Cost of pediatric laryngotracheal reconstruction: Differences between single-versus double-stage procedures

OBJECTIVE

Examine differences in cost between single stage (ss) versus double stage (ds) laryngotracheal reconstruction (LTR) for pediatric subglottic stenosis.

STUDY DESIGN

Retrospective chart review of children who underwent ssLTR or dsLTR from 2014 to 2018 at a single institution.

METHODS

Costs related to LTR and post-operative care up to one year after tracheostomy decannulation were extrapolated from charges billed to the patient. Charges were obtained from the hospital finance department and the local medical supplies company. Patient demographics including baseline severity of subglottic stenosis and co-morbidities were noted. Variables assessed include duration of hospital admission, number of ancillary procedures, duration of sedation wean, cost of tracheostomy maintenance, and time to tracheostomy decannulation.

RESULTS

Fifteen children underwent LTR for subglottic stenosis. D Ten patients underwent ssLTR, while five underwent dsLTR. Grade 3 subglottic stenosis was more prevalent in patients who underwent dsLTR (100%) than ssLTR (50%). The average per-patient hospital charges for ssLTR was $314,383 versus $183,638 for dsLTR. When estimated mean cost of tracheostomy supplies and nursing care until tracheostomy decannulation was included, the mean total charges associated with dsLTR patients was $269,456. Average hospital stay after initial surgery was 22 days for ssLTR versus 6 days for dsLTR. Average time to tracheostomy decannulation for dsLTR was 297 days. Average number of ancillary procedures needed was 3 versus 8 for ssLTR versus dsLTR.

CONCLUSION

For pediatric patients with subglottic stenosis, dsLTR may have a lower cost than ssLTR. Although ssLTR has the benefit of immediate decannulation, it is associated with higher patient charges, as well as longer initial hospitalization and sedation. For both patient groups, fees associated with nursing care comprised the majority of charges. Recognizing the factors that contribute to cost differences between ssLTR and dsLTR may be useful when performing cost-benefit analyses and assessing value in health care delivery.

Multidisciplinary shock team is associated with improved outcomes in patients undergoing ECPR

OBJECTIVES

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has been increasingly used in cardiopulmonary resuscitation (ECPR) in select patients. Few centers have published their experience or outcomes with ECPR. The aim of our study was to evaluate outcomes of adult patients in cardiac arrest placed on VA ECMO in the catheterization laboratory.

METHODS

We performed a retrospective analysis of adult patients in refractory cardiac arrest who underwent ECPR at the Minneapolis Heart Institute (MHI) at Abbott Northwestern Hospital from January 2012 to December 2017. Relevant data were obtained from electronic medical records, including arrest to ECMO flow time, total ECMO support time, and outcomes.

RESULTS

Twenty-six adult patients underwent ECPR at the study site during the defined time period. Seven patients (27%) sustained cardiac arrest out of hospital, 19 patients arrested in-hospital with eight of those occurring in the catheterization laboratory. Seventeen (65%) patients had initial rhythm of ventricular fibrillation or tachycardia (VF/VT). All patients underwent mechanical CPR with LUCAS device. Overall 30 day and 6 month survival was 69%. Median time from arrest to ECMO flow was 46 mins (21,68) vs 61 mins (36,71) in survivors and non-survivors, respectively. Sixteen of 18 survivors discharged with a CPC score of 1 or 2.

CONCLUSIONS

We demonstrate that adult patients in cardiac arrest initiated on VA ECMO in the cardiac catheterization laboratory and cared for by a multidisciplinary shock team in the critical care unit have superior long-term survival and functionally favorable neurologic recovery when compared to current literature.

A Unique Case Report on Hypersensitivity Vasculitis as an Allergic Reaction to the Herpes Zoster Vaccine

Hypersensitivity vasculitis (HV) or leukocytoclastic vasculitis is a rare small-vessel vasculitis that may occur as a manifestation of the body's extreme allergic reaction to a drug, infection, or other foreign substance. Characterized by the presence of inflammatory neutrophils in vessel walls, HV results in inflammation and damage to blood vessels, primarily in the skin. Histologically, when neutrophils undergo leukocytoclasia and release nuclear debris into the vasculature, vascular damage manifests as palpable purpura. The incidence of HV is unknown and its relationship and interaction with certain vaccinations is rare and poorly understood. Affected patients with HV generally have a good prognosis; however, fatality may occur if organs such as the central nervous system, heart, lungs, or kidneys are involved. We report a unique case of a 60-year-old man who presented with a serious case of HV after receiving the herpes zoster vaccine. A thorough literature review yielded only one similar case of vascular reaction to the varicella vaccine that was reported in the Annals of Internal Medicine in 1997; however, no other reported cases with regard to the herpes zoster vaccine have been found. Our case presents a rare glimpse into HV that may result from varicella vaccine administration.

Quercetin attenuates lactate production and extracellular matrix secretion in keratoconus

Keratoconus(KC) is an ecstatic corneal disease leading to corneal-thinning and the formation of a cone-like cornea. Elevated lactate levels, increased oxidative stress, and myofibroblast formation have all been previously reported. In the current study, we assess the role of Quercetin on collagen secretion and myofibroblast formation in KC in vitro. Human corneal fibroblasts(HCFs) and human keratoconus cells(HKCs) were treated with a stable Vitamin C derivative and cultured for 4 weeks, stimulating formation of a self-assembled extracellular matrix. All samples were analyzed using Western blots and targeted tandem mass spectrometry. Our data showed that Quercetin significantly down regulates myofibroblast differentiation and fibrotic markers, such as α-smooth muscle actin (α-SMA) and Collagen III (Col III), in both HCFs and HKCs. Collagen III secretion was reduced 80% in both HCFs and HKCs following Quercetin treatment. Furthermore, Quercetin reduced lactate production by HKCs to normal HCF levels. Quercetin down regulated TGF-βR2 and TGF-β2 expression in HKCs suggesting a significant link to the TGF-β pathway. These results assert that Quercetin is a key regulator of fibrotic markers and ECM assembly by modulating cellular metabolism and TGF-β signaling. Our study suggests that Quercetin is a potential therapeutic for treatment of corneal dystrophies, such as KC.

Cefepime vs. Ampicillin/Sulbactam and Aztreonam as antibiotic prophylaxis in neurosurgical patients with external ventricular drain: result of a prospective randomized controlled clinical trial

INTRODUCTION

We aimed to find out whether single board spectrum antibiotic prophylaxis was as good as dual specific antibiotic prophylaxis in neurosurgical patients with external ventricular drain (EVD) in situ.

METHOD

In a 2-year period, 255 eligible patients were recruited. Patients were randomized into two groups of antibiotic prophylaxis as long as the ventricular catheter in situ. Group A employed Cefepime 2G 12 hourly and Group B employed dual antibiotics as Ampicillin/Sulbactam 3 g 8 hourly and Aztrenam 2 g 8 hourly.

RESULTS

There was no statistically significant difference in cerebrospinal fluid (CSF) infection rate with 14 patients (11.5%) in group A (Cefepime prophylaxis) and eight patients (6.0%) in group B (dual prophylaxis with Ampicillin/Sulbactam and Aztrenam) had CSF infection (P=0.18). There was also no statistical significant difference between wound infection rate happened in eight patients (6.6%) in Group A and three patients (2.3%) in Group B (P=0.17). There was no statistical significant difference in extracranial infection rate between both groups (P=0.70).

CONCLUSION

Single board spectrum antibiotic prophylaxis with Cefepime was an effective alternative regimen for neurosurgical patients with an EVD in situ.

Failure of regular external ventricular drain exchange to reduce cerebrospinal fluid infection: result of a randomised controlled trial

BACKGROUND

It is controversial whether regular changes of external ventricular drains can reduce cerebrospinal fluid (CSF) infection.

OBJECTIVE

To carry out a randomised controlled clinical trial over a two year period to determine whether a regular change of ventricular catheter every five days could reduce CSF infection and improve outcome.

METHODS

103 patients requiring external ventricular drains for more than five days and with no evidence of concurrent CSF infection were studied. The patients were randomised to regular change of ventricular catheter (every five days) and no change unless clinically indicated.

RESULTS

The CSF infection rates were 7.8% for the catheter change group and 3.8% for the no change group, respectively (rate ratio = 1.80, 95% confidence interval 0.33 to 9.81, p = 0.50). No significant difference was found in intensive care unit stay, ward stay, or clinical outcome between the two groups.

CONCLUSIONS

Regular changes of ventricular catheter at five day intervals did not reduce the risk of CSF infection. A single external ventricular drain can be employed for as long as clinically indicated.

Incidence and risk factors for microbial keratitis in Hong Kong: comparison with Europe and North America

PURPOSE

To establish the incidence, etiology and risk factors for microbial keratitis (MK) in Hong Kong.

METHODS

Two hundred and twenty-three new cases of presumed MK were recruited over a period of 17 months and comprehensive microbiologic studies performed. A nested case-control study was pursued for patients wearing contact lenses (CLW) to determine risk factors for MK with regards to types of CLW and hygiene practice.

RESULTS

Of the 223 patients recruited, 59 (26%) wore contact lenses. Corneal scrapes yielded positive cultures from 77 patients (35% overall, 56 non-CLW, 21 CLW). Two hundred and six CLW volunteers were recruited to participate in the case-control study, of whom 135 were matched with 45 CLW patients. The annual incidence of MK was 0.63 per 10,000 population and 3.4 per 10,000 CLW with rates for daily, extended and rigid lens wear of 3.09, 9.30 and 0.44 per 10,000 CLW respectively. Pseudomonas aeruginosa was the dominant bacterial pathogen. Six cases of Acanthamoeba keratitis occurred, five in CLW (incidence 0.33 per 10,000 CLW) and one following corneal abrasion. Non-CLW developed MK at a peak age of 73, which is 10 years younger than expected for Scotland and USA.

CONCLUSIONS

Previous ocular surface disease and trauma were the main risk factors for MK in Hong Kong. CLW appears at least as safe as that found in Scotland and the USA. Acanthamoeba keratitis was detected but with an incidence rate five times lower than Scotland. Factors predisposing hydrogel CLWs to MK, that were statistically significant, included overnight wear, poor hygiene and smoking.

The opposing roles of the Akt and c-Myc signalling pathways in survival from CD95-mediated apoptosis

Expression of the proto-oncogene c-myc stimulates cell proliferation in the presence of the appropriate survival factors and triggers apoptosis in their absence; this dual capacity ensures that cell growth is restricted to the correct paracrine environment and is thereby strictly controlled. Recently our laboratory demonstrated that c-Myc-induced apoptosis requires the CD95 death receptor pathway and that insulin-like growth factor (IGF-1) signalling suppresses this killing. To investigate further the links between c-Myc and IGF-1 pathways in CD95-induced apoptosis, we examined the effects of c-Myc and a downstream IGF-1 survival kinase, Akt, on killing mediated by CD95 and its recruited effector proteins (FADD and caspase-8). Here, we show that c-Myc activation does not exacerbate killing induced by FADD or pro-caspase-8, which narrows the point at which c-Myc exerts its action downstream of the interaction of CD95 with its ligand and upstream of FADD. We show further that activated Akt suppresses CD95-induced apoptosis and that Akt exerts its activity at a point downstream of FADD but upstream of caspase-8. These results restrict the possible mechanisms by which CD95-induced apoptosis is modulated by death signals and survival factors.

Specific TrkA survival signals interfere with different apoptotic pathways

Survival signalling by ligand-activated tyrosine kinase receptors plays a crucial role in maintaining the balance between cell viability and apoptosis in multicellular organisms. To identify receptor domains and pathways involved in survival signalling, the nerve growth factor receptor TrkA was expressed in Rat-1/MycER fibroblasts. We demonstrate that wt-TrkA receptor delays c-Myc-, U.V.- and Cycloheximide-induced apoptosis and activates targets such as the mitogen-activated protein kinase (MAPK) Erk2 and the serine/threonine kinase Akt/PKB, both of which have been implicated in survival signalling. TrkA mutated within its SHC binding site (Y490F) delays c-Myc-induced apoptosis without activating endogenous Akt/PKB. In contrast, the TrkA Y490F mutant receptor does not delay U.V.-induced apoptosis whilst TrkA mutated at its PLC-gamma binding site (Y785F) is capable of protecting from apoptosis induced by c-Myc or U.V. treatment. The double mutant TrkA YY490/785FF fails to block either of these two apoptotic stimuli. While P13-kinase inhibitors LY294002 and Wortmannin completely block survival signalling following U.V. treatment, neither drug affects the ability of TrkA to block c-Myc-induced apoptosis. We show that the Akt/PKB pathway is essential for NGF stimulated TrkA survival signalling in the case of U.V.-induced apoptosis, but that apoptosis induced by c-Myc is also blocked by a novel, Akt/PKB-independent, pathway. These observations suggest that TrkA can activate different survival signalling pathways, which can interfere with specific apoptotic pathways.

Requirement for the CD95 receptor-ligand pathway in c-Myc-induced apoptosis

Induction of apoptosis by oncogenes like c-myc may be important in restraining the emergence of neoplasia. However, the mechanism by which c-myc induces apoptosis is unknown. CD95 (also termed Fas or APO-1) is a cell surface transmembrane receptor of the tumor necrosis factor receptor family that activates an intrinsic apoptotic suicide program in cells upon binding either its ligand CD95L or antibody. c-myc-induced apoptosis was shown to require interaction on the cell surface between CD95 and its ligand. c-Myc acts downstream of the CD95 receptor by sensitizing cells to the CD95 death signal. Moreover, IGF-I signaling and Bcl-2 suppress c-myc-induced apoptosis by also acting downstream of CD95. These findings link two apoptotic pathways previously thought to be independent and establish the dependency of Myc on CD95 signaling for its killing activity.

Attention and nontarget effects in the location-cuing paradigm

Three experiments were conducted in order to determine whether irrelevant items presented outside the focus of attention would affect the identification of a precued target. A peripheral cue indicated one of eight possible locations in a circular array, centered on fixation with a radius of 5.25 degrees. After a variable interval (0-200 msec), eight characters were presented briefly and masked. In each experiment, there was an effect of the identity of the characters at the seven noncued locations (the nontargets) on the accuracy of identification of the target. When there were more nontargets identical to the target, accuracy was higher than when there were fewer nontargets identical to the target. Nontargets consistently affected performance despite incentives to focus only on the target.

In-vitro activity of quinolones and macrolides against mycobacteria

The activities of eight quinolones (ciprofloxacin, clinafloxacin, levofloxacin, ofloxacin, A-80556, sparfloxacin, temafloxacin and tosufloxacin) and three macrolides (azithromycin, clarithromycin and erythromycin) against 98 clinical isolates of Mycobacterium tuberculosis and 120 isolates of five different atypical mycobacterial species including 20 Mycobacterium kansasii, 25 Mycobacterium scrofulaceum, 25 Mycobacterium avium/intracellulare, 25 Mycobacterium chelonae and 25 Mycobacterium fortuitum were determined with the Middlebrook 7H9 broth macrodilution method. Sparfloxacin, clinafloxacin, levofloxacin, ciprofloxacin and ofloxacin were active against M. tuberculosis (MIC90 0.06-0.5 mg/L; MBC90 0.125-2.0 mg/L). However, higher MIC90S and MBC90S of these quinolones were obtained for strains of multi-drug resistant M. tuberculosis. The macrolides tested had poor activity against M. tuberculosis isolates (MIC90 > 8.0 mg/L). Furthermore, high MIC90S of the quinolones and macrolides (2.0 to 8.0 mg/L) were obtained for clinical isolates of atypical mycobacteria, with the exception of clarithromycin against M. kansasii (MIC90 = 1.0 mg/L) and sparfloxacin against M. scrofulaceum (MIC90 = 1.0 mg/L).

Evaluation of three culture media and their combinations for the isolation of Mycobacterium tuberculosis from pleural aspirates of patients with tuberculous pleurisy

The abilities of three culture systems to detect Mycobacterium tuberculosis from 480 pleural aspirate specimens in 347 patients were compared. The systems were the Bactec 12B radiometric detection system (Bactec 12B), the Middlebrook 7H9 broth (7H9), and two solid media including one pyruvate enriched Lowenstein-Jensen slope (LJP) and one non-selective Middlebrook 7H11 agar slope (7H11). In the 116 specimens obtained from 85 patients of confirmed pleural tuberculosis for the isolation of Mycobacterium tuberculosis, the diagnostic yields were 33 (39%) cases from Bactec 12B, 24 (28%) cases from 7H9 and 21 (25%) cases from LJP/7H11, with median detection times of 18, 47.5 and 44 days respectively. Thirteen isolates were recovered by the Bactec 12B only, 9 by the 7H9 broth only, and 2 by the LJP/7H11 agar only. The use of a combination of the three culture systems substantially increased the diagnostic yield to 47% over the individual systems. These results show that a significantly greater and faster diagnostic yield can be obtained by including Bactec 12B in pleural aspirate cultures for the recovery of Mycobacterium tuberculosis.

Comparison of flow cytometric DNA content analysis of fresh and formalin-fixed paraffin-embedded solid neoplasms

In an attempt to compare results of fresh and fixed tissue flow cytometric DNA analysis we analyzed paraffin blocks of 87 solid tumors; 67 of these were DNA aneuploid and 20 were DNA euploid by fresh flow cytometric analysis. Forty-two aneuploid tumors and all diploid tumors were concordant (71.3% concordance), whereas 25 of 67 (37%) aneuploid tumors appeared diploid on fixed tissue analysis. Reasons for discordance included loss of small aneuploid peaks, merging of G1/G0 peaks of diploid and aneuploid stemlines giving a broad G1/G0 peak, and masking of near-tetraploid aneuploid peaks by the G2/M peak in fixed tissue. S-phase fraction could be determined in 51 of 67 (76%) aneuploid cases analyzed fresh and 29 of 42 (69%) concordant aneuploid cases analyzed from fixed tissues. All parameters were consistently higher in the fixed tissue: S-phase fraction (mean = 18.29% versus 12.82%), coefficient of variation of diploid G1/G0 peak (5.62% versus 2.11%), and DNA index (1.79 versus 1.69). We conclude that significant differences exist between flow cytometric data obtained from analysis of fresh versus fixed tissues and therefore prognostic correlations made on the basis of results of fixed tissue flow cytometric analysis may not necessarily parallel those of fresh tissue studies.

A novel arrangement of zinc-binding residues and secondary structure in the C3HC4 motif of an alpha herpes virus protein family

A highly conserved, cysteine-rich region plays a crucial role in the function of a family of regulatory proteins encoded by alpha herpes viruses. The so-called C3HC4 motif spans approximately 60 residues and has been predicted to bind zinc. This motif occurs in a number of other viral and cellular proteins, many of which appear to be involved in some aspect of the regulation of gene expression. We have cloned and expressed in bacteria a portion of immediate-early protein Vmw110 of herpes simplex virus type 1 that encompasses the C3HC4 motif, and the equivalent regions from the homologous proteins of varicella zoster virus and equine herpes virus type 1 (EHV-1). All three polypeptides were purified and found to bind zinc stably. None of the three interacted significantly with either DNA or RNA under our assay conditions. The EHV-1 domain yielded interpretable proton nuclear magnetic resonance spectra. Assignment of resonances and analysis of nuclear Overhauser effects revealed its secondary structure. Starting from the N terminus, this consists of an ordered but irregular loop, the first two strands of a triple-stranded antiparallel beta-sheet, two turns of an alpha-helix, a second irregular loop, and the third strand of the beta-sheet. It appears that, taking the cysteine and histidine residues in turn, cysteine residues I, II, IV and V co-ordinate one zinc atom while the histidine residue and cysteine residues III, VI and VII co-ordinate a second zinc atom. This arrangement of secondary structure differs from that found in other characterized zinc-containing proteins.

Why do people need self-esteem? Converging evidence that self-esteem serves an anxiety-buffering function

Three studies were conducted to assess the proposition that self-esteem serves an anxiety-buffering function. In Study 1, it was hypothesized that raising self-esteem would reduce anxiety in response to vivid images of death. In support of this hypothesis, Ss who received positive personality feedback reported less anxiety in response to a video about death than did neutral feedback Ss. In Studies 2 and 3, it was hypothesized that increasing self-esteem would reduce anxiety among individuals anticipating painful shock. Consistent with this hypothesis, both success and positive personality feedback reduced Ss' physiological arousal in response to subsequent threat of shock. Thus, converging evidence of an anxiety-buffering function of self-esteem was obtained.

Acupuncture fails to improve treatment outcome in alcoholics

Fifty-six alcoholics (49 male, 7 female) of lower socioeconomic class attending an outpatient treatment program in Brooklyn, New York were prospectively randomized to one of three treatment group: point-specific acupuncture, sham transdermal stimulation or standard care (control). One third of the subjects reported a history of drug use in addition to alcohol. Results in this small sample showed no significant differences in attendance at Alcoholics Anonymous meetings, number of outpatients sessions attended, number of weeks in either the study or in the outpatient program, number of persons completing treatment or in the number of relapses. It is therefore concluded that in this small racially mixed sample of urban outpatient alcoholics, fixed point-specific standardized acupuncture did not improve outcome. We caution against the routine use of this treatment until more randomized controlled trials demonstrate a beneficial effect.

Why do people need self-esteem? Converging evidence that self-esteem serves an anxiety-buffering function

Three studies were conducted to assess the proposition that self-esteem serves an anxiety-buffering function. In Study 1, it was hypothesized that raising self-esteem would reduce anxiety in response to vivid images of death. In support of this hypothesis, Ss who received positive personality feedback reported less anxiety in response to a video about death than did neutral feedback Ss. In Studies 2 and 3, it was hypothesized that increasing self-esteem would reduce anxiety among individuals anticipating painful shock. Consistent with this hypothesis, both success and positive personality feedback reduced Ss' physiological arousal in response to subsequent threat of shock. Thus, converging evidence of an anxiety-buffering function of self-esteem was obtained.

Evidence of codependency in women with an alcoholic parent: helping out Mr. Wrong

A conceptualization of codependency and its development, which is based largely on the writings of Karen Horney, is presented. It is proposed that having learned to obtain approval and self-esteem by conforming to the demands of an exploitive person, women with alcoholic parents will continue to seek opportunities to help such people. On the basis of this analysis, it was hypothesized that women with alcoholic parents would be more helpful to an experimenter portrayed as exploitive than to one portrayed as nurturant; women with nonalcoholic parents were expected to exhibit the opposite pattern. The results strongly supported the existence of codependent behavior in the women with alcoholic parents. The implication of these findings and directions for future research were briefly discussed.

Evidence for sulfite as an essential metabolite for human peripheral lymphocytes

Sulfite has been identified as an essential metabolite by means of growth studies using a chemically-defined, protein-free medium for culture of human peripheral lymphocytes. Sulfite reduced the amount of cysteine required for optimum growth by at least four-fold. In some subjects, sulfite stimulated growth even in the presence of optimal amounts of cysteine indicating that lymphocytes of some individuals are unable to convert cysteine to sulfite in adequate amounts.

Evidence of codependency in women with an alcoholic parent: Helping out Mr. Wrong

A conceptualization of codependency and its development, which is based largely on the writings of Karen Horney, is presented. It is proposed that having learned to obtain approval and self-esteem by conforming to the demands of an exploitive person, women with alcoholic parents will continue to seek opportunities to help such people. On the basis of this analysis, it was hypothesized that women with alcoholic parents would be more helpful to an experimenter portrayed as exploitive than to one portrayed as nurturant; women with nonalcoholic parents were expected to exhibit the opposite pattern. The results strongly supported the existence of codependent behavior in the women with alcoholic parents. The implication of these findings and directions for future research were briefly discussed.

Daptomycin versus vancomycin treatment for Staphylococcus aureus bacteremia in a murine model

Daptomycin (LY 146032), a new lipopeptide antimicrobial agent with activity against gram-positive bacteria, was compared to vancomycin in the treatment of staphylococcal bacteremia in a murine model. Two hundred and ninety-nine mice were inoculated with 1 x 10(8) bacteria by the tail vein, and treatment was begun 3 days later. Two dosage regimens of each drug were used: 10 mg/kg and 5 mg/kg administered every 12 h for 14 days. A control group received no therapy. Survival was determined 31 days after inoculation. There was no significant difference in survival in any of the four treatment groups. The survival in all treatment groups was significantly greater than in the control group. Serum levels of daptomycin remained longer in the therapeutic range than serum levels of vancomycin. In the murine model of staphylococcal disease, daptomycin treatment was as effective as treatment with vancomycin.

Attention effects on form discrimination at different eccentricities

Considerable disagreement exists in the visual attention literature about how attention is allocated over the visual field. One frequently expressed metaphor is that attention moves like a spotlight, and in some variants it is assumed that attention takes longer to shift to targets further from fixation. In order to test this metaphor, five experiments were conducted in which target location was precued and form discrimination accuracy was assessed. By varying the interval between the precue and the target (stimulus onset asynchrony, SOA), a time course of attention effects was obtained for targets at 2 degrees, 6 degrees, and 10 degrees eccentricity. In the first three experiments, precueing effects were found, but there were no differences in performance as a function of eccentricity for very short SOAs, with either a peripheral cue or a foveal arrow cue. For long SOAs, however, performance was better for targets that were closer to fixation. In Experiments 4 (peripheral cue) and 5 (foveal cue), the targets were scaled to make them equally discriminable at all eccentricities. Again precueing effects were found, but there were no differences in accuracy as a function of eccentricity for most SOAs. These results suggest that attention shifting is not analogous to a constant-velocity moving spotlight.

Evidence for terror management theory: I. The effects of mortality salience on reactions to those who violate or uphold cultural values

On the basis of terror management theory, it was hypothesized that when mortality is made salient, Ss would respond especially positively toward those who uphold cultural values and especially negatively toward those who violate cultural values. In Experiment 1, judges recommended especially harsh bonds for a prostitute when mortality was made salient. Experiment 2 replicated this finding with student Ss and demonstrated that it occurs only among Ss with relatively negative attitudes toward prostitution. Experiment 3 demonstrated that mortality salience also leads to larger reward recommendations for a hero who upheld cultural values. Experiments 4 and 5 showed that the mortality salience effect does not result from heightened self-awareness or physiological arousal. Experiment 6 replicated the punishment effect with a different mortality salience manipulation. Implications for the role of fear of death in social behavior are discussed.

Evidence for terror management theory: I. The effects of mortality salience on reactions to those who violate or uphold cultural values

On the basis of terror management theory, it was hypothesized that when mortality is made salient, Ss would respond especially positively toward those who uphold cultural values and especially negatively toward those who violate cultural values. In Experiment 1, judges recommended especially harsh bonds for a prostitute when mortality was made salient. Experiment 2 replicated this finding with student Ss and demonstrated that it occurs only among Ss with relatively negative attitudes toward prostitution. Experiment 3 demonstrated that mortality salience also leads to larger reward recommendations for a hero who upheld cultural values. Experiments 4 and 5 showed that the mortality salience effect does not result from heightened self-awareness or physiological arousal. Experiment 6 replicated the punishment effect with a different mortality salience manipulation. Implications for the role of fear of death in social behavior are discussed.

Evidence for genetic relationship between RNA and DNA viruses from the sequence homology of a putative polymerase gene of bluetongue virus with that of vaccinia virus: conservation of RNA polymerase genes from diverse species

The nucleotide sequence of segment 1 of the double stranded RNA genome of bluetongue virus serotype 10 (BTV-10), encoding the largest viral core protein, VP1, has been determined. Linear sequence analysis of the predicted amino acid sequence of the 149-K Da protein, a putative component of the viral RNA-directed RNA polymerase, revealed extensive homology with the vaccinia virus 147K Da DNA-directed RNA polymerase subunit. Similar homologies were detected between the VP1 polypeptide and the beta chain subunit of Escherichia coli and common tobacco chloroplast RNA polymerases, yeast RNA polymerase II and III and fruit fly polymerase II.

Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects

The bacteriological investigation of an outbreak of Legionnaires' disease in Glasgow Royal Infirmary affecting 16 patients is described. Most of the patients had been treated in high-dependency areas on two floors of the hospital supplied by the same two air-conditioned ventilation systems. The source of infection was traced to contamination of a cooling tower from which a plume of spray discharged into the intake vents of the two ventilation systems. Rubber grommets within the cooling tower probably provided a nidus of infection there. The control and management of the outbreak are discussed: a policy of frankness about the course and progress of the investigations was adopted and helped to allay anxiety on the part of both staff and media.

Increased severity of urinary tract infection and bacteremia in mice with urinary bladder injury induced by cyclophosphamide

The effect of cyclophosphamide on urinary tract infection was studied, using Pseudomonas aeruginosa in a murine model. Urinary tract infections were produced by injecting P. aeruginosa through a urethral catheter into the bladders of mice. The number of P. aeruginosa organisms in the bladder tissue and kidneys, histopathology, peripheral leukocyte count, and antibody response to P. aeruginosa was measured. The local effect of cyclophosphamide on the bladder was determined by measuring the bladder tissue water and examining the histopathology. Cyclophosphamide increased the susceptibility of mice to P. aeruginosa urinary tract infection, resulting in marked cystitis and an increase in renal infection, bacteremia, and mortality. These changes correlated with the toxic effect of cyclophosphamide on the wall of the bladder rather than with peripheral leukopenia or failure of antibody response.

Polydipsia induced by intermittent delivery of salted liquid foods

Food-deprived rats given constant access to water were exposed to fixed-time presentations of soybean milk and diluted sweetened condensed cows' milk. In some conditions these liquid foods were adulterated with varying amounts of sodium chloride. Under a fixed-time 30-sec schedule of food delivery, little water was consumed when the food was soybean milk alone, or soybean milk with sodium chloride added in concentrations of .9, 1.8, or 3.6%. However, schedule-induced polydipsia appeared when soybean milk adulterated with 7.2 or 14.4% sodium chloride was delivered under this schedule. When soybean milk containing 7.2% sodium chloride was presented under fixed-time 15-, 30-, 60-, 120-, and 240-sec schedules, schedule-induced drinking increased with the fixed-time value from 15 to 120 seconds, and decreased at 240 seconds. Like soybean milk, diluted sweetened condensed milk delivered under fixed-time schedules of 30, 60, and 120 seconds failed to evoke schedule-induced polydipsia, but did so when adulterated with 7.2% sodium chloride. Drinking induced by salted liquid foods resembled the polydipsia engendered by spaced dry-food presentations in several ways, including temporal relation to food delivery, persistence within and across sections, sensitivity to interfood interval, and magnitude relative to intake evoked by bulk-food presentation.

Faster histochemical reaction for ATPase in presence of chloride salts, with studies of the mechanism of precipitation

A very rapid localization of nucleoside triphosphate phosphohydrolase activity is given by incubation mixtures containing 2 M chlorides of monovalent cations. An optimal procedure is to fix overnight in cold formaldehyde-calcium, store in gum-sucrose, freeze-section and incubate 4 min or less at 30°C in a solution of 3 mM Na2 adenosine triphosphate (ATP), 2 M KCl, 3 mM MgCl2, and 1 mM Pb(NO3)2 in 24 mM Tris buffer adjusted to pH 7.2 with HCl. In rat intestine, for example, a strong, selective stain was developed in myenteric plexus, blood vessels, lamina propria mucosae and smooth muscle, while paired preparations without 2 M KCl were pale or unstained. The reaction was specific to nucleoside triphosphates and required Mg++. Acceleration by 2 M chloride was also found in the adenosine triphosphate phosphohydrolase reaction given by a single protein fraction (thin disc) in acrylamide gel electropherograms. The histochemical reaction for ATP phosphohydrolase produced residues of lead in formaldehyde-fixed sections, with two-thirds of lead captured as a precipitate of products of enzyme reaction and one-third bound directly to tissue. Only the enzyme-generated precipitate gave an anatomically and chemically selective and time-dependent pattern of staining, while direct binding gave a diffuse and time-independent background stain enhanced by omitting the substrate. Less than 1% of precipitate originated from nonenzymatic breakdown of ATP. Conditions of precipitation were studied. Reaction products were captured by lead as mixed crystals of nucleotides and phosphate. Addition of chloride salts decreased the concentration of lead required to saturate the reaction mixture, and this effect probably accounted for the enhanced histochemical reaction.