Establishing Quality and Outcome Measures for Recovery Housing: A Tiered Approach Supporting Service Evolution

With over one-hundred thousand drug overdose deaths in 2021, substance use disorder (SUD) is a public health crisis in the United States. Medical stabilization has been the predominant focus of SUD interventions despite low levels of retention. Consequently, national quality measures for SUD care outside the clinical continuity of care are limited. The expansion of recovery support services addressing social drivers of health outside clinical settings is needed. The current SUD quality measures are not applicable nor feasible for recovery support service providers with limited resource capacities, like the estimated 17,900 recovery housing providers nationwide. Despite widespread support for recovery housing and its documented effectiveness, no universal set of measures has been developed for widespread adoption. In this brief, a matrix of quality measures are proposed to meet the needs of recovery housing providers with various capacities to support service evolution and improve equitable SUD treatment and recovery care.

Justifying the need for a recovery related surveillance system: Exploratory focused interviews

Background and Aims

No recovery related surveillance system exists but given the evidence of effectiveness and growing supply, a house- and resident- level recovery house (RH) surveillance system could be beneficial for data collection on recovery support service (RSS) engagement, and retention; for improved standardization of RH programs and services; and for identification of outcomes associated with long-term recovery.

Methods

This study aimed to explore current data collection practices at the resident- and house- level through qualitative focus interviews of RH representatives. The 13 RH interviews were scheduled with 16 RH representative respondents.

Results

The most frequently collected resident data was at entry (92%) and departure (85%) and included demographics (n = 5), substance use history (n = 6), treatment and recovery history (n = 5), legal and correctional history (n = 6) and mental health information (n = 7). Recovery support data was collected by 85% of houses. Post-stay data was only collected by four RHs (31%).

Conclusion

These results indicate that there is a lack of standardized systematic collection, analysis, and reporting of recovery related data in the RH field. A recovery related surveillance system has the potential to fill this gap and inform and improve standard of resident care to support long-term recovery from substance use disorder.

State-Level Support for Recovery Housing: Results from a National Collaborative Study of U.S. Single State Agencies

Single State Agencies (SSAs) are responsible for managing the publicly funded alcohol and other drug prevention, treatment, and recovery service system. Recovery housing (RH) is an important recovery support service (RSS) for individuals experiencing substance use disorder (SUD). Despite its effectiveness, information on state utilization and support is limited. To assess state-level support for RH and its incorporation within the SSA-managed SUD service systems, we administered a survey with SSAs in the 50 United States and the District of Columbia. In total, 48 out of the 51 SSAs responded, yielding a 94% response rate. Findings indicate strong state-level support for RH in terms of it being an integral RSS (98%), part of state-level strategic plans (73%) and prioritized for funding (87.5%). States are making progress to formalize RH with 68% reporting RH had been defined formally or within their agency. However, activities around understanding the capacity and need for RH are limited, with 44% indicating a needs assessment had not been conducted. At the same time, states perceive RH as a priority RSS, with growing recognition of its positive impact on long-term SUD recovery. This research identifies the opportunities for stakeholders to further evolve and expand RH at the federal, state, and local levels.

Psychometric properties of the Fletcher Recovery Housing Alliance Measure (FRHAM-12)

Background: Recovery Housing (RH), an important resource for substance use disorder (SUD) recovery, centers on shared lived experience. Program evaluation considers the contribution of environmental factors to outcomes, yet most research on outcomes has focused on patient factors and fidelity to protocols. Investigations of process measures reflecting the dynamic interplay between patient factors and the treatment program are limited. Alliance, one's perceived connection with others, is a process measure associated with mental health outcomes and includes domains "tasks," "goals," and "bonds." We posit that alliance serves as a proxy construct to measure the impact of shared experience in RH.Objectives: Develop and assess the psychometric properties of the Fletcher Recovery Housing Alliance Measure (FRHAM-12) for RH.Methods: A cross-sectional survey with the 12-item FRHAM-12 was administered to 271 individuals (60% men, 39% women, 1% other) within six RH centers in Kentucky. Item-total correlations, internal consistency reliability, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were conducted.Results: The FRHAM-12 was found to have a strong internal consistency (0.924 alpha coefficient) and the EFA yielded a single component (56.38% of cumulative scale variance). CFA indicated acceptable levels of absolute and relative fit of a unidimensional scale with values of 0.67 and 0.976 for the standardized root mean square residual and relative fit index.Conclusion: This study aimed to construct and validate an initial measure for RH alliance resulted in the brief, FRHAM-12; a tool with strong internal and factor validity. Future research should examine the measure's predictive and concurrent validity.

Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta-analysis

OBJECTIVE

Identify independent and novel risk factors for late-preterm (28-36 weeks) and term (≥37 weeks) stillbirth and explore development of a risk-prediction model.

DESIGN

Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors.

SETTING

An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study.

POPULATION

Women with late-stillbirth (cases, n = 851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n = 2257).

METHODS

Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables.

MAIN OUTCOME MEASURES

Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth.

RESULTS

After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86).

CONCLUSIONS

Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in late-stillbirth risk assessment.

Assessing waivered and non-waivered physician barriers to treating patients with substance use disorders: a cross-sectional Kentucky pilot

INTRODUCTION

Opioid and other substance use disorders (OUD/SUDs) have been and continue to be significant public health issues. The standard of care for OUD is the use of medication for opioid use disorder (MOUD) in conjunction with counseling or behavioral therapies, yet research has indicated that barriers exist for patients accessing MOUD as well as for physicians prescribing MOUD due to requirements associated with the DATA 2000 waiver.

METHODS

A pilot cross-sectional survey was conducted among Kentucky physicians in order to reassess common barriers as well as to explore barriers that non-waivered providers face to becoming waivered. Barriers were compared by waiver status (waiver vs. non-waivered) as well as geographic location (rural vs. non-rural).

RESULTS

Compared to waivered physicians, non-waivered physicians were significantly less likely to report positive personal beliefs related to the use of MOUD for OUD and reported significantly more barriers to treating OUD patients in the areas of physicians' practice and culture, auditing, and institutional support and resources (p < .05). The majority (69%) of all physicians indicated they would benefit from a tool kit with evidence-based clinical guidelines.

CONCLUSIONS

The barriers and beliefs identified in this pilot study indicate the need for policy action at the federal level to reduce barriers and incentivize more physicians to obtain waivers to treat OUD. Further, the development of brief educational resources tailored to physicians to treat OUD patients including pregnant patients with OUD is recommended.

Health Insurance Literacy Levels of Information Intermediaries: How Prepared Are They to Address the Growing Health Insurance Access Needs of Consumers?

Background:

With rising unemployment rates brought on by coronavirus disease 2019 pandemic, the rates of underinsured and uninsured consumers are likely to rise. Health information intermediaries play a critical role in assisting consumers with navigating the complexities of the United States health care system and the ever-changing health care policy landscape. Not much is known about the health insurance literacy (HIL) levels of information intermediaries and their ability to assist consumers with making informed decisions about their health insurance.

Objective:

This study aimed to examine the association between information intermediary levels of HIL, sociodemographic factors, and confidence and behaviors in assisting consumers with health insurance needs.

Methods:

We surveyed 118 information intermediaries from various roles to assess objective and subjective HIL, frequency, and confidence in assisting consumers, and confidence in understanding changes in federal health reform policies and state Medicaid waiver programs.

Key Results:

Less than one-half (39%) of information intermediaries had high subjective HIL and much fewer (13%) had high objective HIL. The average frequency of assisting consumers with health insurance scores were somewhat low, and confidence in assisting consumers with health insurance scores and confidence with understanding state and federal policies were modest. Results from our logistic regression model indicated that confidence in assisting consumers was found to be the only significant contributor to high subjective HIL. For every one-point increase on the confidence assisting subscale, there was a 35% increase in the information intermediaries having high subjective HIL.

Conclusions:

Findings from this study, coupled with rising uninsured rates, indicate the need for tailored training programs and resources to equip our information intermediaries to provide timely and appropriate health insurance support for consumers. [HLRP: Health Literacy Research and Practice. 2022;6(1):e30–e36.]

Plain Language Summary:

In a sample of 118 information intermediaries, representing community health workers, navigators, and other people in outreach roles, the majority had low subjective and objective HIL. We also found that as confidence with assisting consumers with health insurance needs increases, HIL increased as well. These findings indicate that tailored training programs and resources are needed to equip information intermediaries to provide health insurance support for consumers.

Perceptions of opioid and other illicit drug exposure reported among first responders in the southeast, 2017 to 2018

BACKGROUND

Opioid use has risen dramatically in recent years, and its illegal use puts first responders at risk when intervening in overdoses. Synthetic opioids, like fentanyl with a potency 50 to 100 times greater than morphine, pose a great risk and accidental exposure via ingestion, inhalation, mucosal, or percutaneous routes, can potentially lead to fatal outcomes. Anecdotal media accounts in early 2017 of accidental occupational opioid exposure among first responders generated a national concern.

METHODS

To identify first responders' recollections, beliefs, and concerns about possible occupational exposure to opioids and other drugs, researchers in Kentucky, Virginia, Mississippi, and Georgia administered an emailed, anonymous convenience sample survey.

RESULTS

A total of 5955 surveys were analyzed with 15% of respondents reporting they believed they had been exposed to opioids, and of those, less than 1% reported experiencing health effects from perceived exposure. Over half (51%) of respondents reported being "very or somewhat concerned" about developing health effects from exposure to opioids. Half of respondents reported being unaware of Centers for Disease Control and Prevention (CDC)/National Institutes for Occupational Safety and Health (NIOSH) guidelines for preventing occupational-related opioid exposures.

CONCLUSIONS

Only a small fraction of first responders believed they had experienced symptoms related to opioid exposure in overdose response calls, but half were concerned about potential exposures and half were unaware of the educational guidance on prevention available. The high level of concern regarding potential exposure warrants the need for the development and or enhancement of targeted educational training interventions and further dissemination of pre-existing training interventions to ensure first responders have the knowledge and understanding of occupational opioid exposures and minimize stress associated with the potential rare exposures.

Body rate decoupling using haltere mid-stroke measurements for inertial flight stabilization in Diptera

Halteres, the modified rear wings of Diptera, have long been recognized as sensory organs necessary for basic flight stability. These organs, which act as vibrating structure gyroscopes, are known to sense strains proportional to Coriolis accelerations. While compensatory responses have been demonstrated that indicate the ability of insects to distinguish all components of the body rate vector, the specific mechanism by which the halteres are able to decouple the body rates has not been clearly understood. The research documented in this report describes a potential mechanism, using averaged strain and strain rate at the center of the haltere stroke, to decouple the inertial rate components. Through dynamic simulation of a nonlinear model of the haltere 3-dimensional trajectory, this straightforward method was demonstrated to provide an accurate means of generating signals that are proportional to three orthogonal body rate components. Errors associated with residual nonlinearity and rate-coupling were quantified for a bilaterally reconstructed body rate vector over a full range of pitch and yaw rates and two roll rate conditions. Models that are compatible with insect physiology are proposed for performing necessary signal averaging and bilateral processing.

Network analysis of Danish cattle industry trade patterns as an evaluation of risk potential for disease spread

Trade patterns of animal movements in a specific industry are complex and difficult to study because there are many stakeholders, premises that are heterogeneously spread over the country, and a highly dynamic flow of animals exists among them. The Danish cattle industry was defined as a network of animal movements and graph theory was used to analyse the movements of cattle within this network. A premise was defined as a farm, an abattoir or a market. These premises constituted the network nodes in the graph and the animal movements between them were the links. In this framework, each premise had a sub-network of other premises to which it was linked by these animal movements. If no movement of animals were registered for a specific farm, then the sub-network for that premise consisted of only that premise. Otherwise, the sub-network linked the premise of interest to all premises from which and to which animals were moved, as long as there was a path linking animal movements to that specific premise. This approach allowed visualization and analyses of four levels of organization that existed in Denmark animal registers: (1) the animal that was moved, (2) the movements of all animals between two premises, (3) the specific premise network, and (4) the overall industry network. When contagious animals are moved from one premise to another, then to a third and so forth, these movements create a path for potential transfer of pathogens. The paths within which pathogens are present identify the transmission risks. A network of animal movements should provide information about pathogen transmission and disease spread. The network of the Danish cattle industry network was a directed scale-free graph (the direction of a movement was known), with an in-degree power of 2 an out-degree power of 1.46, consisted of 29,999 nodes, and 130,265 movements during a 6-month period. The in clustering coefficient was calculated to be 0.52 for the inward direction (movement to), while it was 0.02 for the outward direction (movement from). In Denmark, the cattle movements between premises demonstrated a large degree of heterogeneity. This heterogeneity in movements between farms should be used to evaluate the risk potential of disease transmission for each premise and must be considered when modelling disease spread between premises. The objective of this research was to describe the network of animal movements and not just the animal movements per se.

Ixodes scapularis ticks collected by passive surveillance in Canada: analysis of geographic distribution and infection with Lyme borreliosis agent Borrelia burgdorferi

Passive surveillance for the occurrence of the tick Ixodes scapularis Say (1821) and their infection with the Lyme borreliosis spirochaetes Borrelia burgdorferi s.l. has taken place in Canada since early 1990. Ticks have been submitted from members of the public, veterinarians, and medical practitioners to provincial, federal, and university laboratories for identification, and the data have been collated and B. burgdorferi detected at the National Microbiology Laboratory. The locations of collection of 2,319 submitted I. scapularis were mapped, and we investigated potential risk factors for I. scapularis occurrence (in Quebec as a case study) by using regression analysis and spatial statistics. Ticks were submitted from all provinces east of Alberta, most from areas where resident I. scapularis populations are unknown. Most were adult ticks and were collected in spring and autumn. In southern Québec, risk factors for tick occurrence were lower latitude and remote-sensed indices for land cover with woodland. B. burgdorferi infection, identified by conventional and molecular methods, was detected in 12.5% of 1,816 ticks, including 10.1% of the 256 ticks that were collected from humans and tested. Our study suggests that B. burgdorferi-infected I. scapularis can be found over a wide geographic range in Canada, although most may be adventitious ticks carried from endemic areas in the United States and Canada by migrating birds. The risk of Lyme borreliosis in Canada may therefore be mostly low but more geographically widespread than previously suspected.

Ixodes scapularis ticks collected by passive surveillance in Canada: analysis of geographic distribution and infection with Lyme borreliosis agent Borrelia burgdorferi

Passive surveillance for the occurrence of the tick Ixodes scapularis Say (1821) and their infection with the Lyme borreliosis spirochaetes Borrelia burgdorferi s.l. has taken place in Canada since early 1990. Ticks have been submitted from members of the public, veterinarians, and medical practitioners to provincial, federal, and university laboratories for identification, and the data have been collated and B. burgdorferi detected at the National Microbiology Laboratory. The locations of collection of 2,319 submitted I. scapularis were mapped, and we investigated potential risk factors for I. scapularis occurrence (in Quebec as a case study) by using regression analysis and spatial statistics. Ticks were submitted from all provinces east of Alberta, most from areas where resident I. scapularis populations are unknown. Most were adult ticks and were collected in spring and autumn. In southern Québec, risk factors for tick occurrence were lower latitude and remote-sensed indices for land cover with woodland. B. burgdorferi infection, identified by conventional and molecular methods, was detected in 12.5% of 1,816 ticks, including 10.1% of the 256 ticks that were collected from humans and tested. Our study suggests that B. burgdorferi-infected I. scapularis can be found over a wide geographic range in Canada, although most may be adventitious ticks carried from endemic areas in the United States and Canada by migrating birds. The risk of Lyme borreliosis in Canada may therefore be mostly low but more geographically widespread than previously suspected.

Investigation of ground level and remote-sensed data for habitat classification and prediction of survival of Ixodes scapularis in habitats of southeastern Canada

In southeastern Canada, most populations of Ixodes scapularis Say, the Lyme disease vector, occur in Carolinian forests. Climate change projections suggest a northward range expansion of I. scapularis this century, but it is unclear whether more northerly habitats are suitable for I. scapularis survival. In this study, we assessed the suitability of woodlands of the Lower Great Lakes/St. Lawrence Plain region for I. scapularis by comparing tick egg survival in four different woodlands. Woodlands where I. scapularis are established, and sand dune where I. scapularis do not survive, served as positive and negative control sites, respectively. At two woodland sites, egg survival was the same as at the positive control site, but at two of the sites survival was significantly less than either the positive control site, or one of the other test sites. Egg survival in all woodland sites was significantly higher than in the sand dune site. Ground level habitat classification discriminated among woodlands in which tick survival differed. The likelihood that I. scapularis populations could persist in the different habitats, as deduced using a population model of I. scapularis, was significantly associated with variations in Landsat 7 ETM+ data (normalized difference vegetation index [NDVI] and Tasselled Cap indices). The NDVI index predicted habitat suitability at Long Point, Ontario, with high sensitivity but moderate specificity. Our study suggests that I. scapularis populations could establish in more northerly woodland types than those in which they currently exist. Suitable habitats may be detected by ground-level habitat classification, and remote-sensed data may assist this process.

Investigation of ground level and remote-sensed data for habitat classification and prediction of survival of Ixodes scapularis in habitats of southeastern Canada

In southeastern Canada, most populations of Ixodes scapularis Say, the Lyme disease vector, occur in Carolinian forests. Climate change projections suggest a northward range expansion of I. scapularis this century, but it is unclear whether more northerly habitats are suitable for I. scapularis survival. In this study, we assessed the suitability of woodlands of the Lower Great Lakes/St. Lawrence Plain region for I. scapularis by comparing tick egg survival in four different woodlands. Woodlands where I. scapularis are established, and sand dune where I. scapularis do not survive, served as positive and negative control sites, respectively. At two woodland sites, egg survival was the same as at the positive control site, but at two of the sites survival was significantly less than either the positive control site, or one of the other test sites. Egg survival in all woodland sites was significantly higher than in the sand dune site. Ground level habitat classification discriminated among woodlands in which tick survival differed. The likelihood that I. scapularis populations could persist in the different habitats, as deduced using a population model of I. scapularis, was significantly associated with variations in Landsat 7 ETM+ data (normalized difference vegetation index [NDVI] and Tasselled Cap indices). The NDVI index predicted habitat suitability at Long Point, Ontario, with high sensitivity but moderate specificity. Our study suggests that I. scapularis populations could establish in more northerly woodland types than those in which they currently exist. Suitable habitats may be detected by ground-level habitat classification, and remote-sensed data may assist this process.

Analysis of RUNX1 binding site and RAPTOR polymorphisms in psoriasis: no evidence for association despite adequate power and evidence for linkage

BACKGROUND

A previous study identified two peaks of allelic association between psoriasis and single nucleotide polymorphisms (SNPs) mapping to distal chromosome 17q, including a disease associated SNP that leads to loss of a RUNX1 transcription factor binding site, and additional SNPs in the third intron of the RAPTOR gene. Another study found an association with SNPs in the RAPTOR gene, but not with the RUNX1 binding site polymorphism.

METHODS

In an effort to confirm these observations, we genotyped 579 pedigrees containing 1285 affected individuals for three SNPs immediately flanking and including the RUNX1 binding site, and for three SNPs in the RAPTOR gene.

RESULTS

Here we report further evidence for linkage to distal chromosome 17q, with a linkage peak mapping 1.7 cM distal to the RUNX1 binding site (logarithm of the odds 2.26 to 2.73, depending upon statistic used). However, we found no evidence for association to individual SNPs or haplotypes in either of the previously identified peaks of association. Power analysis demonstrated 80% power to detect significant association at genotype relative risks of 1.2 (additive and multiplicative models) to 1.5 (dominant and recessive models) for the RUNX1 binding site, and 1.3 to 1.4 for the RAPTOR locus under all models except dominant.

CONCLUSIONS

Our data provide no support for the previously identified RUNX1 binding site or for the RAPTOR locus as genetic determinants of psoriasis, despite evidence for linkage of psoriasis to distal chromosome 17q.

Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial

BACKGROUND & AIMS

Ulcerative colitis is most common in Western industrialized countries. Inflammatory bowel disease is uncommon in developing countries where helminths are frequent. People with helminths have an altered immunological response to antigens. In animal models, helminths prevent or improve colitis by the induction of regulatory T cells and modulatory cytokines. This study determined the efficacy and safety of the helminth Trichuris suis in therapy of ulcerative colitis.

METHODS

This was a randomized, double blind, placebo-controlled trial conducted at the University of Iowa and select private practices. Trichuris suis ova were obtained from the US Department of Agriculture. The trial included 54 patients with active colitis, defined by an Ulcerative Colitis Disease Activity Index of > or =4. Patients were recruited from physician participants and were randomly assigned to receive placebo or ova treatment. Patients received 2500 Trichuris suis ova or placebo orally at 2-week intervals for 12 weeks.

RESULTS

The primary efficacy variable was improvement of the Disease Activity Index to > or =4. After 12 weeks of therapy, improvement according to the intent-to-treat principle occurred in 13 of 30 patients (43.3%) with ova treatment compared with 4 of 24 patients (16.7%) given placebo (P = .04). Improvement was also found with the Simple Index that was significant by week 6. The difference in the proportion of patients who achieved an Ulcerative Colitis Disease Activity Index of 0-1 was not significant. Treatment induced no side effects.

CONCLUSIONS

Ova therapy seems safe and effective in patients with active colitis.

Management of asymptomatically/minimally symptomatic post-ERCP serum liver test elevations: first do no harm

Trauma to the major papilla and transient supraphysiologic biliary tract pressure during ERCP may produce transient serum liver test elevation. Further investigation of these abnormal serum tests may be costly, potentially hazardous, and unnecessary. Transient rises in post ERCP serum liver tests may be a common epiphenomenon that requires only careful clinical observation. Our aim was to study serum liver test results collected before and after ERCP in asymptomatic (or minimally symptomatic) patients and determine the natural clinical history of these patients, without further intervention. Data were collected prospectively as part of a larger study, and this subset of data on asymptomatic patients was then analyzed separately. All patients had serum liver tests done before ERCP, and 4 and 18-24 h after ERCP. Thirty-seven patients were evaluated. Sixteen of the 36 (43%) had an abnormal serum liver test after ERCP. Fifteen of the 36 had a biliary or pancreatic papillotomy done. Whether or not a patient had a papillotomy performed did not appear to influence the incidence of abnormal transient serum liver test rise. There were no biliary stents placed in any of the patients evaluated. There were two cases of post-ERCP pancreatitis (one mild; one moderate). There were no cases of cholangitis or persistent biliary tract obstruction. In conclusion, a transient rise in ERCP serum liver tests appears common following ERCP. In the absence of significant clinical signs or symptoms, these isolated serum laboratory test abnormalities should managed expectantly.

Maternal immunization with pneumococcal polysaccharide vaccine in the third trimester of gestation

In a randomized, double blinded study, 23-valent pneumococcal polysaccharide vaccine (PSV) or conjugate Haemophilus influenzae type b (HbOC) vaccine was administered to 60 healthy women in the third trimester of gestation. Total IgG, IgG1, and IgG2 antibodies to pneumococcal serotypes 6B, 14, 19F and 23F were measured by ELISA in mothers prior to immunization, at delivery and 7 months after delivery, and in infants at birth (cord blood), 2 and 7 months after delivery. IgA was evaluated in breast milk at 2 and 7 months, and opsonophagocytic activity in cord blood. PSV was safe and immunogenic in pregnant women. Transplacental transmission of vaccine-specific antibodies was efficient. Maternal immunization with PSV resulted in significantly higher concentrations of pneumococcal antibodies in infants at birth and at 2 months of age, and greater functional opsonophagocytic activity of passively acquired IgG antibody.

The effects of ph, osmolarity and urine contamination on equine spermatozoal motility

Urospermia has been reported as a cause of infertility in numerous species. The detrimental effects of urine on spermatozoa are due, at least in part, to changes in pH and osmolarity. Semen was collected and subjected to conditions of varying pH (Experiment 1), of varying osmolarity (Experiment 2), and various quantities and concentrations of urine (Experiment 3) and effects on motility were recorded. Finally, semen was contaminated with urine and then either of 2 semen extenders was added, with or without centrifugation, in an attempt to alleviate the detrimental effect of urine on motility (Experiment 4). The results of these experiments showed that alterations in pH and osmolarity negatively affected stallion sperm motility. Optimal pH and osmolarity appeared to be approximately 7.7 and 315, respectively. Contamination of the ejaculate with urine significantly decreased sperm motility. Smaller quantities of dilute urine were less detrimental than larger quantities of dilute urine, and dilute urine was less detrimental than more concentrated urine. The addition of semen extender restored the motility of urine contaminated semen to that of the uncontaminated control, however centrifugation to remove urine provided no significant advantage.

Striving to do well what comes naturally: social support, developmental psychopathology, and social policy

Social support can have significant stress-preventive and stress-buffering benefits for troubled individuals in everyday circumstances. Consequently, it is not surprising that many therapeutic and preventive programs enlist social support to address problems of child and family psychopathology, especially in the context of "two-generation interventions" that seek to improve child well-being by strengthening parental functioning and parent-child relationships. Home visitation programs are the best known of these two-generation strategies and have become the focus of state-level and national efforts to support families and prevent harm to children. The conclusions of basic research studies on social support converge significantly with the findings of evaluation studies of the impact of home visitation programs to yield important new insights into the conditions in which formal social support is likely to be beneficial. or ineffective, in improving child and family well-being. Both basic and applied research literatures emphasize the importance of linking formal social support to informal social networks in extended families, neighborhoods, and communities, and attending to the complex reactions of the recipients of support and the needs of support providers. These studies are reviewed and evaluated to highlight the connections between social support, developmental psychopathology. and social policy.

Geographic information systems as a tool for control program management for schistosomiasis in Egypt

During a 4-year study a geographic information system (GIS) risk model was constructed for predicting the relative risk of schistosomiasis in Kafr El-Sheikh governorate, Egypt. A 1-year 1990-1991 time series on diurnal temperature difference (dT) prepared from the advanced very high resolution radiometer (AVHRR) sensor on the NOAA-11 satellite was used to develop a regional risk model for the Nile delta based on thermal-hydrological domains. A May 15, 1990 Landsat TM scene (path 177, Row 38) was used to develop a local 'village-scale' environmental risk model based on higher resolution satellite sensor data (30 m picture element size at earth surface). Four of ten classes derived from a tasseled cap (Tcap) transformation of the Landsat TM scene were shown to be significantly related to a 5-year Schistosoma mansoni prevalence database from the Ministry of Health. A risk model was developed based on dT and the proportional area of the four Tcap classes in 5 km(2) buffer zones centered on rural health unit (RHU) reporting units. Available historical data on S. mansoni and its snail host Biomphalaria alexandrina, as well as recent field collected data were gathered and incorporated as separate themes. Model validation was done using data collected on snail population bionomics-infection rates, water quality, underground water table and cercariometry at 13 hydrologically representative sites. The role of soil type, water table and water quality was studied at 79 of 154 rural health unit sites. The model permitted retrieval of relevant data by RHU point location. For the first time in Egypt, the Kafr El-Sheikh GIS schistosoma prediction model can support MOH efforts to make more accurate control program decisions based on environmental predilection sites of endemic Schistosomiasis mansoni.

Developmental science and the media. Early brain development

Media coverage of early brain development not only has focused public attention on early childhood but also has contributed to misunderstanding of developmental neuroscience research. This article critically summarizes current research in developmental neuroscience that is pertinent to the central claims of media accounts of early brain development, including (a) scientific understanding of formative early experiences, (b) whether critical periods are typical for brain development, (c) brain development as a lifelong process, (d) biological hazards to early brain growth, and (e) strengths and limits of current technology in developmental brain research. Recommendations are offered for strengthening the constructive contributions of research scientists and their professional organizations to the accurate and timely coverage of scientific issues in the media.

Development in the first years of life

Any discussion on how we care for infants and toddlers must begin with the interests and needs of the children themselves. Therefore, this issue opens with an overview of the dramatic development that takes place during the first three years of life, which turns the dependent human newborn into a sophisticated three-year-old who walks, talks, solves problems, and manages relationships with adults and other children. This article explains the new understanding of brain development that has captured public attention in recent years, and links it to developments in infant behavior that are equally impressive and influential: the growth of the body (size and coordination), the growth of the mind (language and problem-solving abilities), and the growth of the person (emotional and social mastery). It emphasizes how much early experiences and relationships matter. The article highlights themes that resonate across these aspects of development: A drive to development is inborn, propelling the human infant toward learning and mastery. The opportunities for growth that enrich the early years also bring with them vulnerability to harm. The experiences that greet children in their human and physical surroundings can either enhance or inhibit the unfolding of their inborn potential. People (especially parents and other caregivers) are the essence of the infant's environment, and their protection, nurturing, and stimulation shape early development. The author envisions a society that stands beside the families and caregivers who nurture young children, equipping them with knowledge and resources, and surrounding them with supportive workplaces, welfare policies, and child care systems.

Mother-child discourse, attachment security, shared positive affect, and early conscience development

The separate literatures on parental discipline, maternal discourse about emotion, and autobiographical memory support the idea that parent-child discourse in the context of a supportive relationship plays a role in a child's early conscience development, and this study was designed to examine this issue. Forty-two preschool children and their mothers took part in a 45-min structured laboratory session, and at their homes, mothers completed the Attachment Q-Set. As part of the laboratory session, each mother was asked to discuss with her child one incident that occurred within the last week in which her child behaved well and one in which her child misbehaved. These conversations were transcribed verbatim and coded for maternal references to feelings, rules, consequences of the child's actions, and moral evaluatives. Each child also took part in a behavioral measure of internalization and several compliance tasks, and mothers completed a maternal report of the child's early conscience development. Consistent with attachment theory, attachment security predicted maternal and child references to feelings and moral evaluatives. Attachment security, shared positive affect between the mother and child, and maternal references to feelings and moral evaluatives also predicted specific aspects of early conscience development.

Hepatic dysfunction in a population of antibody-deficient patients: prevalence, aetiology and outcome of PCR screening for hepatitis C and G viruses

BACKGROUND AND OBJECTIVES

A group of 40 antibody-deficient patients receiving regular infusions of intravenous immunoglobulin underwent close monitoring in an attempt to identify hepatic dysfunction. The continuing risk of hepatitis virus transmission, especially hepatitis C virus via immunoglobulin products prompted this policy. We report our findings.

METHODS

Screening included measurement of transaminase levels at each infusion. The patients were also tested for evidence of infection with hepatitis viruses B, C and G.

RESULTS

Abnormal liver function tests were identified in 6 cases. However, a blood-borne viral aetiology was not found in any of these cases. Additional investigation allowed an alternative aetiology to be identified in most cases. One patient found to be positive for hepatitis G virus (HGV)-RNA by reverse transcriptase-polymerase chain reaction has no evidence to date of clinical problems as a result.

INTERPRETATION

The results are reassuring in that definite iatrogenic hepatitis virus transmission has not been found in this cohort, despite long-term treatment with a wide range of immunoglobulin products. The source of infection of the single patient infected with HGV remains as uncertain as the pathogenic potential of this virus. However, as long as the risk of immunoglobulin-associated viral transmission continues, a strict monitoring programme such as ours should continue to facilitate prompt detection of cases with abnormal liver function. Liver dysfunction in this group requires full investigation and we cannot exclude infection with hitherto unidentified blood-borne viruses.

The legacy of early attachments

The impact of early close relationships on psychological development is one of the enduring questions of developmental psychology that is addressed by attachment theory and research. This essay evaluates what has been learned, and offers ideas for future research, by examining the origins of continuity and change in the security of attachment early in life, and its prediction of later behavior. The discussion evaluates research on the impact of changing family circumstances and quality of care on changes in attachment security, and offers new hypotheses for future study. Considering the representations (or internal working models) associated with attachment security as developing representations, the discussion proposes that (1) attachment security may be developmentally most influential when the working models with which it is associated have sufficiently matured to influence other emerging features of psychosocial functioning; (2) changes in attachment security are more likely during periods of representational advance; and (3) parent-child discourse and other relational influences shape these developing representations after infancy. Finally, other features of early parent-child relationships that develop concurrently with attachment security, including negotiating conflict and establishing cooperation, also must be considered in understanding the legacy of early attachments.

Loss of bactericidal capacity of long-chain quaternary ammonium compounds with protein at lowered temperature

Amphiphilic betaine esters are quaternary ammonium compounds (QACs) with rapid microbicidal effect, which spontaneously hydrolyze into nontoxic products. thus being referred to as soft antimicrobial agents. The bactericidal effect of 1-decyl (B10), 1-dodecyl (B12), and 1-tetradecyl (B14) betaine esters on Salmonella typhimurium was strongly influenced by temperature, pH and length of hydrocarbon chain. At pH 6.0, presence of 1.5 mM (10% w/v) BSA raised the concentration of B14 for 99% killing (BC2) from 0.006 mM to 1.8 mM. There was a stoichiometric relationship between concentration of BSA and BC2 of B14, indicating that one molecule of B14 was bound per BSA molecule when 99% killing was achieved. When the temperature was lowered to 0 degrees C only minor killing was seen in 1.5 mM BSA at the highest concentration of B14 tested, 57 mM. With B10 at 30 degrees C and pH 6.0, the presence of 1.5 mM BSA raised the bactericidal concentration (BC2) from 0.69 mM to 4.1 mM, and at 0 degrees C and 1.5 mM BSA the BC2 was 11 mM. Thus, the impairment caused of the bactericidal effect of B10 by BSA and lower temperature was less than for B14, since B14 is much more active than B10 at 30 degrees C in the absence of BSA, somewhat more active than B10 at 30 degrees C in the presence of 1.5 mM BSA, and much less active than B10 at 0 degrees C in the presence of BSA. B12 showed properties intermediate between B10 and B14. Lowered pH reduced the bactericidal effect particularly when reduced from pH 5.0 to 4.0 with B10. In the presence of 1.5 mM BSA, the bactericidal effect of 1-dodecyl (DTAB) and 1-hexadecyl (CTAB) trimethylammonium bromide decreased in the same manner as for B10 and B14, respectively. Increasing the time of incubation at 0 degrees C to 50 min, a 99% killing effect was seen with 17 mM CTAB, whereas the same killing effect was reached in 8 min with 17 mM DTAB. Binding of [3H]CTAB to S. typhimurium was also reduced at 0 degrees C in the presence of BSA. Thus, in the presence of 1.5 mM BSA, QACs with the longer hydrocarbon chain were most efficient at 30 degrees C, whereas at 0 degrees C those with the shorter hydrocarbon chain were most active. Consequently, QACs with shorter tails should be used for disinfection in the presence of proteins at lower temperatures.

Familial relapsing haemolytic uraemic syndrome and complement factor H deficiency

BACKGROUND

In a recent study of three families we have found that inherited haemolytic uraemic syndrome (HUS) maps to a region of chromosome 1q containing the gene for complement factor H. In one of these families and also in a case of sporadic D-HUS, we have identified mutations in the factor H gene. A further family with inherited HUS has therefore been investigated.

METHODS

DNA extracted from the family members and DNA extracted from archival post-mortem material from a deceased family member, was studied. Review of renal biopsies and study of complement components was also undertaken.

RESULTS

This family demonstrates an inherited deficiency of complement factor H. Non-diarrhoeal HUS has affected at least two family members with half normal levels of factor H.

CONCLUSION

These findings represent further evidence of the association between factor H dysfunction and HUS.

The effect of hydrocarbon chain length, pH, and temperature on the binding and bactericidal effect of amphiphilic betaine esters on Salmonella typhimurium

Amphiphilic betaine esters are quaternary ammonium compounds (QAC) with rapid microbicidal action. They are often labeled 'soft antimicrobial agents', since the compounds hydrolyze spontaneously into betaine and fatty alcohols, thus not only losing their surface active properties and toxicity but also becoming amenable to metabolic use. The present results show that the bactericidal effects of 1-decyl (B10), 1-dodecyl (B12), and 1-tetradecyl (B14) betaine esters on Salmonella typhimurium 395 MS decreased with decreasing hydrocarbon chain lengths, decreased at pH below neutral, and were lower at 0 degrees C that at 30 degrees C. At least part of the decreased effect at pH 4.0 as compared to pH 6.0 can be explained by reduced binding. However, reduced binding cannot explain the decrease in the microbicidal effect at 0 degrees C since the binding of B 14 was the same at 0 degrees C and 30 degrees C although 10-30 times higher concentrations were required at 0 degrees C to achieve the same microbicidal effect as at 30 degrees C. Neither can differences in binding explain the great differences seen in microbicidal effect between QAC with different chain lengths. It is proposed that the membrane deformation resulting in killing of S. typhimurium is more efficiently achieved with QAC with longer hydrocarbon chains and that reduced fluidity of the outer membrane of the bacteria at lower temperatures antagonizes the bactericidal effect. Charge interaction seems to be more important for the binding and bactericidal effect for the QAC with shorter hydrocarbon chains. The different effects of pH, temperature, and hydrocarbon chain length on binding, bactericidal effect, and hydrolysis have to be taken into account when optimizing disinfection and the subsequent elimination of disinfectants.

Attachment and emotional understanding in preschool children

This study was designed to elucidate the association between attachment and emotional understanding in preschool children. Forty children between the ages of 2.5 and 6 years and their mothers participated in the study. Mothers completed the Attachment Q-set, and children took part at their preschools in both an affective perspective-taking task and a series of interviews concerning naturally occurring incidents of emotions. Overall, age and attachment security predicted a child's aggregate score on the emotional understanding tasks. However, when the score was separated by the valence of the emotion, attachment security and age predicted a child's score for only those emotions with a negative valence (e.g., sadness) and not for those emotions with a positive valence (e.g., happiness). Thus, a secure attachment relationship seems to be important in fostering a child's understanding of emotion, primarily negative emotions.

Predicting abuse-prone parental attitudes and discipline practices in a nationally representative sample

OBJECTIVE

According to sociological and ecological models of abuse, typically nonabusive parents could behave abusively towards their children under certain circumstances. The purpose of this study was to examine factors that place parents at risk of abusing their children by predicting parents' use of discipline practices and attitudes that may bias parents towards abusive behaviors, which we refer to as abuse-proneness.

METHOD

A telephone interview was administered by the Gallup Organization to a nationally representative sample of 1,000 parents. Using a set of theoretically relevant risk factors, multiple regression was used to predict variations in parental attitudes (i.e., attitudes towards physical discipline and attitudes that devalue children) and parental discipline practices (i.e., physical discipline, nonphysical discipline, and verbal abuse).

RESULTS

The findings confirmed the importance of examining elements of parental attitudes, history, personality characteristics, as well as religion and ideology in predicting abuse proneness. Child age also was an important predictor in all analyses except predicting parental attitudes that devalue children. The findings suggest also, however, that it may be unduly simplified to regard parents as somewhere on a continuum of nonpunitive to punitive disciplinarians. Social isolation was not a significant predictor in any of the analyses.

CONCLUSIONS

Although many important theoretical predictors of abuse proneness were confirmed, many questions arise regarding the diversity of discipline practices that parents use, and the relevance of child's age and social isolation in predicting abuse proneness. Implications for practitioners and future research are discussed.

A multifaceted educational approach to increasing awareness and use of physician data query (PDQ)

BACKGROUND

PDQ is a database developed by the National Cancer Institute that provides state-of-the-art information about cancer. A study was conducted to raise healthcare professionals' and patients'/families' awareness and use of PDQ's patient information file (PIF).

METHODS

Educational presentations and poster displays were presented for health care staff to inform them of PDQ/PIF's attributes and how to access it. To expand awareness among patients and families, poster displays were presented in high-traffic areas; PDQ/PIF statements were redesigned and displayed in patient information racks.

RESULTS

Among health care professionals, a 54% increase was observed in awareness of the PIF. A ninefold increase in the number of PDQ/PIF statements distributed to patients/families was reported.

CONCLUSIONS

To maintain a level of awareness among health care professionals, a consistent educational strategy should be implemented. The number of PDQ/PIF statements distributed to patients and families increased, especially those redesigned for visual appeal.

Attachment and emotional understanding in preschool children

This study was designed to elucidate the association between attachment and emotional understanding in preschool children. Forty children between the ages of 2.5 and 6 years and their mothers participated in the study. Mothers completed the Attachment Q-set, and children took part at their preschools in both an affective perspective-taking task and a series of interviews concerning naturally occurring incidents of emotions. Overall, age and attachment security predicted a child's aggregate score on the emotional understanding tasks. However, when the score was separated by the valence of the emotion, attachment security and age predicted a child's score for only those emotions with a negative valence (e.g., sadness) and not for those emotions with a positive valence (e.g., happiness). Thus, a secure attachment relationship seems to be important in fostering a child's understanding of emotion, primarily negative emotions.

Heart lung transplantation in a patient with end stage lung disease due to common variable immunodeficiency

The case history is presented of a patient with common variable immunodeficiency in whom heart lung transplantation has been carried out with success. Transplantation was the only long term therapeutic option in this patient due to the progressive respiratory failure resulting from bronchiectasis, emphysema, and granulomatous lung disease.

Separation of cis-/trans-diastereomers and enantiomers of aminoindanol and aminoindan using capillary electrophoresis

Aminoindanol poses an interesting separation problem because it contains two chiral centers and exists as four stereoisomers. The capillary electrophoretic separation of the cis- and the larger trans-diastereomers of aminoindanol is simply achieved by pH control of the tris buffer background electrolyte. In accordance with theory, maximum separation occurs at the pH equal to the mean value of the pKA values of the isomers. The separation of the enantiomers of both the cis- and trans-diastereomers is effected using the chiral selector alpha-cyclodextrin (alpha-CD). The cis-enantiomeric pair is better separated than the trans-pair, as reflected by the larger difference in the binding constants, K, for the cis-enantiomers with the alpha-CD, K values were measured from the change in electrophoretic mobility with selector concentration, over the temperature range 15 degrees C-35 degrees C. The associated delta H degrees and delta S degrees values were determined for the transfer of each enantiomer from the aqueous buffer phase to the alpha-CD phase. The corresponding K values and associated thermodynamic quantities were also measured for the aminoindan enantiomers, which lack the hydroxyl group of aminoindanol. The effect of chiral selector size was evaluated for the aminoindanols by measuring K and the associated values using beta-CD, which has a larger cavity than the alpha-CD. The better fit of the larger trans-isomers leads to larger K values for the trans-isomers but reduced Ks for the cis-. The gamma-CD cavity is too large to produce chiral discrimination. The low solubility of the beta-CD requires the addition of high concentrations of urea to the tris buffer. Urea has little effect on the K values of the trans-aminoindanols with alpha-CD, but leads to larger values for the cis-isomers.

Low IgG subclass levels in brittle asthma and in patients with exacerbations of asthma associated with respiratory infection

Serum total immunoglobulin (G, A, M and E) and IgG subclass levels were studied in 23 patients with brittle asthma, 23 age- and sex-matched patients with mild asthma and 33 patients with recurrent infective exacerbations of their asthma. Patients with brittle asthma showed significantly reduced levels of IgG (mean +/- SD, 8.8 +/- 3.3 g l-1) compared to patients with mild asthma (11.0 +/- 2.5 g l-1) (P < 0.008) with further significant reductions in the brittle compared to the mild group in IgG1 (5.2 vs 6.3, P = 0.035), IgG2 (2.4 vs 3.25, P < 0.006), IgG3 (0.39 vs 0.55, P < 0.05) and IgA (1.91 vs 2.38, P < 0.03). There were no significant differences between the brittle group and the group with recurrent infective exacerbations for any parameter, but the latter group showed significantly reduced levels of IgG (8.2, P < 0.001), IgG1 (4.9, P < 0.00001) and IgG2 (2.5, P < 0.02) compared to the mild group. In all groups, there was no relationship between dose of inhaled steroids and levels of any antibody. These findings suggest that the presence of a mild degree of humoral immunodeficiency relates to severity of asthma, and suggests that immunoglobulin replacement therapy may be appropriate in patients with the more severe forms of asthma.

Submicellar complexes may initiate the fungicidal effects of cationic amphiphilic compounds on Candida albicans

The killing of Candida albicans by a series of amphiphilic quaternary ammonium compounds (QACs) with different hydrocarbon chain lengths was closely related to the binding of the compounds to the cells and damage of the cell membranes. The membrane damage was measured as the level of release of the UV-absorbing material into the medium in which the cells were suspended and as the level of uptake of propidium iodide in individual cells by flow cytometry. It was shown that of the compounds tested, hexadecyltrimethylammonium bromide (cetyltrimethylammonium bromide [CTAB]) bound most efficiently. Tetradecyl betainate chloride (B14), tetradecanoylcholine bromide (C14), tetradecyltrimethylammonium bromide (TTAB), and dodecyltrimethylammonium bromide (DTAB) followed and had declining degrees of binding efficiency. The proportion of CTAB bound was almost total at concentrations up to the critical micelle concentration (CMC) of the compound, whereas that of B14 was somewhat smaller. For the two remaining tetradecyl compounds (C14 and TTAB), still smaller proportions were bound at low concentrations, but the proportions rose disproportionally at increasing concentrations to a distinct maximum at concentrations of 0.2 to 0.5 times the CMC. We propose that interfacial micelle-like aggregates are formed at the cell surface as a step in the binding process. An analogous, but less conspicuous, maximum was seen for DTAB. Thus, great differences in the binding affinity of QACs with different hydrocarbon chains at different concentrations to C. albicans were observed. These differences were related to the CMC of the compound. In contrast, the binding of TTAB to Salmonella typhimurium 395 MS was almost total at low as well as high concentrations until saturation was attained, indicating fundamental differences between binding to the yeast and binding to gram-negative bacteria. The importance of lipid-type complexes or aggregates to the antifungal effect of membrane-active substances are discussed.

Adult perception of emotion intensity in human infant cries: effects of infant age and cry acoustics

The relation between adult perception of emotion intensity in the cries of 1- and 6-month-old infants and the acoustic characteristics of the cries was examined. In the first study, adults who were inexperienced in child care rated 40 cries on 3 emotion intensity scales: anger, fear, and distress. The cries of 6-month-olds were rated as being significantly more intense. Different acoustic variables accounted for emotion intensity ratings for the 2 infant ages. Peak amplitude and noisiness of the cry predicted adult judgments of intensity ratings of 1-month-olds' cries; a measure of amplitude ratio (in 2 frequency bands) was the best predictor of intensity ratings of 6-month-olds' cries. In the second study, parents of infants rated the same cries on the same scales. They also rated the older infants' cries as being more intense. The 2 adult groups did not differ on their ratings, and a regression equation derived from one adult group predicted the other adult group's rating of the same infant age better than it predicted its own ratings for the other infant age. Infant age, and its associated acoustic features, seems to be a more important determinant of adults' perception of emotion intensity than are such adult characteristics as gender or infant-care experience.

CD40lbase: a database of CD40L gene mutations causing X-linked hyper-IgM syndrome

X-linked hyper-IgM syndrome (X-HIM) is an immunodeficiency caused by mutations in the gene encoding the CD40 ligand (CD40L). A database (CD40Lbase) of CD40L mutations has now been established, and the resultant information, together with other mutations reported elsewhere in the literature, is presented here.

Myasthenia gravis and elderly people

Myasthenia gravis is probably commoner than previously suspected, the annual incidence being nearer 9-10/million than earlier figures of 2-4/million. The current study found an annual incidence in Croyden of 9.1 per million (95% confidence limits 5.7-13.8 per million). Of the 22 patients (59%) seen in Croyden with newly diagnosed myasthenia gravis during the past 7 years, 13 were aged over 60. In a separate study of the age distribution of positive acetylcholine receptor antibody assays, 51% were 60 years or above in 1991, and 64% in 1994. The peak age in both sexes was 70-80, and numbers were greatest in men aged 60-80.

Child maltreatment research. Federal support and policy issues

The recent history of federal support for child maltreatment research paints a mixed picture of inadequate funding and uncertain administrative guidance against a backdrop of growing public concern about the prevalence of child abuse and neglect. This article describes some of the problems that have been identified in federal research funding, administration, and support of research initiatives and training concerning child abuse and neglect. Remedies for these difficulties are outlined, priorities for new research in this area are identified, and ways in which to rejuvenate the federal government's role in this area, in league with a concerted commitment to policy-relevant research by behavioral scientists, are suggested.

Enzymatic hydrolysis of long-chain alkanoylcholines in rat intestinal loops

BACKGROUND

The hydrolysis of long-chain alkanoylcholines, presumably catalyzed by butyryl-cholinesterase (EC 3.1.1.8), in rat intestinal loops was studied. The substances have earlier been found to be rapidly degraded in vitro.

METHODS

Radiolabeled substrates were used, and a radiochromatographic detection method was applied.

RESULTS AND CONCLUSION

The long-chain alkanoylcholines were rapidly hydrolyzed. The rates of the reaction and the chain-length dependence were similar to those reported earlier in vitro. At high substrate concentrations the hydrolysis reaction was inhibited. This could be due to conformational changes of the enzyme, caused by the adsorption of the cationic amphiphile, or to a decrease in the free substrate concentration after incorporation of the amphiphilic ester into the lipid layer of the cell membranes. The enzymatic activity towards the substrates in different parts of the rat intestinal tract was also studied and found to be highest in the duodenum.

Long-chain alkanoylcholines, a new category of soft antimicrobial agents that are enzymatically degradable

A new category of amphiphilic hydrolyzable quaternary ammonium compounds with rapid and high levels of antimicrobial activity was studied. The compounds, alkanoylcholines with hydrocarbon chains of 10 to 14 carbon atoms, are hydrolyzed by butyrylcholine esterase, which is present in human serum and mucosal membranes. The hydrolysis products are common components of human metabolism. Alkanoylcholines were tested and found to be active against gram-negative and gram-positive bacteria as well as yeasts. The microbicidal activities of the alkanoylcholines were comparable to the activities of the stable quaternary ammonium compounds of corresponding chain length and increased with an increasing number of carbon atoms. The compounds were also found to be hydrolyzed by enzymes present in certain microorganisms. The degradation was achieved after reaching the microbicidal effect.

Emotion regulation: a theme in search of definition

Contemporary interest in emotion regulation promises to advance important new views of emotional development as well as offering applications to developmental psychopathology, but these potential contributions are contingent on developmentalists' attention to some basic definitional issues. This essay offers a perspective on these issues by considering how emotion regulation should be defined, the various components of the management of emotion, how emotion regulation strategies fit into the dynamics of social interaction, and how individual differences in emotion regulation should be conceptualized and measured. In the end, it seems clear that emotion regulation is a conceptual rubric for a remarkable range of developmental processes, each of which may have its own catalysts and control processes. Likewise, individual differences in emotion regulation skills likely have multifaceted origins and are also related in complex ways to the person's emotional goals and the immediate demands of the situation. Assessment approaches that focus on the dynamics of emotion are well suited to elucidating these complex developmental and individual differences. In sum, a challenging research agenda awaits those who enter this promising field of study.

The role of the father after divorce

Fathers figure prominently in a child's postdivorce life whether they are involved or disinterested, but concerns about inadequate child support, noncustodial fathers who fail to visit, and the economic plight of single mothers have together raised policy questions about how better to enfranchise fathers with the rights and responsibilities of parenting and ensure them a continuing and meaningful role in the lives of their offspring. This article focuses on obstacles and avenues to ensuring a meaningful postdivorce parenting role for fathers by examining the effects on them of custody standards, visitation policies, child support guidelines and their enforcement, and the other economic arrangements surrounding contemporary divorce. In the end, public policies that foster the child's unconflicted relationships with each parent in the context of reliable and adequate economic support will require new ways of structuring relations between ex-spouses in the interests of offspring (for example, new approaches to custody and visitation), nonadversarial modes of assisted dispute resolution to accommodate postdivorce changes in family life, child support policies which guarantee that a child's economic needs will be met when parents are unable to provide adequately (and that assist parents who are unable to provide), and that recognize and ensure both the relational and the economic contributions of each parent to a child's well-being.

Sinus computerized tomography in primary hypogammaglobulinaemia

Thirteen patients suffering from primary hypogammaglobulinaemia receiving intravenous immunoglobulin replacement therapy underwent computerized tomography of the paranasal sinuses. The CT scans were evaluated and related to clinical data from the patients, who were selected for study on the basis of having symptoms of rhinosinusitis. The scans varied from normal to demonstrating widespread sinus abnormality. There was no relationship between the scan findings and duration of ENT symptoms, range of current symptoms, or the interval between the onset of ENT symptoms and the start of intravenous immunoglobulin replacement therapy. It is nevertheless possible that prompt institution of replacement therapy, after correct diagnosis early in the course of the disease, may prevent the development of sinus disease refractory to such treatment.

Quantitation of vitronectin in serum: evaluation of its usefulness in routine clinical practice

AIMS

To make a preliminary assessment of the clinical relevance of serum vitronectin concentrations in various disease groups, using a recently available commercial radial immunodiffusion kit.

METHODS

Serum vitronectin concentrations were measured in 80 control subjects and 144 patients with various diseases. The following characteristics were used to evaluate the test procedures: linearity of method, inter- and intrabatch precision, effect of storage, temperature and in vitro activation of the classical and alternative complement pathways on vitronectin concentrations.

RESULTS

Significantly reduced serum vitronectin concentrations were found in patients with liver disease, renal disease, and systemic lupus erythematosus (SLE) (normal C3 and C4 concentrations, when compared with normal subjects. This particular method was suitable for measuring vitronectin concentrations in serum samples provided they were stored at -20 degrees C.

CONCLUSIONS

The clinical value of measuring serum vitronectin seems to be limited, but a larger study may be justified to ascertain the clinical importance of reduced serum vitronectin concentrations in liver diseases, and the possible role of vitronectin in other disease processes.