Dietary polyphenol intake in the Canadian population: Findings from the 2015 Canadian Community Health Survey-Nutrition

OBJECTIVES

This study aimed to estimate usual polyphenol intake among Canadians using the nationally representative 2015 Canadian Community Health Survey-Nutrition and to explore the main dietary contributors to polyphenol intake and the sociodemographic and lifestyle factors that may impact polyphenol intake.

METHODS

Dietary information was collected from 19,409 respondents using 24-h dietary recalls. The polyphenol content of foods was estimated using the Phenol-Explorer Database (version 3.6). Daily intake values for total polyphenols (adjusted to energy intake), main classes, and subclasses were calculated for each respondent and dietary recall. Usual intake was estimated by age/sex groups and by sociodemographic and lifestyle characteristics independently for adults and children using the National Cancer Institute method. Given-day arithmetic mean polyphenol intakes and mean proportions of main classes contributing to sum total polyphenol intakes were explored. Population proportions were used to determine dietary contributors.

RESULTS

Usual total polyphenol intake was 1119.3 mg/1000 kcal/day (95% CI: 1090.5, 1148.1) for adults ≥ 19 years and 473.0 mg/1000 kcal/day (95% CI: 454.9, 491.0) for children 2‒18 years. Generally, total polyphenol intakes differed by age, sex, ethnicity, and household education status and were higher among coffee and tea consumers. Most polyphenols came from flavonoids (40.0%) and phenolic acids (49.8%), with children consuming more flavonoids and other polyphenols and adults more phenolic acids. The top food contributors to polyphenol intake were coffee (26.8%), tea (8.9%), fruit juice (4.2%), banana (4.1%), and apple (3.8%).

CONCLUSION

Usual intake of total polyphenols among Canadians differed primarily by age. Non-alcoholic beverages were top contributors to total polyphenol intake.

The Ontario Public Does Not Understand the Difference Between Registered Dietitians and Unregulated "Nutritionists": Results from a Cross-Sectional Mixed Methods Study

Background:

Current Ontario healthcare policy permits anyone to use the title “nutritionist” and practice as a clinician regardless of education and training. The title “dietitian,” on the other hand, is protected under the Dietetics Act (1991) for use exclusively by individuals who undergo rigorous education and training in evidence-based nutrition.

Objectives:

The objectives of this study were to: identify whether the Ontario general public understands the difference between a registered dietitian (RD) and an unregulated “nutritionist;” understand experiences with RDs and “nutritionists;” and determine if the current nutrition landscape arising from gaps in healthcare policy has the potential to harm the public.

Methods:

A cross-sectional mixed methods survey study was carried out using inductive content analysis, descriptive statistics and chi-square tests.

Results:

Respondents (n = 402) did not understand the difference between RDs and “nutritionists.” Overall, public experiences have been significantly more positive when nutrition information/advice stemmed from an RD.

Implications:

This study provides justification for proposed legislative amendments to the Dietetics Act (1991) and the Regulated Health Professions Act (1991). These proposed amendments have been detailed in the full-text manuscript.

"Detoxify or Die": Qualitative Assessments of Ontario Nutritionists' and Dietitians' Blog Posts Related to Detoxification Diets

While the title Registered Dietitian (RD) is regulated under provincial legislation in Ontario and other Canadian provinces, the title "nutritionist" is not regulated in Ontario, which poses potential risks to consumers who place misguided trust in those proclaiming to be nutrition experts. This is concerning as nutrition is a complex health care discipline and RDs, the recognized providers of credible nutrition information, must be registered with an accredited regulatory college that requires them to have undergone rigorous training, practicum placements, entrance examinations, and continuous professional development. The purpose of this study was to determine if Ontario-based unregulated nutritionists and RDs are providing safe, evidence-based, information regarding detoxification diets. Content from 10 blog posts were qualitatively analyzed using deductive content analysis with predetermined categorization matrices. The results revealed that Ontario nutritionists promoted detox diets and provided unproven, misleading, and potentially harmful information, whereas Ontario RDs did not promote detox diets and provided evidence-based, harm-reducing information. Additionally, conflicts of interest arose only in nutritionists' blog posts. RDs provided credible references for their information while nutritionists did not. Protecting the term "nutritionist" for use exclusively by RDs under provincial legislation would be a positive step towards ensuring Ontarians are receiving the highest quality evidence-based nutrition information.

Proton-pump inhibitor therapy and vitamin B12 status in an inpatient hospital setting

The risk for impaired vitamin B₁₂ status increases with age, as does the use of proton pump inhibitors (PPI). Long-term use of PPIs is associated with several nutritional deficiencies including B₁₂. Currently, there are no recommendations for B₁₂ screening among patients taking PPIs. Data were abstracted on B₁₂ concentrations, B₁₂-containing supplement use, medications, and select hematological values from a retrospective chart review of 658 adults, 391 with serum B₁₂ concentrations, admitted to 6 different medical units at 2 regional hospitals in Southwestern Ontario between 2010 and 2012. We found no difference between PPI users and nonusers and serum B₁₂ concentrations (404 ± 224 vs 369 ± 213 pmol/L; P = 0.0690). This may be due to use of B₁₂ containing multivitamins in 41% of PPI users. Regression modelling found that aging increases the odds of having an impaired B₁₂ status (<220 pmol/L) by 1.4 times and those using B₁₂ supplements are almost 4 times more likely to have an impaired status. Mean corpuscular volume was not related to B₁₂ status. In this population, older PPI users are more likely to be using multivitamins, which may delay nutritional deficiencies. However, the lower B₁₂ concentrations of PPI users taking only B₁₂ supplements is a concern and requires further research. Finally, physicians need to be aware that mean corpuscular volume is no longer recommended as an effective biomarker for B₁₂ screening and updated screening protocols need to be used to reduce the possibility of adverse neurological effects from impaired B₁₂ status.

Digital subtraction radiography for monitoring dental demineralization. An in vitro study

The aim of the present study was to evaluate the assessment of progression of demineralization by digital subtraction radiography. In each of 14 extracted human teeth, 2 approximal enamel demineralization lesions were induced in vitro to simulate dental caries. A modified tunnel preparation with glass ionomer fillings was performed on one lesion of every tooth as a model of caries inhibition. Every week, radiographs were obtained under standardized conditions over a period of 42 days. The radiographs were digitized and calibrated for grayscales. Reference landmarks were chosen and aligned for the different pictures by computer-assisted imaging to adjust the images for projective distortions. The images of the 7th, 14th, 21st, 28th, 35th and 42nd day were subtracted from the baseline radiograph. The mean value of gray values of the subtraction images was calculated and ANOVA tests for repeated measurements and paired t tests were used for statistical analysis. The results of the present study indicate that statistically significant gray level changes due to progression of demineralization could be detected in the radiographic images by subtraction analysis. Differences between glass ionomer-filled and nonfilled lesions failed to reach significance. The introduced method may have the potential to detect and document minute caries progression.

Boosting social support in caregivers of children with HIV/AIDS

Providing care for a child that is infected with human immunodeficiency virus (HIV) is challenging for the child's caregiver and affects the entire family system. Research has demonstrated that social support has the potential to buffer caregiver stress and facilitate caregiver coping. A two-group experimental study was implemented to test the effect of a social support boosting intervention on caregiver stress, coping and social support among caregivers of children with HIV/acquired immune deficiency syndrome (AIDS). The subjects in the study were caregivers of children with HIV/AIDS. The sample strata included seropositive caregivers (biological parents) and seronegative caregivers (foster parents and extended family members). The measures for the study included the Derogatis Stress Profile, The Family Crisis Oriented Personal Evaluation Scale, and the Tilden Interpersonal Relationship Inventory. These data were then analyzed descriptively and then with a repeated measure MANOVA. Initially, there were no statistically significant differences found between the control and intervention groups. However, when subject HIV status was included in the analysis, the combined dependent variables of stress, coping, and social support were significantly related to the interactions of group by HIV status over time. F values were then computed and no statistically significant differences were found for stress or coping. There were, however, significant differences in measures of social support between groups when adjusting for HIV status of caregivers. In this study, social support levels over time for seronegative caregivers were significantly different from those of seronegative caregivers in the control group. Three case studies are presented that illustrate differences between seronegative and seropositive caregivers. The case studies describe the problems identified by caregivers and the effectiveness of problem solving using the social support boosting intervention. Finally, the mobilization of social support is discussed. Contrasts between the problems of caregivers are made relative to their HIV status. The potential for the effectiveness of the social support boosting intervention is discussed within the context of the caregiver's HIV status.

Recombinant E1-deleted adenovirus-mediated gene therapy for cancer: efficacy studies with p53 tumor suppressor gene and liver histology in tumor xenograft models

Type 5 adenoviral (Ad) vectors have been the "vector-of-choice" for preclinical studies on p53 tumor suppressor gene therapy of cancer. Previous studies have examined the in vivo efficacy of p53 Ad when given intratumorally. However published information does little to guide clinicians in the design of intraperitoneal (i.p.) dosing trials for i.p. tumors, e.g., ovarian, or clinical trials using regional organ perfusion, e.g., for lung tumors. Therefore, we examined several parameters with special significance for these routes of administration. Lung metastases from p53mut MDA-MB-231 mammary xenografts were treated with therapeutic levels of intravenous buffer, beta-galactosidase (beta-Gal) Ad, or p53 Ad. Treatment with intravenous p53 Ad significantly reduced the number of metastases per lung and there was a dramatic reduction in the surface area occupied by these tumors as compared to control groups. Two types of i.p. tumor xenografts were used for preclinical modeling of i.p. gene therapy, the p53null SK-OV-3 ovarian and the p53mut DU-145 prostate human cancers. In a study examining the effect of different vehicle volumes on the efficacy of a constant drug dose, all mice treated with p53 Ad had reduced tumor burden compared to controls. Dosing volumes between 0.2 and 1 ml were equally effective and all were more effective than a dosing volume of 0.1 ml. However, reduced efficacy was observed when a volume of 1.5 ml was used. When the effect of dosing frequency on antitumor efficacy was examined, fractionated doses of p53 Ad had somewhat greater efficacy than fewer, bolus injections. One of the significant elements in the emerging toxicology associated with recombinant adenoviruses is the hepatocyte pathology caused by high systemic concentrations of adenovirus. For recombinant Ad used in this study, there was a pronounced dose-dependence for the liver response, with very high, repeated doses causing significant hepatocellular insult. Expression of cytoplasmic beta-Gal protein coincided with areas of greatest damage in mice treated with high doses of beta-Gal Ad. Ultrastructural examination of hepatocyte intranuclear inclusions revealed moderately electron-dense, tightly packed granular material interspersed with more electron-dense nuclear material. Human tumor xenografts, but not mouse tissues, expressed viral hexon protein. In summary, hepatic toxicity caused by high concentrations of recombinant adenovirus was observed in murine cancer models. However, therapeutic levels of p53 Ad could be achieved which had dramatic efficacy without significant pathology.

The effect of a social support boosting intervention on stress, coping, and social support in caregivers of children with HIV/AIDS

BACKGROUND

Caring for the human immunodeficiency virus (HIV)-infected child is challenging and affects the entire family system. Studies have shown that social support can mitigate caregiver stress and enhance coping; however, social support may not always result in a positive outcome for the recipient.

OBJECTIVES

To measure caregiver stress, coping, and social support, and to test the effect of a social support boosting intervention on levels of stress, coping, and social support among caregivers of children with HIV/acquired immune deficiency syndrome (AIDS).

METHODS

An experimental design was used with monthly social support boosting interventions implemented. The stratified randomized sample included 70 primary caregivers of children with HIV/AIDS. The sample strata were seropositive caregivers (biological parents) and seronegative caregivers (foster parents and extended family members). Study measures included the Derogatis Stress Profile, Family Crisis Oriented Personal Evaluation Scale, and the Tilden Interpersonal Relationship Inventory. Data were analyzed using descriptive statistics and repeated measure MANOVA.

RESULTS

Statistically significant differences between the experimental and control groups were found on changes in the dependent variables over time when caregiver strata were included as a factor in the analysis; no statistically significant results were found when caregiver strata were combined. Univariate Ftests indicated that the level of social support for caregivers who were seronegative in the experimental group was significantly different from seronegative caregivers in the control group and seropositive caregivers in both groups. No significant treatment group differences were found for seropositive caregivers.

CONCLUSIONS

Seronegative caregivers derived substantial benefit from the social support boosting intervention. Seronegative caregivers who acquire a child with HIV/AIDS are confronted with a complex stressful situation; the critical need to enhance their social support is achievable through the intervention tested in this study.

Purkinje cell expression of a mutant allele of SCA1 in transgenic mice leads to disparate effects on motor behaviors, followed by a progressive cerebellar dysfunction and histological alterations

Spinocerebellar ataxia type 1 (SCA1) is an autosomal dominant neurological disorder caused by the expansion of a CAG repeat encoding a polyglutamine tract. Work presented here describes the behavioral and neuropathological course seen in mutant SCA1 transgenic mice. Behavioral tests indicate that at 5 weeks of age mutant mice have an impaired performance on the rotating rod in the absence of deficits in balance and coordination. In contrast, these mutant SCA1 mice have an increased initial exploratory behavior. Thus, expression of the mutant SCA1 allele within cerebellar Purkinje cells has divergent effects on the motor behavior of juvenile animals: a compromise of rotating rod performance and a simultaneous enhancement of initial exploratory activity. With age, these animals develop incoordination with concomitant progressive Purkinje neuron dendritic and somatic atrophy but relatively little cell loss. Therefore, the eventual development of ataxia caused by the expression of a mutant SCA1 allele is not the result of cell death per se, but the result of cellular dysfunction and morphological alterations that occur before neuronal demise.

Observations on in situ degradation of forage cell components in alfalfa and Italian ryegrass

The rate and extent of degradation of forage feed fractions contained in alfalfa and Italian ryegrass hays were determined. Nylon bags filled with 4 g of each forage were suspended in the rumen of two cannulated cows immediately before feeding and incubated for 10 different times (0, 2, 4, 8, 12, 24, 48, 72, 120, and 168 h). The alfalfa hay, which had lower NDF, showed a lower extent, but a higher rate, of NDF degradation than the Italian ryegrass (41.1 vs. 59.8% and 4.64 vs. 2.91%/h, respectively). Alfalfa cell walls were degraded more rapidly than Italian ryegrass even though their lignin content was higher. The hemicellulose fermentation of alfalfa showed a longer lag time (13 h) and an undegradable fraction nearly twice that for Italian ryegrass (63.3 vs. 37.1%). Cellulose from alfalfa was degraded at a higher rate than NDF or ADF, indicating that cellulose may be the primary site of hydrolysis of the cell wall in the rumen. Calculations based on in situ degradability indicate that alfalfa can have a higher inclusion than Italian ryegrass in diets for dairy cows because of lower NDF and greater availability of cell contents.

Effective action by infants to contact objects by reaching and leaning

The ability of infants aged 8-12 months to coordinate their arm and trunk movements to contact an object located in different positions was investigated in 2 experiments. In the first, 8- and 10-month-old infants reached for near objects but both reached and leaned for more distant ones indicating that they perceived that forward leaning extends the range of contact beyond that of reaching alone. In addition, arm and trunk movements were initiated simultaneously; visual information concerning object distance was sufficient to activate an integrated reaching-and-leaning response. Object distances were increased and a mechanical aid was provided on half the trials in the second experiment with 10- and 12-month-old infants. For both age groups the degree of leaning was reduced for objects that were out of reach without the aid. Only older infants were able to use the aid to extend partially their range of contact. Overall the results support the conclusions that, by at least 8 months, infants perceive that leaning extends their effective reaching space; by 10 months they perceive the limits within which reaching together with leaning is likely to be effective; and by 12 months they begin to perceive how this space may be extended by a mechanical aid.

Perceiving the affordance of contact in four- and five-month-old infants

The focus of this study was on the ability of infants to perceive whether an object is positioned at a distance that would make contact possible. As a toy was presented, sometimes within and sometimes beyond reach, the initiation of reaching and leaning forward was scored. Infants were divided into leaning and nonleaning groups. Both leaning and nonleaning 5-month-olds changed their behavior dramatically when the object was placed beyond, as opposed to within, reach. The nonleaners showed a decline in reaching when this boundary for contact was crossed. The "leaners" did not; rather, they began to lean forward. These results suggest that 5-month-olds use information for the affordance of contact. 4-month-olds provided less evidence that arm length regulates reaching. 5-month-old infants acted as if they not only had some sensitivity to the absolute distance of an object but also to the effect that leaning forward has on their ability to make contact with a distant object.

Static and kinetic perimetry results of krypton red laser treatment for macular edema complicating branch vein occlusion

Twenty patients with clinical and angiographic evidence of recent branch vein occlusion complicated by macular edema were assigned to receive krypton red laser treatment if their macular edema lasted more than three months. Visual acuity, static and kinetic perimetry, fundus photography, and fluorescein angiography were evaluated before treatment and at two-month intervals thereafter. Visual acuity improved by two lines one year after treatment in 65% of patients. Each of these patients had a complete perifoveal capillary arcade. Static perimetry results correlated well with visual acuity, and a significant threshold improvement was detected in these patients. Visual-acuity results and static and kinetic perimetry findings are presented. The rationale for selection of the krypton red wavelength (647 nm) is discussed.

[VIth nerve palsy associated with ipsilateral Horner's pupil]

A rare syndrome which includes VIth nerve palsy associated with ipsilateral Horner's pupil was foreseen by Parkinson and Johnston in the mid-seventies. They anticipated the occurrence of this syndrome on the basis of the unique anatomical relationships discovered by them in the cavernous sinus. The main finding consisted of very close proximity between the VIth nerve and a branch emerging from the carotid sympathetic plexus. Recently, several reports of this syndrome caused by a variety of pathologic processes in the cavernous sinus, proved that Parkinson and Johnston were correct. Since it is quite difficult to identify lesions in the cavernous sinus by X-ray or CT scan, the neuroradiologist should utilize special techniques. It is expected that the number of cases of this syndrome will soon increase, due to increasing familiarity with the syndrome and to improved imaging techniques.

Serum propoxyphene concentrations in a cohort of opiate addicts on long-term propoxyphene maintenance therapy. Evidence for drug tolerance in humans

Propoxyphene, norpropoxyphene, and cyclic dinorpropoxyphene concentrations in the sera of eight opiate addicts were measured by gas chromatography. The addicts were enrolled in a propoxyphene maintenance program and had received 800-1600 mg of propoxyphene napsylate daily for 13-50 months. Serum propoxyphene and norpropoxyphene ranged from 127 to 1070 ng/mL and 814 to 2638 ng/mL, respectively, and their ratio ranged from 0.1 to 0.4. A roughly linear dose-to-serum-concentration relationship was found for serum propoxyphene and norpropoxyphene in the cohort. Cyclic dinorpropoxyphene was detected in three of the subjects' sera. Because tolerance to propoxyphene occurs, knowledge of prior drug exposure is necessary to determine whether an elevated propoxyphene or norpropoxyphene concentration is toxic to patients or decedents with apparent propoxyphene overdose. Serum norpropoxyphene concentration exceeds that of propoxyphene following chronic propoxyphene use. Measurable cyclic dinorpropoxyphene implies chronic propoxyphene use but its absence does not exclude chronic use.

Computed tomography of benign cystic teratoma of the omentum

Benign cystic teratoma of the omentum is a rare gynecologic condition. No cases have been diagnosed preoperatively; six cases have been reported in association with an ovarian teratoma. We report a seventh case in which ultrasound and CT were used preoperatively.

Morphometric analysis of dysplasia in cervical cone biopsy specimens in cases with false-negative cytology

Conization specimens with a histologic diagnosis of cervical intraepithelial neoplasia III were reviewed with respect to cytology findings in the three months preceding conization. In 29% of the cases, one or more false-negative cytology reports preceded conization. No dysplastic cells were found on review of the false-negative cytology slides from these cases. Morphometric analysis of surface dysplasia in the conization specimens was performed to explain these findings. A statistically significantly greater surface area of dysplasia and greater spread of dysplastic cells in the endocervical canal was found in the positive cytology when compared to the false-negative cytology cases. No difference in vaginal spread of dysplasia existed between the two groups. The endocervical canal was sampled with a moist cotton swab in all of the cases. The results suggest that small numbers of dysplastic cells high in the endocervical canal may not be effectively sampled by cotton swabs in cases of false-negative cervical cytology, lowering screening sensitivity.

Placental-like alkaline phosphatase. Re-evaluation of the tumor marker with exclusion of smokers

This report demonstrates that smoking is a major factor of nonspecific elevation of the tumor marker placental-like alkaline phosphatase (PLAP). In 98 healthy nonsmokers the mean of the enzyme activity was determined as 0.068 U/L (range, +/- 2 SD 0-0.144 U/L) compared to a mean of 0.378 U/L (range, +/- 2 SD 0-1.02 U/L) in 65 smokers. In view of this finding the usefulness of PLAP as a tumor marker was re-evaluated in 286 patients with various neoplasms and a negative smoking history. Of these patients, 23% and 50% had elevated values for PLAP and carcinoembryonic antigen, respectively. When compared to the range of PLAP in normal smokers only 4.1% of the patients showed elevated values. An increased incidence of elevated PLAP was found in patients with tumors of the lung, pancreas, stomach, colon/rectum, ovaries, and in 2 of 3 seminomas. It was concluded from the data that PLAP is a useful tumor marker for selected neoplasms provided its use is confined to nonsmokers.

A simple and reliable rapid methenamine silver stain for Pneumocystis carinii and fungi

A modification to a rapid hot methenamine silver stain is described that shortens the silver staining step of the procedure to one to five minutes. It also eliminates the requirement to manipulate hot solutions.

Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome (AIDS). Diagnosis with bronchial brushings, biopsy, and bronchoalveolar lavage

Sixty-one diagnostic biopsies for Pneumocystis carinii pneumonia were performed on 40 homosexual male patients with acquired immunodeficiency syndrome (AIDS), using flexible fiberoptic bronchoscopy. Bronchial brushings and bronchoalveolar lavage were performed in conjunction with the biopsy in 58 and 29 bronchoscopies, respectively. Using a rapid methenamine silver stain, P carinii pneumonia was diagnosed in 27 (68 percent) of the patients. Twenty of these patients had a repeat biopsy one or more times for evaluation of therapy. Eighteen of the biopsies following two to three weeks of therapy were positive. There was an 84 percent correlation between findings on transbronchial brushing and biopsy (89 percent on initial biopsy before treatment) and an 86 percent correlation between bronchoalveolar lavage and biopsy. Additionally, transbronchial brushing permitted demonstration of Pneumocystis organisms in four follow-up bronchoscopies in which the biopsy was negative or inadequate. Rapid methenamine silver stain of transbronchial brushings permits diagnosis of P carinii pneumonia in patients with AIDS within one-half hour of bronchoscopy.

Identification of catecholamine cell bodies in the pons and pons-mesencephalon junction of the cat brain, using tyrosine hydroxylase and dopamine-beta-hydroxylase immunohistochemistry

Using a double labeling immunohistochemical method with antibodies to tyrosine hydroxylase and dopamine-beta-hydroxylase, we reexamined the topographical distribution of dopaminergic (DA) and noradrenergic (NA) cells in the pons-mesencephalon junction of the cat. Besides DA cells of SN and its extensions, DA cells were also observed more caudally in nucleus raphe linearis intermedius and dorsalis, decussation of brachium conjunctivum, fasciculus longitudinalis medialis and periaqueductal gray. In nucleus locus coeruleus, cells exhibited variable levels of DBH, but dopaminergic cells were not evidenced in this structure.

Altered penicillin-binding proteins in methicillin-resistant strains of Staphylococcus aureus

The penicillin-binding proteins (PBPs) of a methicillin-resistant (MR) and a methicillin-susceptible (MS) Staphylococcus aureus were compared by various approaches involving the use of high-specific-activity [3H]penicillin as a reagent. The MR and MS strains were found to contain PBPs of the same number and electrophoretic mobilities. However, saturation of PBPs 1, 2, and 3 by methicillin in the MR strain required the use of several thousands of micrograms of antibiotic per milliliter, whereas 0.2 to 0.4 micrograms of methicillin per ml was sufficient to effectively compete with [3H]penicillin for the PBPs for the MS strain. Additional experiments indicate that these differences most likely reflect a greatly decreased affinity of the PBPs of the MR strain as compared to those of the MS strain. Shift of the pH of the culture medium of the MR strain from pH 7.0 to 5.2 resulted in an immediate drop in phenotypic resistance to methicillin (from a minimal inhibitory concentration value of 3,200 micrograms/ml at pH 7.0 to 0.8 microgram/ml at pH 5.2). Examination of the methicillin affinities of PBPs in MR bacteria grown at pH 5.2 showed the presence of the same low-affinity PBPs as in bacteria grown at pH 7.0. Thus, the pH-dependent resensitization to methicillin cannot be explained by a parallel increase in the antibiotic affinities of the PBPs.

A total community approach to the treatment of alcoholism

A review of psychopathology and withdrawal in alcoholics is presented. The use of disulfiram, milieu and half-way houses in the treatment of alcoholic patients is described. The role of the Community Mental Health Center is outlined. An extensive description of Palm Beach County's approach to the treatment of alcoholism is then explained. This heterogeneous county offers facilities for all types of patients, from the lowest to highest socioeconomic backgrounds. Detoxification in the Palm Beach Community Mental Health Center is fully described. The half-way houses, Alcoholics Anonymous programs, and other outpatient and inpatient treatment facilities are depicted.