Powerful solvent systems useful for synthesis of sparingly-soluble peptides in solution.

Our maximum protection strategy for the synthesis of human parathyroid hormone(1-84) indicates that fully protected peptide segments in the form of Boc-peptide phenacyl (Pac) ester are relatively soluble in ordinary organic solvents such as DMF, NMP or DMSO, which are suitable for coupling segments. However, about 1% of such segments synthesized were found to be insoluble even in the most polar solvent, DMSO. Thus, a more powerful solvent which can be used for their peptide synthesis was pursued. Among the solvent systems tested, a mixture of trifluoroethanol (TFE) or hexafluoroisopropanol (HFIP) and trichloromethane (TCM) or dichloromethane (DCM) was found to be most powerful for dissolving such sparingly-soluble protected peptides. These solvent systems were confirmed to be useful for the removal reaction of the carboxy-terminal Pac esters from the sparingly-soluble segments. They were then tested for the coupling reactions of fully protected Boc-peptides with other sparingly-soluble peptide esters. The TFE/TCM or TFE/DCM system was extremely useful for coupling segments without danger of racemization and of trifluoroester formation, if WSCI was used as the coupling reagent in the presence of 3,4-dihydro-3-hydroxy-4-oxo-1,2,3-benzotriazine (HOOBt).


Characterization of desialylated low-density lipoproteins which cause intracellular lipid accumulation.

The properties of sialylated (sialic acid rich) and desialylated (sialic acid poor) fractions of low-density lipoproteins (LDL) isolated from blood plasma of healthy subjects and coronary atherosclerosis patients have been investigated. Sialylated (60-90% of total LDL) and desialylated (10-40%) LDL were separated by affinity chromatography on Ricinus communis agglutinin-agarose. Sialic acid contents in sialylated LDL fractions of healthy subjects and patients were found to be the same, and 1.5 to 3-fold higher than in desialylated LDL. Desialylated LDL had smaller sizes and greater electrophoretic mobility than sialylated, ones. Desialylated, but not sialylated, LDL induced 1.5 to 4-fold accumulation of neutral lipids in human aortic smooth-muscle cells. Desialylated LDL contained lower amounts of cholesteryl esters, free cholesterol and triglycerides as compared to sialylated LDL. On the other hand, the concentrations of di-, monoglycerides and free fatty acids in desialylated LDL were 2 to 3-fold higher than in sialylated lipoproteins. The desialylated LDL fraction was characterized by lower levels of phosphatidylcholine, sphingomyelin and phosphatidylethanolamine, but a higher content of lysophosphatidylcholine. Levels of thiobarbituric acid-reactive substances in freshly isolated desialylated and sialylated LDL were the same. Desialylated LDL had a higher level of oxysterols and lower amounts of vitamins A and E. The content of free amino groups of lysine in desialylated LDL of patients was 2-fold lower than in sialylated LDL. The results of this study demonstrate that multiple physico-chemical parameters of desialylated LDL differ from those of sialylated LDL.


Effect of coenzyme A on triglyceride and very-low-density lipoproteins secretion in cultured rat hepatocytes.

Exogenous coenzyme A (CoA) decreases plasma triglycerides, cholesterol, and Apo B in man. CoA regulates lipid metabolism favouring beta-oxidation in hepatic peroxisomes of very-long-chain fatty acids. Furthermore recent studies show that CoA participates in the transport processes which occur in the Golgi apparatus. The aim of this study was to establish whether exogenous CoA is able to modify the lipid composition of very-low-density lipoproteins (VLDL) and the VLDL secretion in rat hepatocyte culture. The presence of 5mM CoA produces a significant decrease of VLDL triacylglycerol, of VLDL total cholesterol and of VLDL esterified cholesterol by 32%, 39% and 41% respectively. This decrease is observed in all the three days of hepatocyte culture. On the third day a significant decrease of cytosolic triacylglycerols is also observed. The decrease in VLDL secretion depends on the concentration of CoA added to the culture medium. Our study shows that exogenous CoA decreases the plasma VLDL concentration because it reduces VLDL secretion by the hepatocytes.


Coenzyme A protects very-low-density lipoproteins against peroxidation and increases plasma triacylglycerol metabolism.

CoA (coenzyme A) has an antiperoxidative action and protects erythrocytes against oxygen free radicals. The peroxidation favours the uptake of the modified LDL (low-density lipoprotein) by macrophages and has a role in the development of foam cells. A possible relation between the antiperoxidative action of CoA and its normalizing activity on plasma lipids in type IIb and type IV hyperlipoproteinaemias, was investigated in order to see whether CoA protects VLDL (very -low-density lipoproteins) against peroxidation and produces a quicker removal of VLDL from circulation when administered intravenously to rats. The addition of 5 mM CoA to rat hepatocytes in culture was found to produce a significant decrease in VLDL secretion. The plasma clearance was significantly more rapid and the removal of triacylglycerols was significantly enhanced in CoA-treated rats as compared to untreated ones. Furthermore CoA reduced the formation of material reacting with thiobarbituric acid (TBA) in human VLDL peroxidized by exposure to Cu2+. Our study shows that CoA protects VLDL from peroxidation in a significant and concentration-dependent manner and increases plasma triacylglycerol metabolism.


Comparative study of methods to couple hindered peptides.

A comparative study of modern coupling reactions involving Boc-protected amino acid derivatives and dipeptides with N-terminal alpha,alpha-dialkylation and N-methylation was carried out. The coupling reactions were run using either equimolar amounts of the amino and activated carboxyl components or an excess of the activated carboxyl component. Yields of the target tripeptide Boc-Phe-Xaa-Phe-OBzl (Xaa = (NMe)Ala, (NMe)Aib, or (NMe) alpha Ac5c) were compared. Less than 10% of the product was obtained from methods utilizing pivaloyl mixed anhydride, pentafluorophenyl ester or acyl fluoride activation when Xaa = (NMe)Aib and (NMe) alpha Ac5c. At room temperature, significant yields of these two products were obtained from reactions which utilized an excess of the HBTU reagent (O-benzotriazol-1-yl-N,N,N',N'-tetramethyluronium hexafluorophosphate), the PyBroP reagent (bromo-tris-pyrrolidino-phosphonium hexafluorophosphate) or Boc-Phe-NCA (Boc-protected phenylalanine N-carboxyanhydride). Moreover, the Boc-Phe-NCA method was superior when used over a prolonged reaction time or at elevated temperature.


Phase transfer catalysis in solid phase peptide synthesis. Preparation of cyclo[Xxx-Pro-Gly-Yyy-Pro-Gly] model peptides and their conformational analysis.

Relatively small cyclic peptides that contain functionalized side chains provide interesting model compounds for studying side chain-side chain interactions, peptide backbone flexibility (especially if X-Pro bonds are included), and as potential enzyme mimetics. In order to develop more efficient synthetic routes to compounds such as cyclo(Xxx-Pro-Gly-Yyy-Pro-Gly), using the Merrifield method, we have investigated several orthogonal solid phase synthesis strategies and contrasted the use of two solid phase peptide-resin cleavage techniques for preparing partially protected linear sequences. Phase transfer catalysis using tetrabutyl ammonium hydrogen sulfate in THF with saturated aqueous K2CO3 provides peptide acid salts in which most of the common protecting groups (Arg(NO2), Tyr(Bzl), Z-Lys, Lys(Boc), and Glu(tBu)) are not affected. Using 500 MHz proton NMR, peptides having a cyclo (L-L-Gly-L-L-Gly) sequence generally display two conformers in DMSO-d6 with the major isomer being the bis-cis conformer, while the minor form contains two beta turns. For peptides with a cyclo(D-L-Gly-L-L-Gly) sequence, the major conformer contains one cis and one trans X-Pro bond and one Type II beta turn, as previously predicted for related structure by Kopple and others.


Effect of ethylcholine mustard aziridinium (AF64A) and of the monoamine oxidase-B-inhibitor L-deprenyl on the morphology of the rat hippocampus.

The effect of intracerebroventricular (ICV) administration of ethylcholine mustard aziridinium (AF64A) and of the monoamine oxidase (MAO)-B inhibitor L-deprenyl on MAO-A and MAO-B activities and on the morphology of the rat neostriatum and hippocampus were studied. The ICV administration of AF64A was without effect on MAO-A and MAO-B in the neostriatum and caused an increase of MAO-B but not of MAO-A in the hippocampus. No changes in neostriatal micro-anatomy were noticeable in AF64A-injected rats, whereas the neurotoxin caused an impairment in hippocampal micro-anatomy consisting in the loss of nerve cells and of silver-gold impregnated fibres in the CA-1--CA-3 fields. The treatment of AF64A-injected animals with doses of L-deprenyl from 11.17 microM/kg/day significantly reduced MAO-B activity in the hippocampus and improved the morphology of the hippocampus formation. L-deprenyl was without effect on MAO-A activity both in the neostriatum and in the hippocampus, as well as on neostriatal MAO-B activity and morphology. The possibility that MAO-B inhibition may represent a principle for the treatment of age-related physiological and pathological changes characterized by increased MAO-B activity is discussed.


Amino acid structure and "difficult sequences" in solid phase peptide synthesis.

Deprotection peak profiles have been determined as a measure of internal aggregation during Fmoc-polyamide continuous flow solid phase synthesis. The results have been correlated with amino-acid structure and discussed in terms of minimising aggregation during synthesis.


Influence of acetyl-carnitine on some mitochondrial enzymic activities in the human cerebral tissue in conditions of acute hypoxia.

Following previous research on human tissue in conditions of acute and massive hypoxia, in the present work the authors compared the cellular enzymic response to oxidative stress in normoxic (perifocal) and hypoxic (focal) areas in human brain affected by regional acute vasculopathies. Two homogeneous groups of patients were selected following strict clinical inclusion/exclusion criteria. The groups of patients were treated with a placebo or acetyl-carnitine at same doses and following randomized, double-blind procedures. The focal areas showed a significant functional damage in lactate, pyruvate and succinate dehydrogenases and in the cytochrome oxidase activity when compared with the enzymic capacities of perifocal areas (normoxic as controls). The pretreatment with acetyl-carnitine antagonized the above-mentioned enzymic damage by a protective action linked to the endocellular energy restoration. In accordance with these data, the therapeutic role played by acetyl-carnitine in the cerebral focal hypoxia appeared to be a determinant for the cell survival mainly in the reversible phase of oxidative damage.


Structural requirements for biological activity of glucagon-like peptide-I.

Glucagon-like peptide-I (GLP-I) is encoded together with glucagon by the glucagon gene and is related in its structure to the glucagon-secretin family of peptides. Three of the predicted forms of the peptide, a 37-residue long GLP-I(1-37), a 31-residue GLP-I(7-37) and a 30-residue GLP-I(7-36)amide as well as three analogs des [Gly37, Arg36] GLP-I(7-37), des [Gly37, Arg36, Gly35] GLP-I(7-37) and des [His7] GLP-I(7-37) were synthesized by the stepwise solid phase method. These synthetic peptides were used to define the structural domains required for the binding of GLP-I to the pancreatic beta cell. The competitive binding experiments showed that both the amino and carboxyl terminal domains of the molecule contribute to GLP-I binding. In these experiments glucagon, another peptide that stimulates insulin secretion, was a weak full agonist of GLP-I binding. Results from these studies provide further characterization of the physiological role of this new peptide.


Application of carboxylic-phospholanic mixed anhydrides to fragment coupling in peptide synthesis.

The application of 1-oxo-1-chlorophospholane as a novel reagent for the in situ activation of peptide fragments for use in peptide bond forming reactions, either in liquid or solid phase, has been examined. 24.1 MHz 31P NMR spectroscopy has been employed to follow the formation, stability and reactivity of the intermediate phospholanic-carboxylic mixed anhydride.


Bombesin/gastrin releasing peptide levels of peripheral mononuclear cells, monocytes and alveolar macrophages in chronic bronchitis.

Bombesin-related peptides (BRP), a family of neuropeptides showing carboxy-terminal homology with the amphibian bombesin, are present in humans in many body systems (CNS, lung, gastro-intestinal tract) with a variety of biological activities. In the lung, BRP are mitogens for normal bronchial epithelial cells and fibroblasts, chemoattractant for monocytes and exert bronchoconstrictive activity. Increased levels of BRP have been described in the lung of cigarette smokers and in smoking-related diseases. Moreover appreciable quantities of BRP have been recently found in lysates of peripheral monocytes and alveolar macrophages of man and guinea pig. It has therefore been inferred that these peptides may play a role in the immunological function of lung tissue. The aim of this study was to determine the amount of BRP present in peripheral-blood mononuclear cells (PBMNC), monocytes and alveolar macrophages (AM) of normal subjects (n = 36) and chronic bronchitis patients (n = 36). Patients with chronic bronchitis showed a significant increase in BRP levels in all cell types (PBMNC, monocytes and AM) (p < 0.005) in comparison with normal subjects. In addition levels of BRP in monocytes and AM were found to be nearly four times higher than in PBMNC in both groups of subjects. We can therefore confirm previous observations concerning the presence of BRP in human cells of the monocyte-macrophage lineage. Furthermore our results demonstrate that BRP levels are increased in monocytes of chronic bronchitis patients and imply a potential role for these neuropeptides in lung immunological response in smoking-related diseases.


Spondylarthropathy and gut inflammation: immunopathogenetic mechanisms.

In 62% of patients with spondylarthropathy (SpA) we found clinically unsuspected gut inflammation to feature acute or chronic enterocolitis on ileocolonoscopy. A proportion of patients of the latter group had subclinical Crohn's disease as demonstrated clinically, endoscopically, genetically, histologically and immunopathologically. There is a relation between the activity of the gut inflammation and clinical rheumatic symptoms. A pathogenetic mechanism is increased handling of luminal (bacterial or nutritional) antigen, hence inducing T-cell activation and intestinal inflammation. In ileal mucosal biopsies we showed two different cellular events: increased enterocytic expression of class II molecules in active inflammation and an increase of membranous (M) cells overlying lymphocytes in inflamed mucosa. Although the number of intraepithelial lymphocytes was not increased in inflammation, intraepithelial T lymphocytes had protruding processes in close apposition to the tips of epithelial plasma membranes. Lymphocytes crossing the basement membrane were a frequent finding. These features indicate that the intestinal immune response caused by increased antigen processing in the terminal ileum induces an inflammatory immunocascade responsible for the clinical picture of SpA.


The rational use of mesh in hernias. A perspective.

The decision to use mesh in abdominal wall hernia repairs is not always based on rationale. Some surgeons use mesh on nearly all cases, encouraged by the impression that they never get recurrences. Other surgeons rarely use mesh, citing the fact that there is always enough tissue on site and that foreign bodies can have their complications. A third group of surgeons will respond to the particular need of that herniorrhaphy. Because few surgeons have a large personal experience, it becomes difficult to scan the spectrum of hernias seen in the surgical population. Yet, when numbers are available, a pattern may be discerned which reveals four classes of hernias. These four classes are those which require mesh--"rarely" (less than 1%), "sometimes" (less than 5%), "frequently" (38% and 63.3%) and "always" (91.0% and 100%). These statistics should provide surgeons with some insight as to when mesh may be used.


A randomized controlled trial for inguinal hernia repair to compare the Shouldice and the Bassini-Kirschner operation.

A randomized controlled trial was conducted on 142 adult male and female patients for primary inguinal hernias by the Shouldice or the Bassini-Kirschner surgical technique. Follow-up after one year revealed 7 recurrences out of 72 patients having had Bassini-Kirschner's operation and three recurrences out of 70 patients having had Shouldice's operation (p = 0.326, NS). Six patients died during the follow-up period and two were lost to the study. At two years follow-up examination nine recurrences out of 63 patients having had Bassini-Kirschner's operation and seven recurrences out of 65 patients having had Shouldice's operation were found (p = 0.792, NS). Both operations gave the same results when performed by either a consultant surgeon or a surgeon in training. The complication rate was high but similar for both techniques (18%). Although surgical literature abounds with excellent low recurrence rates using the Shouldice surgical technique, we were unable to reproduce these results. This might be due to lack of experience.


Infiltration of S-100 protein positive dendritic cells and peritoneal recurrence in advanced gastric cancer.

We investigated the influence of the infiltration of S-100 protein positive dendritic cells on peritoneal recurrence of carcinoma in 113 patients who had undergone curative resection for gastric carcinoma invading beyond the muscularis propria. The infiltration of dendritic cells was classified into marked and slight. In patients with marked infiltration, peritoneal recurrences were rare, the rate being 5.6%, with a statistical difference compared to the rate of 20.3% with slight infiltration (p < 0.05). When patients were classified into infiltrative and expanding types with regard to the mode of invasion, patients with a marked infiltration survived longer than did those with slight infiltration in the infiltrative type carcinoma (p < 0.01). Such relationship was also observed when width of the serosal invasion was less than 4 cm in diameter (p < 0.01). Analysis of the pattern of recurrence revealed that infiltration of dendritic cells may prevent peritoneal recurrences in patients with advanced gastric cancer which has infiltrative mode of invasion.


Experience with the intra-abdominal approach for complicated hernias of the inguinal region.

In this report we describe our experience using the transabdominal approach for the reduction and repair of incarcerated or strangulated hernias of the inguinal or femoral region. This technique allows for the division of the constricting ring under direct vision as atraumatically as possible and permits a simplified Cooper's ligament type of repair with great accuracy, safety and ease. Thus, all risks associated with the conventional techniques are minimized and the chances for success of reconstruction are markedly enhanced. Short and long term results have been excellent in 22 patients with complicated inguinal or femoral hernias, five of them recurrent and five with strangulated bowel, with a mean follow up of 80 months.


The influence of tumor lymphocytic infiltration on long term survival of surgically treated colorectal cancer patients.

Prognostic significance of host-immune response, as gathered by the degree of tumour lymphocytic infiltration (TLI), and its relationship to other prognostic variables were investigated in 361 colorectal cancer patients admitted to our Institution for curative resection from January 1960 to December 1978. The presence of a local immune reactivity was significantly related to a less advanced stage of disease and a better differentiated tumour. A poorer prognosis was detected in patients with minor or no lymphocytic infiltration. TLI was the single most important prognostic parameter, according to the Cox model and to logistic regression analysis. These findings suggest that also TLI should be considered in the current Staging System of colorectal cancer.


Simplified perioperative management in vertical banded gastroplasty.

Vertical Banded Gastroplasty (VBG) is the most commonly performed weight loss operation in the United States and is of proven adjunctive benefit in the treatment of morbid obesity. In an attempt to reduce the hospital related complications associated with morbidly obese patients we simplified the perioperative management of 244 patients undergoing VBG. Our goals were early feeding, early ambulation and a short hospital stay. Neither nasogastric tube nor Foley catheter was used after surgery. Mean postoperative stay was 3.24 +/- 0.8. Forty-one patients (16.8%) developed significant complications. Only two of these had a nosocomial complication (0.8%). The remaining 39 patients had technical complications not related to the protocol of simplified perioperative care. Short hospital stay and simplified perioperative management are feasible and safe for the large majority of patients undergoing VBG and may, in fact, significantly decrease the nosocomial morbidity common to this type of patients.


Anal dilatation, lateral subcutaneous sphincterotomy and haemorrhoidectomy for the treatment of second and third degree haemorrhoids. A prospective randomized study.

Patients with second or third degree haemorrhoids were randomized for treatment by anal dilatation, lateral subcutaneous sphincterotomy or haemorrhoidectomy. The patients were studied by means of proctoscopy, anal manometry and symptom grading preoperatively, two months and one year after the procedure. After one year, more than half of the patients were symptomless in each treatment group. Both anal dilatation and sphincterotomy gave poor results in 25% of the patients, compared with 9% after haemorrhoidectomy. Young age was related to good results in anal dilatation or sphincterotomy, but not in haemorrhoidectomy. Results of anal dilatation and sphincterotomy in treating haemorrhoids are unpredictable, so they cannot be recommended as routine procedures. Maximal basal pressure was reduced after all three procedures, but neither the preoperative nor postoperative anal pressures were able to predict the result of the different treatment techniques.


Extension of lymph node dissection and survival in primary gastric cancer.

The histories of 429 patients who underwent surgery for primary gastric cancer at our ward from January 1970 to December 1985, were reviewed. All patients underwent surgery: potentially curative surgery, 54.8%, non-curative resection, 18.2%; palliative surgery, 27%. Nodal status was as follows: N0, 28%; N1, 17.7%; N2, 44.5%; N3, 9.8%. The incidence of N0 cases was significantly increased in Stage T1 and T2 disease compared to Stage T3 and T4 lesions (p < 0.001). In Stage T3 and T4 patients the incidence of distant metastases increased if lymph node involvement was also present (p < 0.005). In patients without nodal metastases 5-year survival was 70% (median survival: 60+ months) whereas, in patients with lymph node involvement survival was 32% (median survival: 24 months) (p < 0.001). Our data suggest that elective extensive lymph node dissection (R2) is indicated in all patients because survival is improved by this procedure. We recommend R3 lymph node dissection only in macroscopic N3 node involvement patients.


Correlation between plasma or blood transfusion and survival after curative surgery for colorectal cancer.

Out of 473 patients operated radically for colon or rectal cancer different survival curves have been calculated according to whether they had received or not blood or plasma transfusions during their hospital stay. The non-transfused patients have a better 5-year survival rate and the difference is statistically significant both including and not including Duke's C stage cases. Anemia on hospital admission, on the contrary, does not seem to influence patients survival. Immune depression after blood or plasma transfusion is a very well known phenomenon in transplant surgery and actually depends on the infusion of leucocytes. Is not yet clearly demonstrated that in cancer surgery immune depression may lead to a poorer survival of transfused patients but several papers, including ours, suggest that this effect is very likely. At present in cancer patients it is preferable to limit transfusions to the minimum. If they are absolutely necessary leucocyte poor or, better still, leucocyte free preparations should be administered.


Infectious complications of endoscopic retrograde cholangio-pancreatography managed in a surgical unit.

The immediate infectious pancreato-biliary complications of endoscopic retrograde cholangiopancreatography (ERCP) warranting transfer to a surgical unit are analyzed, in order to evaluate their frequency and severity as well as means of treatment and prevention. Thirty complications of this type were observed in a series of 3226 ERCP performed with or without endoscopic sphincterotomy (ES) over a six year period (0.9%). ES had been performed in 12 of 30 cases, but the complication could not be attributed to the procedure. Post-ERCP complications included: acute cholangitis: 16 cases (53%); acute cholecystitis: 8 cases (26%); acute pancreatitis: 4 cases (13%); infected pancreatic pseudocyst: 2 cases (6%). The global mortality rate was 16.6% (five patients): Four of the deaths were due to septic complications. Twenty-seven of the 30 patients underwent surgery, and three of them died (11%). Acute cholangitis was responsible for most of the deaths (four of five) and the mortality appeared related to the long interval before surgery (three of four deaths). Strict adherence to good endoscopic procedures (aseptic conditions, injection without excessive pressure, antibiotic prophylaxis) and decompression of the biliary tract (nasobiliary drain or transhepatic catheter) should help reduce the frequency of post-ERCP complications, and especially cholangitis, which appears to benefit from early surgical treatment.


Drainage after cholecystectomy. A prospective randomized clinical trial.

This prospective clinical study was done to assess the efficacy of postcholecystectomy drainage. A total of 173 cholecystectomized patients were randomized into two groups; group A (86 patients) without drainage and group B (87 patients) with drainage. Group B included two types of patients; B1 (52 patients) with suction drain and B2 (35 patients) with gravity drain. Evidence of wound infection, chest complications, and duration of hospital stay were recorded in every case. Ninety five patients were assessed for chest complications and subhepatic collection by chest x-ray and abdominal ultrasonography. In group B patients the total amount of fluid drained was measured. The results were analysed by appropriate statistical methods. There was no significant difference in the rate of wound infection or atelectasis in either group, although there was apparent increase of lung complications and subhepatic collections in Group B1. The average postoperative hospital stay was significantly increased in group B patients. Considering all the parameters of this study, it was found that drainage with gravity was attended with the least morbidity.


Post-thyroidectomy hypocalcemia: does arterial ligation play a significant role?

To assess the possible role of truncal ligation of inferior thyroid arteries on post-thyroidectomy hypocalcemia, a prospective study was carried out on 80 patients. Bilateral subtotal thyroidectomy was performed for non-toxic nodular goiter in two groups. Inferior thyroid arteries were ligated bilaterally in 50 patients but not ligated in 30 patients. In both groups mean serum calcium levels on the first and second postoperative days were found to be significantly lower than preoperative levels. However these falls were similar in both groups. We conclude that bilateral truncal ligation of inferior thyroid arteries is not a factor that may cause hypocalcemia due to vascular insufficiency of parathyroid glands.


Causes and effects of systemic complications among severely head injured patients transferred to a neurosurgical unit.

Hypoxia and hypotension are potent causes of avoidable secondary brain damage after severe head injury. These systemic insults were studied in three cohorts of patients (600 in all) transferred in coma from general hospitals to a regional neurosurgical unit between 1979 and 1990. The incidence of hypoxia and hypotension on arrival at the neurosurgical unit fell from 30% in 1979-80 to 12% in 1989-90, even though the proportion of patients arriving within three hours of injury rose from 33% to 52%. Hypoxia was associated with airway obstruction, and hypotension with unsuspected or undertreated multiple injuries. Whatever the patient's age, CT scan findings, or depth of coma, hypoxia and hypotension has independent and additive adverse effects on outcome. The improvements between 1979 and 1990 are attributed to better airway care, especially the increased use of intubation and mechanical ventilation during transfer, and to greater appreciation of how relatively simple measures can reduce the potential hazards of ambulance transfer.


Anastomotic healing in dogs under cortisone treatment. A pilot study comparing compression and stapled anastomosis.

Colonic anastomoses made both by a new Compression Anastomotic Device (CAD) and by a traditional stapler (Autosuture CDEEA) were evaluated in impaired anastomotic healing induced by systemic cortisone in the dog. Twenty dogs were given daily i.m. hydrocortisone (25 mg/kg) starting one month before surgery and then until sacrifice. Eight untreated dogs served as controls. Surgery consisted of colonic transection and anastomosis done with CAD-25 in half the cases and with CDEEA-25 in the remaining half. The dogs were sacrificed six and 13 days after surgery. Macroscopic assessment, bursting pressure test, and histology were performed on the anastomosis. One dog died from peritonitis due to anastomotic dehiscence. No other clinical complications were observed. Although the number of observations was too small to attain statistical significance, CAD anastomoses appeared better than stapled ones as regards peri-anastomotic adhesions, anastomotic index, and histology. This preliminary study suggests that compression is as reliable as the stapler in the construction of colon anastomosis even in such situations of delayed anastomotic healing. Further experience is required to substantiate this conclusion.


Course of the recurrent laryngeal nerve relative to the inferior thyroid artery and the suspensory ligament of Berry.

An awareness of the surgical anatomy and the possible dispositions of the recurrent laryngeal nerve (RLN) is very helpful in avoiding its injury during thyroidectomy. The relationship of the RLN to the inferior thyroid artery (ITA) and the suspensory ligament of Berry were studied in 172 patients undergoing thyroidectomy. One hundred and ninety one nerves were identified, 109 on the right and 82 on the left. Most nerves, both on the right (82.6%) as well as on the left (85.4%) ran either posterior or between the branches of the inferior thyroid artery. The majority of nerves were found within 3 mm from Berry's ligament. The relationship of the recurrent laryngeal nerve to the inferior artery and to the ligament of Berry does not follow a constant anatomical pattern. Nevertheless these structures have a quite close relationship to the nerve in the majority of cases.


A new and easy classification system for ankle fractures.

A classification system for ankle fractures was developed. The system was based on 2 general fracture divisions, namely uni-, bi-, and tri-malleolar ankle fractures, and the localisation of the fracture at the level of the fibula. The use of the system in 612 ankle fractures that were surgically treated at the Leuven University Hospital between 1978 and 1988 led to the following conclusions: 1. All the 612 ankle fractures could be classified without ambiguity. 2. The system was easy workable also for young residents and physiotherapists. 3. It was accessible to repetition, allowing for comparisons between different subjects. 4. Taking into account the type of fracture, the final result could be predicted.


The operative treatment of unstable pelvic ring fractures.

Pelvic ring injuries due to high energy forces are among the most serious, involving the musculoskeletal system. Life threatening hemorrhage, local and distant associated injuries, deformity, pain and diminished functional capacity are all potential problems for a patient with a disrupted pelvis. There is a clear correlation between total blood loss, incidence of associated injuries, final functional result and the type of pelvic ring injury. Between January 1987 and July 1989, 44 patients with an unstable lesion, type B or type C in Tile's classification have been treated in the University Hospital Gasthuisberg of the Katholieke Universiteit Leuven. In 28 cases, primary stabilisation was done by means of an external fixator, "Monofixateur" type. The overall mortality rate was less than 7%. Thirty-five patients could be seen for follow-up six months to three years after injury. Our findings confirm that compared to type B lesions there is a higher incidence of pain, permanent deformity and diminished functional capacity in type C lesion (p < 0.05). The external fixator, used in the immediate post injury period provides an effective splint that reduces bleedings from bone and veins but cannot maintain reduction in lesions with rotational and vertical instability. In these cases, a semi-elective internal fixation, after defining the exact patho-anatomy by means of a CT-scan has to be performed in selected areas.


Parkinson syndrome. A significant risk factor in the patient with acute surgical disorder.

Ten Parkinsonic patients presenting with acute surgical disease were studied to determine the effects of both conditions on each other and the patient's outcome. Severe motion and communication disturbances led, invariably, to a delay in seeking medical assistance, with most of the patients' presenting symptoms and signs being non-specific and misleading. As a result half the patients presented already in a state of septic shock, and a correct preoperative diagnosis could be achieved in three patients only. The functional status significantly deteriorated in six patients, in four of whom a prolonged rehabilitation course was necessary. Although there was no immediate perioperative mortality, morbidity was significant as 50% and 100% major "surgery-related" and "Parkinson-related" complications accordingly. It is concluded that the coexistence of acute surgical disease with Parkinson syndrome has a profound adverse effect on the patient's outcome. High index of suspicion, early mobilisation, intense physiotherapy and early resumption of the anti-Parkinson drugs are the key points in the management of these patients.


A study of intracolonic hydrogen and methane levels during colonoscopy.

Gas samples were obtained during colonoscopy for analysis. Patients were prepared with polyethylene glycol (PEG) (N = 23), phosphate enema (N = 34) and mannitol (N = 4). Air insufflation was used in all procedures. High concentrations of hydrogen were detected in 3 out of 38 gas samples in the PEG group, in 2 of 41 samples in the phosphate enema group and in one of the 8 samples in the mannitol group. All patients had a coexisting intracolonic oxygen concentration > 5%. The results suggest that potentially explosive concentrations of hydrogen may occur after conventional bowel preparations, and that insufflation of carbon dioxide during polypectomy should be a routine.


The phenylpropionic acid load test: experience with 72 children at-risk for beta-oxidation disorders.

The urinary excretion of metabolites of orally administered phenylpropionic acid (PPA) in 72 children, aged 2 days to 16 years, thought to be at-risk of medium acyl CoA dehydrogenase deficiency has been studied. Forty had presented as Reye Syndrome, 9 as a Reye-like syndrome and 24 were sibs of decreased RS, sibs of RLS cases or sibs of infants who had died suddenly and without explanation where an autopsy revealed the presence of very heavy fatty infiltration of the liver. These studies demonstrated that PPA metabolites are maximally excreted during the 3 hours following the oral load and that this urine collection should be diagnostic. PPA loading is a relatively simple, safe test which is part of the investigation of a patient suspected of having an inborn error of metabolism.


The prevalence, antibiotic susceptibility and phage-type of nasally carried Staphylococcus aureus in the Dublin community.

A study was undertaken to determine the distribution, antibiotic susceptibility and phage type pattern of nasally-carried Staphylococcus aureus in the community. Coagulase-positive staphylococci were isolated from 180 of 440 individuals. The rate was higher in the inner city and among young adults and middle-aged males. The isolates were examined for phage-type patterns and antibiotic susceptibility. Most (60.6%) of the isolates were typable either at Routine Test Dilution (RTD) or at 100 RTD. Most belonged to phage group I (53.2%) and phage group III (21.1%). Susceptibility to penicillin and ampicillin was low at 12.3 and 15.5% respectively. All were susceptible to vancomycin. Methicillin-resistance was unexpectedly low at 0.6% whereas tetracycline and erythromycin resistance were in line with recent trends at 4.5 and 2.7%. The rate of multiple resistance was low at 2.3%.


Pre-hospital management of acute myocardial infarction.

Two-hundred and eleven Irish GPs responded to a questionnaire survey of their experience and management of acute myocardial infarction (MI) and their attitudes to the use of thrombolytic therapy Three-quarters of the respondents felt they dealt with three or more MIs per year; most felt that the majority of MIs were initially seen by a GP. Diagnosis is based on clinical findings; only 11% routinely take an ECG. Management is largely oriented to relief of pain but intravenous narcotics are only used by a minority. Hospital referral for suspected acute MI was the preferred choice for almost all GPs in a variety of patient-care scenarios. Home care for MI was chosen only for a minority of elderly patients when some hours had elapsed since the onset of symptoms. Definitive guidelines on the pre-hospital use of thrombolysis are not yet available. However, eighty per cent of respondents in this study feel that thrombolysis is beneficial and many feel that it has value in the pre-hospital situation. Respondents identified educational, organisational and financial problems to be overcome before this could happen.


Management of patients with diffuse toxic goitre in Ireland, a country with low iodine intake.

The present study was undertaken to examine the response rate of thyrotoxicosis in patients with diffuse toxic goitre to thiouracil drug treatment for 1 year in an Irish population, reported to have a low iodine intake. Evidence exists that a low iodine intake is associated with a high long-term remission rate for drug treatment of diffuse toxic goitre. Seventy-five patients participated with 45% of patients entering into long-term remission which has been maintained for a mean of 52.5 +/- 38.8 months. Fifty-five per cent of patients demonstrated relapse at a mean of 7.4 +/- 10.4 months following the withdrawal of thiouracil treatment. These findings were similar to those reported from countries with abundant iodine intake. The data in the present study confirms the usefulness of drug treatment for diffuse toxic goitre in an Irish population but the reported iodine deficiency does not appear to confer a particular advantage.


Susceptibility of urinary pathogens in a Dublin teaching hospital.

The range and resistance patterns of organisms causing urinary tract infections (UTI) vary with time and place. A prospective study of midstream urine (MSU) specimens, received over a 3 month period, was therefore undertaken. The antibiotic sensitivities of 528 isolates from 196 domiciliary and 332 hospitalised patients with significant bacteriuria (> 10(5) organisms/ml) were determined using the modified Stokes method. Escherichia coli accounted for 79% of domiciliary isolates and 57% in hospitalised patients. Gram positive organisms causing UTI have become increasingly common and were isolated from 8% and 15% of domiciliary and hospitalised patients respectively. Resistance levels for co-amoxiclav (Augmentin) were low (7% domiciliary, 14% hospitalised). However 46 Gram negative isolates (10%) had intermediate sensitivities to co-amoxiclav on disc testing. Breakpoint testing showed 89% of these to be sensitive at the urinary breakpoint but only 52% were sensitive at the systemic breakpoint. Forty nine percent of E. coli from hospital specimens were resistant to pipercillin, due to TEM-1 beta lactamase production. A 6% resistance level to ciprofloxacin in domiciliary E. coli is considerably higher than previous reports and gives cause for concern. Gentamicin resistance was found in 4% of Gram negative hospital isolates, a finding of some significance in the empiric treatment of septicaemia of urinary tract origin.


Antenatal detection of renal abnormalities.

The aim of this retrospective study is to assess the value of routine ultrasonography in the detection of renal abnormalities. Twenty-nine pregnancies (one set of twins) with suspected renal abnormalities (i.e. renal cystic spaces, oligohydramnios or hyperechoic kidneys) were delivered over a two year period (1.8.1987-31-7-1989) in a unit where 90% of pregnancies (6,562) were scanned routinely at 18-20 weeks gestation or later, if booking for confinement was delayed. In pregnancies with suspected anomalies prenatal ultrasound was performed monthly until 28 weeks and fortnightly until delivery. Non survivors [5] had histological or postmortem examination. Liveborn infants [25] had renal ultrasonography in the neonatal period and paediatric follow-up if abnormal. Sixteen (53%) of the 30 cases (one set of twins) suspected of renal abnormalities by routine prenatal ultrasonography had renal anomalies confirmed postnatally. Five women were non survivors, all of which had associated anomalies. In the eleven survivors the diagnoses were pelvi-ureteric junction obstruction [6], renal dysplasia [2], vesicoureteric reflux [2] and suspected ureterocele [1]. Fourteen infants with pelvicalyceal dilatation had normal postnatal renal ultrasound. Although abnormal prenatal renal ultrasound is a useful indicator of postnatal disease and aids decisions on the management of pregnancy, further large collaborative studies with extended paediatric follow-up are required to assess the significance of pelvicalyceal dilatation.


Serum ferritin in newly diagnosed and poorly controlled diabetes mellitus.

Serum ferritin was measured in 50 patients at diagnosis of diabetes mellitus (DM) and in 20 patients with established DM and poor metabolic control. Twenty-two patients had hyperferritinemia at diagnosis. Four patients had a recognised cause for their hyperferritinemia. In the remaining 18 patients ferritin levels decreased from a mean of 506 +/- 3.6 (SE) ug/l at diagnosis to 254 +/- 29.2 ug/l seven months later (p < 0.001). Metabolic control improved significantly over the same time. All 20 patients with established DM and poor metabolic control had normal ferritin levels. When compared with the newly diagnosed hyperferritinemic patients no difference was found in levels of glycosylated haemoglobin, but ferritin values differed significantly between the two groups (p < 0.001). These results indicate that transient hyperferritinemia is a feature of newly diagnosed DM but not of established DM with poor control. If used to screen diabetic patients for haemochromatosis, serum ferritin should be measured in established DM rather than at diagnosis.


Interhemispheric communication following unilateral cerebrovascular lesions.

39 patients with a single small cerebrovascular lesion (20 in the right, 19 in the left hemisphere) were subjected to a simple reaction time (RT) task with visual stimuli flashed to the visual field either ipsilateral or contralateral to the cerebral lesion. The subject responded always with the ipsilateral hand. The crossed-uncrossed difference (CUD), i.e. the RT when both stimulus and response occur on the same side minus the RT when stimulus and response occur on opposite sides, is assumed to assess the transit time of information through callosal fibers, and in normal people is about 3-5 msec. In our patients the mean CUD, expressed as the difference between contralateral and ipsilateral responses, was 20 msec. Patients with parietal lesions had still longer CUDs, 37 msec on the average. There was no statistical difference in CUDs between right and left brain-damaged patients. The CUD in brain-damaged patients was of the same order of magnitude as that found in acallosal or split-brain patients. Nonetheless, the present findings are interpreted as reflecting the intrahemispheric rather than the interhemispheric delay in information transmission, with the possible additive effect of an asymmetrical orienting of attention.


Interleukin-2 receptor expression on blood monocytes of patients with multiple sclerosis.

We studied the expression of class II MHC product (HLA DR) and IL-2 receptor on circulating monocytes (M phi) in MS patients, neurological and healthy controls, by double color flow cytometry. In all groups most M phi were DR+ without significant differences. More interesting, low percentages of IL-2+ M phi were detectable in healthy and neurological controls, whilst a few MS patients with active disease showed higher levels. This finding is in agreement with similar studies in other T-cell mediated diseases and with the report of rare IL-2+ macrophages in MS plaques. Although the actual role of IL-2+ M phi in the immune response still needs elucidation, our findings suggest their relevance to the pathological process of demyelinating disease.


Massive cerebellar infarct complicated by hydrocephalus.

We report a case of massive cerebellar infarction in which CT and MRI led to the diagnosis of acute hydrocephalus. All the neurological symptoms cleared after CSF shunting.


Cerebrospinal fluid (CSF) analyses in HIV-1 primary neurological disease.

This paper will focus on CSF findings in HIV-1 Neurological Disease (ND). Why use CSF as exploration window of the HIV-CNS involvement? Traditionally, CSF analysis has been an effective diagnostic method as well as a means of monitoring treatment in several infectious and immune pathologies of the CNS. Consequently there is an abundance of mature background information [113, 145, 147] particularly in terms of detecting infectious agents, using IgG findings as immunological indexes, and utilizing CSF findings to map the evolution of ND. We will explore the papers that utilize CSF variables as dependent measures to explore the effects of HIV disease, particularly HIV ND, cited in Index Medicus and MEDLINE data base, and published in Spanish, Italian and English, between 1985 to 1991. We will restrict our review to those studies that exclude HIV cases with CNS opportunistic infections or neoplasms, and thus focus on what the CSF can tell us about the primary effects of HIV on the brain as defined above. The primary long-term goal is to find some elements of the CSF that would lead to an understanding of the etiopathogenesis of HIV ND. However, an almost equally important aim is to determine which CSF variables may be clinically predictive of HIV ND occurrence and progression. The latter variables can also be expected to provide the best measures of HIV ND treatment efficacy. This is particularly important since it is our contention that treatment of HIV ND will eventually be initiated and monitored on the basis of laboratory markers of HIV ND, most likely from the CSF. Finally, this summarized information would be useful in drafting a CSF profile in order to have a reference pattern for cases with complications. The data of this review will be broken down, when the information permits, according to clinical stage and presence or absence of clinical manifestations of ND.


Inhibition of human lymphoproliferative responses and altered lymphocyte membrane phenotype by succinylacetone.

Succinylacetone (SA) proved to be a potent inhibitor of in vitro lymphoproliferative responses. This compound (3.0 mM) reduced the incorporation of 3HTdr by > 90% in mononuclear cell cultures stimulated with PHA, anti-CD3, IL-2 or phorbol dibutyrate-Ca2+ ionomycin. Furthermore, SA caused profound reduction in isotope uptake even if added to 3-day PHA-stimulated cultures as late as 6 h prior to harvest. Cells exposed to SA prior to mitogenic challenge and washed were not impaired in their proliferative activities. The addition of hematin to SA-containing cultures did not reverse the proliferative block. Phenotypic studies of stimulated cells suggested that SA does not preferentially affect one functional group of lymphocytes. However, it appeared that SA may act selectively to inhibit expression of transferrin receptors (CD71), a T-cell activation antigen. These data suggest that SA acts as a noncytotoxic immune inhibitor; this activity may be mediated, in part, by blocking cell activation and subsequent progress through the mitotic cycle.


Tamm-Horsfall glycoprotein (THG) purified from normal human pregnancy urine increases phagocytosis, complement receptor expressions and arachidonic acid metabolism of polymorphonuclear neutrophils.

Tamm-Horsfall glycoprotein (THG) purified from normal human pregnancy urine was found to increase polymorphonuclear neutrophil (PMN) phagocytosis (46.57 +/- 3.54% in the medium versus 75.85 +/- 5.37% in the presence of 25 micrograms/ml THG) after 30 min preincubation. The phagocytosis-enhancing activity of THG was dose-dependent (5-50 micrograms/ml) and was possibly mediated by the increased expressions of complement receptor type 1 (CR1) and type 3 (CR3) on the neutrophils. The release of [3H]arachidonic acid and prostaglandin E2 (PGE2), but not thromboxane B2 (TXB2), from neutrophils were also significantly enhanced by THG. Using 3,3'-dihexyloxacarbocyanine iodide as indicator, THG (25 micrograms/ml) depolarized the membrane potential of PMN after 30 min preincubation. In addition, THG exhibited a specific membranotropic effect with PMN. It is conceivable that THG binds to the cell surface and depolarizes the membrane potential of PMN which subsequently enhances the release of arachidonic acid metabolites and the translocation of the complement receptors to the membrane. These biochemical events lead to the increment of PMN phagocytosis and suggests that THG may play an important role in the defense mechanisms of the urinary tract in that a large amount of THG is usually present.


A functional characterization of macrophage alterations in casein-treated B6C3F1 mice.

We have previously reported that subcutaneous injection of casein, a potent inducer of the immunomodulatory acute phases reactant, serum amyloid A (SAA) protein, produces a marked suppression of humoral responses that require macrophage accessory cell cooperativity in the B6C3F1 mouse. The objective of these studies was to further characterize the immunological changes produced by casein treatment. It was observed that the inhibition of the sRBC IgM AFC response which accompanies casein treatment is dose related to the amount of casein introduced subcutaneously to the mouse. These studies, as well as those previously reported by several laboratories including our own have demonstrated that spleen cells isolated from casein-treated mice also exhibit markedly suppressed humoral responses in vitro. However, casein added directly to naive spleen cell cultures at concentrations significantly higher than those which would be found in the lymphoid tissues of the intact animal have no direct inhibitory effect on the sRBC IgM AFC response, suggesting that casein alone does not exert a direct immunosuppressive effect. Kinetics of recovery studies indicate that the casein-induced immunosuppression is readily reversible. Humoral responses are fully recovered within 3 days, once subcutaneous injections of casein are terminated. In vitro measurements of IL-1 secretion following stimulation of splenic macrophages, isolated from casein treated mice, with lipopolysaccharide indicate no significant effect on the capacity of these cells to produce this cytokine. Direct addition of recombinant IL-1 or interferon-gamma to spleen cell cultures isolated from casein-treated mice also was found to be incapable of reversing the inhibited IgM AFC response. Taken together, these studies strongly suggest that the accessory cell dysfunction associated with macrophages from casein-treated mice is not due to the inability of these cells to secrete IL-1 and indicate that the dysfunction cannot be reversed by IL-1 or interferon-gamma. Casein treatment was also found to markedly inhibit DTH, a cell-mediated immune response requiring macrophage accessory cell function. interestingly, the DTH responses were only affected by casein when it was administered post-sensitization with antigen (sRBC) but prior to antigen challenge. When casein was administered prior to sensitization with antigen, which is analogous to the treatment schedule that was found to suppress the sRBC antibody response, no effect was observed on DTH.


Components of men's well-being at mid-life.

This study was designed to examine the correlates of psychological well-being for 75 middle-aged professional men. Based on sex-role convergence and role adjustment theories, three sets of predictor variables (i.e., interpersonal family factors, role adjustment, and extrafamilial interpersonal factors) were hierarchically entered into a multiple regression equation. The well-being outcome was found to be influenced by interpersonal family factors. The role adjustment and extrafamilial interpersonal factors did not account for a significant increase in variance. The best univariate predictors of men's well-being at midlife were perceived closeness to child, perceived closeness to wife, adjustment to the husband role, and number of close friends.


Violence. Upping the ante. Interview by Cath Jackson.

Handling a physical attack is 'just the tip of the volcano' says Stevie Holland, author of a radical new distance learning pack on 'Managing aggression' at work. Health visitors, school nurses and their managers need training in preventive strategies to defuse potentially violent situations. They should also be looking at their own attitudes to colleagues and clients and at the culture of the organisation within which they work.


Methylxanthine-induced inhibition of the antigen- and superantigen-specific activation of T and B lymphocytes.

Methylxanthines have been shown to have a variety of effects on hematopoietic cell activation and function. These compounds inhibit cAMP-specific phosphodiesterase activity resulting in increased levels of intracellular cAMP. In the present study, we examined the effects of two methylxanthines, pentoxifylline (PTX) and caffeine, on the responses of both mouse and human lymphocytes to stimulation with polyclonal T- and B-cell mitogens, antigens, and the microbial superantigen, staphylococcal enterotoxin B (SEB). Both PTX and caffeine significantly inhibited mitogen- and SEB-induced proliferation by murine spleen cells, SEB- and antigen-induced proliferation and lymphokine secretion by murine Th1 and Th2 clones, and the generation of antigen-specific antibody producing murine spleen cells. These compounds also inhibited the proliferative responses of human lymphocytes to phytohemagglutinin, SEB, and tetanus toxoid. Efforts to determine whether these methylxanthine compounds mediated their inhibitory effects through a specific protein kinase pathway revealed a role for cAMP-dependent protein kinase A in methylxanthine-induced immunomodulation. However, it is possible that a protein kinase A-independent pathway may also be involved. These data demonstrate that the methylxanthines, PTX and caffeine, have profound effects on cells of the immune system and may have a potential use as immunotherapeutic agents in the treatment of various inflammatory conditions and autoimmune diseases.


Part II: The treatment of torture survivors: a review of the literature.

Various treatment modalities have been proposed for working with survivors of torture. In this article, treatment aimed at both the individual and community is discussed. The role of nurses in preserving human rights and healing the victims of human rights' violations is also outlined.


Part I: Torture and mental health: a review of the literature.

Torture affects a large number of people worldwide and poses a serious threat to mental health. This article presents an overview of torture as a current issue and reviews the literature that addresses the mental health effects of torture. Subtopics addressed include the effects of torture on the individual, the effects of torture on the community, studies of women who have survived torture, the ethics involved in studying torture victims, and the debate over identifying a torture syndrome.


Accident prevention: the health visitor's role.

The health of the nation white paper sets targets in five key areas for reductions in both mortality and morbidity: coronary heart disease and stroke, cancers, mental illness, HIV/Aids and sexual health and accidents. In a series of articles in Health visitor, experts will be considering the opportunities the white paper offers for community nurses in each of the key areas. Here Dr Sara Levene, medical consultant to the Child Accident Prevention Trust, considers accidents, a major problem which health visitors can do much to control. She reviews how accidents are presented in the white paper, what health visitors can do and what resources are available to help them. She offers particular advice on special accident prevention initiatives and discusses some of the opportunities created by the white paper.


Family functioning as perceived by parents of boys with attention deficit disorder.

The purpose of this study was to describe adaptability, cohesion, and family type in families of boys with attention deficit disorder. Comparisons were made across diagnostic groups for boys with and without hyperactivity and aggressive symptoms. Parents (N = 123) of 79 boys with attention deficit disorder (ADD), attention deficit hyperactivity disorder and attention deficit hyperactivity disorder plus aggressive symptoms participated in the study. The families were not significantly different in their functioning when compared to family norms established by Olson, Portner, and Lavee (1985). There were, however, significant differences in functioning across diagnostic categories. Parents of boys with ADD only, without the additional problem of hyperactivity or aggressive symptoms, reported the highest level of family functioning, and a larger percentage of parents whose child had hyperactivity or hyperactivity plus aggression reported extreme family functioning.


Differentiation of self and attachment among adult daughters.

The relation among the variables differentiation of self, attachment to mother, and two indicators of mental health were studied in 83 nonclinical adult daughters from a Southern community. An a priori causal model was proposed and tested. Bowen's (1976) theory of differentiation of self and Bowlby's (1969) attachment theory provided the conceptual framework. An operational Daughter Model was tested using the statistical program LISREL. Compared to mothers, daughters scored significantly lower on differentiation of self. Daughter's attachment to mother and daughter's level of self-differentiation were not causally related, supporting the view that differentiation of self and attachment are separate variables in personality development. The daughters' levels of differentiation of self were positively related to positive energy, thus supporting Bowen's theory. These findings affirm the value of attachment behaviors and differentiation of self in adulthood, challenge therapists' bias against attachment behaviors of women, and provide a focus for mental health promotion among women.


Using community health profiles to improve service provision.

Profiling has become increasingly important to the purchasing and provision of todays' health care. Kate Cernik and Mandy Wearne examine the concept and its importance to health visitors and community nurses and ask what is involved in the profiling process and who should be doing it.


Meeting the health needs of older homeless people.

Inclusion of health visiting services in packages of care for older people could play an important part in tackling the health and housing problems many experience, argues Kenneth Kelling. Here he draws attention to the often severe health problems of homeless older people and warns that current policies, far from improving their plight, will lead to further deterioration in services.


A field study of couples recovering from alcoholism.

Effective recovery from alcoholism demands commitment from both partners in a marriage. The focus of this qualitative study was to learn how couples progressed through recovery and how they achieved their goals conjointly. The Model of Recovering Alcoholics' Behavior Stages and Goal Setting was used as the theoretical base. Twenty-eight couples participated in the study. The author used analytic fieldwork to learn if spouses of alcoholics conformed to the same stages as indicated by the model and to learn the interactive effects of alcoholics' and spouses' stages. As a result, the author developed the Model of Alcoholic Spouses' Behavior Stages and Goal Setting. The research has implications for planning nursing care, determining when to intervene individually versus conjointly, and identifying indicators of relapse.


Caring for the professional caregiver: the application of Caplan's model of consultation in the era of HIV.

Nurses as well as other health-care professionals have been impacted by the current human immunodeficiency virus (HIV) epidemic. Issues related to virus transmission, voluntary testing, and professional requirements to provide care for those infected can trigger emotional as well as cognitive responses for all involved. The heavy emotional needs of patients and the regular confrontation of death increase the risk of burnout for those caring for the growing number of patients with acquired immunodeficiency syndrome. In an effort to retain and to recruit nurses who are willing to become involved in the care of those infected with the virus, it is imperative that nursing administration provide psychosocial support services for those nurses. This article describes the development and implementation of a psychosocial support program, based on Caplan's (1973) model of mental health consultation, for nursing staff impacted by the HIV epidemic. The program, established through a cooperative alliance between psychiatric/mental health clinical nurse specialists and nursing staff, has proved to be effective and efficient. It is recommended that other psychiatric/mental health nurses, including faculty, use the consultation model to improve the psychosocial support available to health-care professionals affected by the HIV epidemic.


Hospital violence: site, severity, and nurses' preventive training.

A sample of 663 nurses was surveyed about exposure to violence at the work site; 243 (37%) had faced violence. Hospitals with low response rates to the questionnaire reported less assault, yet the violence admitted to was described as more deadly. More nurses at public than private hospitals had obtained some training to handle potentially violent situations. Serious assault was negatively related to amount of training. At the public psychiatric hospital, violent acts were most frequent, but the rate of deadly violence (e.g., rape, use of knives or guns, etc.) was lowest. The need to train staffs at general as well as psychiatric hospitals was discussed.


Reasons for attending GP or health authority clinics.

A survey of 564 users of health authority and general practitioner-run child health clinics since the introduction of the 1991 GP contract revealed a level of 91 per cent satisfaction with the service regardless of the venue, write Hilary Sharpe and Del Loewenthal. However, the demand for health visiting expertise to cover both GP and health authority child surveillance services and the requests of many users for more health visitor input highlight the need for an adequately resourced health visiting service.


'Not just me dreaming': parents mourning pregnancy loss.

Part of a government-backed study of social support in pregnancy explored women's feelings about pregnancy loss and how the process of mourning and coming to terms with the baby's death can be facilitated. Lynda Rajan considers the practicalities involved in the immediate aftermath of perinatal loss. She discusses the need for recognition of the dead baby as a person for whom grieving is a legitimate process and suggests ways in which health professionals can contribute to promoting the mother's long term emotional health.


Loneliness in low-vision older women.

The purpose of this analysis was to identify predictors of loneliness in women 75 years of age and older with low vision. The sample of 56 women was derived from a larger study of low-vision adults. Women's loneliness, optimism, social support, living arrangement, vision, and perceived health were examined using the revised University of California, Los Angeles, Loneliness Scale, the Life Orientation Test, the Social Support Questionnaire, and a demographic questionnaire. Data were analyzed using descriptive statistics, Pearson correlations, multiple regressions, and t-tests. Optimism and social support satisfaction were found to predict degree of loneliness in the sample. Women who were less optimistic and less satisfied with their social support system experienced higher levels of loneliness. Duration of visual impairment was associated with duration of loneliness. The findings provide nurses with information for identifying low-vision older women who are at risk for loneliness.


Influence of psychosocial development and life events on the health practices of adults.

The purpose of this study was to examine variables believed to contribute to healthy life-styles of adults. Psychosocial development and the presence of stressors (i.e., life changes) were selected for the potential contribution they make to the practice of health behaviors of adults. Psychosocial theory of development and theory of human adaptation provided the conceptual framework that guided the investigation. Using a survey design, three self-report instruments were mailed to 216 potential subjects. The study participants (N = 156) were employees (current or retired) of a large midwestern university ranging in age from 24 to 80. The results revealed that the means for each stage of psychosocial development were at the upper end of the scale. Positive resolution of intimacy, the stage of early adulthood, was more strongly correlated with the health practices than the remaining seven stages, and four of the stages were significantly associated with the practice of healthy behaviors. Exposure to stressors as measured by life changes increased the predictive values of two of the subscales of the total health behaviors score, nutrition and safety. Stressors and their impact did not, in general, lend strength to the predictive value of healthy life-styles.


Defining the primary health care team.

Health visitors work in primary health care but do they work in primary health care teams? What is the primary health care team and what can health visitors' involvement contribute? Pauline Pearson explores the views of some of the central participants in the delivery of primary health care services in Newcastle upon Tyne.


A bright future for community nursing.

Lisa Rodrigues argues that health visitors and community nurses have a world to gain from the current flux in community health services. But they must actively seek out ways of working jointly with other agencies if they are not to be left on the sidelines.


Stepfamilies. 'A child of our own'.

An analysis of over 300 calls made to the Stepfamily telephone counselling service reveals the frequency and intensity of problems about pregnancy and young children in stepfamilies. BRIAN DIMMOCK highlights the pressure on stepmothers in particular and argues that professionals, including health visitors, need to be able to recognise the ways in which family structure can impact on people's lives.


Health promotion. It's all at the shopping co-op. Interview by Cath Jackson.

Residents on council estates in Bolton have got together to shop co-operatively to bulk-buy fresh fruit and vegetables more cheaply. CATH JACKSON talks to Steffie Price and Jane Sephton, the food and health advisers behind these practical schemes to help local people improve their diet.


On the use of tester stocks to predict the competitive ability of genotypes.

It has been recently claimed that the outcome of competition between two phenotypically indistinguishable strains cannot be predicted from comparisons of their respective performances against a mutant tester stock. Our aim in the present paper is to disprove this claim and to show the potential pitfalls of deriving conclusions from a statistical analysis of experimental designs commonly employed for the study of competitive interactions in genetically homogeneous and heterogeneous mixtures. Using our own data, we conclude that evaluating the competitive interactions of phenotypically indistinguishable wild-type strains by competing them against mutant marked stocks still remains a valuable method.


Increase in the resistance to the Bacillus thuringiensis supernatant effect in a Drosophila melanogaster wild type Oregon R line.

We report here the genetical and X chromosome rDNA molecular study of two Drosophila melanogaster Oregon R lines. These lines differ extensively in the degree of resistance of the females both to the lethal effect of an increased temperature and to that of Bacillus thuringiensis beta-exotoxin, which is an inhibitor of the nucleolar RNA polymerase. The 3B line, whose females are resistant, came from an Oregon R population subjected over several generations to increased temperature, 28 degrees C or over, while the other line is derived from the initial stock. Twofold variation was observed in the total number of ribosomal genes between the two lines. This variation applied to most ribosomal units, including the active ones. Variations among X chromosome rDNA content in a wild type population have thus been revealed using tests of resistance to the Bacillus thuringiensis beta-exotoxin. Additive variations in specific unit types between the two lines indicate that modifications to the rDNA content are not rare events.


Differential phosphorylation of some proteins of the neuronal cytoskeleton during brain development.

The cytoskeleton is important for neuronal morphogenesis. During the postnatal development of cat brain, the molecular composition of the neuronal cytoskeleton changes with maturation. Several of its proteins change in their rate of expression, in their degree of phosphorylation, in their subcellular distribution, or in their biochemical properties. It is proposed that phosphorylation is an essential mechanism to regulate the plasticity of the early, juvenile-type cytoskeleton. Among such proteins are several microtubule-associated proteins (MAPs), such as MAP5a, MAP2c or the juvenile tau proteins. Phosphorylation may also act on neurofilaments, postulated to be involved in the adult-type stabilization of axons. These observations imply that phosphorylation may affect cytoskeleton function in axons and dendrites at various developmental stages. Yet, the mechanisms of phosphorylation and its regulation cascades are largely unknown. In view of the topic of this issue on CD15, the potential role of matrix molecules being involved in the modulation of phosphorylation activity and of cytoskeletal properties is addressed.


Glycoproteins and lectins in cell adhesion and cell recognition processes.

The discovery of endogenous lectins having specific and high affinity for the carbohydrate portions of glycoproteins has opened up new directions in the field of cell adhesion and cell recognition. Two endogenous lectins, termed as CSL and R1, initially isolated from the rat cerebellum and having a wide distribution in mammalian tissues, have been shown to participate in essential mechanisms of cell adhesion. The membrane-bound lectin R1 seems to be involved in transient recognition between neuronal cells, followed by elimination of the glycoprotein ligands at the surface of the recognized cell. In contrast, CSL is a molecule involved in adhesion between various normal or transformed cells since it participates in the formation of tight junctions. The glycoprotein ligands recognized with higher affinity by these two lectins seem to possess a special structure which defines a sub-class of oncofetal HNK-1 glycans. The over-expression of the glycoprotein ligands of these lectins in most transformed cells provides new tools for understanding the underlying mechanism of malignant transformation as well as the generation of signals through cell adhesion.


A metastasis-associated antigen is present on a 60 kDa glycoprotein in transitional cell carcinoma of the human urinary bladder.

We have previously shown that the degree of expression of Lex-related carbohydrate epitopes, namely, Lotus tetragonolobus agglutinin (LTA) receptors, SSEA-1 and FH6, correlates with the metastatic potential of transitional cell carcinoma of the human urinary bladder. In an effort to obtain a better reagent with which to detect a metastasis-associated epitope, monoclonal antibodies were produced against LTA receptors from BOY bladder carcinoma cells. One antigen defined by such a monoclonal antibody, MM4, indeed showed better correlation with the metastatic potential of the tumour than did other carbohydrate markers. In the LTA receptors, MM4 antigen was located only on a 60 kDa glycoprotein. In extracts from primary carcinomas and lymph node metastases, the 60 kDa glycoprotein was the principal carrier of MM4 antigen. LTA receptors from these sources were composed of arrays of glycoproteins, while the 60 kDa one was invariably present. Metastasis-associated carbohydrate epitopes on the 60 kDa glycoprotein may promote metastasis by interaction with carbohydrate-recognizing proteins such as selectins on host cells.


A monoclonal anti-glycoconjugate antibody defines a stage and position-dependent gradient in the developing sympathoadrenal system.

The expression of complex carbohydrate antigens was analysed in developing sympathoadrenal cells of the rat using monoclonal antibodies that react with unique carbohydrate structures. CC1 and CC4 are monoclonal antibodies that react specifically with beta-N-acetylgalactosamine and alpha-galactose/alpha-fucose moieties, respectively. CC1-reactive glycoconjugates are expressed in embryonic superior cervical ganglion (SCG) cells as early as embryonic day 15 (E15). CC4 is expressed in the SCG only for a brief period starting at E18 and then disappearing at P5. During their transient period of expression, CC1 antigens are expressed uniformly throughout the SCG at E15-17, but are then restricted to the rostral portion of the SCG from E18 to P4. CC4 is also concentrated in the rostral portion of the SCG between E21 and P4. In the adrenal medulla, CC1 and CC4 antigens display a post-natal onset of expression commencing approximately at P14 and continue to be expressed on a subset of cells which contain tyrosine hydroxylase (TH). The expression of CC1, however, is restricted to phenylethanolamine-N-methyltransferase-(PNMT)-negative chromaffin cells, whereas CC4 is not. CC1 and CC4-expressing cells appear to be scattered throughout the adrenal medulla without any particular topographic orientation. These findings suggest that the CC1 monoclonal antibody defines a stage-specific differentiation antigen in the sympathoadrenal lineage. Additionally, the CC1 antigen may confer important positional information in the embryonic SCG by distinguishing rostral from caudal neuronal cell bodies.


HLA class II nucleotide sequences, 1992.

The HLA class II sequences included in this compilation are taken from publications listed in these papers: Nomenclature for factors of the HLA system, 1991 [1], Nomenclature for factors of the HLA system, 1990 [2] and Nomenclature for factors of the HLA system, 1989 [3]. Where discrepancies have arisen between reported sequences, the original authors have been contacted where possible, and necessary amendments to published sequences have been incorporated into this alignment. Future sequencing may identify errors in this list and we would welcome any evidence that helps to maintain the accuracy of this compilation. In the sequence alignments, identity between residues is indicated by a hyphen (-). An unavailable sequence is indicated by an asterisk (*). Gaps in the sequence are inserted to maintain the alignment between different alleles showing variation in amino acid number.


Evolutionary stability of transspecies major histocompatibility complex class II DRB lineages in humans and rhesus monkeys.

Sequence analysis of rhesus monkey (Macaca mulatta) polymorphic second exon of major histocompatibility complex class II DRB subregion genes demonstrates the existence of at least 34 alleles. Some of these rhesus monkey alleles are very similar (or nearly identical) to HLA-DRB alleles. These data demonstrate that members of the lineages for Mhc-DRB1*03, -DRB1*04, -DRB1*10, and the loci of Mhc-DRB3, -DRB4, -DRB5, and -DRB6 predate speciation of man and rhesus monkey and were already present 25 million years ago. Calculation of evolutionary rates suggests that the various allele lineages have differential stabilities. Furthermore, the data indicate that distinct species may not have inherited or lost transspecies Mhc-DRB lineages in evolution, because several allele lineages in rhesus monkeys appear to be absent in humans and vice versa.


Mutant HLA-A201 heavy chains with lowered affinity for beta 2m are transported after growth at reduced temperatures.

Forty-five site-directed mutants bearing single amino acid substitutions in the alpha 3 domain of the class I molecule HLA-A201 were previously transfected into CIR cells and screened for surface expression by antibody binding. Eight mutants are expressed at significantly reduced levels relative to HLA-A201, including two with substitutions at residues contacting beta 2m. One of the latter mutations, position 242 gln > lys (242K), is now shown to block assembly with beta 2m and prevent intracellular transport at 37 degrees C. At temperatures ranging from 21 degrees C to 30 degrees C, 242K heavy chains and beta 2m form dimers that are exported to the cell surface. Surface expression at 26 degrees C is not blocked by cycloheximide pretreatment, but is completely inhibited by Brefeldin A, suggesting that at 37 degrees C preformed heavy chains accumulate in the ER. Glycans on the retained heavy chains are sensitive to digestion by Endo H, but become Endo H resistant after cells are grown at 26 degrees C. Preincubation of 242K cells with synthetic peptides shown previously to bind HLA-A201 does not increase reactivity with anti-HLA-A2 antibodies, suggesting that the defective phenotype is not due to instability of cell surface mutant class I dimers, but derives instead from impaired assembly of 242K heavy chains with beta 2m inside the cell. This contrasts with mutant cells such as .174, T2 and RMA-S, which exhibit defects in internal peptide transporters, but assemble and export "empty" dimers to their surfaces that can be stabilized subsequently by exogenous peptides. 242K mutants may therefore be suited uniquely for studying assembly and peptide binding to class I molecules in the ER.


Usage of human T-cell receptor V beta, J beta, C beta, and V alpha gene segments is not proportional to gene number.

Certain T-cell receptor (TCR) beta-chain variable (V), joining (J), and constant (C) gene segments, as well as TCR alpha-chain V gene segments, are disproportionally represented in TCR alpha and beta cDNA libraries derived from PHA-stimulated peripheral blood lymphocytes. Sequences of 138 TCR alpha clones and 96 TCR beta clones were determined and of these 128 TCR alpha clones and 88 TCR beta clones were found to contain unique combinations of V, J, and C gene segments or to display diversity in N region nucleotides. The frequency of the V, J, and C genes used in the assembly of unique transcripts was ascertained. Of the 24 reported V beta gene families, 21 were observed among the 88 TCR beta clones including four V beta families (V beta 1, V beta 2, V beta 3, and V beta 4) that were represented in the sample 2 1/2-5 times more frequently than would be expected on the basis of copy number within the gene complex. Seventy-eight percent of the clones were positive for C beta 2 and more than half of the clones (53%) used one of two J beta 2 genes: J beta 2.1 was present in 27 clones and J beta 2.7 in 20 clones. TCR V alpha families were also disproportionately represented in this sample. Twenty-five of 30 V alpha families were observed in the sample of 128 clones including six recently reported V alpha families. Three V alpha families, V alpha 2, V alpha 8, and V alpha 23, accounted for approximately 40% of the TCR alpha clones and were represented at 18%, 9.4%, and 13.3%, respectively. Both V alpha 2 and V alpha 8 gene families contain more than one gene; thus the number of clones observed in these families may, in part, be related to gene number. However, V alpha 23, which appears to be a single-copy gene family, is significantly overrepresented in this sample. Although disproportional usage of V beta genes may be accounted for by superantigen exposure, reasons for disproportional usage of J beta, C beta, and V alpha genes are presently unknown.


Comparison of the social support networks of Filipino and Mexican-American primigravidas.

In this descriptive-exploratory study, we sought to describe and compare the similarities and differences between Filipino and Mexican-American primigravidas in social support networks, type of support received, and expectations regarding care from health care providers. Convenience sampling was used, and face-to-face interviews using the Norbeck Social Support Questionnaire (Norbeck, Lindsey, & Carrieri, 1983) were conducted in Filipino and Spanish by trained data collectors. The profiles obtained for both groups were similar in sociodemographic characteristics; possession of an adequate social support network, predominantly composed of the spouse and family members; and expectations of more personalized care and decreased waiting time than transpired. The groups differed slightly with regard to ability to discuss pregnancy with persons reported in the network. Overall findings reflect the central role of the family as a source of support during pregnancy. Recommendations are made to conduct research addressing populations of varied ethnic groups and with different educational backgrounds, populations of single and teenage pregnant women, and spousal support.


Women and eating disorders, Part II: Developmental, familial, and biological risk factors.

The problem of eating disorders in women is a topic of concern for health care providers today. The focus of this article is on the developmental, familial, and biological factors that may put young women at risk. Identity, body image, autonomy, and separation-individuation are the developmental issues explored. Particular family characteristics such as enmeshment, cohesiveness, overprotectiveness, and boundary rigidity are presented as risk factors as well. The biological predisposition to obesity and the possibility of a predisposition to an affective disorder are considered. The role of the health professional with respect to prevention by intervening in risk factor development is discussed with an emphasis on the education and guidance of parents throughout the life cycle.


Behavior change in the funny papers: feedback to cartoonists on safety belt use.

A multiple baseline across 8 nationally syndicated cartoonists evaluated the effects of personal advocacy letters encouraging presentations of a specific prevention message--the depiction of safety belt use in comic strips showing motor vehicle occupants. During baseline these cartoonists depicted safety belt use in only 15% (6 of 41) of their strips with occupied vehicles, but following receipt of a personal letter requesting safety belt use 41% (42 of 102) of their strips depicted safety belt use. Four cartoonists showed clear and immediate increases in depiction of safety belt use, 2 demonstrated delayed and somewhat less consistent belt use, and 2 cartoonists showed no change. The approach and results are discussed with regard to advocacy efforts intended to influence presentation of prevention messages in the media.


An analysis of maintenance following functional communication training.

The multiple and long-term effects of functional communication training relative to a common reductive procedure (time-out from positive reinforcement) were evaluated. Twelve children participated in a functional analysis of their challenging behaviors (Study 1), which implicated adult attention as a maintaining variable. The children were then matched for chronological age, mental age, and language age and assigned to two groups. One group received functional communication training as an intervention for their challenging behavior, and the second group received time-out as a contrast. Both interventions were initially successful (Study 2), but durable results were achieved only with the group that received functional communication training across different stimulus conditions (Study 3). Students whose challenging behaviors were previously reduced with time-out resumed these behaviors in the presence of naive teachers unaware of the children's intervention history. The value of teaching communicative responses to promote maintenance is discussed as it relates to the concept of functional equivalence.


Report on a panel longitudinal study of college women's eating patterns and eating disorders: noncontinuum versus continuum measures.

The self-reported frequencies (prevalence and incidence) of eating patterns and disorders in a matched longitudinal sample of college women (N = 141) interviewed during their sophomore year (Time 1) and senior year (Time 2) were compared. The rate of eating disorders was assessed using a noncontinuum measure, the Eating Attitudes Test (Garner, Olmsted, Bohr, & Garfinkel, 1982), as well as continuum measures based on criteria in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980). The noncontinuum measure revealed a prevalence rate of eating disorders per 2-year period comparable to that found in other studies of college student populations. The incidence rate per 2-year period was not of epidemic proportions. A sizable percentage of women appeared to get better from Time 1 to Time 2; a small percentage of women remained abnormal eaters. The continuum measurement uncovered a large group of women whose eating patterns were chronic but not severe enough to classify them as "abnormal" eaters. The implications of using different measures for defining and treating college women's eating disorders are discussed.


Too much reinforcement, too little behavior: assessing task interspersal procedures in conjunction with different reinforcement schedules with autistic children.

Task interspersal procedures have been quite effective in increasing autistic children's motivation to learn. These procedures have typically demonstrated that the inclusion of reinforced maintenance tasks (previously learned tasks) increases responding to new acquisition tasks because more reinforcers, in general, are available. However, studies have not specifically addressed the effects of various schedules of reinforcement, used in conjunction with task interspersal procedures, upon response acquisition. In the present study, a multiple baseline design across subjects was used to assess different reinforcement schedules. Five autistic children participated in learning sessions, during which trials of an acquisition task were interspersed with trials of three maintenance tasks. Correct responses to acquisition tasks were continuously reinforced throughout all conditions, while the reinforcement schedule for competent performance of maintenance tasks differed systematically. Results indicated that all children learned the new tasks when food reinforcers were presented only for acquisition tasks. Results are discussed in terms of behavioral contrast and improving the effectiveness of motivation-enhancing procedures for autistic children.


Work, marital status, and heart disease.

Longitudinal data from the U.S. National Health and Nutrition Survey and its follow-up were used to analyze the effects of marriage and work roles and changes in these roles on the incidence of coronary heart conditions in a sample of 3,097 middle-aged women. Education, age, family income, race, and number of children were included as covariates. The data indicated that women who became unmarried, younger women, and better educated women were at relatively low risk, whereas women who left the labor force and women who were homemakers were at relatively high risk for the conditions. Additional analyses were done on employed women. These findings support the "well-worker effect" but cast doubt on the belief that marriage is always beneficial to health.


Toward culturally sensitive research in a multicultural society.

Applying research methods and techniques developed in a dominant culture to other cultures can threaten the validity and generalizability of research conducted with other cultures. Guidelines are proposed for increasing the cultural sensitivity of research, and a case example is discussed.


Women and eating disorders, Part I: Significance and sociocultural risk factors.

Eating disorders are a significant health problem for women today and therefore are a concern for the health professionals who work with women. The significance of this problem is addressed through epidemiological data from a Western cultural perspective. Many risk factors contribute to the development of these disorders. Broad categories including sociocultural, developmental, familial, and biological factors have been identified by clinicians and researchers. The sociocultural risk factors are the norms, standards, or values of a society. The sociocultural risk factors explored in this article are (a) the value of a thin physique, (b) the value of perfection, (c) the norm of dieting, (d) the influence of the media on these values, and (e) the choice of certain professions. The role of the health professional in prevention with respect to sociocultural factors is discussed.


Use of descriptive and experimental analyses to identify the functional properties of aberrant behavior in school settings.

We conducted descriptive and experimental analyses of aberrant behavior in school settings with 2 children with autism, using teachers as assessors. Experimental functional analyses carried out by the investigators were followed by training teachers to conduct a descriptive analysis and a classroom experimental analysis. A comparison of the assessment procedures showed that each procedure identified negative reinforcement as a maintaining variable for aberrant behavior. The teacher implemented an intervention based on the assessment with mixed results. We then replicated the initial results by having the first teacher train a second teacher to carry out the two assessment procedures. The results of these analyses were also in agreement, again identifying negative reinforcement as a variable maintaining aberrant behavior. An intervention based on negative reinforcement was then successfully implemented. These results suggest the applicability and utility of functional analyses carried out in school settings.


Analysis of the effects of task preferences, task demands, and adult attention on child behavior in outpatient and classroom settings.

Two studies were conducted with children who displayed behavior problems to evaluate the effects of task preference, task demands, and adult attention on child behavior. In Study 1, we conducted brief functional analyses in an outpatient clinic to identify variables that facilitated appropriate behavior. For 8 of 10 children, distinct patterns of performance occurred; 3 children displayed improved behavior with changes in task demands, 1 child displayed improved behavior with a preferred task, and 4 children displayed improved behavior with changes in adult attention. In most cases, the children's parents carried out the assessments with adequate procedural integrity. In Study 2, we applied similar assessment methods to a classroom setting over an extended period of time. We identified independent variables controlling appropriate, on-task, and academic behavior for 2 children on two tasks, with slightly different treatment procedures across tasks for both children. In addition, the results of brief functional analyses for both children corresponded to the extended classroom assessments.


Generalized effects of a peer-delivered first aid program for students with moderate intellectual disabilities.

Peers with mild intellectual disabilities taught first aid skills to 4 students with moderate intellectual disabilities. A multiple probe design across participants was used to examine the effects of the peer teaching program during an acquisition and a partial sequential withdrawal phase. Generalization assessments were conducted in the participants' homes using novel, randomized simulated injuries. Results suggested that the peer teaching program resulted in acquisition of first aid skills, and the participants' skills generalized to the home, to novel simulated-injury locations, and to new trainers. Additionally, a more detailed analysis of the generalized responding suggested that when given a choice among first aid materials, participants treated burns using large adhesive bandages rather than the materials used in training. Participants also successfully treated injuries when novel instructional cues were used. The findings are discussed with respect to training issues, generalization and maintenance of the acquired skills, and the use of peer tutors with disabilities.


Gentle teaching and applied behavior analysis: a critical review.

In recent years, there has been a growing controversy surrounding gentle teaching. This paper explores the nature of this controversy with particular reference to the relationship between gentle teaching and applied behavior analysis. Advantages and disadvantages of this approach are discussed, and it is suggested that gentle teaching and applied behavior analysis need not be regarded as mutually exclusive approaches to working with persons with mental retardation.


Promoting law enforcement for child protection: a community analysis.

The Colorado Occupant Protection Project (COPP) intervention provided police with brief instruction concerning the importance of citations for drivers' failure to use child safety seats and special coupons to accompany citations. Coupons were exchangeable by drivers for a safety seat and brief training in its use, plus a waiver of the $50 citation fine. Over 4.5 years of archival records were employed, using an ABA design and a comparison community to evaluate the program. Few tickets were issued for nonuse of safety seats during the 3-year baseline in either community. Citations for nonuse of safety seats increased to over 50 per month during the intervention period at the test site, whereas rates remained essentially zero at the comparison site. After the COPP intervention was removed at the intervention site, citation rates for nonuse of safety seats decreased to about 15 per month. Differences between intervention conditions and settings were statistically significant. During the intervention, officers were 44 times more likely to write citations than were controls. Results suggested that a behavioral program can increase police citation writing for child protection purposes.


Spelling and emergent picture-printed word relations established with delayed identity matching to complex samples.

Students with academic deficits learned delayed matching-to-sample tasks that used complex sample stimuli, each consisting of a picture and a printed word. A touch to the sample complex removed it from the computer display and produced either picture comparisons or a choice pool of letters. If the comparisons were pictures, selecting the picture identical to the preceding sample was reinforced. If the letters appeared, letter-by-letter construction of the preceding printed word sample was reinforced. The procedure engendered new constructed-response spelling performances and arbitrary relations among pictures and printed words in matching to sample. The emergence of relations among different sets of printed words (paired with the same pictures) suggested classes of equivalent stimuli. Outcome tests involving spoken words as sample stimuli suggested expansion of subjects' spelling repertoires and stimulus classes.