The initiation of mutual-help groups within residential treatment settings

Mutual- and self-help groups for persons with severe mental illness have typically been most accessible to individuals who live independently. In an effort to make their organization more accessible to those who live in residential treatment facilities, Schizophrenics Anonymous (SA) ran introductory mutual-help meetings in four group homes. The results of a quantitative/qualitative case study of this effort are reported. The SA meetings were characterized as more and less successful based on the criteria of residents' attendance, participation, evaluation of the meetings, and interest in continued participation. The following characteristics distinguished between more and less successful meetings: staff support, referent power (i.e., identification with group leaders), and resident characteristics (e.g., gender, education, marital status, level of symptomatology). In spite of behavioral and self-reported evidence of interest and involvement in the meetings and the potential for continued involvement in the organization, no group home residents continued their participation in SA following the introductory meetings. This finding is interpreted from an institutional theory perspective that focuses on incompatibility between the ideologies underlying mutual help and the residential treatment system.

Psychological adaptation and adjustment of mothers of children with congenital heart disease: stress, coping, and family functioning

OBJECTIVE

Investigate support for the transactional stress and coping model for mothers of children with congenital heart defects, in accounting for the variance in maternal adjustment.

METHODS

Participants were 52 mothers of children recruited from a university medical center. Measures included illness variables, cognitive processes (i.e., appraisals of stress, expectations, methods of coping, family functioning, and maternal psychological adjustment).

RESULTS

Maternal adjustment was associated with high levels of daily stress and palliative coping techniques and was not significantly associated with severity of the cardiac defect. Together, the variables of the model accounted for approximately 38% of the variance in maternal adjustment.

CONCLUSIONS

The findings are in accord with previous research among other chronically ill populations in suggesting an association between stress, coping, and maternal adjustment. Within the limitations of the study, the data were interpreted to support the utility of theoretical models in identifying areas in need of intervention across chronic illness groups.

Binding affinity independent contribution of peptide length to the stability of peptide-HLA-DR complexes in live antigen presenting cells

The effect of peptide length on the stability of peptide-HLR-DR1 (DR1) complexes was analyzed using two peptide series of increasing length, each containing a 7mer core with five DR1-binding anchors, extended stepwise with Ala residues at the N- and C-terminus, respectively. The Ala extensions, although did not affect binding affinity, significantly increased the half lives of peptide-DR1 complexes (from 1.5 h up to 10 h) in live antigen presenting cells (APC). Flanking residues from position -2 to 0 and 8 to 11 were involved in the affinity-independent increase of complex stability. The shortest (8mer and 9mer) peptides, with in vivo half lives of <2.5 h, were unable to form stable complexes with DR1 in presence of HLA-DM (DM) molecules, and were poor competitors of antigen presentation. Longer peptides were resistant to DM-mediated unloading, and were efficient competitors of antigen presentation. Thus, DM appears to limit short peptides in establishing biologically relevant DR occupancy, despite their high binding affinity. In APC, stable complexes can form only with high affinity peptides of >9 residues, and the longevity of complexes seems to depend on full of occupation of the binding site.

The community response to rape: victims' experiences with the legal, medical, and mental health systems

This research examined how the legal, medical, and mental health systems respond to the needs of rape victims. A national random sample of rape victim advocates (N = 168) participated in a phone interview that assessed the resources available to victims in their communities, as well as the specific experiences of the most recent rape victim with which they had completed work. Results from hierarchical and iterative cluster analysis revealed three patterns in victims' experiences with the legal, medical, and mental health systems. One group of victims had relatively positive experiences with all three systems, a second group had beneficial outcomes with only the medical systems, and the final group had difficult encounters with all three systems. Multinominal logistic regression was then used to evaluate an ecological model predicting cluster membership. Community-level factors as well as features of the assault and characteristics of the victims predicted unique variance in victims' outcomes with the legal, medical, and mental health systems. These findings provide empirical support for a basic tenet of ecological theory: environmental structures and practices influence individual outcomes. Implications for ecological theory and interventions to improve the community response to rape victims' needs are discussed.

Remaining radical? Organizational predictors of rape crisis centers' social change initiatives

Rape crisis centers have undergone significant changes since their birth during the feminist movement of the 1970s. As has happened with many other radical social movements, there is growing evidence that the antirape movement has become more institutionalized. This research used a combination of quantitative and qualitative methods to examine the current structure and functions of a national random sample of 168 rape crisis centers. An organizational-level model predicting involvement in three types of social change activities was tested: (a) participation in public demonstrations to raise awareness about sexual assault; (b) political lobbying for violence against women legislation; and (c) primary prevention programs to eliminate sexual violence against women. Results of logit modeling suggested that how long a rape crisis center had been in existence moderated the relationships between organizational characteristics and involvement in community activism. Findings of this study suggest that although many of today's centers bear little resemblance to the grass-roots collectives of years past, rape crisis centers have been remarkably adaptive in weathering changing political climates to continue to provide comprehensive services for rape victims.

New assay technologies for high-throughput screening

The use of high-throughput screening for early stage drug discovery imposes several constraints on the format of assays for therapeutic targets of interest. Homogeneous cell-free assays based on energy transfer, fluorescence polarization spectroscopy or fluorescence correlation spectroscopy provide the sensitivity, ease, speed and resistance to interference from test compounds needed to function in a high-throughput screening mode. Similarly, novel cell-based assays are now being adapted for high-throughput screening, providing for in situ analysis of a variety of biological targets. Finally, recent advances in assay miniaturization mark a transition to ultra high-throughput screening, ensuring that identification of lead compounds will not be the rate-limiting step in finding new drugs.

Measurement of Clostridium perfringens beta-toxin production by surface plasmon resonance immunoassay

A rapid and sensitive assay using surface plasmon resonance (SPR) immunoassay has been developed for the detection of Clostridium perfringens beta-toxin. The SPR immunoassay was conducted off-line by passing fermentation broth by a sensor chip coated with a monoclonal antibody specific for C. perfringens beta-toxin. Quantitation of toxin using SPR immunoassay was achieved by mass transport analysis; results were obtained within 20 min. The SPR immunoassay was compared with an ELISA and the traditional bioassay for C. perfringens beta-toxin. The SPR immunoassay and ELISA detected at least twofold differences in toxin levels at 95% confidence over a broad range of toxin concentrations. The traditional bioassay did not produce the resolution observed with the immunoassays. The SPR immunoassay allows for real-time monitoring of beta-toxin accumulation during production and permits the bioengineer to harvest C. perfringens fermentations when toxin is most concentrated. The SPR methodology may be applied to other fermentations to enhance and optimize toxin yields.

Executive function in treated phenylketonuria as measured by the one-back and two-back versions of the continuous performance test

The executive dysfunction hypothesis in treated phenylketonuria was investigated by means of the one-back and two-back versions of the continuous performance test. Eleven non-retarded, primary school-age children with classical phenylketonuria who had been treated early and continuously were indistinguishable from healthy, matched controls on the measures and test performance was not predicted by historical or concurrent plasma phenylalanine concentrations. Mean lifetime phenylalanine concentrations for the phenylketonuric subjects were within ranges currently recommended as dietary optima in the United Kingdom. The negative neuropsychological test findings add weight to the rationale for this policy.

Total hip arthroplasty in an adult with proximal femoral focal deficiency

A 40-year-old woman with isolated unilateral proximal femoral focal deficiency presented with 2 years of gradually increasing left hip pain that interfered with her activities of daily living. A total hip arthroplasty was performed through a posterior approach. At 12 months, she had minimal discomfort about the hip, a markedly increased level of activity, and improved gait, and she required no ambulatory aids. This procedure is cautiously recommended for use in selected patients with proximal femoral focal deficiency.

Kawasaki disease and the T-cell antigen receptor

We investigated the evidence for an infectious etiology of Kawasaki disease (KD), an acute vasculitis of unknown etiology, by assessing the effects of KD on the T cell antigen receptor variable beta region families (V beta). Using 3-color flow cytometry, we studied KD patients pre- and post-intravenous gamma globulin (IVIG) therapy and at > 40 days post therapy, additionally comparing them to matched pediatric control patients (PCC) and their own healthy parents (one parent/KD child). Of all the V beta families examined, only V beta 2 exhibited statistically significant differences, between the pre- and post-IVIG samples and preIVIG and parent samples. No associations were found between V beta 2 findings and T cell memory, activation, or adhesion markers. For 2 KD patients, 4 parents, and 1 PCC participant, > 15% of resting CD8+ lymphocytes and > 15% of blastic CD8+ lymphocytes expressed a single V beta family, which varied by individual, without similar expansions in the CD4+ cell populations. One of the participants with this abnormality was the only one with significant cardiac abnormalities. For all participants with the V beta abnormality, other T-cell abnormalities were extensive and involved both CD4+ and CD8+ cells. We suggest that V beta 2 changes do occur in KD, as previously reported. However, these may not be involved in disease pathogenesis. Other V beta changes also occur. Those occurring in parents may reflect asymptomatic reinfection with an infectious agent causing KD. Further, some KD patients may have restricted cytotoxic T-cell responses to that as yet unidentified agent; this restricted response may be associated with more severe cardiac involvement.

Emergency medical services for rape victims: detecting the cracks in service delivery

Rape victims have many emergency medical needs, yet there has been very little research examining whether victims are receiving desired assistance. In this study, 147 rape victim advocates were interviewed about their most recent case in which a victim has sought treatment in an emergency room (ER). The results of this study indicated that there is some inconsistency in which services victims receive and that many women did not obtain the resources they wanted. Some forms of assistance were not provided to victims due to lack of resources in their communities (e.g., follow-up medical care). Other services were not offered due to problems in the implementation of available services (e.g., the morning-after pill [ethinyl estradiol-norgestrel] to prevent pregnancy). This research also examined how characteristics of the hospitals, the assaults themselves, and the victims impacted whether women would receive desired help. These findings indicated that women who were treated in hospitals affiliated with the Catholic church; those who were raped by their friends, dating partners, or husbands; those who experienced multiple forms of forced penetration (vaginal rape and anal rape, oral rape, or rape by an object); women of Color; and victims who did not present a sympathetic demeanor in the ER were less likely to receive several forms of assistance, such as treatment of physical injuries, arranging follow-up medical care, information and treatment for sexually transmitted diseases, information on the risk of pregnancy, the morning-after pill, and information on the physical and psychological health effects of sexual assault. Victims who were taken to hospitals that had coordinated response teams (e.g., Sexual Assault Response Teams) to work with survivors were more likely to receive some forms of treatment (e.g., information on the physical and psychological health effects of sexual assault). Implications for future research and policy initiatives in women's health are discussed.

Are faces of different species perceived categorically by human observers?

What are the species boundaries of face processing? Using a face-feature morphing algorithm, image series intermediate between human, monkey (macaque), and bovine faces were constructed. Forced-choice judgement of these images showed sharply bounded categories for upright face images of each species. These predicted the perceptual discrimination boundaries for upright monkey-cow and cow-human images, but not human-monkey images. Species categories were also well-judged for inverted face images, but these did not give sharpened discrimination (categorical perception) at the category boundaries. While categorical species judgements are made reliably, only the distinction between primate faces and cow faces appears to be categorically perceived, and only in upright faces. One inference is that humans may judge monkey faces in terms of human characteristics, albeit distinctive ones.

Speechreading in the akinetopsic patient, L.M

Patient L.M. has a well-documented, long-standing and profound deficit in the perception of visual movement, following bilateral lesions of area V5 (visual movement cortex). Speechreading was explored in this patient in order to clarify the extent to which the extraction of dynamic information from facial actions is necessary for speechreading. Since L.M. is able to identify biological motion from point-light displays to whole-body forms and has some limited visual motion capabilities, we expected that some speechreading of faces in action would be possible in this patient. L.M.'s reading of natural speech was severely impaired, despite unimpaired ability to recognize speech-patterns from face photographs and reasonable identification of monosyllables produced in isolation. She was unable to track multisyllabic utterances reliably and was insensitive to vision when incongruent audiovisual speech syllables were shown. Point-light displays of speech were as poorly read as whole face displays. Rate of presentation was critical to her performance. With speech, as with other visual events, including tracking the direction of gaze and of hand-movement sequences, she could report actions that unfolded slowly (approximately one event per 2 s). In line with this, she was poor at reporting whether seen speech rate was normal, fast (double-speed) or slow (half-speed). L.M.'s debility is the converse of that reported for a patient with lesions primarily to V4 (H.J.A.), who is unable to speechread photographs of faces but can speechread moving faces. The visual analysis of both form and motion is required for speechreading; the neural systems that support these analyses are discussed.

Immunoregulatory changes in Kawasaki disease

Kawasaki disease (KD) is an acute vasculitis of unknown etiology, occurring in young children and treated with intravenous gamma globulin (IVIG) to prevent significant cardiac morbidity and mortality. We studied KD patients pre- and post-IVIG therapy and at >40 days posttherapy, additionally comparing them with matched pediatric control patients and parents. Using three-color flow cytometry, we examined immune changes in KD, especially previously unassessed markers of T-lymphocyte activation, memory, and adhesion. The percentage of cells positive for CD19, CD25, CD38, and CD71 was significantly lower during convalescence compared with pre-IVIG (medians: CD19, 18% vs 26%, P = 0.0004; CD25, 6% vs 9% for CD3(+) cells, P = 0.0074; CD38, 78% vs 89% for CD8(+) cells, P = 0.0015; CD71, 1% vs 6% for CD4(+) cells, P = 0.0024). The proportion of CD3(+) cells increased (medians: CD3, 66% vs 45%, P < 0.0001). Values for all parameters varied greatly pre- and post-IVIG, but not in a consistent direction. The sole patient with cardiac abnormalities had the greatest pre-/post-IVIG variability. These changes support the involvement of T-lymphocytes in the acute KD vasculitic process. They also suggest that T-lymphocytes involved in endothelial damage during acute KD may be subsequently removed or eliminated from the peripheral blood.

Leukaemia inhibitory factor mRNA is expressed in the brains of patients with subacute sclerosing panencephalitis

We have examined the in situ transcription of leukaemia inhibitory factor (LIF) in brain tissue from 3 cases of subacute sclerosing panencephalitis (SSPE) and in 2 non-neurological control brains. This has been compared with expression of interleukin 2 (IL-2), interleukin 6 (IL-6) and tumour necrosis factor beta (TNF beta) in the same tissues. All of the cytokines in the study were expressed in cells in the inflammatory infiltrate as well as in glial cells. LIF mRNA was also found to be expressed in neurons, in foci where these cells were also virally infected. No hybridization was found with any of the probes in areas of SSPE brain, which were negative for measles virus RNA or in the non-neurological control cases, although expression was demonstrated in the latter by use of reverse transcription-polymerase chain reaction (RT-PCR). Differentiated, cultured human neuronal cells were also positive, by RT-PCR, for LIF. This is the first demonstration of LIF expression in human brain and the results suggest that this cytokine is up-regulated, in several cell types, including neurons, following virus infection.

The medical therapy of cardioinhibitory syncope in pediatric patients

A small percentage of pediatric patients with neurally mediated syncope will have an asystolic response during upright tilt table testing. The purpose of this study is to evaluate the incidence of asystole during tilt table testing, and to assess the outcome of medical management of such patients. Of 398 patients undergoing evaluation for recurrent syncope between January 1989 and 1994, 18 (4.5%) experienced asystole lasting > or = 5 seconds during baseline tilt test. Patients had experienced a mean of four episodes of syncope, with a mean age at the time of tilt test of 11.1 +/- 4.0 years. The median duration of asystole was 10 seconds (range 5-40 s). Treatment was individualized to increased fluids and salt intake (3 patients), metoprolol (8 patients), pseudoephedrine (4 patients), disopyramide (1 patient), or combination therapy with fludrohydrocortisone (2 patients). During a median duration of follow-up of 31 months, no additional syncope was experienced by 78% of patients. Recurrent syncope in 4 patients was associated with either noncompliance or discontinuation of therapy in 3 patients; in 1 patient, increasing the dose of metoprolol was effective in preventing recurrences. We conclude that young patients with recurrent syncope and asystole during tilt test may be safely and effectively managed with pharmacological therapy, without resorting to pacemaker implantation.

Activation of auditory cortex during silent lipreading

Watching a speaker's lips during face-to-face conversation (lipreading) markedly improves speech perception, particularly in noisy conditions. With functional magnetic resonance imaging it was found that these linguistic visual cues are sufficient to activate auditory cortex in normal hearing individuals in the absence of auditory speech sounds. Two further experiments suggest that these auditory cortical areas are not engaged when an individual is viewing nonlinguistic facial movements but appear to be activated by silent meaningless speechlike movements (pseudospeech). This supports psycholinguistic evidence that seen speech influences the perception of heard speech at a prelexical stage.

The impact of legislatively imposed practice guidelines on cesarean section rates: the Florida experience

Florida legislation implemented in the fall of 1992, unique in the nation, mandated that practice guidelines regarding cesarean section deliveries be disseminated to obstetric physicians. The law also required that peer review boards at hospitals be established to review cesarean deliveries and that the exact dates of implementation of the guidelines be reported to a state agency. To determine the impact of the legislation, we conducted a retrospective analysis of 366,246 total live births occurring in Florida hospitals during 1992 and 1993, before and after formal hospital certification of the implementation of the guidelines. Changes in primary and repeat cesarean rates were analyzed for 108 independent groups of births, controlling for the mother's age, race, payment source, and the timing of the implementation of the guidelines at hospitals. The guideline certification program did not accelerate the consistent but gradual downward trend in cesarean births which had already been evident in the three prior years. The data do suggest that the guideline program may have affected repeat cesareans more than primary cesareans, especially in the first quarter of 1993, immediately after the hospital certification period. Reductions in repeat cesareans involved both Medicaid and commercially insured births, whereas reductions in primary cesareans were found almost exclusively within commercially insured mothers, where the existing rates are highest. Although births with a prior cesarean represent only 12.5% of all births, significant decreases in repeat cesareans were found in groups representing 72.6% of this population. By comparison, significant decreases in primary cesareans were found in groups representing only 36.5% of the births without a prior cesarean. The date of guideline implementation reported by hospitals was not related to any systematic change in observed cesarean section rates. We concluded that the mere dissemination of practice guidelines by a state agency may not achieve either the magnitude or the specificity of the results desired without an explicit and thorough guideline implementation program. Blunt legislative mandates may be ineffective when multiple initiatives are already achieving desired outcomes.

Weight changes and serum sodium concentrations after an ultradistance multisport triathlon

OBJECTIVE

This study describes the incidence of hyponatremia and the weight changes during an ultradistance multisport triathlon.

DESIGN

Descriptive research.

SETTING

A 1-day triathlon in which each athlete kayaks 67 km, cycles 148 km, and runs 23.8 km.

PARTICIPANTS

Forty-eight athletes competing in the race were studied.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

All subjects were weighed before the race and on completion of the race. A blood sample for serum sodium was taken at the finish of the race.

RESULTS

The mean weight change over the course of the race was a loss of 2.5 kg (SD +/- 1.7, n = 48), or a mean percentage loss of body weight of 3.1% (SD +/- 2.07). This was highly statistically significant (p < 0.0001) using the Student paired t test. No athletes gained weight, and six athletes maintained their same weight. Only one athlete was hyponatremic (Na = 134 mEq/L). This athlete maintained his weight over the course of the race and he did not seek medical attention. The mean serum sodium concentration at the end of the race was 139.3 mEq/L (SD = 2.28, n = 47). There was a significant correlation (r = 0.30, p = 0.04) between sodium levels and weight change during the race: the greater the weight loss, the higher the serum sodium concentration. There was no significant correlation between the degree of weight loss and athletes' finishing times (r = 0.11, p = 0.45).

CONCLUSIONS

Symptomatic hyponatremia did not occur in the 1996 Coast to Coast multisport triathlon, although one athlete had borderline hyponatremia. Athletes lose significant amounts of weight over the course of this multisport event, but nevertheless manage to complete the race.