not a homogeneous abnormality and because there is no single pathogenic mechanism, research progress may depend upon delineation of these and other patient subgroups for separate data analysis. Despite preliminary data, no physical finding or laboratory test was deemed confirmatory of the diagnosis of CFS. For assessment of clinical status, investigators must rely on the use of standardized instruments for patient self-reporting of fatigue, mood disturbance, functional status, sleep disorder, global well-being, and pain. Further research is needed to develop better instruments for quantifying these domains in patients with CFS.

Gender differences in pharmacokinetics and pharmacodynamics of psychotropic medication

OBJECTIVE

This review explores the theoretical background for and empirical evidence supporting gender-related differences in pharmacokinetics and pharmacodynamic properties of psychotropic medications.

METHOD

The authors reviewed all English-language articles on this topic that involved original research using human subjects.

RESULTS

Limited evidence suggests that young women seem to respond better to and require lower doses of antipsychotic agents and benzodiazepines than young men. The administration of exogenous hormones interacts with medications, changing plasma levels and possibly conferring greater risks for toxicity. Young women may have an enhanced response to nontricyclic antidepressants.

CONCLUSIONS

Too little basic and clinical research has been conducted on sex differences in therapeutic effects and side effects of psychopharmacological treatments. Addressing these differences as well as similarities will lead to safer and more effective treatment for all patients.

[Integration and reintegration of first admission psychiatric patients]

In the framework of a prospective follow-up study, development and outcome of the occupational and social status in 258 first-admission psychiatric patients was investigated. Interviews were made at the time of discharge, 1 year and 5 years later. For that reason prospective data exist on the prehospital and hospital time as well as on short-term and long-term course. Social adjustment, occupational rehabilitation, early retirement, social status and pre- and post-hospital occupational integration were investigated. It must be placed on record, that psychiatric patients are subjected to severe negative changes in their occupational and social life even after the first hospital treatment. Type and quantity of disintegration depended on the diagnostic group. Schizophrenic patients differed from the other patients in every intergration area.

Work and psychiatric illness: the significance of the posthospitalization occupational environment for the course of psychiatric illnesses

The value of the reintegration and rehabilitation of inpatients vocationally was studied. Certain of the vocational experiences (unemployment and stressful working conditions) of former psychiatric inpatients were examined, with attention being paid to their stabilizing or destabilizing effect on symptomatic behaviour. A cohort of 230 first-time admissions for treatment of various disorders were interviewed while hospitalized and 1 year later. A 20-item list prepared by INFAS was used for indexing stressful working conditions. Psychopathological states were assessed with the help of the Present State Examination of Wing et al. (1973). The results indicate that mentally ill persons (especially those with organic or affective disorders), when confronted with unemployment after discharge from hospital, will usually respond by developing new or worse syndromes. Stressful working conditions appear to have very different effects in schizophrenia and affective disorders, viz. deterioration and amelioration of psychopathological syndromes respectively.

Mortality and rate of suicide of first admission psychiatric patients. A 5-year follow-up of a prospective longitudinal study

Patients who commit suicide in a psychiatric hospital are, in general, patients who have had previous admission or who have already made at least one suicide attempt. The following study focuses upon an earlier time within the course of a psychiatric illness, that is the time of first admission, and examines the rate of suicide of 258 patients after 5 years. Two control groups were selected: first admitted psychiatric patients who did not commit suicide, and patients who died a 'natural death'. We analyzed how the suicides were integrated into the vocational, social and medical areas of life before they were admitted to the hospital. Further it was possible to identify predictors of future suicide.

The problem of readmission with respect to occupational factors. Course and predictive influences after 5 years

In this study the course of Readmission after one, 2.5 and 5 years was examinated at a sample of 258 first admitted psychiatric patients of different diagnostic groups. In the analysis occupational, soziodemographic and clinical parameters of these patients were related to the readmission after 5 years and studied if these parameters allow a predictive statement. It was shown that 40%-60% (dependent of diagnoses) of the patients were readmitted in a period of 5 years. The course of the readmission also varied in the different diagnostic groups. The most striking result was the rate of readmission of the schizophrenic psychoses which was at the time of the 1 year catamnesis below average after the 2.5 year analysis however above average. Beside these findings occupational and clinical predictors were identified in all diagnostic groups with exception of the schizophrenic psychoses group. The results are discussed and attention is put on possible consequences to prevent rehospitalization.

[Readmission of psychiatric patients hospitalized for the first time--course and predictive factors after 5 years]

In this study the course of rehospitalisation after one, 2 1/2 and 5 years was examined in a sample of 113 readmitted patients of different diagnostic groups. In a second step of analysis occupational, sociodemographic and clinical parameters of these patients were related to the readmission after 5 years and studied if these parameters allow a predictive statement. It was shown that 40%-60% (dependent of diagnoses) of the patients were readmitted in a period of 5 years. The course of the rehospitalization also varied in the different diagnostic groups. The most striking result was the rate of readmission of the schizophrenic psychoses which was at the time of the 1 year catamnesis below average after the 2 1/2 years analysis however above average. Besides these findings occupational and clinical predictors were identified in all diagnostic groups with exception of the schizophrenic psychoses group. The results are discussed and attention is put on possible consequences to prevent rehospitalization.