Coupling habitat-specific temperature scenarios with tolerance landscape to predict the impacts of climate change on farmed bivalves

Due to climate change, heatwaves are likely to become more frequent, prolonged and characterized by higher peak values, compared with climatological averages. However, the thermal tolerance of organisms depends on the actual exposure, which can be modulated by environmental context and microhabitat characteristics. This study investigated the frequency of occurrence of mass mortality events in the next decades for two species of farmed bivalves, the mussel Mytilus galloprovincialis and the clam Ruditapes philippinarum, in a shallow coastal lagoon, characterised by marked diurnal oscillations of water temperature. The effect of heatwaves was estimated by means of tolerance landscape models, which predict the occurrence of 50% mortality based on the exposure intensity and duration. Scenarios of water temperature up to the year 2100 were modelled by combining two mechanistic components, namely: 1) monthly mean water temperatures, simulated using a hydrodynamic model including the heat budget; 2) daily oscillations, estimated from the harmonic analysis of a twenty year-long site-specific time series of water temperature. Scenarios of mean daily sediment temperature were estimated by means of a cross-correlation model, using as input the water temperature one: the model parameters were estimated based on a comprehensive set of site-specific water and sediment temperature observations. The results indicate that for both species the risk of mass mortality rapidly increases starting from the 2060s. Furthermore, the daily patterns of water temperature seemed to be relevant, as overnight it falls below the predicted mortality thresholds for a few hours. These findings suggest that further studies should address: 1) the improvement of tolerance landscape models, in order to take into account the integrated effect of repeated non-lethal stress events on mortality rate; 2) the prediction of environmental temperature in specific habitat, by means of both process-based and data driven models.

Impaired myocellular Ca2+ cycling in protein phosphatase PP2A-B56α knockout mice is normalized by β-adrenergic stimulation

The activity of protein phosphatase 2A (PP2A) is determined by the expression and localization of the regulatory B-subunits. PP2A-B56α is the dominant isoform of the B′-family in the heart. Its role in regulating the cardiac response to β-adrenergic stimulation is not yet fully understood. We therefore generated mice deficient in B56α to test the functional cardiac effects in response to catecholamine administration versus corresponding WT mice. We found the decrease in basal PP2A activity in hearts of KO mice was accompanied by a counter-regulatory increase in the expression of B′ subunits (β and γ) and higher phosphorylation of sarcoplasmic reticulum Ca²⁺ regulatory and myofilament proteins. The higher phosphorylation levels were associated with enhanced intraventricular pressure and relaxation in catheterized KO mice. In contrast, at the cellular level, we detected depressed Ca²⁺ transient and sarcomere shortening parameters in KO mice at basal conditions. Consistently, the peak amplitude of the L-type Ca²⁺ current was reduced and the inactivation kinetics of I_CaL were prolonged in KO cardiomyocytes. However, we show β-adrenergic stimulation resulted in a comparable peak amplitude of Ca²⁺ transients and myocellular contraction between KO and WT cardiomyocytes. Therefore, we propose higher isoprenaline-induced Ca²⁺ spark frequencies might facilitate the normalized Ca²⁺ signaling in KO cardiomyocytes. In addition, the application of isoprenaline was associated with unchanged L-type Ca²⁺ current parameters between both groups. Our data suggest an important influence of PP2A-B56α on the regulation of Ca²⁺ signaling and contractility in response to β-adrenergic stimulation in the myocardium.

Continual near-infrared spectroscopy monitoring in the injured lower limb and acute compartment syndrome: an FDA-IDE trial

Aims

The aim of this study was to evaluate near-infrared spectroscopy (NIRS) as a continuous, non-invasive monitor for acute compartment syndrome (ACS).

Patients and Methods

NIRS sensors were placed on 86 patients with, and 23 without (controls), severe leg injury. NIRS values were recorded for up to 48 hours. Longitudinal data were analyzed using summary and graphical methods, bivariate comparisons, and multivariable multilevel modelling.

Results

Mean NIRS values in the anterior, lateral, superficial posterior, and deep posterior compartments were between 72% and 78% in injured legs, between 69% and 72% in uninjured legs, and between 71% and 73% in bilaterally uninjured legs. In patients without ACS, the values were typically > 3% higher in injured compartments. All seven limbs with ACS had at least one compartment where NIRS values were 3% or more below a reference uninjured control compartment. Missing data were encountered in many instances.

Conclusion

NIRS oximetry might be used to aid the assessment and management of patients with ACS. Sustained hyperaemia is consistent with the absence of ACS in injured legs. Loss of the hyperaemic differential warrants heightened surveillance. NIRS values in at least one injured compartment(s) were > 3% below the uninjured contralateral compartment(s) in all seven patients with ACS. Additional interventional studies are required to validate the use of NIRS for ACS monitoring. Cite this article: Bone Joint J 2018;100-B:787-97.

Impaired Ca2+ cycling of nonischemic myocytes contributes to sarcomere dysfunction early after myocardial infarction

Changes in the nonischemic remote myocardium of the heart contribute to left ventricular dysfunction after ischemia and reperfusion (I/R). Understanding the underlying mechanisms early after I/R is crucial to improve the adaptation of the viable myocardium to increased mechanical demands. Here, we investigated the role of myocyte Ca²⁺ handling in the remote myocardium 24 h after 60 min LAD occlusion. Cardiomyocytes isolated from the basal noninfarct-related parts of wild type mouse hearts demonstrated depressed beat-to-beat Ca²⁺ handling. The amplitude of the Ca²⁺ transients as well as the kinetics of Ca²⁺ transport were reduced by up to 25%. These changes were associated with impaired sarcomere contraction. While expression levels of Ca²⁺ regulatory proteins were unchanged in remote myocardium compared to the corresponding regions of sham-operated hearts, mobility shift analyses of phosphorylated protein showed 2.9 ± 0.4-fold more unphosphorylated phospholamban (PLN) monomers, the PLN species that inhibits the Ca²⁺ ATPase SERCA2a (P ≤ 0.001). Phospho-specific antibodies revealed normal phosphorylation of PLN at T17 in remote myocardium, but markedly reduced phosphorylation at its PKA-dependent phosphorylation site, S16 (P ≤ 0.01). The underlying cause involved enhanced activity of protein phosphatases, particularly PP2A (P ≤ 0.01). In contrast, overall PKA activity was normal. The PLN interactome, as determined by co-immunoprecipitation and mass spectrometry, and the phosphorylation state of PKA targets other than PLN were also unchanged. Isoproterenol enhanced cellular Ca²⁺ cycling much stronger in remote myocytes than in healthy controls and improved sarcomere function. We conclude that the reduced phosphorylation state of PLN at S16 impairs myocyte Ca²⁺ cycling in the remote myocardium 24 h after I/R and contributes to contractile dysfunction.

The FIELDS Instrument Suite for Solar Probe Plus: Measuring the Coronal Plasma and Magnetic Field, Plasma Waves and Turbulence, and Radio Signatures of Solar Transients

NASA's Solar Probe Plus (SPP) mission will make the first in situ measurements of the solar corona and the birthplace of the solar wind. The FIELDS instrument suite on SPP will make direct measurements of electric and magnetic fields, the properties of in situ plasma waves, electron density and temperature profiles, and interplanetary radio emissions, amongst other things. Here, we describe the scientific objectives targeted by the SPP/FIELDS instrument, the instrument design itself, and the instrument concept of operations and planned data products.

An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children

OBJECTIVE

To explore attachment narratives in children diagnosed with reactive attachment disorder (RAD).

METHOD

We compared attachment narratives, as measured by the Manchester Child Attachment Story Task, in a group of 33 children with a diagnosis of RAD and 37 comparison children.

RESULTS

The relative risk (RR) for children with RAD having an insecure attachment pattern was 2.4 (1.4-4.2) but 30% were rated as securely attached. Within the RAD group, children with a clear history of maltreatment were more likely to be Insecure-Disorganised than children without a clear history of maltreatment.

CONCLUSIONS

Reactive attachment disorder is not the same as attachment insecurity, and questions remain about how attachment research informs clinical research on attachment disorders.

Drilling systems for extraterrestrial subsurface exploration

Drilling consists of 2 processes: breaking the formation with a bit and removing the drilled cuttings. In rotary drilling, rotational speed and weight on bit are used to control drilling, and the optimization of these parameters can markedly improve drilling performance. Although fluids are used for cuttings removal in terrestrial drilling, most planetary drilling systems conduct dry drilling with an auger. Chip removal via water-ice sublimation (when excavating water-ice-bound formations at pressure below the triple point of water) and pneumatic systems are also possible. Pneumatic systems use the gas or vaporization products of a high-density liquid brought from Earth, gas provided by an in situ compressor, or combustion products of a monopropellant. Drill bits can be divided into coring bits, which excavate an annular shaped hole, and full-faced bits. While cylindrical cores are generally superior as scientific samples, and coring drills have better performance characteristics, full-faced bits are simpler systems because the handling of a core requires a very complex robotic mechanism. The greatest constraints to extraterrestrial drilling are (1) the extreme environmental conditions, such as temperature, dust, and pressure; (2) the light-time communications delay, which necessitates highly autonomous systems; and (3) the mission and science constraints, such as mass and power budgets and the types of drilled samples needed for scientific analysis. A classification scheme based on drilling depth is proposed. Each of the 4 depth categories (surface drills, 1-meter class drills, 10-meter class drills, and deep drills) has distinct technological profiles and scientific ramifications.

Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain

AIMS

To determine prognostic indicators in children with severe functional abdominal pain (FAP) and to test the hypothesis that "healthcare consumerism" in these families might be deleterious to the child.

METHODS

Retrospective analysis of a cohort of 23 children aged <16 years fulfilling the Rome II diagnostic criteria for FAP during the period December 1997 to February 2001. Poor outcome was defined as continued pain and failure to return to normal functioning >12 months after onset.

RESULTS

Poor outcome was associated with refusal to engage with psychological services, involvement of more than three consultants, lodging of a manipulative complaint with hospital management by the child's family, and lack of development of insight into psychosocial influences on symptoms. Three of four adverse prognostic indicators reflected healthcare consumerism by the families.

CONCLUSIONS

Actions of families who lack insight into their child's illness may perpetuate FAP in childhood. A culture of parental consumerism in healthcare, however well intentioned, needs to be accompanied by robust systems to protect the interests of the child.

Gustatory responses of pigs to sixty compounds tasting sweet to humans

The gustatory responses of pigs to 60 compounds perceived as sweet by humans were studied via a semi-quantitative behavioural method derived from the Richter two-bottle preference test. Among the 60 compounds tested 35 are effective in pigs, but with an effectiveness much lower in pigs than in humans. Lugduname and carrelame, which are the two most potent sweeteners in humans, are also the most effective compounds in pigs.

Psychotherapy for sexually abused girls: psychopathological outcome findings and patterns of change

BACKGROUND

Controversy exists about the efficacy of psychotherapy for the mental health problems of sexually abused children.

AIMS

To compare the relative efficacy of focused individual or group therapy in symptomatic sexually abused girls, and to monitor psychiatric symptoms for persistence or change.

METHOD

A multi-centre psychotherapy outcome study recruited 71 sexually abused girls aged 6-14 years who were randomly assigned to focused individual psychotherapy (up to 30 sessions) or psychoeducational group therapy (up to 18 sessions). Changes over the course of the study were monitored.

RESULTS

Both treatment groups showed a substantial reduction in psychopathological symptoms and an improvement in functioning, but with no evident difference between individual and group therapy. However, individual therapy led to a greater improvement in manifestations of post-traumatic stress disorder (PTSD).

CONCLUSIONS

The beneficial effects on PTSD support the use of individual therapy. However, the small sample size and lack of a control group limit conclusions about changes attributable to treatment.

Testing a predictive model of what makes a critical thinker

The goal of nursing education is to help individuals become self-determining, independent thinkers. Cognitive development may be the outcome that best characterizes such a thinker. The purpose of this study was to test a model of cognitive development in which four independent variables--knowledge base, critical thinking skills, critical thinking dispositions, and experience--were used to predict cognitive development. Data were analyzed from 232 practicing registered nurses. Three hierarchical levels of cognitive development were examined: dualism, relativism, and commitment. Critical thinking skill was a significant contributor only to the dualistic level of cognitive development. Critical thinking dispositions contributed to all three levels of cognitive development. Experience contributed only to the commitment level. The results of this study suggest that the development of a critical thinker may require time and experience. These findings can be used to examine current policy regarding the criteria used to evaluate nursing education.

Mast cell involvement in fibrodysplasia ossificans progressiva

Fibrodysplasia ossificans progressiva (FOP) is a catastrophic genetic disorder of progressive heterotopic ossification associated with dysregulated production of bone morphogenetic protein 4 (BMP4), a potent osteogenic morphogen. Postnatal heterotopic ossification in FOP is often heralded by hectic episodes of severe post-traumatic connective tissue swelling and intramuscular edema, followed by an intense and highly angiogenic fibroproliferative mass. The abrupt appearance, intense size, and rapid intrafascial spread of the edematous preosseous fibroproliferative lesions implicate a dysregulated wound response mechanism and suggest that cells and mediators involved in inflammation and tissue repair may be conscripted in the growth and progression of FOP lesions. The central and coordinate role of inflammatory mast cells and their mediators in tissue edema, wound repair, fibrogenesis, angiogenesis, and tumor invasion prompted us to investigate the potential involvement of mast cells in the pathology of FOP lesions. We show that inflammatory mast cells are present at every stage of the development of FOP lesions and are most pronounced at the highly vascular fibroproliferative stage. Mast cell density at the periphery of FOP lesional tissue is 40- to 150-fold greater than in normal control skeletal muscle or in uninvolved skeletal muscle from FOP patients and 10- to 40-fold greater than in any other inflammatory myopathy examined. These findings document mobilization and activation of inflammatory mast cells in the pathology of FOP lesions and provide a novel and previously unrecognized target for pharmacologic intervention in this extremely disabling disease.

Comparative expression of hedonic impact: affective reactions to taste by human infants and other primates

This study examines behavioral affective reactions elicited by tastes from eight newborn human infants, and from 27 other infant or adult primates. Non-human primates belonged to 11 species: three great apes (chimpanzee, orangutan, gorilla), three Old World monkeys (rhesus monkey, greater spot-nosed monkey, and red-capped mangabey), four New World monkeys (golden-handed tamarin, cotton-top tamarin, white tufted-ear marmoset, and Humboldt's night monkey), and one lemur (mongoose lemur). The taste of sucrose elicited homologous positive hedonic patterns of facial affective reactions from humans and other primates, whereas quinine elicited homologous aversive or negative affective patterns. The degree of similarity between human and other primate affective reaction patterns appeared to be strongly indicative of their phylogenetic relatedness. For example, affective reaction patterns of human infants and great apes were more similar to each other than either were to Old World monkeys or New World monkeys. Certain affective reaction components were found to be shared by humans and all primates, whereas other components were restricted to particular taxonomic groups. Finally, allometric timing parameters for the duration of components indicated that the 'same' affective reaction could have different durations in species of different size. These results show that both positive/negative valence and intensity of affective reaction may be quantitatively assessed in human and non-human primates, and indicate that taste-elicited affective reaction patterns of human infants are related systematically to those of other primate species.

Which patients with heart failure respond best to multidisciplinary disease management?

BACKGROUND

Multidisciplinary disease management approaches have been shown to decrease resource use in selected samples of patients with heart failure. We remain uncertain regarding the effectiveness of this approach in a general heart failure population and who can be expected to benefit most. The purpose of this study was to test the effectiveness of a multidisciplinary disease management intervention in an unselected population of patients with heart failure and to determine if subgroups could be identified in which the intervention is most effective.

METHODS AND RESULTS

Two hundred forty patients with heart failure who were matched on preadmission functional status, comorbidity, and age participated in a quasi-experimental clinical trial. Half (n = 120) were given a multidisciplinary disease management intervention, whereas the other half (n = 120) received usual care. Data on acute care resource use were collected 3 and 6 months after enrollment. No intervention effect was seen in the primary analysis. When the data were analyzed by preadmission functional status (I to IV), acute care resource use was lower in the class II intervention patients. Class I intervention patients had a 288% increase in total costs and a 14-fold increase in heart failure costs. A model of predictor variables explained 17.2% of the variance in heart failure readmission at 3 months.

CONCLUSIONS

An intervention of this type and intensity is recommended primarily for functional class II heart failure patients. Increases in cost in class I patients may have resulted from improved access to care.

Children's sexual play and behavior in pre-school settings: staff's perceptions, reports, and responses

OBJECTIVES

The aims of this study were to learn about the nature, frequency, and patterns of young children's observed sexual play and behavior in pre-school settings, and staff responses to them.

METHOD

Fifty eight staff in 11 pre-school settings were interviewed and data obtained about their recall of observed sexualized play and behaviors of children in their care. Responses were sought both to an open question and to 20 different hypothetical scenarios describing children's behaviors with a genital or sexual content. They were asked about the proportion of children observed and the frequency of the behaviors. They were also asked for their predicted responses to encountering each of these scenarios.

RESULTS

Children's curiosity about genitalia, looking and limited touching were more commonly observed, and drawing or modeling of genitalia and simulating sexual intercourse were also reported. Children inserting anything into another child and oral-genital contact had only rarely been observed. Rare behaviors always caused concern and led to some intervention. Concern about the more common behaviors was related to additional factors such as frequency, manner and talk accompanying the behavior and to other information known about the child.

CONCLUSIONS

The results confirm findings from studies in other countries about the reported prevalence of more and less commonly observed sexual and genitally orientated behaviors in young children. They lend justification for concerns about children showing rarely observed behaviors or showing preoccupation with genitalia and indicate the need for a search for an explanation of these behaviors when observed.

Rate of metabolism in the smallest simian primate, the pygmy marmoset (Cebuella pygmaea)

Rate of metabolism was measured with six adult pygmy marmosets (Cebuella pygmaea) at regulated ambient temperatures ranging between 20 degrees C and 35 degrees C. A novel combined nest box and metabolic chamber was designed to allow nighttime measurements on immobile animals in their home cage without disturbance. The basal rate of metabolism (BMR) was 98 ml O2 h-1, representing 74% of the value expected from the equation of McNab [Quarterly Review of Biology 63:25-54, 1988] relative to body mass. The thermoneutral zone was approximately 27-34 degrees C. Below the lower critical temperature (27-28 degrees C), thermal conductance (12.9 ml O2 h-1 degree C-1) was close to the predicted value. Body temperature ranged between 34.9 degrees C and 35.5 degrees C at night. When two animals rested together overnight in the nest box, the lower critical temperature was slightly lowered, and individual energy expenditure at 20-21 degrees C was reduced by about 34%. The basal rate of metabolism of C. pygmaea is much lower than reported in an earlier study based on daytime measurements but agrees with values reported from a more recent study conducted at night with a classical metabolic chamber. In order to compare the BMR of C. pygmaea with that of other primates, 23 species were included in a comparative study taking into account both phylogeny and body mass (independent contrasts approach). The scaling exponent of BMR to body mass obtained was indistinguishable from that published for eutherian mammals in general. Cebuella and Callithrix exhibit the lowest basal rates known for simians. This trait may possibly be linked to the natural diet, which includes a large proportion of gums that are difficult to digest, but additional metabolic studies on primates are needed for further examination of its adaptive significance.

Cost-effectiveness of immediate postoperative radiographs after uncomplicated total knee arthroplasty: a retrospective and prospective study of 750 patients

We have questioned the value of postoperative radiographs after uncomplicated, primary total knee arthroplasty (TKA). A total of 750 patients were included in this 2-part study. In the first part, we retrospectively reviewed 200 consecutive, primary TKAs to determine if the immediate postoperative radiographs offered any information that altered the clinical course or if these radiographs could serve as baselines for future images. In the second part, 550 patients who underwent an uncomplicated TKA had their first postoperative radiographs taken at the initial visit. These patients were followed prospectively until the 6-week follow-up appointment to determine if any events occurred in which predischarge radiographs would have been useful as a comparison study. Of the 200 patients who underwent a primary TKA, 192 had postoperative radiographs performed before discharge. Among the 192 patients, the radiographs did not alter the postoperative management. In examining overall quality of the radiographs, only 36% were of sufficient quality to provide an accurate baseline for further studies. Total cost was approximately $36,000. In the 550 patients who had the first postoperative radiograph performed at 6 weeks, there were no instances in which radiographs taken before discharge were needed to aid in further management or legal defense. As with total hip arthroplasty, the past standard has been to obtain immediate postoperative radiographs after primary TKA. Although the information obtained in a total hip arthroplasty patient can be clinically important, the practice of obtaining routine, immediate postoperative knee radiographs in the absence of a specific clinical indication does not provide any additional clinical information and does not appear to benefit patient care.

Development and testing of a clinical tool measuring self-management of heart failure

BACKGROUND

Self-management is a primary goal of treatment for heart failure. Yet no measure of self-management in this patient group currently exists.

OBJECTIVES

To develop a clinically useful measure of the abilities of patients with heart failure to manage their disease. Self-management in this context was defined as a cognitive decision-making process undertaken in response to signs and symptoms of heart failure. A panel of experts agreed that the process involved 4 distinct stages: recognizing a change, evaluating the change, implementing a treatment strategy, and evaluating the treatment. The tool was developed to reflect this process.

METHODS

Face validity of the process model was assessed in a sample of 25 patients with heart failure and used to develop a 65-item tool with 6 subscales. The subscales measure the 4 stages as well as the patients' ease in evaluating the signs and symptoms and their self-efficacy. The tool was pilot tested with 2 samples of patients with heart failure (N = 17; N = 129). Psychometrics of the final tool were then tested in a sample of 127 patients with heart failure.

RESULTS

Face and content validity of the tool were demonstrated adequately through this study. Internal consistency scores of the 6 subscales of the Self-Management of Heart Failure instrument ranged from 0.79 (ease of evaluating treatment) to 0.92 (evaluating the change). Reliability could not be calculated for 1 subscale (evaluating the treatment) because of missing data that resulted from patients skipping sections because they had not experienced a symptom.

CONCLUSION

Clinicians interested in evaluating the self-management abilities of their patients with heart failure are encouraged to use this tool and to contribute to additional testing.

Taste preference in nonhuman primates to compounds sweet in man

Primates have stimulated more interest than any other group as humans are ranked in this same mammalian order. Gustatory responses of human and nonhuman primates have already been compared for compounds such as monosaccharides, oligosaccharides, polyols, amino acids, dipeptides, proteins, dihydrochalcones, sulfamates, saccharin, acesulfame, diterpenes or urea derivatives, all known to be sweet in man. But no rational comparison in primates has been attempted. Using a structure-activity relationship study in primates, it is now possible to classify the primate sweetness receptors into four types according to the behavioral responses observed from various selected compounds sweet in humans. The four types are represented by (1) the Callitrichidae and (2) the Cebidae, both from the infraorder Platyrrhini (New World monkeys), (3) the Lemuridae and Lorisidae, from the suborder Prosimii (prosimians), and (4) the Cercopithecidae (Old World monkeys), Hylobatidae (lesser apes), Pongidae (great apes), and Hominidae (humans) from the infraorder Catarrhini (Old World simians). By a comparative study of the putative receptor recognition sites postulated for each type of receptor, it is inferred that the Callitrichidae (marmosets and tamarins) have retained the most primitive sweetness receptor among primates. As we believe that the evolution of the sweetness receptor is a key factor involved in the raising of nonhuman primates from a 'primitive grade' towards a more 'advanced' or 'simian grade,' the possible phylogenetic implications of these findings will be discussed.

Improving staffing with a resource management plan

To change from a crisis to a proactive mode for staffing, scheduling, resource pool utilization, information management, and unit workload, nursing leaders developed a resource management plan. Changes that assisted in achieving that goal included: revision of department scheduling guidelines, elimination of day shift central supervisor, responsibility for daily staffing moved to unit-based managers, creation of a staffing model for the nursing resource pool staff, establishment of ideal complement of positions for every unit, expectation for unit to meet its staffing model every shift, reinforced department efforts to fill vacant positions, participation in computerized databases to study the use of resources, and identified critical staffing indicators for each unit.

A longitudinal causal model of cardiac invalidism following myocardial infarction

BACKGROUND

Invalidism has been discussed in the cardiovascular literature for decades. Researchers have studied health perceptions, emotional distress, and dependency in patients after acute myocardial infarction in an attempt to understand the phenomenon. However, no theory of the manner in which these variables interact has been proposed.

OBJECTIVES

Using previous research, a model of invalidism was specified in which individuals' perceptions that their health is poor lead to emotional distress and increased dependency. As health perceptions improve over time, emotional distress and dependency decrease.

METHOD

Survey data were collected from 111 men and women 1 and 4 months after a first myocardial infarction and were tested using structural equation modeling.

RESULTS

The model was rejected using a confirmatory approach (chi2(89) = 141.40; p= .00034). The fit indices, however, suggested an adequate fit of the model to the data (CFI = .96; NNFI = .94).

CONCLUSION

The conclusion is that the model is reasonable and serves as a starting point for a theory-based empirical exploration of the invalidism process.

Recovered memories of childhood sexual abuse. Implications for clinical practice

BACKGROUND

The growth in the USA of 'recovered memory therapy' for past sexual abuse has caused great public and professional concern. It became apparent that the polarisation of views and fierce controversy within the American psychiatric community was in danger of bringing psychotherapy into disrepute and it seemed important to examine objectively the scientific evidence before such polarisation developed in the UK.

METHOD

A small working group reviewed their own experience, visited meetings and centres with expertise in this field, interviewed 'retractors' and accused parents, and then began a comprehensive review of the literature.

RESULTS

There is a vast literature but little acceptable research. Opinions are expressed with great conviction but often unsupported by evidence.

CONCLUSIONS

The issue of false or recovered memories should not be allowed to confuse the recognition and treatment of sexually abused children. We concluded that when memories are 'recovered' after long periods of amnesia, particularly when extraordinary means were used to secure the recovery of memory, there is a high probability that the memories are false, i.e. of incidents that had not occurred. Some guidelines which should enable practitioners to avoid the pitfalls of memory recovery are offered.

Urinary basic fibroblast growth factor. A biochemical marker for preosseous fibroproliferative lesions in patients with fibrodysplasia ossificans progressiva

Angiogenesis is a prominent histopathologic feature of preosseous fibroproliferative lesions in patients who have fibrodysplasia ossificans progressiva. Basic fibroblast growth factor is an extremely potent in vivo stimulator of angiogenesis, and has been implicated in the growth of solid tumors. An enzyme linked immunosorbent assay for basic fibroblast growth factor was performed on urine samples from patients who had active (n = 28) and inactive (n = 39) fibrodysplasia ossificans progressiva, and compared with urine samples from normal age and gender matched control subjects (n = 54). Median basic fibroblast growth factor levels were 2705 pg/g of creatinine in the normal control group, 5058 pg/g of creatinine in patients with inactive fibrodysplasia ossificans progressiva (no significant difference), and 8793 pg/g of creatinine in patients with active fibrodysplasia ossificans progressiva. Female subjects, both normal and with fibrodysplasia ossificans progressiva, had higher levels of urinary basic fibroblast growth factor than did male subjects. There was no correlation of urinary basic fibroblast growth factor levels with age or severity of preexisting disability. These data document an elevation of urinary basic fibroblast growth factor during acute flareups of fibrodysplasia ossificans progressiva and provide a biochemical basis for considering antiangiogenic therapy for inhibiting endochondral osteogenesis in this disorder.

Development of an instrument to measure cardiac illness dependency

OBJECTIVE

Dependency is frequently mentioned in the literature as a response of patients with cardiac disease. The purpose of this study was to develop and test a measure of dependency occurring in response to a cardiac illness. Illness dependency is defined as the need for emotional protection and social support after a significant change in health.

DESIGN

Instrument development study.

SAMPLE

Convenience sample of 311 patients with cardiac disease.

RESULTS

The final version of the instrument has 25 items, each of which is measured on a 5-point Likert-type scale. Content validity was demonstrated using a panel of experts. Internal consistency of the total scale was 0.90; subscale alpha coefficients ranged from 0.64 to 0.81. Exploratory factor analysis supported a four factor solution: Attention, Reassurance, Concern, and Assistance, which accounted for 57.4% of the variance in scores. Discriminant validity was demonstrated by a low correlation with neuroticism. Social desirability of responses was minimal.

CONCLUSION

Internal consistency reliability, content validity, and discriminant validity of the Illness Dependency Scale have initial support. This instrument is ready for use in research in which the investigator wishes to measure dependency associated with cardiac illness.

Evolution of the sweetness receptor in primates. II. Gustatory responses of non-human primates to nine compounds known to be sweet in man

The gustatory responses of nine compounds, namely glycine, D-phenylalanine, D-tryptophan, cyanosuosan, magapame, sucrononate, campame, cyclamate and superaspartame, all known as sweet in man, were studied in 41 species or subspecies of non-human primates, selected among Prosimii (Lemuridae and Lorisidae), Platyrrhini (Callitrichidae and Cebidae) and Catarrhini (Cercopithecidae, Hylobatidae and Pongidae). The first six compounds are generally sweet to all primates, which implies that they interact with the primate sweetness receptors essentially through constant recognition sites. Campame is sweet only to Cebidae and Catarrhini, cyclamate only to Catarrhini, superaspartame principally to Callitrichidae and Catarrhini, which implies that all these compounds interact with the receptors partly through variable recognition sites. From the present work, from other previous results (where notably it was observed that alitame is sweet to all primates, ampame only to Prosimii and Catarrhini, and aspartame only to Catarrhini), and from the multipoint attachment (MPA) theory of sweetness reception (as elaborated by Nofre and Tinti from a detailed study of structure-activity relationships of various sweeteners in man), it is inferred that the primate sweetness receptors are very likely made up of eight recognition sites, of which the first, second, third, fourth, seventh and eighth are constant, and the fifth and sixth variable. From these results and from the MPA theory, it is also inferred that the recognition sites of the primate sweetness receptors could be: Asp-1 or Glu-1, Lys-2, Asp-3 or Glu-3, Thr-4, X-5, X-6, Thr-7, Ser-8, where the variable recognition sites X-5 and X-6 would be: Ala-5 and Ala-6 for Callitrichidae, Ser-5 and Ala-6 for Cebidae, Ala-5 and Thr-6 for Prosimii, and Thr-5 and Thr-6 for Catarrhini. By using Tupaiidae (tree shrews) as a reference outgroup and by means of other structural and functional molecular considerations, it appears that Callitrichidae have retained the most primitive receptor among the four types of primate receptors. The possible taxonomic and phylogenetic implications of these findings are discussed.

Stark self-referral law

Should Iowa physicians worry about the Stark law? Probably. In September, after a nearly four-year delay, the regulations for Stark I took effect. This article discusses how the Stark I and II self-referral laws might affect your practice.

Evolution of the sweetness receptor in primates. I. Why does alitame taste sweet in all prosimians and simians, and aspartame only in Old World simians?

In the order Primates the responses to sucrose, alitame and aspartame were ascertained. All primates tested to date like sucrose and prefer this sweet substance to tap water. The artificial dipeptide aspartame was found to be not sweet in Prosimii and Platyrrhini (New World monkeys). Only the Cercopithecoidea (Old World monkeys) and Hominoidea (apes and humans) show the same response to aspartame and to sucrose. In contrast, all primates tested so far prefer alitame, another artificial dipeptide sweetener, which is structurally closely related to aspartame. This phylogenetic difference is consistent with the existence in catarrhine primates of a sweetness receptor containing two differently located hydrophobic recognition sites, one for the hydrophobic binding site of alitame, the other for the hydrophobic binding site of aspartame. On the basis of these results, it is suggested that the alitame-related hydrophobic recognition site, which is found in the sweetness receptor of all primates, could be a requisite for the interaction of the receptor with sucrose, while the aspartame-related hydrophobic recognition site, which is found exclusively in the sweetness receptor of Old World simians, could have been a crucial factor in the improvement in detection or selection of sucrose in foods, so favouring the mental development of these simians and maybe the emergence of humans.

Immunolocalization and expression of bone morphogenetic proteins 2 and 4 in fracture healing

Recently, it has become increasingly evident that fracture healing involves a complex interaction of many local and systemic regulatory factors. The roles of some of these growth factors have been described; however, little is understood about the presence of the bone morphogenetic proteins in fracture repair, despite the fact that they are the most potent osteoinductive proteins known. This study defines and characterizes the physiologic presence, localization, and chronology of the bone morphogenetic proteins in fracture healing with an established rat fracture healing model. With use of a recently developed monoclonal antibody against bone morphogenetic proteins 2 and 4 developed with standard avidin-biotin complex/immunoperoxidase protocols, frozen undecalcified fracture calluses were analyzed semiquantitatively for the percentage of various types of fracture cells staining positively. During the early stages of fracture healing, only a minimum number of primitive cells stained positively in the fracture callus. As the process of endochondral ossification proceeded, the presence of bone morphogenetic proteins 2 and 4 increased dramatically, especially in the primitive mesenchymal and chondrocytic cells. While the cartilaginous component of the callus matured with a concomitant decrease in the number of primitive cells, there was a concomitant decrease in both the intensity and the number of positively staining cells. As osteoblasts started to lay down woven bone on the chondroid matrix, these osteoblastic cells exhibited strong positive staining. The intensity of this staining decreased, however, as lamellar bone replaced the primitive woven bone. A similar observation was noted for the areas of the callus undergoing intramembranous ossification. Initially, within several days after the fracture, periosteal cells and osteoblasts exhibited intense staining for bone morphogenetic proteins 2 and 4. As the woven bone was replaced with mature lamellar bone, this staining decreased. These data, and the awareness of the strong osteoinductive capacities of bone morphogenetic protein, suggest that bone morphogenetic proteins 2 and 4 are important regulators of cell differentiation during fracture repair.