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Testing, Research, Age groups -- Testing, Intelligence (Psychology) -- Testing, Form perception (Psychology) -- Research, Age and intelligence -- Testing, and Form perception -- Research

An automated method for measuring beta-hydroxybutyrate was adapted to the Ciba-Corning 550 Express trade mark random access analyzer. The assay was based on a kinetic reaction utilizing hydroxybutyrate-dehydrogenase. Beta-hydroxybutyrate concentration (mmol/L) was calculated ratiometrically using a 1.0 mmol/l standard. Canine serum, plasma, and urine were used without prior deproteinization and only a 30-microliter sample was required. The method demonstrated good linearity between 0 to 2 mmol/l of beta-hydroxybutyrate. Analytical recovery (accuracy) within these concentrations ranged from 85.8 to 113.3%. Both within-run and day-to-day precision were determined, as was specificity of the assay in the presence of a variety of interfering substances. The automated assay was rapid and economical, with reagent stability maintained for at least 2 weeks at 4 degrees C. This assay can readily be applied toward the assessment of ketoacidosis in dogs, and with further validation, other species.

Physiological aspects, Evaluation, Gonads -- Physiological aspects, Ovaries -- Physiological aspects, Testis -- Physiological aspects, Sex hormones -- Physiological aspects, Peptide hormones -- Evaluation, and Hormones, Sex -- Physiological aspects

The various peptide factors produced in the testes and ovaries are reviewed. Chemical isolation, purification, and amino acid and nucleotide sequencing have led to the understanding of the mechanisms of actions of these nonsteroidal agents. Among the gonadal peptides identified are inhibin, relaxin, oocyte meiosis inhibitor and growth factors. The study of the functions of these peptides have led to the identification of other proteins such as luteinizing inhibitor and clusterin. Immunological or molecular probes were also able to detect factors originally identified in other glands such as propiomelanocortin and atrial natriuretic factor.

Self-presentation -- Research, Identification (Psychology) -- Research, and Social psychology -- Research

Eighty undergraduate students were asked to describe themselves using high-level or low-level terms of action identification theory and self-presentation. The subjects were told that they were trying to impress an easily-impressionable person or a difficult-to-impress person. Ratings made by the subjects and observers showed that low-level terms of action identificationtheory and self-presentation such as smiling when appropriate, were more effective in terms of getting positive first impressions.

International trade, Laws, regulations and rules, Alcoholic beverage industry -- International trade, International trade regulation, and International trade -- Laws, regulations and rules

Public health often conflicts with economic benefit in trade agreements covering alcoholic beverages. In North America, states and provinces tend to bear the brunt of costs. Several alcohol trade and marketing agreements are discussed.

Adaptation, Psychological, Adult, Chronic Disease, Factor Analysis, Statistical, Female, Humans, Male, Regression Analysis, Social Support, Socioeconomic Factors, Surveys and Questionnaires, Life Change Events, Pain psychology, and Quality of Life

Cognitive appraisal processes or the meaning a person gives a stressful event are believed to mediate an individual's reaction to an event and, as such, have been demonstrated to explain adjustment to illness. The purpose of this paper is to test this cognitive as well as other social and illness variables to explain the variance in a person's adjustment to chronic pain. Two hundred and twenty-two patients, who were randomly selected from an original sample of referrals to a chronic pain specialty clinic, completed a questionnaire by telephone interview or mail. The questionnaire consisted of psychosocial scales (PAIS-SR; Social Support) and cognitions including the Meaning of Illness Questionnaire (MIQ). Fifty-six percent of the sample had poor psychosocial adjustment to their pain problem. Seventy percent of the variance in adjustment was explained by social and cognitive variables which corroborates their importance. The MIQ 5-factor structure was supported and provides credible evidence of the role of cognitions in differentiating between the poor and well adjusted.

Sea urchins -- Eggs and Spermatozoa -- Analysis

Western and Northern blot analyses and immunocytochemistry of the sea urchin egg receptor for sperm to study the receptor expression during oogenesis indicate that in the last two developmental phases of oogenesis the receptor mRNA level exhibits a very high increase despite the absence of receptor glycoprotein or receptor mRNA in the early oocytes. The development of receptor occurs in association with the spatial and temporal formation of cortical granules. Development of the receptor in the late stages and its localization to the cell surface and cortical granules indicates that the receptor mediates attachment of sperm to the surface of the mature egg cell.

Ambiguity -- Economic aspects, Decision-making -- Research, Insurance industry -- Psychological aspects, and Risk assessment -- Psychological aspects

Research is presented demonstrating the impact of ambiguity and risk on the insurance pricing decisions of underwriters. Premiums are shown to be substantially higher where there is uncertainty about potential loss levels and where the probability of an event occurring is ambiguous.

Physiological aspects, Kaposi's sarcoma -- Physiological aspects, HIV, Virus inactivation, HIV infections -- Physiological aspects, HIV (Viruses) -- Inactivation, and HIV infection -- Physiological aspects

Kaposi's sarcoma (KS) is a highly angiogenic multicentric tumor most commonly seen in immunodeficient individuals. Since the acquired immunodeficiency syndrome (AIDS) epidemic, KS has become one of the most common [...]
Unique among known human herpesviruses, Kaposi's sarcoma-associated herpesvirus (KSHV or HHV-8) encodes chemokine-like proteins (vMIP-I and vMIP-II). vMIP-II was shown to block infection of human immunodeficiency virus-type 1 (HIV-1) on a CD4-positive cell line expressing CCR3 and to a lesser extent on one expressing CCR5, whereas both vMIP-I and vMIP-II partially inhibited HIV infection of peripheral blood mononuclear cells. Like eotaxin, vMIP-II activated and chemoattracted human eosinophils by way of CCR3. vMIP-I and vMIP-II, but not cellular MIP-1 [Alpha] or RANTES, were highly angiogenic in the chorioallantoic assay, suggesting a possible pathogenic role in Kaposi's sarcoma.

Prevention, Complications and side effects, Evaluation, Tuberculosis -- Prevention, HIV infections -- Complications, Rifampin -- Evaluation, Pyrazinamide -- Evaluation, Isoniazid -- Evaluation, and HIV infection -- Complications

A short course of treatment with rifampicin and pyrazinamide may effectively prevent tuberculosis in HIV-infected people with a positive skin test for the disease. Researchers assigned 750 people in Haiti to six months of treatment with isoniazid or two months of treatment with rifampicin and pyrazinamide. Tuberculosis developed in 3.8% of the people who took isoniazid and 5% of those who took the two-drug combination. Both treatments provided similar levels of tuberculosis prevention, but people were more likely to comply with treatment instructions when the course of therapy was shorter.
Background Tuberculosis is a common complication of HIV-1 infection, especially in developing countries. Practical and effective chemoprophylaxis regimens for HIV-1-related tuberculosis are needed. Our aim was to test the efficacy of isoniazid versus rifampicin with pyrazinamide for prevention of tuberculosis in HIV-1-positive individuals. Methods We compared the efficacy of 6 months of isoniazid with 2 months of rifampicin and pyrazinamide for prevention of tuberculosis in HIV-1-seropositive individuals. Eligible participants were aged 16-77 years, HIV-1 seropositive, had a positive purified-protein derivative (PPD) skin test reaction of at least 5 mm, and had a normal chest radiograph. Participants were randomly assigned partially supervised twice weekly isoniazid for 24 weeks or twice weekly rifampicin and pyrazinamide for 8 weeks. Participants were followed up for up to 4 years for the development of tuberculosis and survival. Findings Tuberculosis developed in 14 (3.8%) of 370 participants assigned isoniazid and 19 (5.0%) of 380 participants assigned rifampicin and pyrazinamide (Cox model rate ratio 1.3 [95% CI 0.7-2.7]). The Kaplan-Meier estimate of the risk of tuberculosis during the first 10 months after entry was 3.7% among participants who received rifampicin and pyrazinamide compared with 1.0% (p=0.03) among participants who received isoniazid, and 5.4% versus 5.1%, respectively (p=0.9) at 36 months after entry. Higher rates of tuberculosis were observed in people with baseline CD4 percentages (of total lymphocytes) of less than 20 (rate ratio 40 [95% CI 1.8-9.0]). There were no significant differences in total mortality at any time. Interpretation Twice-weekly isoniazid preventive therapy for 6 months or rifampicin and pyrazinamide for 2 months provided similar overall protection against tuberculosis in HIV-1-infected. PPD-positive adults. The better protection among recipients of isoniazid during the first 10 months was most likely secondary to the longer duration of chemoprophylaxis. Preventive therapy for HIV-1-seropositive, PPD-positive individuals could be practical in developing countries with a once weekly clinic visit, but optimum duration of chemoprophylaxis has not been determined. Lancet 1998; 351: 786-92

Anger -- Research, Interpersonal conflict -- Research, Traffic police -- Psychological aspects, and Social psychology -- Research

This study evaluates the psychosocial correlates of anger-related traits. Participants include New York City traffic enforcement agents (TEAs), who issue summonses for vehicular and parking violations and are frequently confronted by angry motorists. This sample of TEAs is 53% African American and 57% female. Participants completed surveys at 2 points, 4 months apart, which measured attitudinal, affective, and expressive components of hostility and anger, as well as dimensions of workplace psychosocial response. Results indicate that trait anger-in was positively associated with frequency of conflict, anger intensity, and burnout in cross-sectional analyses; and positively associated with frequency of conflict in prospective analyses. Trait anger was positively associated with an increase in burnout over a 4-month period. These findings provide support for the transactional model of hostility and health and have implications for worksite interventions promoting cardiovascular health.

Adolescent, Adult, Age of Onset, Alleles, Child, Disease Progression, Female, Haplotypes genetics, Heterozygote, Humans, Male, Middle Aged, Molecular Sequence Data, Multiple Sclerosis pathology, Phenotype, Polymorphism, Single Nucleotide genetics, Probability, Survival Analysis, Apolipoproteins E genetics, Genetic Predisposition to Disease, Multiple Sclerosis genetics, Multiple Sclerosis physiopathology, and Polymorphism, Genetic genetics

Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system, with a complex etiology that includes a strong genetic component. The contribution of the major histocompatibility complex (MHC) has been established in numerous genetic linkage and association studies. In addition to the MHC, the chromosome 19q13 region surrounding the apolipoprotein E (APOE) gene has shown consistent evidence of involvement in MS when family-based analyses were conducted. Furthermore, several clinical reports have suggested that the APOE-4 allele may be associated with more-severe disease and faster progression of disability. To thoroughly examine the role of APOE in MS, we genotyped its functional alleles, as well as seven single-nucleotide polymorphisms (SNPs) located primarily within 13 kb of APOE, in a data set of 398 families. Using family-based association analysis, we found statistically significant evidence that an SNP haplotype near APOE is associated with MS susceptibility (P=.005). An analysis of disease progression in 614 patients with MS from 379 families indicated that APOE-4 carriers are more likely to be affected with severe disease (P=.03), whereas a higher proportion of APOE-2 carriers exhibit a mild disease course (P=.02).

Animals, Carcinogens, Environmental toxicity, Environmental Monitoring, Gasoline toxicity, Mollusca, Petroleum toxicity, and Polycyclic Aromatic Hydrocarbons toxicity

Fish and shellfish are exposed to a wide range of polycyclic aromatic hydrocarbons (PAH) following oil spills at sea, and can become contaminated as a result. Finfish have a more effective mixed-function oxidase enzyme system than shellfish, and are therefore able to metabolise and excrete PAH more effectively than the invertebrates. Thus, contamination by high-molecular weight PAH, including those with carcinogenic potential and so of concern with regard to human consumers, is therefore usually observed in shellfish, and particularly in bivalve molluscs. Oil spills are not the sole source of PAH, however, as parent compounds are also generated by a wide range of combustion processes. In this paper, consideration is given to monitoring data gathered following recent oil spills (both of crude oil and diesel fuel), alongside data from other studies. These include studies conducted around a former gasworks site and downstream of an aluminium smelter in the UK, and from mussel monitoring studies undertaken in the UK and the USA (including the Exxon Valdez oil spill and the National Status and Trends programme), and in other countries in Europe. For comparative purposes the PAH concentrations are summed and also expressed as benzo[a]pyrene equivalents, their relative concentrations being weighted in relation to the carcinogenic potential of individual PAH compounds using toxic equivalency factors (TEF). Our aim was to assess the utility of this approach in fishery resource monitoring and control following oil spills. Certainly this approach seems useful from the data assessed in this study. and the relative ranking of the various studies seems to reflect the relative degree of concern for human consumers due to the differing contamination sources. As a simple tool for control purposes it is equally applicable to PAH derived from oil spills, and from industrial and combustion sources.

Animals, Dose-Response Relationship, Drug, Drug Administration Schedule, Endothelin Receptor Antagonists, Endothelium, Vascular physiology, Enzyme Inhibitors pharmacology, Female, In Vitro Techniques, Infusion Pumps, Implantable, Nitric Oxide Synthase antagonists inhibitors, Peptides, Cyclic pharmacology, Pregnancy, Rats, Rats, Long-Evans, Receptor, Endothelin B, Vascular Patency drug effects, Vasoconstrictor Agents pharmacology, Vasodilator Agents pharmacology, Vasomotor System physiology, Arteries drug effects, Arteries physiology, Kidney blood supply, Relaxin pharmacology, and Vasomotor System drug effects

Administration of the ovarian hormone relaxin to nonpregnant rats vasodilates the renal circulation comparable to pregnancy. This vasodilation is mediated by endothelin (ET), the ET(B) receptor, and nitric oxide. Furthermore, endogenous relaxin mediates the renal vasodilation and hyperfiltration that occur during gestation. The goal of this study was to investigate whether myogenic reactivity of small renal and mesenteric arteries is reduced in relaxin-treated rats comparable to the pregnant condition. Relaxin or vehicle was administered to virgin female Long-Evans rats for 5 days at 4 microg/h, thereby producing midgestational blood levels of the hormone. The myogenic responses of small renal arteries (200-300 microm in diameter) isolated from these animals were evaluated in an isobaric arteriograph system. Myogenic reactivity was significantly reduced in the small renal arteries from relaxin-treated compared with vehicle-treated rats. The reduced myogenic responses were mediated by the ET(B) receptor and nitric oxide since the selective ET(B) receptor antagonist RES-701-1 and the nitric oxide synthase inhibitor N(G)-nitro-L-arginine methyl ester restored myogenic reactivity to virgin levels. The influence of relaxin was not limited to the renal circulation because myogenic reactivity was also reduced in small mesenteric arteries isolated from relaxin-treated rats. Thus relaxin administration to nonpregnant rats mimics pregnancy, insofar as myogenic reactivity of small renal and mesenteric arteries is reduced in both conditions.

Animals, Antithrombin III metabolism, Binding Sites, Brain Ischemia blood, Cattle, DNA Mutational Analysis, Factor Xa Inhibitors, Family Health, Genetic Variation, Humans, Hypercholesterolemia blood, Male, Middle Aged, Mutation, Missense, Protein Binding genetics, Antithrombin III chemistry, Antithrombin III genetics, and Heparin metabolism

Here we report the finding of a new natural antithrombin mutation that confirms the critical contribution of lysine 114 to the binding of the core heparin pentasaccharide, with the replacement of lysine 114 by glutamate causing a complete loss in affinity. The variant was identified in a father and son, the father having been investigated for an episode of cerebral ischaemia associated with hypercholesterolaemia. The variant forms SDS-stable complexes with activated factor X (fXa) and its thermal stability and rate of factor Xa inhibition in the absence of heparin are identical to those of normal antithrombin. Normal antithrombin binds to the high affinity heparin pentasaccharide with a Kd of 1nM, as detected by a 45% change in intrinsic fluorescence, resulting in a 230-fold increase in rate of factor Xa inhibition. However, no change in fluorescence was detected for the variant when titrated with heparin or the heparin pentasaccharide, nor was there detectable activation towards factor Xa, indicating a complete loss of heparin binding.

Chromosomes, Human, Pair 13, Chromosomes, Human, Pair 6, Chromosomes, Human, Pair 7, Genetic Heterogeneity, HLA-DR2 Antigen genetics, Humans, Lod Score, Multiple Sclerosis etiology, Genetic Linkage, Genetic Predisposition to Disease, and Multiple Sclerosis genetics

Multiple sclerosis (MS) is a common and frequently disabling autoimmune disorder mediated by autoaggressive T cells and autoantibodies that target central nervous system myelin. While numerous studies have demonstrated a strong genetic component to MS, it has been difficult to identify the specific genes involved. Several genomic screens have been undertaken to locate such genes, but have not provided consistent gene localization, except for the MHC on chromosome 6p21 and a locus on chromosome 19q13. To determine which of the original genomic locations presented in the US genome screen could be replicated, a more detailed analysis of additional families was performed. The results, derived from a population of 266 affected individuals belonging to 98 multiplex families, continue to support linkage to chromosomes 6p21, 6q27, and 19q13 with LOD scores>3.0, and suggest that regions on chromosomes 12q23-24 and 16p13 may also harbor susceptibility loci for MS. Analysis taking into account the known HLA-DR2 association identified two additional potential linkage regions on chromosomes 7q21-22 and 13q33-34. These regions can now be targeted for detailed study to identify the underlying MS susceptibility genes.

Consultants, Humans, Librarians, Personnel Staffing and Scheduling standards, Societies, Workforce, Information Management standards, Libraries, Hospital standards, Library Services standards, and Professional Role

The Medical Library Association's "Standards for Hospital Libraries 2002" have been developed as a guide for hospital administrators, librarians, and accrediting bodies to ensure that hospitals have the resources and services to effectively meet their needs for knowledge-based information. Specific requirements for knowledge-based information include that the library be a separate department with its own budget. Knowledge-based information in the library should be directed by a qualified librarian who functions as a department head and is a member of the Academy of Health Information Professionals. The standards define the role of the medical librarian and the links between knowledge-based information and other functions such as patient care, patient education, performance improvement, and education. In addition, the standards address the development and implementation of the knowledge-based information needs assessment and plans, the promotion and publicity of the knowledge-based information services, and the physical space and staffing requirements. The role, qualifications, and functions of a hospital library consultant are outlined. The health sciences library is positioned to play a key role in the hospital. The increasing use of the Internet and new information technologies by medical, nursing, and allied health staffs; patients; and the community require new strategies, strategic planning, allocation of adequate resources, and selection and evaluation of appropriate information resources and technologies. The Hospital Library Standards Committee has developed this document as a guideline to be used in facing these challenges.

Air Pollutants analysis, Aircraft, Humans, Musculoskeletal Diseases etiology, Musculoskeletal Diseases psychology, New York City, Occupational Diseases psychology, Occupational Health, Pilot Projects, Respiratory Tract Diseases psychology, Air Pollutants adverse effects, Occupational Diseases etiology, Occupational Exposure adverse effects, Rescue Work, Respiratory Tract Diseases etiology, and Terrorism

Aspergillus genetics, Aspergillus growth development, Blotting, Northern, Blotting, Southern, Fermentation, Heme metabolism, Mitosporic Fungi genetics, Peroxidase metabolism, Plasmids, Promoter Regions, Genetic, Aspergillus enzymology, Biotechnology methods, Mitosporic Fungi enzymology, and Peroxidase genetics

The heterologous production of Arthromyces ramosus peroxidase (ARP) was analysed in the filamentous fungus Aspergillus awamori under control of the inducible endoxylanase promoter. Secretion of active ARP was achieved up to 800 mg l(-1) in shake flask cultures. Western blot analysis showed that an rARP product of the correct molecular weight was produced. In contrast to several other studies about heterologous production of heme containing peroxidases, our results suggest that in A. awamori no heme limitation exists during overproduction of ARP.

Apoptosis drug effects, Butyrates pharmacology, Caco-2 Cells, Carcinoma drug therapy, Carcinoma metabolism, Carcinoma physiopathology, Caspase 3, Caspases drug effects, Caspases metabolism, Cell Adhesion drug effects, Cell Differentiation drug effects, Colonic Neoplasms drug therapy, Colonic Neoplasms metabolism, Colonic Neoplasms physiopathology, Down-Regulation drug effects, Down-Regulation physiology, Focal Adhesion Kinase 1, Focal Adhesion Protein-Tyrosine Kinases, Humans, Integrin beta1 drug effects, Integrin beta1 metabolism, Integrins drug effects, Intestinal Mucosa drug effects, NF-kappa B drug effects, NF-kappa B metabolism, Phosphatidylinositol 3-Kinases drug effects, Phosphatidylinositol 3-Kinases metabolism, Phosphorylation drug effects, Protein-Tyrosine Kinases drug effects, Protein-Tyrosine Kinases metabolism, Proto-Oncogene Proteins drug effects, Proto-Oncogene Proteins metabolism, Proto-Oncogene Proteins c-akt, Proto-Oncogene Proteins c-bcl-2 drug effects, Proto-Oncogene Proteins c-bcl-2 metabolism, Signal Transduction drug effects, Signal Transduction physiology, Sucrase drug effects, Sucrase metabolism, Apoptosis physiology, Cell Adhesion physiology, Cell Differentiation physiology, Integrins metabolism, Intestinal Mucosa metabolism, and Protein Serine-Threonine Kinases

We previously reported that the enterocytic differentiation of human colonic Caco-2 cells correlated with alterations in integrin signaling. We now investigated whether differentiation and apoptosis of Caco-2 cells induced by the short-chain fatty acid butyrate (NaBT) was associated with alterations in the integrin-mediated signaling pathway with special interest in the expression and activity of focal adhesion kinase (FAK), of the downstream phosphatidylinositol 3'-kinase (PI 3-kinase)-Akt pathway and in the role of the nuclear factor kappaB (NF-kappaB). NaBT increased the level of sucrase. It induced apoptosis as shown by: (1) decreased Bcl-2 and Bcl-X(L) proteins and increased Bax protein; (2) activation of caspase-3; and (3) increased shedding of apoptotic cells in the medium. This effect was associated with defective integrin-mediated signaling as shown by: (1) down-regulation of beta1 integrin expression; 2) decreased FAK expression and tyrosine phosphorylation; (3) concerted alterations in cytoskeletal and structural focal adhesions proteins (talin, ezrin); and (4) decreased FAK ability to associate with PI 3-kinase. However, in Caco-2 cells, beta1-mediated signaling failed to be activated downstream of FAK and PI 3-kinase at the level of Akt. Transfection studies show that NaBT treatment of Caco-2 cells promoted a significant activation of the NF-kappaB which was probably involved in the NaBT-induced apoptosis. Our results indicate that the prodifferentiating agent NaBT induced apoptosis of Caco-2 cells probably through NF-kappaB activation together with a defective beta1 integrin-FAK-PI 3-kinase pathways signaling.

Action Potentials physiology, Animals, Cells, Cultured, Cochlear Nerve physiology, Culture Techniques, Electric Stimulation methods, Immunohistochemistry, Kv1.1 Potassium Channel, Mice, Mice, Inbred CBA, Neurons classification, Neurons metabolism, Patch-Clamp Techniques, Potassium Channels biosynthesis, Protein Subunits biosynthesis, Reaction Time physiology, Neurons physiology, Potassium Channels, Voltage-Gated, and Spiral Ganglion cytology

Type I and type II spiral ganglion neurons convey auditory information from the sensory receptors in the cochlea to the CNS. The numerous type I neurons have been extensively characterized, but the small population of type II neurons with their unmyelinated axons are undetectable with most recording methods. Despite the paucity of information about the type II neurons, it is clear that they must have a significant role in sound processing because they innervate the large number of outer hair cells that are critical for maintaining normal responses to stimuli. To elucidate the function of type II neurons, we have developed an approach for studying their electrophysiological features in vitro. Type II neurons obtained from postnatal day 6-7 mice displayed distinctly different firing properties than type I neurons. They showed slower accommodation, lower action potential thresholds, and more prolonged responses to depolarizing current injection than the type I neurons. These differences were most evident in neurons from the basal, high-frequency region of the cochlea. The basal type I neurons displayed uniformly fast firing features, whereas the basal type II neurons showed particularly slow accommodation and responses to depolarization. Interestingly, neurons from the apical, low-frequency region of the cochlea showed the opposite trend. These data suggest that the type I and type II neurons have specialized electrophysiological characteristics tailored to their different roles in auditory signal processing. In particular, the type II neuron properties are consistent with cells in other sensory systems that receive convergent synaptic input for high-sensitivity stimulus detection.

Chromosomes, Human, Pair 1, Chromosomes, Human, Pair 19, Chromosomes, Human, Pair 3, Cooperative Behavior, France, Genetic Predisposition to Disease, HLA-DR Antigens genetics, HLA-DR Serological Subtypes, Humans, United States, Genetic Linkage genetics, and Multiple Sclerosis genetics

Multiple sclerosis (MS) is a demyelinating autoimmune disease with a strong yet complex genetic component. To date only the HLA-DR locus, and specifically the HLA-DR15 allele, has been identified and confirmed as influencing the risk of developing MS. Genomic screens on several datasets have been performed and have identified several chromosomal regions with interesting results, but none have yet been confirmed. We tested seven of the most-promising regions (on chromosomes 1p, 2p, 3p, 3q, 5q, 19q, and Xp) identified from several genomic screens in a dataset of 98 multiplex MS families from the United States and 90 multiplex MS families from France. The results did not confirm linkage to 2p, 3q, 5q, or Xp in the overall dataset, or in subsets defined by geographic origin or HLA-DR15 status. Regions on 1p34, 3p14, and 19q13 produced lod scores >0.90 in at least one subset of the data, suggesting that these regions should be examined in more detail.

Genetic Linkage, Genetic Markers, Genetic Predisposition to Disease, Humans, Lod Score, Chromosomes, Human, Pair 2, Chromosomes, Human, Pair 9, Cleft Lip genetics, and Cleft Palate genetics

Isolated or nonsyndromic cleft lip with or without cleft palate (CL/P) is a common birth defect with a complex etiology. A 10-cM genome scan of 388 extended multiplex families with CL/P from seven diverse populations (2,551 genotyped individuals) revealed CL/P genes in six chromosomal regions, including a novel region at 9q21 (heterogeneity LOD score [HLOD]=6.6). In addition, meta-analyses with the addition of results from 186 more families (six populations; 1,033 genotyped individuals) showed genomewide significance for 10 more regions, including another novel region at 2q32-35 (P=.0004). These are the first genomewide significant linkage results ever reported for CL/P, and they represent an unprecedented demonstration of the power of linkage analysis to detect multiple genes simultaneously for a complex disorder.

Animals, Animals, Newborn, Biopsy, Needle, Cell Movement, Disease Models, Animal, Female, Immunohistochemistry, Lung Compliance, Male, Positron-Emission Tomography, Probability, Pulmonary Ventilation, Random Allocation, Respiratory Distress Syndrome diagnostic imaging, Sensitivity and Specificity, Tidal Volume, Neutrophils physiology, Positive-Pressure Respiration methods, Respiratory Distress Syndrome pathology, and Respiratory Distress Syndrome therapy

Objectives: To compare the effects of low vs. high tidal volume (Vt) with three positive end-expiratory pressure (PEEP) strategies on activated neutrophil influx into the lung.
Design: Prospective, randomized controlled animal study.
Setting: Animal laboratory in a university hospital.
Subjects: Newborn piglets.
Interventions: Surfactant-depleted piglets were randomized in littermate pairs; to PEEP of either 0 (zero end-expiratory pressure [ZEEP]; n = 6), 8 cm H2O (PEEP 8; n = 5), or 1 cm H2O above the lower inflection point (LIP) (PEEP>LIP; n = 6). Within each pair piglets were randomized to a low VT (5-7 mL/kg) or high VT strategy (17-19 mL/kg). After 4 hrs of mechanical ventilation, 18-fluorodeoxyglucose (18FDG) was injected and positron emission tomography scanning was performed.
Measurements and Main Results: VT and PEEP changes on influx constants of 18FDG were assessed by analysis of variance. A within-litter comparison of Vt was nonsignificant (p = .50). A between-litter comparison, ordered in linear trend rank, from ZEEP, to PEEP 8, to PEEP>LIP, showed a strong effect of PEEP on influx constant (p = .019).
Conclusions: PEEP set above the LIP on the inspiratory limb of the pressure-volume curve affords a stronger lung protection than VT strategy.

Adult, Comorbidity, Ethnicity, Female, Humans, Interview, Psychological, Male, Obsessive-Compulsive Disorder complications, Prevalence, Schizophrenia epidemiology, Schizophrenia ethnology, Schizophrenic Psychology, South Africa epidemiology, Obsessive-Compulsive Disorder epidemiology, and Schizophrenia complications

Obsessive compulsive disorder (OCD) has been reported in up to 31% of schizophrenia sufferers. This study evaluated the presence of OCD in a Xhosa-speaking schizophrenia group. Xhosa patients (N = 509, including 100 sibships) with schizophrenia were recruited from hospital and community settings. The patients underwent a structured clinical interview for the presence of lifetime co-morbid schizophrenia and OCD. Only 3 patients (0.5%) fulfilled criteria for OCD. No concordance for OCD was noted in the sibship group. Our findings differ from those in other parts of the world, and if replicated, might suggest unique protective environmental or genetic factors for OCD in certain ethnic groups.

Adaptation, Psychological, Adult, Age Distribution, Comorbidity, Female, HIV Infections psychology, Health Care Costs statistics numerical data, Health Care Surveys, Health Expenditures statistics numerical data, Health Services statistics numerical data, Health Status, Health Surveys, Humans, Male, Middle Aged, Ontario epidemiology, Prevalence, Quality of Life, Risk Factors, Sex Distribution, Socioeconomic Factors, Depression economics, Depression epidemiology, HIV Infections economics, and HIV Infections epidemiology

As new technologies extend the lives of people living with HIV/AIDS (PHA), the need increases for services that optimize their quality-of-life cost effectively. This study of PHAs (n = 297) in Ontario, Canada, examined the prevalence of depression, and its association with quality-of-life, coping strategies, social support, and use of health and social services. Results showed that depression was widespread (54.2%) and largely unrelated to demographic characteristics, but associated with diminished health status, health-related quality-of-life, and coping strategies. Depressed PHAs used significantly more crisis health care and related services, and community-based HIV/AIDS service organizations (ASOs). Findings suggest quality-of-life of PHAs may be improved by expanding the capacity of ASO workers to recognize and address depression, including helping depressed PHA access appropriate medication and sustain medication regimes.

Humans, Information Management standards, Library Associations standards, Professional Role, United States, Information Storage and Retrieval standards, Librarians, Libraries, Hospital standards, and Library Services standards

Adolescent, Base Sequence, Child, Child, Preschool, Choristoma genetics, Chromosomes, Human, X, Gene Duplication, Human Growth Hormone deficiency, Humans, Infant, Male, Molecular Sequence Data, Mutation, Pedigree, Phenotype, Pituitary Gland, Anterior, Polymorphism, Genetic, SOXB1 Transcription Factors, DNA-Binding Proteins genetics, High Mobility Group Proteins genetics, Hypopituitarism genetics, Pituitary Gland, Posterior abnormalities, and Transcription Factors genetics

Duplications of Xq26-27 have been implicated in the etiology of X-linked hypopituitarism associated with mental retardation (MR). Additionally, an expansion of a polyalanine tract (by 11 alanines) within the transcription factor SOX3 (Xq27.1) has been reported in patients with growth hormone deficiency and variable learning difficulties. We report a submicroscopic duplication of Xq27.1, the smallest reported to date (685.6 kb), in two siblings with variable hypopituitarism, callosal abnormalities, anterior pituitary hypoplasia (APH), an ectopic posterior pituitary (EPP), and an absent infundibulum. This duplication contains SOX3 and sequences corresponding to two transcripts of unknown function; only Sox3 is expressed in the infundibulum in mice. Next, we identified a novel seven-alanine expansion within a polyalanine tract in SOX3 in a family with panhypopituitarism in three male siblings with an absent infundibulum, severe APH, and EPP. This mutation led to reduced transcriptional activity, with impaired nuclear localization of the mutant protein. We also identified a novel polymorphism (A43T) in SOX3 in another child with hypopituitarism. In contrast to findings in previous studies, there was no evidence of MR or learning difficulties in our patients. We conclude that both over- and underdosage of SOX3 are associated with similar phenotypes, consisting of infundibular hypoplasia and hypopituitarism but not necessarily MR.

Adaptation, Psychological, Chi-Square Distribution, Community Health Services economics, Cross-Sectional Studies, Depression virology, Female, Financing, Personal statistics numerical data, HIV Infections complications, HIV Infections epidemiology, Health Care Surveys, Health Expenditures statistics numerical data, Health Services Needs and Demand, Health Status, Health Surveys, Humans, Karnofsky Performance Status, Male, Ontario epidemiology, Poverty psychology, Poverty statistics numerical data, Quality of Life, Social Work statistics numerical data, Socioeconomic Factors, Surveys and Questionnaires, Community Health Services statistics numerical data, HIV Infections psychology, Patient Acceptance of Health Care psychology, and Patient Acceptance of Health Care statistics numerical data

Community-based AIDS service organizations (CBAOs) direct services to multiple-needs people living with HIV/AIDS who are less likely to use mainstream health promotion services. As people live longer with HIV, the potential to enhance quality of life increases, yet little is known about who uses CBAOs or how this use affects other health and social services. This study of people living with AIDS in Ontario, Canada (n = 297) examined the demographic and health-related characteristics of people with AIDS who do and do not use CBAOs and their patterns of mainstream service utilization. It found that users of CBAOs were significantly less healthy, less able to sustain normal activities, and more often depressed. They reported physical disabilities significantly more often. Their quality of life was also lower along certain dimensions. They were significantly poorer and more reliant on government income supports. They consumed significantly more nonhospital health and social services and had significantly higher out-of-pocket costs. These results suggest CBAOs are being accessed appropriately by those most vulnerable. In an effort to strengthen CBAO capacity to recognize and address depression and physical health problems prevalent among their clients, links to other mainstream health promotion and social services is recommended.

Australia, Chromosome Mapping, Europe, Family, Genetic Markers genetics, Genomics methods, Humans, Middle Aged, United States, Chromosomes, Human genetics, Genetic Linkage, Genetic Predisposition to Disease genetics, Genetic Testing methods, and Multiple Sclerosis genetics

To provide a definitive linkage map for multiple sclerosis, we have genotyped the Illumina BeadArray linkage mapping panel (version 4) in a data set of 730 multiplex families of Northern European descent. After the application of stringent quality thresholds, data from 4,506 markers in 2,692 individuals were included in the analysis. Multipoint nonparametric linkage analysis revealed highly significant linkage in the major histocompatibility complex (MHC) on chromosome 6p21 (maximum LOD score [MLS] 11.66) and suggestive linkage on chromosomes 17q23 (MLS 2.45) and 5q33 (MLS 2.18). This set of markers achieved a mean information extraction of 79.3% across the genome, with a Mendelian inconsistency rate of only 0.002%. Stratification based on carriage of the multiple sclerosis-associated DRB1*1501 allele failed to identify any other region of linkage with genomewide significance. However, ordered-subset analysis suggested that there may be an additional locus on chromosome 19p13 that acts independent of the main MHC locus. These data illustrate the substantial increase in power that can be achieved with use of the latest tools emerging from the Human Genome Project and indicate that future attempts to systematically identify susceptibility genes for multiple sclerosis will have to involve large sample sizes and an association-based methodology.

Adult, Aged, Cohort Studies, Disability Evaluation, Female, Humans, Inpatients, Longitudinal Studies, Male, Middle Aged, Ontario, Patient Transfer, Predictive Value of Tests, Probability, Prospective Studies, Recovery of Function, Risk Factors, Socioeconomic Factors, Treatment Outcome, Activities of Daily Living, Continuity of Patient Care organization administration, Patient Discharge, Physical Therapy Modalities, and Rehabilitation Centers organization administration

Objective: To determine which sociodemographic and clinical characteristics of patients admitted to a general activation service (GAS) are predictive of discharge to patients' discharge goal locations (DGLs).
Design: Prospective cohort study.
Setting: Rehabilitation and complex continuing care hospital in southern Ontario, Canada.
Participants: Patients admitted from January 2000 to December 2002 (N=154).
Intervention: The GAS.
Main Outcome Measure: Patients indicated on their service applications where they wanted to be discharged. This is termed the DGL.
Results: Fifty-three percent of the sample were discharged to their DGLs. Ninety-eight percent of these patients were discharged by 9 months. Eighty-seven percent who were discharged to their DGLs were discharged to their own home. Predictors of being discharged to the DGL were better activities of daily living scores, good vision, and having sufficient help at home. Expert clinician opinion of the likelihood of each patient being discharged to his/her DGL, based on initial assessment, was also predictive of each patient's eventual discharge to his/her DGL.
Conclusions: The GAS has a 53% success rate in discharging patients to their DGLs. Variables have been identified that should be useful in predicting whether patients will be discharged to their DGLs. Our findings are meaningful and informative in determining future admission criteria for the service.

Adult, Antipsychotic Agents therapeutic use, Humans, Hysteria drug therapy, Male, Religion and Psychology, South Africa, Syndrome, Culture, Hysteria psychology, and Hysteria rehabilitation

Adult, Chi-Square Distribution, Demography, Factor Analysis, Statistical, Family Health, Female, Humans, Male, Middle Aged, Schizophrenia complications, Severity of Illness Index, South Africa epidemiology, Psychiatric Status Rating Scales, Schizophrenia diagnosis, Schizophrenia epidemiology, Schizophrenic Psychology, and Sibling Relations

Careful phenotyping and the identification of subtypes of schizophrenia can contribute significantly to the success of genetic studies in schizophrenia. The phenomenology of schizophrenia in affected sib pairs has been well-described in Caucasian populations, however a paucity of data exists for African populations. This study therefore investigated symptom dimensions in a sizeable group of affected Xhosa sib pairs as a means of evaluating the role of shared familial factors in the psychosis of schizophrenia. Five hundred and thirteen participants were interviewed with the Diagnostic Interview for Genetic Studies (DIGS), which included the Schedules for the Assessment of Negative and Positive symptoms (SANS/SAPS). One hundred and four sib pairs were then extracted (N = 208) for analysis of concordance for lifetime psychotic symptoms and an exploratory factor analysis of the SANS/SAPS. Concordance analysis of life-time symptoms indicated a significant concordance for olfactory hallucinations, persecutory delusions, jealousy, somatic, reference and control delusions as well as thought insertion and withdrawal. The factor analysis of the global scores of the SAPS and SANS revealed a five factor best-fit model and accounted for 92.5% of variance. The factors included a negative symptom factor, a positive symptom factor, a positive thought disorder and a bizarre behaviour component. The core symptomatology of schizophrenia in this sib pair sample was similar to that reported in Caucasian populations with the exception of higher rates of auditory hallucinations and delusions of persecution. In summary therefore; although the factor analysis only supported the concept of the universality of psychotic symptoms in schizophrenia, the concordance analysis of these symptoms did reveal hallucinations as well as delusions of control as possible candidates relevant for future research into genotype-phenotype relationships.

Antineoplastic Agents chemical synthesis, Humans, Microtubules drug effects, Molecular Structure, Structure-Activity Relationship, Triazoles chemical synthesis, Tubulin Modulators chemical synthesis, Tumor Cells, Cultured, Antineoplastic Agents chemistry, Antineoplastic Agents pharmacology, Triazoles chemistry, Triazoles pharmacology, Tubulin Modulators chemistry, and Tubulin Modulators pharmacology

A novel triazole-containing chemical series was shown to inhibit tubulin polymerization and cause cell cycle arrest in A431 cancer cells with EC(50) values in the single digit nanomolar range. Binding experiments demonstrated that representative active compounds of this class compete with colchicine for its binding site on tubulin. The syntheses and structure-activity relationship studies for the triazole derivatives are described herein.

Community-Acquired Infections epidemiology, Drug Resistance, Bacterial, Electrophoresis, Gel, Pulsed-Field, Florida epidemiology, Humans, Staphylococcus aureus isolation purification, Washington epidemiology, Wound Infection epidemiology, Wound Infection microbiology, Community-Acquired Infections microbiology, Methicillin pharmacology, Methicillin Resistance, Staphylococcal Infections epidemiology, and Staphylococcus aureus drug effects

We examined 299 methicillin-resistant, community-associated Staphylococcus aureus isolates from Florida and Washington State for the presence of the USA300 epidemic clone. Pulsed-field gel electrophoresis demonstrated the epidemic clone in 43% of our S. aureus strains and in isolates from both states. The majority of the USA300 isolates (88%) were from wound infections.

Animals, Antimitotic Agents chemistry, Antimitotic Agents classification, Biopolymers chemistry, Biopolymers metabolism, Cell Line, Tumor, Humans, Inhibitory Concentration 50, Mice, Molecular Structure, Oxadiazoles chemical synthesis, Oxadiazoles classification, Protein Conformation drug effects, Structure-Activity Relationship, Antimitotic Agents chemical synthesis, Antimitotic Agents pharmacology, Oxadiazoles chemistry, Oxadiazoles pharmacology, Tubulin chemistry, and Tubulin metabolism

Oxadiazole derivatives were synthesized and evaluated for their ability to inhibit tubulin polymerization and to cause mitotic arrest in tumor cells. The most potent compounds inhibited tubulin polymerization at concentrations below 1 microM. Lead analogs caused mitotic arrest of A431 human epidermoid cells and cells derived from multi-drug resistant tumors (10, EC(50)=7.8 nM). Competition for the colchicine binding site and pharmacokinetic properties of selected potent compounds were also investigated and are reported herein, along with structure-activity relationships for this novel series of antimitotic agents.

Administration, Oral, Animals, Antioxidants administration dosage, Ascorbic Acid administration dosage, Dose-Response Relationship, Drug, Female, Fetal Weight drug effects, Gestational Age, Methacholine Chloride pharmacology, Phenylephrine pharmacology, Pregnancy, Rats, Rats, Mutant Strains, Vasoconstrictor Agents pharmacology, Vasodilator Agents pharmacology, Vasomotor System drug effects, Antioxidants pharmacology, Ascorbic Acid pharmacology, Ascorbic Acid Deficiency physiopathology, Mesenteric Arteries physiopathology, Pregnancy Complications physiopathology, and Vasomotor System physiopathology

Plasma ascorbic acid is decreased in women with the pregnancy disorder preeclampsia. We used a mutant strain of rats (Osteogenic Disorder Shionogi), dependent on dietary sources of vitamin C, to investigate whether reduced intake of the vitamin would differentially affect vascular function in late-pregnant (day 19) and age-matched virgin rats. The animals were given either 1 mg/mL of ascorbic acid ad libitum in drinking water [fully supplemented (FS)] or 0.25 mg/mL [marginally supplemented (MS)]. Fetal weights were 21% lower in MS than FS rats, whereas mean maternal weights and pup numbers did not differ. Small mesenteric arteries (diameter, 268+/-7 microm) were mounted in a pressurized arteriograph. Myogenic reactivity (contractile response to step increases in intraluminal pressure) was increased in arteries from MS pregnant compared with FS pregnant rats to levels observed in virgin rats. Ascorbic acid intake did not affect myogenic responses of arteries from virgin rats. Hence, the normal pregnancy-induced reduction in myogenic reactivity was abrogated in MS pregnant animals. Inhibition of nitric oxide synthase had no effect on the myogenicity of arteries from virgin or MS pregnant rats but increased myogenicity of FS pregnant rats to the level of MS pregnant rats. Free radical scavengers reversed the accentuated myogenicity of MS pregnant rats without affecting FS pregnant or virgin rat arteries. These data indicate that moderate ascorbate deprivation increases mesenteric artery myogenic responsiveness during pregnancy. This increase may result from a decrease in nitric oxide-mediated modulation of the myogenic contractile response.

Adenosine Triphosphate metabolism, Azepines chemistry, Binding Sites, Cell Proliferation drug effects, Cells, Cultured, Humans, Molecular Structure, Phosphorylation drug effects, Protein Kinase Inhibitors chemistry, Protein Serine-Threonine Kinases antagonists inhibitors, Protein-Tyrosine Kinases antagonists inhibitors, Receptor, ErbB-2 antagonists inhibitors, Structure-Activity Relationship, Substrate Specificity, Azepines chemical synthesis, Azepines pharmacology, ErbB Receptors antagonists inhibitors, Protein Kinase Inhibitors chemical synthesis, and Protein Kinase Inhibitors pharmacology

A novel class of pyrimido[4,5-b]-1,4-benzoxazepines is described as inhibitors of epidermal growth factor receptor (EGFR) tyrosine kinase. Two compounds display potent EGFR inhibitory activity of less than 1 microM in cellular phosphorylation assays (IC(50) 0.47-0.69 microM) and are highly selective against a small kinase panel. Such compounds demonstrate anti-EGFR activity within a class that is different from any known EGFR inhibitor scaffolds. They also provide a basis for the design of kinase inhibitors with the desired selectivity profile.

Anxiety epidemiology, Asbestos adverse effects, Construction Materials adverse effects, Depression epidemiology, Dust, Humans, Inhalation Exposure adverse effects, Mineral Fibers adverse effects, Neoplasms epidemiology, Particle Size, Polycyclic Aromatic Hydrocarbons adverse effects, Respiratory Tract Diseases epidemiology, Respiratory Tract Diseases etiology, Risk Factors, Stress Disorders, Post-Traumatic epidemiology, Stress Disorders, Post-Traumatic etiology, Air Pollutants adverse effects, Environmental Exposure adverse effects, Occupational Exposure adverse effects, and September 11 Terrorist Attacks psychology

In the aftermath of the September 11 World Trade Center (WTC) attack, a large number of people sustained potential exposures to smoke, dust, particulate matter, and a variety of toxins, including asbestos, pulverized concrete, glass fibers, polycyclic aromatic hydrocarbons (PAHs), and polychlorinated furans and dioxins. Additionally, many had exposure to psychological traumatogens. The most common effects seen to date are respiratory and mental health consequences. The long-term consequences of exposures are not yet known, and there remains concern about the potential for late-emerging diseases such as cancers. This article reviews WTC-related health effects, the spectrum of exposures and how they were documented, and discusses future preventive efforts.

Adaptation, Psychological, Aged, Aged, 80 and over, Depression psychology, Emotions, Female, Health Care Costs, Health Promotion economics, Health Status, Home Nursing economics, Humans, Male, Mental Health, Patient Acceptance of Health Care, Patient Dropouts, Quality of Life, Single-Blind Method, Social Support, Frail Elderly psychology, Health Promotion methods, and Home Nursing methods

Aim: This paper reports a study evaluating the comparative effects and costs of a proactive nursing health promotion intervention in addition to usual home care for older people compared with usual home care services alone.
Background: An ageing population, budget constraints and technological advances in many countries have increased the pressure on home care resources. The result is a shift in nursing services from health promotion to meet the more pressing need for postacute care. For frail older people with long-term needs, these changes combine to create a fragmented system of health service delivery, characterized by providing nursing on demand rather than proactively.
Methods: A two-armed, single-blind, randomized controlled trial was carried out with older people > or =75 years and eligible for personal support services through a home care programme in Ontario, Canada. Participants were randomly allocated either to usual home care (control) or to a nursing (experimental) group. In addition to usual home care, the nursing group received a health assessment combined with regular home visits or telephone contacts, health education about management of illness, coordination of community services, and use of empowerment strategies to enhance independence. The data were collected in 2001-2002.
Results: Of the 288 older people who were randomly allocated at baseline, 242 (84%) completed the study (120 nursing group; 122 control group). Proactively providing older people with nursing health promotion, compared with providing nursing services on-demand, resulted in better mental health functioning (P = 0.009), a reduction in depression (P = 0.009), and enhanced perceptions of social support (P = 0.009) at no additional cost from a societal perspective.
Conclusions: Home based nursing health promotion, proactively provided to frail older people with chronic health needs, enhances quality of life while not increasing the overall costs of health care. The results underscore the need to re-invest in nursing services for health promotion for older clients receiving home care.

Bipolar Disorder diagnostic imaging, Bipolar Disorder physiopathology, Humans, Limbic System physiopathology, Magnetic Resonance Imaging, Mood Disorders physiopathology, Positron-Emission Tomography, Bipolar Disorder pathology, and Bipolar Disorder psychology

Antineoplastic Agents pharmacology, Azepines chemistry, Cell Line, Tumor, Heterocyclic Compounds, 3-Ring chemistry, Humans, Inhibitory Concentration 50, Neoplasm Proteins antagonists inhibitors, Phosphorylation drug effects, Structure-Activity Relationship, Vascular Endothelial Growth Factor Receptor-2 antagonists inhibitors, Antineoplastic Agents chemical synthesis, Azepines chemical synthesis, Azepines pharmacology, ErbB Receptors antagonists inhibitors, Heterocyclic Compounds, 3-Ring chemical synthesis, and Heterocyclic Compounds, 3-Ring pharmacology

Novel tricyclic derivatives containing an oxazepine, thiazepine, or diazepine ring were studied for their EGFR tyrosine kinase inhibitory activity. While the oxazepines were in general more potent than thiazepines, the diazepines displayed somewhat different structure-activity relationships. Moreover, the diazepines, in contrast to the oxazepines, showed appreciable inhibitory activity against the KDR tyrosine kinase. Furthermore, both oxazepines and diazepines demonstrated significant ability to inhibit autophosphorylation of EGFR in DiFi cells (generally, IC(50) values in the single-digit micromolar to submicromolar range).

Adult, Cross-Over Studies, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Practice Patterns, Physicians', Research Design, Rheumatology trends, Sickness Impact Profile, Surveys and Questionnaires, Treatment Outcome, Amitriptyline therapeutic use, Antidepressive Agents therapeutic use, Fibromyalgia drug therapy, Fluoxetine therapeutic use, and Randomized Controlled Trials as Topic statistics numerical data

Objective: Applying population research to individual treatment requires understanding the connections between patient-specific characteristics, population-based studies, and treatment responses. Conducting practice-based research using individual-focused (N-of-1) trials may aid this process. We combined N-of-1 trials to compare fibromyalgia therapies and to assess the feasibility and outcomes of this approach for practice-based effectiveness research.
Methods: Community- and center-based rheumatologists enrolled patients with fibromyalgia syndrome in randomized, double-blind, multi-crossover, N-of-1 trials comparing amitriptyline and the combination amitriptyline and fluoxetine. Fibromyalgia Impact Questionnaire outcomes were used for the individuals' treatment and combined across patients for sample-based analyses. Outcomes were compared with results from more standard trial designs.
Results: Eight rheumatologists enrolled 58 patients in N-of-1 trials. Most physicians and patients had not previously participated in clinical trials. Using several analytic methods, the pooled results showed a better outcome score (mean difference: -6.1 +/- 2.0 to -8.0 +/- 3.7 points) in patients taking combination therapy. These population results are similar to published outcomes from a more traditional crossover trial. Neither practice type nor patient characteristics were significantly associated with the observed treatment-effect variation. Most participants, irrespective of selected treatment, felt their individual N-of-1 trials were helpful.
Conclusion: Implementation of the combined N-of-1 methodology is feasible in rheumatology practices and results confirm greater fibromyalgia improvement with combination therapy. This research approach broadens participation, although our trials' specifics likely influenced enrollment eligibility. In addition to individual benefits, combining N-of-1 trial data provides population research benefits. This patient-focused approach should be further explored to bridge research and practice.

Aged, House Calls, Humans, Randomized Controlled Trials as Topic, Geriatric Nursing, Health Promotion, Home Care Services, and Program Evaluation

Despite the large potential role that community nurses have in providing individualized health promotion to older people, there is a lack of consensus in the literature regarding this role's effectiveness and efficiency. This article presents a literature review and synthesis of 12 randomized controlled trials selected from 344 published studies on preventive home visitation programs for older people. The findings suggest that a diversity of home visiting interventions carried out by nurses can favorably affect health and functional status, mortality rates, use of hospitalization and nursing homes, and costs. Further research is needed that focuses on the outcomes of quality of life, mental health, social support, caregiver burden, the acceptability of intervention, and specific subgroups of clients who benefit most. Findings also indicate the need for a theoretical foundation, increased emphasis on health-promotion strategies, and more research using a more complete economic evaluation to establish efficiency.

Adolescent, Adult, Aged, Aged, 80 and over, Air Pollution adverse effects, Air Pollution analysis, Dust analysis, Female, Humans, Male, Mass Screening methods, Middle Aged, Occupational Diseases etiology, Occupational Diseases physiopathology, Respiratory Tract Diseases etiology, Respiratory Tract Diseases physiopathology, Spirometry, Time Factors, Occupational Diseases diagnosis, Occupational Exposure adverse effects, Respiratory Tract Diseases diagnosis, and September 11 Terrorist Attacks

Background: Approximately 40,000 rescue and recovery workers were exposed to caustic dust and toxic pollutants following the 11 September 2001 attacks on the World Trade Center (WTC). These workers included traditional first responders, such as firefighters and police, and a diverse population of construction, utility, and public sector workers.
Methods: To characterize WTCrelated health effects, the WTC Worker and Volunteer Medical Screening Program was established. This multicenter clinical program provides free standardized examinations to responders. Examinations include medical, mental health, and exposure assessment questionnaires; physical examinations; spirometry; and chest X rays.
Results: Of 9,442 responders examined between July 2002 and April 2004, 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. Among those who had been asymptomatic before September 11, 61% developed respiratory symptoms while performing WTC work. Twenty-eight percent had abnormal spirometry; forced vital capacity (FVC) was low in 21%; and obstruction was present in 5%. Among nonsmokers, 27% had abnormal spirometry compared with 13% in the general U.S. population. Prevalence of low FVC among nonsmokers was 5-fold greater than in the U.S. population (20% vs. 4%). Respiratory symptoms and spirometry abnormalities were significantly associated with early arrival at the site.
Conclusion: WTC responders had exposure-related increases in respiratory symptoms and pulmonary function test abnormalities that persisted up to 2.5 years after the attacks. Longterm medical monitoring is required to track persistence of these abnormalities and identify late effects, including possible malignancies. Lessons learned should guide future responses to civil disasters.