Aberrant CD8+T cells drive reproductive dysfunction in female mice with elevated IFN-γ levels

Introduction

Interferon-gamma (IFN-γ) is pivotal in orchestrating immune responses during healthy pregnancy. However, its dysregulation, often due to autoimmunity, infections, or chronic inflammatory conditions, is implicated in adverse reproductive outcomes such as pregnancy failure or infertility. Additionally, the underlying immunological mechanisms remain elusive.

Methods

Here, we explore the impact of systemic IFN-γ elevation on cytotoxic T cell responses in female reproduction utilizing a systemic lupus-prone mouse model with impaired IFN-γ degradation.

Results

Our findings reveal that heightened IFN-γ levels triggered the infiltration of CD8+T cells in the pituitary gland and female reproductive tract (FRT), resulting in prolactin deficiency and subsequent infertility. Furthermore, we demonstrate that chronic IFN-γ elevation increases effector memory CD8+T cells in the murine ovary and uterus.

Discussion

These insights broaden our understanding of the role of elevated IFN-γ in female reproductive dysfunction and suggest CD8+T cells as potential immunotherapeutic targets in female reproductive disorders associated with chronic systemic IFN-γ elevation.

Isolation of single cells from individual mouse ovaries for flow cytometry and functional analysis

Here, we present a validated workflow to isolate sufficient viable single ovary cells from a single mouse without the need to pool from several mice. We provide steps essential for estrous staging, ovary harvesting and dissociation, ovary cell staining, data collection, and analysis. Our approach allows the use of these single-cell suspensions for flow sorting, flow cytometry analysis, or functional in vitro assays. Importantly, our protocol is designed to maximize the isolation of immune cells, including T cell subsets.

IFN-γ and androgens disrupt mitochondrial function in murine myocytes

The effect of cytokines on non-traditional immunological targets under conditions of chronic inflammation is an ongoing subject of study. Fatigue is a symptom often associated with autoimmune diseases. Chronic inflammatory response and activated cell-mediated immunity are associated with cardiovascular myopathies which can be driven by muscle weakness and fatigue. Thus, we hypothesize that immune dysfunction-driven changes in myocyte mitochondria may play a critical role in fatigue-related pathogenesis. We show that persistent low-level expression of IFN-γ in designated IFN-γ AU-Rich Element deletion mice (ARE mice) under androgen exposure resulted in mitochondrial and metabolic deficiencies in myocytes from male or castrated ARE mice. Most notably, echocardiography unveiled that low ejection fraction in the left ventricle post-stress correlated with mitochondrial deficiencies, explaining how heart function decreases under stress. We report that inefficiencies and structural changes in mitochondria, with changes to expression of mitochondrial genes, are linked to male-biased fatigue and acute cardiomyopathy under stress. Our work highlights how male androgen hormone backgrounds and active autoimmunity reduce mitochondrial function and the ability to cope with stress and how pharmacological blockade of stress signal protects heart function. These studies provide new insight into the diverse actions of IFN-γ in fatigue, energy metabolism, and autoimmunity. © 2023 The Pathological Society of Great Britain and Ireland. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Abstract 5138: Systemic agonist anti-CD40 treatment delivers precise melanoma immunotherapy within established autoimmune landscapes

The overlapping signatures of type 1 interferons (IFN) and IFN-gamma (IFNg) has proven challenging in human autoimmunity and cancer immunotherapy, particularly for resistance to anti-programmed death 1 (anti-PD1) monotherapy. By contrast, agonist abs targeting of CD40 (anti-CD40) antibodies (abs) has clinically elicit anti-tumor immunity with limited autoimmune complications. Here, we explore the relationships between anti-PD1 or agonist CD40 responses in melanoma tumors from type 1 IFN alpha receptor (IFNAR)-sufficient and type 1 IFNAR-deficient lupus-prone mice that overexpress IFNg. To address this, RNA-sequencing (RNA-seq) data on tumors treated with either anti-PD1 or agonist anti-CD40 was evaluated for tumor objective responses compared to untreated controls. Cellular and canonical pathway identification from RNA-seq data were interrogated from the IPA library for significantly differential expressed genes (DEG). Variance patterns of the anti-PD1 and anti-CD40 monotherapies identified known resistance and response pathways highly concordant with IFN co-expression patterns in the RNA-sequencing data, respectively. IPA biomarker analysis for uniquely regulated genes showed that anti-PD1 induced only 59 DEG; while anti-CD40 induced 494 DEG including Il-27, and PR/SET Domain 1 (PRDM1), a transcription factor regulated by IL-27. Specifically, signatures of MDSC development (irf8, il10); and adaptive resistance (pdcd1, pdcd1lg2, and TNFRSF5/CD40)) were negatively associated with response to anti-P1 monotherapy. By contrast, signatures of IFN activation (stat1, Ifng, and Ifngr1), chemotaxis (Cxcl10, Il12b and Il-27), attractants (Sema3g and Sema4a), and antigen presentation MHC II (h2-Aa, h2-Ab1, and ciita) were associated positively with response to agonist anti-CD40 monotherapy. Importantly, anti-CD40 alone delivered anti-tumor immune responses in type 1 IFN receptor-deficient lupus-prone mice that overexpress IFNg (Ifnar-/-ARE-/-) mice suggesting synergy with therapies blocking type 1 IFN signaling. Thus, these findings indicate that the rational use of CD40 agonists abs provide a better therapeutic platform to deliver precise anti-melanoma responses in complex autoimmune landscapes.

Citation Format: Julio C. Valencia, Michael Sanford, Howard A. Young. Systemic agonist anti-CD40 treatment delivers precise melanoma immunotherapy within established autoimmune landscapes. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5138.

High-Frequency Sampling of Small Streams in the Agroecosystems of Southwestern Ontario, Canada, to Characterize Pesticide Exposure and Associated Risk to Aquatic Life

The temporal dynamics of pesticide concentrations in streams remains poorly characterized in southwestern Ontario, a region of the province where land use is dominated by agriculture. Understanding the magnitude and duration of pulsed exposures to pesticides in these small streams is critical when estimating the risk of pesticides to these aquatic ecosystems. The present study investigated the application of a high-frequency water sampling approach paired with the collection of flow data to characterize the pulsed exposure of pesticides to small streams in southwestern Ontario. Six sites along 2 different streams with different magnitudes of agricultural land use in their upstream catchments were sampled using half-day composite samples from July to October 2018 and from May to September 2019. A total of 1043 samples were collected over the 2 yr, of which 210 were analyzed. Samples for analysis were chosen based on flow, water level, and precipitation data. Liquid and gas chromatography coupled with tandem mass spectrometry was used to measure >500 pesticides in each water sample. A total of 35 different compounds were detected over the 6 sampling sites. For pesticides that were detected in >10% of water samples above the method quantification limit, a deterministic risk assessment using water quality guidelines and a probabilistic risk assessment using species sensitivity distributions were performed. The calculated hazard quotients showed that 2,4-D, atrazine, metolachlor, and metribuzin exceeded a level of concern of 1 at the highest concentrations detected. In all cases, hazard concentrations that would be protective of 95% of species from the species sensitivity distributions were greater than the 95th centile of the environmental exposure distributions, meaning that the risk from the pesticides was low. Environ Toxicol Chem 2020;39:2570-2587. © 2020 SETAC.

The interplay of type I and type II interferons in murine autoimmune cholangitis as a basis for sex-biased autoimmunity

We have reported on a murine model of autoimmune cholangitis, generated by altering the AU-rich element (ARE) by deletion of the interferon gamma (IFN-γ) 3' untranslated region (coined ARE-Del^-/- ), that has striking similarities to human primary biliary cholangitis (PBC) with female predominance. Previously, we suggested that the sex bias of autoimmune cholangitis was secondary to intense and sustained type I and II IFN signaling. Based on this thesis, and to define the mechanisms that lead to portal inflammation, we specifically addressed the hypothesis that type I IFNs are the driver of this disease. To accomplish these goals, we crossed ARE-Del^-/- mice with IFN type I receptor alpha chain (Ifnar1) knockout mice. We report herein that loss of type I IFN receptor signaling in the double construct of ARE-Del^-/- Ifnar1^-/- mice dramatically reduces liver pathology and abrogated sex bias. More importantly, female ARE-Del^-/- mice have an increased number of germinal center (GC) B cells as well as abnormal follicular formation, sites which have been implicated in loss of tolerance. Deletion of type I IFN signaling in ARE-Del^-/- Ifnar1^-/- mice corrects these GC abnormalities, including abnormal follicular structure.

CONCLUSION

Our data implicate type I IFN signaling as a necessary component of the sex bias of this murine model of autoimmune cholangitis. Importantly these data suggest that drugs that target the type I IFN signaling pathway would have potential benefit in the earlier stages of PBC. (Hepatology 2018;67:1408-1419).

Autoimmunity in interferon-gamma AU-rich element deleted-mice is associated with loss of marginal zone B cells and macrophages. (BA15P.217)

We generated a mouse model with a 162 nt AU-rich element (ARE) region deletion in the 3’ untranslated region (3’UTR) of the interferon (IFN)-gamma gene that results in chronic circulating serum IFN-gamma levels. Mice homozygous for the ARE deletion present both serologic and cellular abnormalities typical of patients with systemic lupus erythematosus (SLE). Marginal zone B (MZB) cells and marginal zone macrophages (MZMs) are absent in ARE-deleted (ARE-Del)-/- mice. ARE-Del+/- mice retain both MZB cells and MZMs and develop no or mild autoimmunity. However, low dose clodronate treatment in ARE-Del+/- mice specifically eliminates MZMs and promotes anti-DNA antibody development and glomerulonephritis. Our findings demonstrate the consequences of a chronic IFN-gamma milieu on MZB cell loss and MZM function in autoimmunity. Furthermore, similarities between disease states in ARE-Del-/- mice and SLE patients suggest that IFN-gamma may not only be a product of SLE but may be critical for disease onset and progression.

S-1 (Teysuno®): a review of its use in advanced gastric cancer in non-Asian populations

S-1 (Teysuno(®)) is an oral anticancer agent comprising the 5-fluorouracil (5-FU) prodrug tegafur and targeted modulators, gimeracil and oteracil. S-1 in combination with cisplatin is a recommended first-line treatment for gastrointestinal cancers in Japan and has recently been approved in the EU for the treatment of advanced gastric cancer. This article reviews S-1 pharmacology from an EU perspective. In a randomized, open-label trial in 24 non-Asian countries in patients with advanced gastric cancer, there were no significant differences between S-1 plus cisplatin and 5-FU plus cisplatin groups in median overall survival (OS) [primary endpoint], progression-free survival or overall response rate. In a post hoc analysis of OS, S-1 plus cisplatin was noninferior to 5-FU plus cisplatin. There were no significant between-group differences in patient quality of life, according to the Functional Assessment of Cancer Therapy (Gastric) Trial Outcome Index, except that S-1 plus cisplatin recipients had a significantly longer time to worsening in physical well-being than 5-FU plus cisplatin recipients. Overall, S-1 plus cisplatin was better tolerated than 5-FU plus cisplatin, with significantly lower rates of haematological, some gastrointestinal tract and other adverse events, serious adverse events and deaths resulting from toxicity, along with significantly fewer haematological and renal function abnormalities. Compared with 5-FU, S-1 plus cisplatin recipients had significantly higher rates of hand-foot syndrome and hyperbilirubinaemia, although there were no between-group differences in the proportions of patients with increased liver enzymes. S-1 is a useful alternative to 5-FU for patients with advanced gastric cancer.

Murine beta-defensin 2 promotes TLR-4/MyD88-mediated and NF-kappaB-dependent atypical death of APCs via activation of TNFR2

Mammalian antimicrobial peptides, including beta-defensins, represent an ancient arm of innate immunity designed to directly neutralize invading microbes. Previously, we demonstrated that murine beta-defensin 2 (mDF2beta) also acted as an endogenous ligand for TLR-4-activating maturation of dendritic cells (DCs). Herein, we report that this TLR-4 -dependent activation leads to induction of an atypical cell death that is unexpectedly exaggerated by the inhibition of caspases. Experiments using APCs with nonfunctional TNF-alpha or its receptors suggest that this is a NF-kappaB- and TNF-alpha-dependent process that does not require TNFR1. We demonstrate that mDF2beta triggers a TNFR2-mediated signaling cascade of "self-destruction" through up-regulation of membrane-bound TNF-alpha and TNFR2. This appears not to be an isolated phenomenon, as human synthetic beta-defenisn 3 was also able to activate and kill DCs. We propose that beta-defenins may play an important immunoregulatory role as controllers of the natural process of elimination of activated APCs.

Peroxisome proliferator activated receptor gamma in colonic epithelial cells protects against experimental inflammatory bowel disease

INTRODUCTION

Peroxisome proliferator activated receptor gamma (PPARgamma) is expressed in epithelial cells, macrophage, and T and B lymphocytes. Ligand induced activation of PPARgamma was reported to attenuate colitis activity but it is not clear whether this protection is mediated by epithelial or leucocyte PPARgamma.

METHODS

Mice with targeted disruption of the PPARgamma gene in intestinal epithelial cells, generated using a villin-Cre transgene and floxed PPARgamma allele and designated PPARgamma(DeltaIEpC), were compared with littermate mice having only the PPARgamma floxed allele with no Cre transgene that expressed PPARgamma in the gut, designated PPARgamma(F/F). Colitis was induced by administering dextran sodium sulphate (DSS) and the two mouse lines compared for typical symptoms of disease and expression of inflammatory cytokines.

RESULTS

PPARgamma(DeltaIEpC) mice displayed reduced expression of the PPARgamma target genes ADRP and FABP in the gut but were otherwise normal. Increased susceptibility to DSS induced colitis, as defined by body weight loss, colon length, diarrhoea, bleeding score, and altered histology, was found in PPARgamma(DeltaIEpC) mice in comparison with PPARgamma(F/F) mice. Interleukin (IL)-6, IL-1beta, and tumour necrosis factor alpha mRNA levels in colons of PPARgamma(DeltaIEpC) mice treated with DSS were higher than in similarly treated PPARgamma(F/F) mice. The PPARgamma ligand rosiglitazone decreased the severity of DSS induced colitis and suppressed cytokine production in both PPARgamma(F/F) and PPARgamma(DeltaIEpC) mice.

CONCLUSIONS

These studies reveal that PPARgamma expressed in the colonic epithelium has an endogenous role in protection against DSS induced colitis and that rosiglitazone may act through a PPARgamma independent pathway to suppress inflammation.

Regulation of ITAM-positive receptors: role of IL-12 and IL-18

Our previous studies have identified mechanisms by which cytokine production, blocked by Ly49G2 receptor cross-linking, can be overridden. In this study we analyzed the regulation of other ITAM-positive receptor signaling on NK, NKT, and T cells and characterized the biochemical pathways involved in this signaling. Our studies demonstrate that cross-linking of NKG2D and NK1.1 results in a synergistic NK IFN-gamma response when combined with IL-12 or IL-18. Examination of NKT- and T-cell responses demonstrated that cross-linking of NKG2D and CD3 resulted in potent synergy when combined with IL-12 and, to a lesser degree, with IL-18. We have now found that both the p38 MAP kinase and the ERK-dependent signal transduction pathways are required for the synergistic response. Further mechanistic examination of the synergy indicated a potent up-regulation of total IFN-gamma mRNA in the nuclear and the cytoplasmic compartment, but mRNA half-life was not affected. Fifteen minutes of IL-12 pretreatment was sufficient to result in maximal synergistic activation, indicating that the response of the cells to the IL-12 signal was rapid and immediate. Thus, our data demonstrate that multiple convergent signals maximize the innate immune response by triggering complementary biochemical signaling pathways.

TGF-beta and vitamin D3 utilize distinct pathways to suppress IL-12 production and modulate rapid differentiation of human monocytes into CD83+ dendritic cells

We previously demonstrated that agents known to signal infection or inflammation can rapidly and directly drive differentiation of human CD14+ monocytes into CD83+ dendritic cells (DCs) when introduced to cells under serum-free conditions. In this study, we evaluated the effects of TGF-beta and vitamin D3 (VitD3) on the proportion and function of monocytes that adopt DC characteristics. TGF-beta significantly decreased the proportion of cells that rapidly adopted stable DC characteristics in response to LPS, but had little or no effect on calcium ionophore-induced differentiation. In contrast, VitD3 showed no such pathway specificity and dramatically suppressed differentiation of monocytes into DCs in response to these agents. Both TGF-beta and VitD3 altered cytokine and chemokine production in LPS-treated monocytes, inhibited IL-12 and IL-10 secretion, and decreased the functional capacity of DCs. Despite the similar effects of TGF-beta and VitD3, there are significant differences in the signaling pathways used by these agents, as evidenced by their distinct effects on LPS- and calcium ionophore-induced DC differentiation, on LPS-induced secretion of IL-10, and on two members of the NF-kappaB family of transcription factors, RelB and cRel. These studies identify TGF-beta and VitD3 as potent regulatory factors that use distinct pathways to suppress both the differentiation of DCs as well as their capacity to secrete the Th1-polarizing cytokine IL-12. Because these agents are present in serum and negatively affect DC differentiation at physiological concentrations, our findings are likely to have significance regarding the in vivo role of TGF-beta and VitD3 in determining the type of immune responses.

The human MIP-1beta chemokine is encoded by two paralogous genes, ACT-2 and LAG-1

Human macrophage inflammatory protein-1 beta (MIP-1beta) is an Mr 8,000 acidic protein that is upregulated upon stimulation in monocytes, T cells, and other lymphocytes. This protein belongs to the CC chemokine subfamily and directs the migration of specific subsets of leukocytes. The first molecular clone was isolated in 1988, and ever since there has been confusion regarding the exact number of genes encoding this and closely related proteins. PCR primers were designed from two genomic GenBank entries to conduct single-strand conformational polymorphism analysis, sequence analysis, and PCR-RFLP, and we conclude that previously isolated clones referred to as MIP-1beta are derived from two genes, originally called ACT-2 and LAG-1. The two proteins share a common length and are identical at 89 of 92 amino acids. The first two amino acid differences, V12M and L20P, occur in the signal peptide, while the third, G70S, is in the mature protein. Within the transcribed region, the genes differ at 25 of 662 nucleotides. A survey of the NCBI expressed sequence tag database reveals that both genes are expressed in a variety of tissues, and five clones representing LAG-1 transcripts are alternatively spliced, with the 115-bp exon 2 omitted. Database searches for putative orthologues in other species revealed that the rabbit protein is about 80% similar to the two human proteins, while those of rat and mouse are 70-75% similar. Comparative sequence analysis of the human and animal proteins indicates substantially higher rates of protein evolution in the two rodents compared to human and rabbit.

Familial influences on substance use by adolescents and young adults

This study uses data from the Ontario Health Survey to examine within-family influences (sibship number, age and sex composition; family structure and parental substance use) on the use of tobacco, alcohol and marijuana in households (N = 4,643) among offspring aged 12 to 24 years. Using a modification of the kappa statistic, concordance among siblings is modest generally and undifferentiated across substance type. Concordance is stronger among sibships that are either all male or older (19-24 years) and is particularly strong for siblings < or = two years apart in age. The dominant influence of substance use behaviour appears to be from older siblings to younger siblings and not from parents to offspring. Sibling concordance for substance use suggests that the treatment and prevention of substance use (and abuse) among adolescents and young adults might be enhanced by including a family focus, especially where there are two or more siblings at home.

Age-of-onset classification of conduct disorder: reliability and validity in a prospective cohort study

OBJECTIVE

To test in a prospective clinical cohort study the reliability and validity of the age-of-onset subtyping of conduct disorder.

METHOD

Participants were adolescents referred to psychiatric clinics who met DSM-III-R criteria for conduct disorder by structured diagnostic interview. Age of onset was the reported age of the first conduct disorder symptom. The reliability of age-of-onset report was tested by assessing agreement within informant on interviews 2 to 4 weeks apart. Age-of-onset groups were compared within informant on rates of correlates and symptom and social functioning outcomes over a period of 3 years.

RESULTS

The reliability of age-of-onset report was low (kappa of 0.1 and 0.4 by adolescent and parent informant, respectively). Although the early-onset group had elevated rates of attention-deficit/hyperactivity disorder, family disadvantage, and aggressive and nonaggressive antisocial behaviors at inclusion, growth curve analysis showed that age-of-onset subtyping had no predictive validity.

CONCLUSIONS

The reliability of ascertainment of age of onset of antisocial behavior requires further study. While age-of-onset subtyping has heuristic value with respect to the study of the causal pathways to conduct disorder, it is premature to use this system in clinic settings.

Patient education for discharge after coronary bypass surgery in the 1990s: are patients adequately prepared?

Short hospitalizations for patients undergoing coronary artery bypass grafting (CABG) require continuous nursing evaluation of patients' discharge education. Six institutions collaborated in surveying 300 postoperative patients with CABG to identify learning priorities and patients' perceptions of the effectiveness of discharge education. Data analysis from the self-administered questionnaire demonstrated consistent patient priorities across institutions. Differences in teaching methods and content did not affect perceived preparedness or importance scores. Regional experience demonstrates that variable teaching efforts meet patients' priorities and provide high overall patient preparedness for discharge. Patients with the shortest hospitalizations had higher preparedness scores.

Adequacy of interviews vs checklists for classifying childhood psychiatric disorder based on parent reports

BACKGROUND

The advantages and disadvantages of lay-administered structured interviews and self-administered problem checklists for estimating prevalence and associated features of childhood psychiatric disorder have attracted little comment. This article compares the scientific adequacy of these 2 instruments for classifying DSM-III-R categories of childhood psychiatric disorder in general population samples.

METHODS

Study data are from parental assessments of 251 children aged 6 to 16 years participating in a 2-stage measurement evaluation study. Reliability and validity were compared between the Diagnostic Interview for Children and Adolescents (the structured interview in the study) and the revised Ontario Child Health Study scales (the self-administered problem checklist used in the study).

RESULTS

Reliability estimates based on the kappa statistic were comparable for the 2 instruments and ranged from 0.21 (conduct disorder) to 0.70 (depression) on the lay interview and from 0.17 (depression) to 0.61 (oppositional defiant disorder) on the self-administered checklist. Validity coefficients tended to favor the checklist categories, but only marginally.

CONCLUSIONS

On balance, differences in reliability and validity were small between the 2 instruments. These differences would appear to have no discernible impact on the knowledge about prevalence and associated features of disorder generated by use of such instruments in general population surveys.

Identifying thresholds for classifying childhood psychiatric disorder: issues and prospects

OBJECTIVE

To evaluate empirically the implications of choosing different thresholds to classify conduct disorder and attention-deficit hyperactivity disorder for estimating prevalence, test-retest reliability of measurement, and informant (parent/teacher) agreement and for evaluating comorbidity and associated features of disorder.

METHOD

Data for the study came from problem checklist assessments done by parents and teachers of children aged 6 to 16 years (N = 1,229) selected with known probability from a general population sample and from structured interviews obtained in a stratified, random subsample (n = 251).

RESULTS

Estimates varied widely depending on the rationale used to set thresholds. Percent prevalence went from 0.1 to 39.2; kappa estimates of test-retest reliability went from .19 to .82. Parent-teacher agreement based on kappa went from .0 to .38. Relative odds between disorder and associated features varied twofold.

CONCLUSION

Use of different rationales to set thresholds for classifying childhood psychiatric disorder in the general population has profound implications for what we learn about the epidemiology of childhood disorder.

Integrating assessment data from multiple informants

OBJECTIVE

To examine the consequences for measurement of child psychiatric disorder (conduct and oppositional disorders) of not integrating the data on the same individual from different informants compared with integrating the information from parents and teachers, using three different strategies.

METHOD

Data for the study came from problem checklist assessments done by parents and teachers of children aged 6 to 16 years (N = 1,134) selected with known probability from a general population sample and from structured interviews obtained in a stratified random subsample (n = 251).

RESULTS

As expected, parent-teacher agreement was low. The pattern of associated features of disorder was found to vary markedly in parent-identified compared with teacher-identified disorder. Furthermore, combining informants had the disadvantage of masking the distinctive patterns of associated features noted in informant-specific disorders. Finally, by treating disorder as informant-specific, the internal properties of the measure are not generally inferior to those obtained by combining informants in various ways.

CONCLUSION

Child psychiatric disorders should be conceptualized as informant-specific phenomena.

Predicting the one-year course of adolescent major depression

OBJECTIVE

To identify specific clinical and social functioning variables that predict persistence of major depression over a 1-year period of follow-up.

METHOD

The sample consisted of 67 adolescents with major depression, drawn from consecutive referrals to psychiatric clinics in a defined, geographic catchment area. Clinical interviews and questionnaires measuring behaviors, symptoms, and social functioning were administered to both the adolescent and a parent at inception and at follow-up. Discriminant function analyses were used to identify inception variables that predicted clinical course independent of severity of depressive symptoms and global functioning.

RESULTS

At 1-year follow-up, major depression remitted in 66% of subjects. Persisters were characterized at inception as older, more likely to have substance use or anxiety disorders, less involved with fathers, and less responsive to mother's discipline compared with remitters. The effect of these prognostic factors was independent of symptom severity and global functioning.

CONCLUSION

These variables appear to reflect perpetuating and ameliorating factors influencing the short-term course of major depression. The findings suggest that treatments for adolescent depression that aim to enhance parent-adolescent relationships, and that specifically target coexisting disorders, should be evaluated for effectiveness.

Pathways into the work force: antecedents of school and work force status

OBJECTIVE

The study aim was to identify risk factors for specific pathways into the work force using data from the Ontario Child Health Study Follow-up.

METHOD

Potential predictor variables were derived from data collected in 1983 on adolescents aged 13 to 16 years. The subjects were followed up 4 years later and the school/work force outcome was determined. Bivariate and multivariate statistical analyses were used to identify variables with a strong independent association with this outcome.

RESULTS

Subjects in the work force were four times more likely than those attending school to have come from a low-income family and at least two times more likely to have a family background of low maternal education, to have failed a grade, or to have used substances heavily during early adolescence. Subjects with two or more of these risk factors were likely to be in part-time work or unemployed.

CONCLUSIONS

Preventive interventions should be targeted at children from poor families, or who fail at school, or show early onset of substance abuse and other deviant behaviors. Studies are needed to further elucidate the relationship between these risk factors and pathways into the work force and beyond.

Evaluation of the Diagnostic Interview for Children and Adolescents for use in general population samples

This article presents evaluative data on the use of the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) to classify DSM-III-R disorders in the general population. Data for the analyses came from a probability sample (N = 251) of parent-child/adolescent dyads aged 6 to 16 separately administered the DICA-R on two occasions, 10- to 20 days apart, by trained lay interviewers and child psychiatrists. Data are presented on prevalence, test-retest reliability, parent-child/adolescent agreement, and trained lay interviewer-child psychiatrist agreement. High prevalences of oppositional defiant disorder derived from parent assessments and overanxious disorder and dysthymia derived from adolescent assessments suggest that these disorders may be overidentified. Interview data provided by 6- to 11-year olds to classify the internalizing disorders were too unreliable to be useful. Agreement between parent-child/adolescent dyads was generally low while agreement between trained lay interviewers-child psychiatrists was generally high.

Evaluation of the original Ontario Child Health Study scales

This article presents evaluative information on the use of the original Ontario Child Health Study scales to serve as original-level measures of conduct disorder, hyperactivity and emotional disorder among children in the general (non clinic) population. Problem checklist assessments were obtained from parents and teachers of children aged six to 16 and youth aged 12 to 16 drawn from a general population (n = 1,751); and a mental health clinic sample (n = 1,027) in the same industrialized, urban setting. The results showed that the original OCHS scales possess adequate psychometric properties to be used as original-level measures of disorder. Correlations between individual items and their hypothesized scales were very strong, indicating convergent validity, while correlations between the same items and other (non hypothesized) scales were lower, indicating discriminant validity. Item analyses indicated that individual scale items possess both convergent and discriminant validity. Although the scales were skewed to the positive end of the continuum, they demonstrated good internal consistency (all estimates > or = 0.74) and test-retest (all estimates > or = 0.65) reliability. Finally, three different validity analyses confirmed hypotheses about how the original OCHS scales should perform if they provide useful measures of disorder.

Evaluation of the revised Ontario Child Health Study scales

This article describes the development and evaluation of the revised Ontario Child Health Study (OCHS) scales to measure conduct disorder, oppositional disorder, attention-deficit hyperactivity disorder, overanxious disorder, separation anxiety and depression based on DSM-III-R symptom criteria. Problem checklist assessments were obtained from parents and teachers of children aged 6-16 and youths aged 12-16 drawn from: (1) a general population sample (N = 1751); and (2) a mental health clinic sample (N = 1027) in the same industrialized, urban setting. Evaluation of the revised OCHS scales indicates that they possess adequate psychometric properties and provide an efficient means to obtain measurements of childhood psychiatric disorder, in general population studies, that correspond to DSM-III-R classification of disorder.

Application of a biotyping system and DNA restriction fragment analysis to the study of Serratia marcescens from hospitalized patients

We applied a nine-test biotyping system to the study of 138 Serratia marcescens isolates from 93 patients hospitalized in 33 different hospital bed units. Test reproducibility for a panel of 10 isolates tested in triplicate on 3 separate days was 100%. Overall, the biotyping system delineated 25 strains. In examining strain variation among isolates obtained from multiple anatomic sites over time we found that the same biotype was recovered from tracheal aspirates, urine, wounds, and blood in a given patient and that these strains were carried over time. In general, patients were infected or colonized with their own distinct biotype of S. marcescens. Temporally related isolates from seven surgical intensive care unit (SICU) patients and six unrelated control isolates were typed by biotyping and DNA restriction fragment analysis (RFA). The distribution of biotypes was similar among SICU outbreak and control isolates, with five distinct biotypes among the seven SICU isolates. Each isolate had a different DNA subtype by RFA, confirming the lack of nosocomial transmission of a single strain. These results will be useful in studying the epidemiology of S. marcescens.

The impact of a physically ill parent on adolescents: cross-sectional findings from a clinic population

The degree to which the physical illness of a parent affects adolescents is unknown. This study examines this issue through a cross-sectional survey of patients referred consecutively to an adolescent outpatient psychiatry clinic. Demographic and clinical data concerning symptoms, diagnosis of major depression, peer isolation, and family functioning were collected on all subjects from both the adolescent and a parent (usually the mother). No significant differences were found between the groups on measures of family functioning, peer isolation and major depression. According to both youth and parent report, adolescents with physically ill parents had more somatic symptoms than controls. These findings are discussed in the light of the existing literature and the methodological shortcomings of the study.

Clinical significance of type 5 patterns in platform posturography

Several abnormal patterns have been identified on the sensory portion of the computerized dynamic posturography test. The vestibular deficit pattern, also known as the "5-6" pattern, is frequently seen in patients with either uncompensated unilateral vestibular lesions, severe bilateral peripheral vestibular loss, or dysfunction involving the vestibular pathways in the brain stem and/or cerebellum. In both sensory conditions 5 and 6, the patient's balance/equilibrium is determined primarily by the vestibular system. A subgroup of the vestibular deficit pattern has been identified, in which only sensory condition 5 is abnormal. This article presents findings in several cases identified with the 5 pattern. Implications for diagnosis and for monitoring the recovery phase after treatment are discussed.

A Study to Determine the Difference in Clinical Judgment Abilities Between BSN and Non-BSN Graduates

The purpose of this retrospective study is to determine the difference in clinical judgment abilities of recent baccalaureate nurses (BSN) seeking employment in a large metropolitan hospital and of nurses without a baccalaureate degree. Using an ex post facto design, the orientation records of 116 newly hired nurses were analyzed to determine the clinical judgment abilities using video vignettes produced by Medcom, Inc. Findings indicated that there was no difference in clinical judgment in newly hired BSN and non-BSN graduates. These findings indicate a need for more research studies to determine how clinical judgment is developed and to evaluate teaching strategies that facilitate clinical judgment.

Hemispheric asymmetry in the matching of melodies to rhythm sequences tapped in the right and left palms

Two experiments were conducted to investigate the ability of the cerebral hemispheres to match rhythm sequences tapped in the palms of the hands to tape-recorded melodies. Reaction time (RT) for same/different judgments and accuracy of responses served as the (LP/RH) advantage was found in the ability to match tapped rhythms to tape-recorded melodies, but only on Different trials. On Same trials (which were found to be somewhat easier), both hemispheres were equally efficient at making such comparisons. In Experiment 2, there was no reliable difference between the LP/RH and the RP/LH in the ability to match tapped rhythms to tape-recorded rhythm sequences which were devoid of melodic intonation (i.e., the sound of two blocks of wood struck together in a specified rhythm). The results of these experiments taken in composite lend support to the contention that the right hemisphere advantage typically reported for the processing of musical stimuli is primarily related to pitch and/or intonation rather than rhythm.

Transesophageal atrial pacing threshold: role of interelectrode spacing, pulse width and catheter insertion depth

This study evaluated the role of interelectrode spacing, pulse widths greater than 10 ms, and depth of esophageal insertion on minimizing transesophageal atrial pacing threshold in 30 patients aged 1 day to 77 years. Interelectrode spacings of 15, 22 and 28 mm were evaluated by establishing strength-duration curves in 2 or more serial studies in 12 patients; electrode spacing had no effect on pacing threshold. In 23 patients studied with 22-mm electrode spacing, pulse widths of 15 and 20 ms had no significant effect on current threshold requirements compared with 10-ms pulse widths. In 20 patients, pacing threshold and esophageal electrograms were obtained at 1.0- to 2.5-cm intervals with a 22-mm lead using a pulse width of 10 ms. Average minimal pacing threshold was 10.2 mA (range 4.5 to 20). The site of minimal pacing threshold was highly correlated with patient height (r = 0.987), and occurred within 1.1 cm (0 to 2.5 cm) of the site of the maximal bipolar atrial electrogram amplitude and 0.95 cm (0 to 3 cm) of the site of the maximal unipolar atrial electrogram. Bipolar electrode spacing of 15, 22 or 28 mm has little effect on transesophageal pacing threshold. In most patients, pulse widths greater than 10 ms do not significantly decrease pacing threshold. Correct catheter insertion depth is critical to minimize pacing threshold and may be predicted by either the site of the maximal atrial electrogram amplitude or patient height.

Interpersonal factors in suicide attempts: a pilot study in Christchurch

Attempted suicide is a behavioural pattern with complex psychological and sociological determinants, many of which have been extensively studied in recent years. The basic facts of its changing incidence, its demography, and its place within a broader spectrum of self-destructive behaviour are well established but authorities are still divided on many issues related to its aetiology, its function in the individual and the kinds of services required for its clinical management. (Kessel 1965, Anderson 1974, Weissman 1974, Henderson and Williams 1974). The study reported here was designed partly to define the characteristics of a group of patients for whom clinical services were being planned and partly as a pilot study to develop a methodology for a more extensive controlled study which we hope to carry out next year. The preliminary findings are sufficiently interesting to report now.