Pediatric Emergency Physicians' Knowledge, Attitudes, and Behaviors Regarding Confidential Adolescent Care

OBJECTIVES

More than 19 million adolescents seek care in the emergency department (ED) annually. We aimed to describe the knowledge, attitudes, and behaviors related to confidential adolescent care among pediatric ED physicians.

METHODS

We conducted a cross-sectional questionnaire of US physician members of the Pediatric Emergency Medicine Collaborative Research Committee survey listserv. The 24-item questionnaire assessed familiarity with adolescent confidentiality laws, attitudes toward providing confidential care, frequency of discussing behavioral health topics confidentially, and factors influencing the decision to provide confidential care. We dichotomized Likert responses and used χ2 to compare subgroups.

RESULTS

Of 476 eligible physicians, 151 (32%) participated. Most (91. 4%) had completed pediatric emergency medicine fellowship. More participants reported familiarity with all sexual health-related laws compared with all mental health-related laws (64% vs 49%, P < 0.001). The median age at which participants thought it was important to begin routinely providing confidential care was 12 years; 9% thought confidential interviews should not be routinely conducted until older adolescence or at all. Their decision to provide confidential care was influenced by the following: chief complaint (97%), time (43%), language (24%), presence of family (23%) or friends (14%), and space (22%).

CONCLUSIONS

Respondents reported moderate familiarity with adolescent confidentiality laws. Although they viewed confidential care as something they were comfortable providing, the likelihood of doing so varied. Barriers to confidential care were influenced by their assessment of adolescents' behavioral health risk, which may contribute to health inequity. Future efforts are needed to develop strategies that augment confidential ED care for adolescents.

Assessing the Healthcare Utilization of Youth Who Died by Suicide: A Case-Control Study

OBJECTIVE

Suicide is the second leading cause of death in youth ten years old or older. Healthcare utilization prior to death by suicide is high in adults, but there is conflicting evidence in youth. The objective of this study was to compare healthcare utilization in youth who died by suicide to youth who died in a motor vehicle accident (MVC) to determine whether healthcare utilization is associated with death by suicide in youth.

METHODS

This retrospective case-control study used death records from Coroners/Medical Examiners (C/MEs) for children 11-17 years old who died by suicide (case) and MVC (control) between October 2013 and October 2018 were obtained. Data from the electronic medical record (EMR) at a healthcare system was reviewed. The primary outcome was healthcare utilization. Secondary outcomes included mental health diagnosis. Data was analyzed using Fisher's Exact Test and considered significant if p < 0.05.

RESULTS

The analysis included 60 youth who died by suicide and 14 youth who died by MVC. Most decedents were male (68%) and white (80%). Mean age at death was 16 years old. Only 25 decedents had a corresponding record in the EMR, with no significant difference based on manner of death (35% suicide vs 29% MVC, p = 0.8). Fourteen decedents had a known mental health diagnosis in their EMR with no difference based on manner of death (p = 0.5).

CONCLUSIONS

There was no difference in healthcare utilization or mental health diagnosis in youth who died by suicide compared to youth who died by MVC. Strict reliance on both of these factors when considering youth who may be at risk of suicide is inadequate. Expanding universal suicide screening to other settings, including schools or primary care, can help identify youth at risk for suicide and may prevent unnecessary deaths.HIGHLIGHTSLittle is known regarding the healthcare utilization of youth who died by suicide prior to their death.This study uses a case-control design to investigation healthcare utilization of youth who died by suicide versus youth who died in a motor vehicle crash.We did not find a significant difference in healthcare utilization between cases and controls. These findings suggest that non-clinical interventions would be useful in detecting suicide risk.

A Scoping Review of Digital Health Interventions to Promote Healthy Romantic Relationships in Adolescents

Despite a robust field of study in healthy romantic relationship education and risk prevention interventions that employ traditional forms of delivery, the field of digital health interventions (DHIs) in healthy relationship programming for adolescents remains undefined. The purpose of this scoping review was to summarize the scope of published research in DHIs that promote healthy romantic relationships in adolescents. We conducted database searches, 2000-2022; hand searches; reference list and literature review searches, and emailed study authors to identify articles. Included were experimental, development, and feasibility studies. We summarized features of selected studies and their healthy relationship aims/components and identified patterns of emphasis and areas of future need. Sixteen publications describing 15 unique DHIs were reviewed with interventions developed and or trialed in 11 countries. We identified 10 web-based or downloadable applications, four serious game applications, one video-voice program, and one social media-based program. DHIs focused on improving knowledge/attitudes/skills of healthy adolescent romantic relationships directly or through prevention-focused programs. Interventions that measured outcomes found small effects, primarily in healthy romantic relationship communication skills. DHIs offer unique opportunities to provide user-responsive and culturally specified programming for adolescents and to involve adolescents themselves in processes of program design, development, and evaluation. Further research is warranted to define relevant outcomes for adolescents and validated measures to evaluate them. Future research might seek to address the social ecology of adolescent romantic relationships beyond the individual and interpersonal and explore combinations of virtual and adult-moderated in-person delivery to ensure youth are adequately supported.

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

BACKGROUND

It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations.

METHODS

Systematic review of the literature and narrative synthesis.

RESULTS

We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma.

CONCLUSIONS

This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.

Beyond sexual assessment: lessons learned from couples post radical prostatectomy

PURPOSE

To share selected experiences of advanced practice nurses (APNs) who implemented a home-based nursing protocol related to psychosexual function for couples following radical surgery for prostate cancer.

DATA SOURCES

Selected research-based articles, the PLISSIT Model for sexual rehabilitation counseling, and the authors' experiences.

CONCLUSIONS

Five lessons related to communicating about sexuality and intimacy were synthesized from the experience, including examining knowledge and self-awareness regularly, using a structured interview guide to facilitate the process, developing a trusting relationship with the couple, attending to verbal and nonverbal cues, and providing information about the full range of sexual expression.

IMPLICATIONS FOR PRACTICE

Include an assessment of sexual health as an integral part of a general health assessment. Patients do not generally volunteer information about their sexual concerns unless the subject is introduced by the APN.

Fatigue and quality of life outcomes of exercise during cancer treatment

PURPOSE

Despite the recognition of fatigue as a common and distressing symptom during cancer treatment, there are few evidence-based interventions available to manage such fatigue. The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue, physical functioning, emotional distress, and quality of life (QOL) during breast cancer treatment.

DESCRIPTION OF STUDY

Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design. Subjects were randomly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer. Symptoms, physical functioning, and QOL were measured at baseline, midtreatment, and at the end of treatment.

RESULTS

Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment.

CLINICAL IMPLICATIONS

A home-based walking exercise program is a potentially effective, low-cost, and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer. This health-promoting self-care activity needs further testing in large randomized clinical trials.

Development of a home-based family caregiver cancer education program

INTRODUCTION

This article describes a home-based educational program developed specifically for family caregivers of cancer patients who receive hospice and home care. The overall aim of this educational program is to specifically address family caregivers' needs for acquisition of necessary knowledge and skills to meet the physical and psychosocial demands associated with caring for a patient with advanced cancer.

PROGRAM DEVELOPMENT

Originally, components of this program were offered in a small group discussion format within hospital and community settings. The educational program was transformed to accommodate the unique needs and constraints of homebound family caregivers who have very limited time and/or opportunities for support and education outside of the home. The program is comprised of educational modules that provide hospice and home care professionals with written and audiovisual materials designed to facilitate brief, structured, educational encounters with family caregivers in the home setting.

DISCUSSION

Two hundred thirty-seven educational module kits were distributed to professionals affiliated with twenty-four home care and hospice agencies in the Greater Philadelphia area. Results of a telephone survey designed to elicit evaluation data from professional staff members who had used the educational modules are presented. Limitations, plans for future program evaluation, cost implications, and implementation recommendations related to this educational program are described.

A typology of residential fire survivors' multidimensional needs

This article presents an analysis of the tangible, psychological, and general needs of adults and their children reported by residential fire survivors approximately 14 weeks postfire. Three hundred and seven survivors, who identified that they needed help for themselves or their children, differed from 133 survivors who did not request help. Those needing help were more likely to be women with children younger than age 18 living in their household, have low-income status, less education, and to have already received services from church groups. The classification of self-identified needs of fire survivors included the need for specific tangible and social service assistance, psychological and spiritual support, and nonspecific assistance. This classification contributes to our understanding of the relationship between needs and loss, grief, and changes in family and life situations postfire.

Establishing mechanisms to conduct multi-institutional research--fatigue in patients with cancer: an exercise intervention

PURPOSES/OBJECTIVES

To describe the process of establishing a multi-institutional interdisciplinary team of oncology researchers and conducting a pilot study of an exercise intervention for fatigue.

DATA SOURCES

Project meeting minutes and records, research team members' logs, subjects' research records, the research study proposal, and team members' individual and collective shared experiences.

DATA SYNTHESIS

Site investigators established research teams at five academic medical centers. Fifty subjects were enrolled in the study and tested during their cancer treatment. Study methods, including instrumentation, were evaluated carefully and revised.

CONCLUSIONS

The multi-institutional network of researchers is an effective and efficient model for testing an intervention to manage fatigue during cancer treatment.

IMPLICATIONS FOR NURSING PRACTICE

Exercise is a feasible and potentially beneficial intervention to combat distressing cancer treatment-related fatigue. A pilot study is essential to determine the best methods for conducting a clinical trial and to develop the teams of researchers necessary for such a project.

Sociocultural influences and care of dying children in Japan and the United States

Caring for dying children and their families is one of the most difficult and challenging aspects of professional nursing. An analysis of cultural influences provides insight into the diverse worldviews held by people in Japan and the United States that affect nursing care of dying children. Selected cultural aspects that influence behaviors in Japanese and American cultures are reviewed in this article. Characteristics of support models for dying children and their families established in Western cultures are discussed. This cross-cultural review of prevalent sociocultural influences on the care of dying children and their families in Japan and the United States clearly demonstrates numerous contrasts and parallels.

Palliative care: past, present, and future perspectives

OBJECTIVES

To provide a review of the development and impact of palliative care; to discuss quality of lie as a framework for guiding clinical practice and research in palliative care; and to identify future trends that are likely to affect palliative care services.

DATA SOURCES

Research studies, review articles, and book chapters.

CONCLUSIONS

Palliative care is in the process of dynamic change. Advocates of palliative care are suggesting that cost-effective holistic care strategies should be available to patients and families throughout the illness trajectory, not just reserved for end of life care.

IMPLICATIONS FOR NURSING PRACTICE

Incorporation of palliative care principles across the cancer illness trajectory requires an attitude shift by all members of the multidisciplinary team.

Psychosocial aspects of palliative care

OBJECTIVES

To provide information about factors that affect psychosocial adjustment among individuals and families who are faced with chronic illness; to discuss assessment guidelines and risk factors that may indicate a need for professional intervention; and to review psychosocial interventions that are used to minimized distress and promote adaptation.

DATA SOURCES

Research studies, review articles, and book chapters.

CONCLUSIONS

The majority of cancer patients experience emotional turmoil that occurs at transition points along the illness trajectory. Psychosocial issues faced by patients and their families are influenced by individual, sociocultural, medical, and family factors.

IMPLICATIONS FOR NURSING PRACTICE

Supportive psychotherapeutic measures help to minimize distress, enhance feelings of control, and improve quality of life.

A model of survivors' psychological responses following a residential fire

Residential fires result in loss of life, property, and displacement from one's neighborhood. It would be expected that grief experienced in the aftermath of residential fires has a significant impact on survivor's recovery and reintegration into the community. Although there is some research on psychological responses to community-wide fires and large scale disasters, little is known about such responses among survivors of home fires that occur episodically. Appropriate interventions cannot be developed until more is learned about variables influencing survivors' psychological response to a residential fire. A theoretical model of survivors' psychological response post-fire is proposed.

Comparative performance of Colisure

Colisure presence-absence medium was compared with standard reference methods for detecting low numbers of total coliform bacteria and E. coli in drinking water when the bacteria were subjected to chlorine stress. When Colisure was compared with established reference methods to detect total coliforms in dilute, disinfected samples, Colisure yielded more positive results after 24, 28, and 48 h than lauryl tryptose broth (LTB) confirmed in bile green lactose broth after 48 h. Colisure also detected higher levels of chlorine-injured E. coli than LTB confirmed in EC medium with 4-methylumbelliferyl B-D-glucuronide (EC/MUG). The sensitivity and specificity of Colisure were also evaluated and were determined to be between 96 and 100 percent on nonchlorinated samples when positive and negative tests were verified.

Experiences of African American and Caucasian women who survive urban residential fires

This study examined differences in socioeconomic characteristics, traumatic experiences suffered, and psychological distress in African American and Caucasian women 3 months after urban residential fires. Distress was measured by the Brief Symptom Inventory (BSI). The sample included 310 women (224 African Americans and 86 Caucasians). The African American women had lower levels of education and income than the Caucasian women, and were more likely to be unmarried. Injury and deaths of loved ones were similar in the two groups; African American women reported greater loss of possessions, less insurance coverage, and less displacement than Caucasian women. African American and Caucasian women scored similarly on the BSI. Scores on the BSI for both groups were higher than the norms reported in the literature.

Demographic characteristics, fire experiences, and distress of residential fire survivors

The United States has one of the highest per capita fire death rates in the world. Death rates alone, however, fail to reflect the breadth of loss experienced by residential fire survivors. Despite the frequency of home fires and the potential for loss, little is known about this vulnerable population. Interviews were conducted with 440 fire survivors 14 weeks after fires. Demographic characteristics of residential fire survivors, survivors' fire experiences, psychological distress after fires and the interrelationships among these variables were examined. This sample of urban fire survivors largely comprised poor, middle-aged African American women. Psychological distress was measured by the General Severity Index of the Brief Symptom Inventory, and the results showed that survivors were highly distressed, even in the absence of fire-related death or physical injury.

Assessment of adult sibling grief: a review of measurement issues

Over the past decade hospice care has been delivered to an increasing population of persons with Acquired Immunodeficiency Syndrome (PWAS) and their families. Adult siblings likely comprise a large number of these surviving family members. Investigations that examine sibling bereavement are scarce (Osterweis, Solomon & Green, 1984) and assessment of the unique experience of adult sibling grief requires careful consideration before existing measures can be applied. The purpose of this paper is to present theoretical and psychometric considerations regarding assessment of adult sibling grief that are pertinent for hospice workers who provide bereavement care to this population.

Comparative performance of Colisure (TM) and accepted methods in the detection of chlorine-injured total coliforms and E.coli

Studies were done to examine the comparability of Colisure (TM) and accepted reference methods to detect low numbers of total coliform bacteria and E.coli subjected to chlorine stress. Colisure (TM) is a medium designed to concurrently detect coliform bacteria and E.coli in drinking water by the specific action of beta-galactosidase (total coliforms) and beta-glucuronidase (E.coli). The methods used to compare the performance of various media followed a protocol established by the USEPA. Samples (31) of sewage from six different regions of the US were treated with sufficient concentrations of chlorine (1.2-2.5mg/l) to reduce viability 1-3 logs (39% average injury) and diluted with drinking water to achieve ca. 3 viable coliforms/100ml. The mean log reductions in viable bacteria, determined with various media following disinfection of the 31 samples were: mEndo = 1.87 (TC), Colisure (TM) = 1.55 (TC), mTec = 3.63 (E.coli) and Colisure (TM) = 2.01 (E.coli). When Colisure (TM) was compared with accepted methods to detect total coliforms in the dilute, disinfected samples, Colisure (TM) yielded results that were 1.6 times greater than LTB confirmed in BGLB at 28h. Colisure (TM) also detected 1.7 times greater levels of E.coli than LTB confirmed in EC/MUG at 28h. Sensitivity and specificity of Colisure (TM) were between 96 and 100% when positive and negative tests were verified. These findings indicate that Colisure (TM) is superior to certain accepted reference methods in the detection of chlorine-injured coliforms and E.coli under conditions that resemble contaminated drinking water.

In vivo and in vitro effects of mutagenesis of active site tyrosine residues of mercuric reductase

X-ray crystal structure analysis of mercuric reductase suggested that the binding site for Hg2+ consisted of two tyrosine residues, Tyr264 and Tyr605, as well as two cysteine residues, Cys207 and Cys628. We have previously shown that mutagenesis of Tyr605 to Phe lowered the kcat of the enzyme 6-fold, whereas the same mutation of Tyr264 resulted in a reduction of 160-fold [(1993) Biochemistry 32, 7475-7478]. Tyr605 occupies the same position in mercuric reductase as the active site His residue in the related enzyme glutathione reductase. The mutation of Tyr605 of mercuric reductase to a His residue produced a 24-fold decrease in kcat and a 15-fold decrease in Km. The in vivo resistance to Hg2+ of E. coli strains carrying wild type or mutant merA genes correlated with the in vitro measurements of kcat/Km for mercuric reductase activity.

Molecular epidemiology of trachoma in a Gambian village

The application of a diagnostic and genotyping technique based on the polymerase chain reaction (PCR) to the study of trachoma epidemiology in the Gambian village of Jali is reported. PCR based on the major outer membrane protein (MOMP) gene of Chlamydia trachomatis appears to be more sensitive than either isolation or antigen detection by enzyme immunoassay; it had a specificity of 95% and sensitivity of 51% against clinical signs. PCR genotyping identified genotypes A and B of Chlamydia trachomatis circulating in Jali. Sequencing revealed a Pst1 restriction endonuclease site in the amplified MOMP gene of some B strains but not others; Pst1 digestion of the PCR product proved an easy method of distinguishing these strains. The distribution of serotypes and B strain variants shows a significant degree of household clustering (p < 0.001). PCR based genotyping combined with strain typing provides a new and powerful epidemiological tool for the study of transmission events in trachoma.

Short report: identification of a specific pattern of vascular endothelial growth factor mRNA expression in human placenta and cultured placental fibroblasts

Reverse transcription and the polymerase chain reaction (PCR) were used to detect vascular endothelial growth factor (VEGF) mRNA in human placental tissue and cultured placental fibroblasts obtained during the first trimester of pregnancy. The primers for VEGF corresponded to areas in exon 4 and exon 8 of the VEGF gene. After one round of PCR three products, equivalent to VEGF121, VEGF165 and VEGF189, were detected within placental tissue and cultured placental fibroblasts. A further round of PCR revealed the presence of two more products equivalent to VEGF206 and VEGF145. Thus, in addition to the production of readily secreted forms of VEGF (VEGF121 and VEGF165), the placenta produces several transcripts expected to increase the growth factor pool of the extracellular matrix.

Psychological distress in survivors of residential fires

This paper presents preliminary findings from an ongoing study of survivors of residential fires. The purpose of this study was to examine psychological distress and extent of loss in order to provide a psychological profile of survivors overtime. The sample (N = 69) was drawn consecutively from the database of residential fires available through the Philadelphia Fire Department. Levels of psychological distress were measured as well as reports of symptoms consistent with the diagnostic criteria for Post-traumatic Stress Disorder. The major findings indicate that residential fires caused significant and sustained distress. An agenda for further research and for services to survivors of these fires is presented.

Role of tyrosine residues in Hg(II) detoxification by mercuric reductase from Bacillus sp. strain RC607

Two tyrosine residues of mercuric reductase (MerA), Tyr-264 and Tyr-605, which were shown by the X-ray crystal structure to be involved in metal binding, were changed to phenylalanine residues by site-directed mutagenesis, both singly (Y264F, Y605F) and to form a double mutant (Y264,605F). The effect of these mutations on Hg(II) reduction activity varied. While MerA Y605F has a similar apparent Km to the wild-type enzyme and an apparent kcat reduced by 6-fold, MerA Y264F has an apparent Km 5-fold lower than the wild type and apparent kcat 160-fold lower. The double mutant MerA Y264,605F has the same apparent Km as MerA Y264F, but its apparent kcat was reduced by a further 7-fold. These results show that the roles of the two tyrosine residues are not equivalent and that Y264 is important for catalysis, possibly by destabilizing the binding of Hg(II) to the two ligating thiolates at the active site of MerA.

Cultural awareness in the context of terminal illness

While cultural awareness provides direction for planning effective nursing interventions at all stages of health and illness, this article specifically addresses applications for patients who are terminally ill. Professional nurses encounter unique challenges in caring for terminally ill patients. Assisting patients to achieve an "appropriate death" requires communication and collaboration among patients, family members, and professional caregivers. Since patients and their families represent many systems of complex beliefs and values, nurses must be aware of the impact of cultural pluralism on nursing assessment and intervention in terminal illness. Reordering priorities and redistributing resources have been identified as new approaches in caring for terminally ill patients and their families. Two concepts that cut across all cultural boundaries are loss and grief. Expressions of loss and grief take on a variety of forms among members of diverse cultures. It is critical that nurses recognize, understand, and respect each family's culture-specific patterns with regard to terminal illness. Understanding the culture will lead to the design of culturally appropriate nursing care for patients and families. Culture brokerage is defined as an act of translation, where messages, instructions, and belief systems are exchanged between cultural groups. This strategy has the potential to increase understanding among those with diverse cultural backgrounds, resulting in increased patient/family satisfaction within the supportive care setting. Consonance between patients' needs and nurses' understanding of those needs will lead to more culturally appropriate intervention strategies.

Reverse transcription with nested polymerase chain reaction shows expression of basic fibroblast growth factor transcripts in human granulosa and cumulus cells from in vitro fertilisation patients

Basic fibroblast growth factor (bFGF) is a potent angiogenic factor that has also been implicated in granulosa cell and oocyte maturation. We now report the expression of messenger ribonucleic acid (mRNA) encoding bFGF in human granulosa and cumulus cells obtained at oocyte recovery in in vitro fertilisation patients. It was necessary to use the sensitive technique of a nested polymerase chain reaction (PCR) after reverse transcription (RT) to detect transcripts. This finding in conjunction with a recent report showing the presence of transcripts for transforming growth factor beta (TGF beta) in the same type of cells by PCR indicates that mechanisms are in place for controlling extracellular proteolysis and cell differentiation.

Determinants of anticipatory nausea and anticipatory vomiting in adults receiving cancer chemotherapy

There is a need for further empirical investigation of variables that may contribute to the occurrence of anticipatory nausea and/or anticipatory vomiting (AN/AV) in persons receiving cancer chemotherapy. The purpose of this study was to examine the relationship of AN/AV in adults receiving an initial course of cancer chemotherapy in an outpatient setting with the following set of variables: symptom distress, mood disturbance, stage of disease, sensitivity to conditioning cues, emetic potential of antineoplastic drugs, age, psychosocial stress, and ability to cope. Thirty-two percent of the sample developed anticipatory nausea. Multivariate statistics were used to examine the contribution of the variables to the prediction of AN/AV. Analysis of the data revealed that 53% of the variance accounted for was contributed by the following combination of variables: emetic potential of drug, level of symptom distress, mood disturbance, stress and ability to cope (p = .001). The total percentage of cases correctly classified was 88.3%. This combination of variables correctly classified 100% of patients who experienced anticipatory nausea (n = 15). Eighty-two percent of patients who did not experience anticipatory nausea and/or anticipatory vomiting (n = 28) were classified correctly.

Cloning and characterization of the aldA gene of Aspergillus nidulans

We have cloned and sequenced the aldA (encoding aldehyde dehydrogenase) gene of Aspergillus nidulans. The gene contains two introns which are similar in size and structure to other fungal introns. The amino acid sequence of aldehyde dehydrogenase (497 residues) shows a significant level of homology with analogous sequences in other organisms. Comparison of the primary structure of the active sites of the mammalian cytosolic and mitochondrial enzymes shows that the Aspergillus enzyme closely resembles the mammalian mitochondrial enzyme. Analysis of the 5' non-coding region of the aldA gene shows a TATA-like sequence located 90 bp upstream from the initiation codon. Two messenger-RNA start points are located 36 and 42 bp upstream from the start codon.

Sequence of an antifreeze protein precursor

The amino acid sequence of the precursor to the second-most-abundant serum antifreeze protein (B) in the winter flounder has been determined by a combination of protein and DNA sequencing. The precursor is an 82-residue preproprotein which differs in only three positions from the amino acid sequence of the precursor for the most-abundant serum antifreeze protein (A). The base changes responsible for these substitutions, as well as several silent changes, are all clustered within the DNA coding for the mature protein portion. Among the post-translational modifications that the precursor undergoes is the removal of the c-terminal glycine residue. Cloning of full-length antifreeze protein cDNA has enabled us to identify the transcription initiation site which occurs 49 nucleotides upstream from the initiation codon.