Abstract OT3-03-01: Open-label, single-arm study evaluating the antitumor activity and safety of niraparib as neoadjuvant treatment in patients with localized, HER2-negative, BRCA-mutant breast cancer

Background: Neoadjuvant chemotherapy is administered to patients with operable breast cancer to downstage the tumor to allow for less extensive surgery and to provide prognostic information about drug efficacy and risk of disease recurrence. Patients who achieve a pathological complete response (pCR) following neoadjuvant treatment have a more favorable outcome than patients with residual invasive disease. Single-agent poly(ADP-ribose) polymerase (PARP) inhibitors have clinical efficacy in BRCA-mutated breast cancer. Niraparib, a potent and selective PARP1/2 inhibitor, is approved for maintenance treatment of patients with recurrent ovarian cancer and has demonstrated strong antitumor activity in in vivo studies with BRCA1-mutant breast cancer. The objective of this study is to evaluate the antitumor activity of single-agent niraparib in the neoadjuvant treatment of patients with localized, human epidermal growth factor receptor 2 (HER2)-negative, BRCAmut breast cancer.

Trial Design: This is an open-label, single-arm pilot study with a target enrollment of 20 evaluable patients. Eligible patients are those ≥18 years old with histologically-confirmed HER2-negative localized breast cancer and either a BRCA1 or BRCA2 mutation (germline or somatic) and no prior anti-cancer therapies for the current malignancy. Patients will receive 200 mg of oral niraparib once daily for 2 months, after which they may either proceed directly to surgery or receive chemotherapy at the discretion of the physician. The primary endpoint is tumor response rate based on the change in tumor volume as measured by breast MRI after 2 months of treatment with niraparib; a response is defined as ≥30% reduction of tumor volume from baseline. Secondary endpoints include pCR rate, tumor response rate based on the change in tumor volume as measured by breast ultrasound, and safety and tolerability. Data will be summarized in a descriptive nature by frequency distributions (number and percentage of patients) for categorical variables and by the mean, median, and standard deviation for continuous variables. Tumor response rate will be tabulated together with its 95% binomial exact confidence interval.

Funding: TESARO, Inc., Waltham, MA, USA sponsored the study.

Citation Format: Han H, Hamilton E, Irie H, Isakoff S, Jelovac D, Liem A, Liu MC, Milillo A, Nangia J, Page D, Reeves J, Santa-Maria C, Duncan M, Graham JR, Chen J, Dezube BJ, Spring L. Open-label, single-arm study evaluating the antitumor activity and safety of niraparib as neoadjuvant treatment in patients with localized, HER2-negative, BRCA-mutant breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-03-01.

Letter to the Editor -- Who benefits from the professionalization of health promotion?

In 2007, Health Promotion Ontario (HPO) began working to advance the "profession" of health promotion (HP) in Canada through development of national competencies for health promoters. Their work was continued by the Pan-Canadian Network for Health Promoter Competencies ("the Network"). Funded by the Public Health Agency of Canada, the Network aimed to address (1) the recommendation made by the Canadian Joint Task Group on Public Health Human Resources for function specific competencies (including "HP Specialists"); and (2) the marginalization health promoters face in practice. The current health promoter competencies were released in November 2015, following a series of literature reviews and practitioner consultations.

A review of the otological aspects of whiplash injury

Approximately 10% of patients who have suffered with whiplash injury will develop otological symptoms such as tinnitus, deafness and vertigo. Some of these are purely subjective symptoms; nevertheless, for the majority there are specific tests that can be undertaken. These tests can quantify the extent and severity of the symptoms as well as provide guidance as to the correct rehabilitation pathway. This article reviews the body of literature relating to the otological aspects of whiplash injury and gives an overview for medical and legal professionals.

Butyrylcholinesterase in Guinea Pig Lung Lavage: A Novel Biomarker to Assess Lung Injury Following Inhalation Exposure to Nerve Agent VX

Respiratory disturbances play a central role in chemical warfare nerve agent (CWNA) induced toxicity; they are the starting point of mass casualty and the major cause of death. We developed a microinstillation technique of inhalation exposure to nerve agent VX and assessed lung injury by biochemical analysis of the bronchoalveolar lavage fluid (BALF). Here we demonstrate that normal guinea pig BALF has a significant amount of cholinesterase activity. Treatment with Huperzine A, a specific inhibitor of acetylcholinesterase (AChE), showed that a minor fraction of BALF cholinesterase is AChE. Furthermore, treatment with tetraisopropyl pyrophosphoramide (iso-OMPA), a specific inhibitor of butyrylcholinesterase (BChE), inhibited more than 90% of BChE activity, indicating the predominance of BChE in BALF. A predominance of BChE expression in the lung lavage was seen in both genders. Substrate specific inhibition indicated that nearly 30% of the cholinesterase in lung tissue homogenate is AChE. BALF and lung tissue AChE and BChE activities were strongly inhibited in guinea pigs exposed for 5 min to 70.4 and 90.4 microg/m3 VX and allowed to recover for 15 min. In contrast, BALF AChE activity was increased 63% and 128% and BChE activity was increased 77% and 88% after 24 h of recovery following 5 min inhalation exposure to 70.4 microg/m3 and 90.4 mg/m3 VX, respectively. The increase in BALF AChE and BChE activity was dose dependent. Since BChE is synthesized in the liver and present in the plasma, an increase in BALF indicates endothelial barrier injury and leakage of plasma into lung interstitium. Therefore, a measure of increased levels of AChE and BChE in the lung lavage can be used to determine the chronology of barrier damage as well as the extent of lung injury following exposure to chemical warfare nerve agents.

Acute toxic effects of nerve agent VX on respiratory dynamics and functions following microinsillation inhalation exposure in guinea pigs

Exposure to a chemical warfare nerve agent (CWNA) leads to severe respiratory distress, respiratory failure, or death if not treated. We investigated the toxic effects of nerve agent VX on the respiratory dynamics of guinea pigs following exposure to 90.4 mug/m3 of VX or saline by microinstillation inhalation technology for 10 min. Respiratory parameters were monitored by whole-body barometric plethysmography at 4, 24, and 48 h, 7 d, 18 d, and 4 wk after VX exposure. VX-exposed animals showed a significant decrease in the respiratory frequency (RF) at 24 and 48 h of recovery (p value .0329 and .0142, respectively) compared to the saline control. The tidal volume (TV) slightly increased in VX exposed animals at 24 and significantly at 48 h (p = .02) postexposure. Minute ventilation (MV) increased slightly at 4 h but was reduced at 24 h and remained unchanged at 48 h. Animals exposed to VX also showed an increase in expiratory (Te) and relaxation time (RT) at 24 and 48 h and a small reduction in inspiratory time (Ti) at 24 h. A significant increase in end expiratory pause (EEP) was observed at 48 h after VX exposure (p = .049). The pseudo lung resistance (Penh) was significantly increased at 4 h after VX exposure and remained slightly high even at 48 h. Time-course studies reveal that most of the altered respiratory dynamics returned to normal at 7 d after VX exposure except for EEP, which was high at 7 d and returned to normal at 18 d postexposure. After 1 mo, all the monitored respiratory parameters were within normal ranges. Bronchoalveolar lavage (BAL) 1 mo after exposure showed virtually no difference in protein levels, cholinesterase levels, cell number, and cell death in the exposed and control animals. These results indicate that sublethal concentrations of VX induce changes in respiratory dynamics and functions that over time return to normal levels.

Acute lung injury following inhalation exposure to nerve agent VX in guinea pigs

A microinstillation technique of inhalation exposure was utilized to assess lung injury following chemical warfare nerve agent VX [methylphosphonothioic acid S-(2-[bis(1-methylethyl)amino]ethyl) O-ethyl ester] exposure in guinea pigs. Animals were anesthetized using Telazol-meditomidine, gently intubated, and VX was aerosolized using a microcatheter placed 2 cm above the bifurcation of the trachea. Different doses (50.4 microg/m3, 70.4 micro g/m(m3), 90.4 microg/m(m3)) of VX were administered at 40 pulses/min for 5 min. Dosing of VX was calculated by the volume of aerosol produced per 200 pulses and diluting the agent accordingly. Although the survival rate of animals exposed to different doses of VX was similar to the controls, nearly a 20% weight reduction was observed in exposed animals. After 24 h of recovery, the animals were euthanized and bronchoalveolar lavage (BAL) was performed with oxygen free saline. BAL was centrifuged and separated into BAL fluid (BALF) and BAL cells (BALC) and analyzed for indication of lung injury. The edema by dry/wet weight ratio of the accessory lobe increased 11% in VX-treated animals. BAL cell number was increased in VX-treated animals compared to controls, independent of dosage. Trypan blue viability assay indicated an increase in BAL cell death in 70.4 microg/m(m3) and 90.4 microg/m(m3) VX-exposed animals. Differential cell counting of BALC indicated a decrease in macrophage/monocytes in VX-exposed animals. The total amount of BAL protein increased gradually with the exposed dose of VX and was highest in animals exposed to 90.4 microg/m(m3), indicating that this dose of VX caused lung injury that persisted at 24 h. In addition, histopathology results also suggest that inhalation exposure to VX induces acute lung injury.

Assembly and annotation of human chromosome 2q33 sequence containing the CD28, CTLA4, and ICOS gene cluster: analysis by computational, comparative, and microarray approaches

Human chromosome 2q33 is an immunologically important region based on the linkage of numerous autoimmune diseases to the CTLA4 locus. Here, we sequenced and assembled 2q33 bacterial artificial chromosome (BAC) clones, resulting in 381,403 bp of contiguous sequence containing genes encoding a NADH: ubiquinone oxidoreductase, the costimulatory receptors CD28, CTLA4, and ICOS, and a HERV-H type endogenous retrovirus located 366 bp downstream of ICOS in the reverse orientation. Genomic microarray expression analysis using differentially activated T-cell RNA against a subcloned CTLA4/ICOS BAC library revealed upregulation of CTLA4 and ICOS sequences, plus antisense ICOS transcripts generated by the HERV-H, suggesting a potential mechanism for ICOS regulation. We identified four nonlinked, polymorphic, simple repetitive sequence elements in this region, which may be used to delineate genetic effects of ICOS and CTLA4 in disease populations. Comparative genomic analysis of mouse genomic Icos sequences revealed 60% sequence identity in the 5' UTR and regions between exon 2 and the 3' UTR, suggesting the importance of ICOS gene function.

Use of the MMPI-A to detect substance abuse in a juvenile correctional setting

In this study, we examined the ability of the MMPI-A (Butcher et al., 1992) to detect substance abuse problems in a juvenile correctional setting. Specifically, we evaluated the Alcohol/Drug Problem Acknowledgment scale (ACK; Weed, Butcher, & Williams, 1994), the Alcohol/Drug Problem Proneness scale (PRO; Weed et al., 1994), and the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., 1992) in the prediction of substance abuse. In addition, the incremental validity of ACK in comparison to PRO was evaluated, as was the incremental validity of PRO in comparison to ACK. The sample consisted of 123 boys and girls from ajuvenile correctional facility in Northeastern Ohio. Results indicate that ACK and PRO, but not MAC-R, were related to interviewer ratings of substance abuse. Results point to the superiority of ACK over PRO in substance abuse identification.

Ethnic and gender differences in mental health utilization: the case of Muslim Jordanian and Moroccan Jewish Israeli out-patient psychiatric patients

A sample of 148 (87 Jordanian [61 male, 26 female] and 61 Israeli [26 male, 35 female]) was selected from a psychiatric clinic in Ashdod Israel and Zarka Jordan, using convenience sampling methodology over a 12 month period in late 1997 and early 1998. A revised Hopkins Symptom Checklist: A Self-Report Symptom Inventory (HSCL) was translated into Arabic and Hebrew and distributed to subjects; additional questions explored demographic characteristics, forms of received treatment, patient perceptions of treatment efficacy, patient use of traditional healers, and patient explanation of etiology. Data revealed that there were differences in dimensions between the 2 groups based on nationality and gender. More Jordanians than Israelis expected medications as the main treatment, and unlike Israelis, no Jordanian patients received individual psychotherapy. Israelis expected medications, advice, directions, and instructions from psychiatrists. Both ethnic groups consulted a wide array of traditional healers, although precise types of healers varied according to gender and ethnicity. Israeli subjects gave more diverse explanations of mental health etiologies: physical, family, divorce, economic, unemployment; whereas Jordanians tended to emphasize divine and spiritual sources. Implications for psychiatric practice are discussed.

Gendered utilization differences of mental health services in Jordan

A revised Hopkins Symptom Checklist (HSCL), translated into Arabic, was distributed to a sample of 87 nonpsychotic mental health out-patients in Zarka, Jordan (male = 61, female = 26). Findings revealed no significant gendered differences, but higher responses among women in all dimensions. Regardless of gender, patients also expected and were satisfied with medicinal treatment; explained etiologies as having supernatural origins; and utilized informal community traditional healing and religious healing systems. The supernatural explanations and community healing systems varied by gender. Findings emphasize future treatment and programme development strategies that take into account the biomedical/traditional interface, culturally appropriate treatment modalities, different gendered patient needs, and the potential stigma of professional treatment.

Detection of coached general malingering on the MMPI-2

The current study examined the effects of validity-scale coaching on one's ability to feign general psychopathology. College students were coached on malingering strategies and completed the MMPI-2. Their responses were compared with students asked to malinger psychopathology without validity-scale coaching and with psychiatric inpatients completing the MMPI-2 under standard instructions. In accordance with previous research (e.g., J. R. Graham, D. Watts, & R. E. Timbrook, 1991), uncoached malingerers were adequately discriminated from patients by using the Infrequency (F) scale. However, as suggested by previous research (R. Rogers, R. M. Bagby, & D. Chakraborty, 1993), the F scale was not as effective at classifying coached malingerers. It was found that other validity indicators, such as the Infrequency Psychopathology Scale were more accurate at discriminating between coached malingerers and hospitalized patients.

Detection of coached general malingering on the MMPI-2

The current study examined the effects of validity-scale coaching on one's ability to feign general psychopathology. College students were coached on malingering strategies and completed the MMPI-2. Their responses were compared with students asked to malinger psychopathology without validity-scale coaching and with psychiatric inpatients completing the MMPI-2 under standard instructions. In accordance with previous research (e.g., J. R. Graham, D. Watts, & R. E. Timbrook, 1991), uncoached malingerers were adequately discriminated from patients by using the Infrequency (F) scale. However, as suggested by previous research (R. Rogers, R. M. Bagby, & D. Chakraborty, 1993), the F scale was not as effective at classifying coached malingerers. It was found that other validity indicators, such as the Infrequency Psychopathology Scale were more accurate at discriminating between coached malingerers and hospitalized patients.

Hot Stars and Cool Clouds: The Photodissociation Region M16

We present high-resolution spectroscopy and images of a photodissociation region (PDR) in M16 obtained during commissioning of the near-infrared spectrometer (NIRSPEC) on the Keck II telescope. PDRs play a significant role in regulating star formation, and M16 offers the opportunity to examine the physical processes of a PDR in detail. We simultaneously observe both the molecular and ionized phases of the PDR and resolve the spatial and kinematic differences between them. The most prominent regions of the PDR are viewed edge-on. Fluorescent emission from nearby stars is the primary excitation source, although collisions also preferentially populate the lowest vibrational levels of H2. Variations in density-sensitive emission-line ratios demonstrate that the molecular cloud is clumpy, with an average density n=3x105 cm-3. We measure the kinetic temperature of the molecular region directly and find that TH2=930 K. The observed density, temperature, and UV flux imply a photoelectric heating efficiency of 4%. In the ionized region, ni=5x103 cm-3 and THii=9500 K. In the brightest regions of the PDR, the recombination line widths include a nonthermal component, which we attribute to viewing geometry.

J-Band Infrared Spectroscopy of a Sample of Brown Dwarfs Using NIRSPEC on Keck II

Near-infrared spectroscopic observations of a sample of very cool, low-mass objects are presented with higher spectral resolution than in any previous studies. Six of the objects are L dwarfs, ranging in spectral class from L2 to L8/9, and the seventh is a methane or T dwarf. These new observations were obtained during commissioning of the near-infrared spectrometer (NIRSPEC), the first high-resolution near-infrared cryogenic spectrograph for the Keck II 10 m telescope on Mauna Kea, Hawaii. Spectra with a resolving power of R approximately 2500 from 1.135 to 1.360 µm (approximately J band) are presented for each source. At this resolution, a rich spectral structure is revealed, much of which is due to blending of unresolved molecular transitions. Strong lines due to neutral potassium (K i) and bands due to iron hydride (FeH) and steam (H2O) change significantly throughout the L sequence. Iron hydride disappears between L5 and L8, the steam bands deepen, and the K i lines gradually become weaker but wider because of pressure broadening. An unidentified feature occurs at 1.22 µm that has a temperature dependence like FeH but has no counterpart in the available FeH opacity data. Because these objects are 3-6 mag brighter in the near-infrared compared with the I band, spectral classification is efficient. One of the objects studied (2MASSW J1523+3014) is the coolest L dwarf discovered so far by the 2 Micron All-Sky Survey (2MASS), but its spectrum is still significantly different from the methane-dominated objects such as Gl 229B or SDSS 1624+0029.

Infrared Spectroscopy of a Massive Obscured Star Cluster in the Antennae Galaxies (NGC 4038/9) with NIRSPEC

We present infrared spectroscopy of the Antennae galaxies (NGC 4038/9) with the near-infrared spectrometer (NIRSPEC) at the W. M. Keck Observatory. We imaged the star clusters in the vicinity of the southern nucleus (NGC 4039) with 0&farcs;39 seeing in the K band using NIRSPEC's slit-viewing camera. The brightest star cluster revealed in the near-IR [MK&parl0;0&parr0; approximately -17.9] is insignificant optically but is coincident with the highest surface brightness peak in the mid-IR (12-18 µm) Infrared Space Observatory image presented by Mirabel et al. We obtained high signal-to-noise ratio 2.03-2.45 µm spectra of the nucleus and the obscured star cluster at R approximately 1900. The cluster is very young ( approximately 4 Myr), massive (M approximately 16x106 M middle dot in circle), and compact (with a density of approximately 115 M middle dot in circle pc-3 within a 32 pc half-light radius), assuming a Salpeter initial mass function (0.1-100 M middle dot in circle). Its hot stars have a radiation field characterized by Teff approximately 39,000 K, and they ionize a compact H ii region with ne approximately 104 cm-3. The stars are deeply embedded in gas and dust (AV approximately 9-10 mag), and their strong far-ultraviolet field powers a clumpy photodissociation region with densities nH greater, similar105 cm-3 on scales of approximately 200 pc, radiating LH21-0S&parl0;1&parr0;=9600 L middle dot in circle.

2 Micron Spectroscopy within 0&farcs;3 of Sagittarius A*

We present moderate- (R approximately 2700) and high-resolution (R approximately 22,400) 2.0-2.4 µm spectroscopy of the central 0.1 arcsec2 of the Galaxy obtained with the facility near-infrared spectrometer (NIRSPEC) for the Keck II telescope. The composite spectra do not have any features attributable to the brightest stars in the central cluster; i.e., after background subtraction, W12CO&parl0;2-0&parr0;<2 Å. This stringent limit leads us to conclude that the majority, if not all, of the stars are hotter than typical red giants. Coupled with previously reported photometry, we conclude that the sources are likely OB main-sequence stars. In addition, the continuum slope in the composite spectrum is bluer than that of a red giant and is similar to that of the nearby hot star IRS 16NW. It is unlikely that they are late-type giants stripped of their outer envelopes because such sources would be much fainter than those observed. Given their inferred youth (tauage<20 Myr), we suggest the possibility that the stars have formed within 0.1 pc of the supermassive black hole. We find a newly identified broad-line component (VFWHM approximately 1000 km s-1) toward the 2.2178 µm [Fe iii] line located within a few arcseconds of Sagittarius A*. A similar component is not seen in the Brgamma emission.

The Rest-Frame Optical Spectrum of MS 1512-cB58

Moderate-resolution, near-IR spectroscopy of MS 1512-cB58 is presented, obtained during commissioning of the near-infrared spectrometer (NIRSPEC) on the Keck II telescope. The strong lensing of this z=2.72 galaxy by the foreground cluster MS 1512+36 makes it the best candidate for detailed study of the rest-frame optical properties of Lyman-break galaxies. In 80 minutes of on-source integration, we have detected Halpha, [N ii] lambdalambda6583, 6548, [O i] lambda6300, He i lambda5876, [O iii] lambdalambda5007, 4959, Hbeta, Hgamma, [O ii] lambda3727, and a strong continuum signal in the range of 1.29-2.46 µm. A redshift of z=2.7290+/-0.0007 is inferred from the emission lines, in contrast to the z=2.7233 calculated from UV observations of interstellar absorption lines. Using the Balmer line ratios, we find an extinction of E(B-V) = 0.27. Using the line strengths, we infer a star formation rate (SFR) of 620+/-18 M middle dot in circle yr-1 (H0=75, q0=0.1, and Lambda=0), which is a factor of 2 higher than that measured from narrowband imaging observations of the galaxy but is a factor of almost 4 lower than the SFR inferred from the UV continuum luminosity. The width of the Balmer lines yields a mass of Mvir=1.2x1010 M middle dot in circle. We find that the oxygen abundance is 13 solar, in good agreement with other estimates of the metallicity. However, we infer a high nitrogen abundance, which may argue for the presence of an older stellar population.

Discovery of an Obscured Broad-Line Region in the High-Redshift Radio Galaxy MRC 2025-218

This Letter presents infrared spectra taken with the newly commissioned near-infrared spectrometer (NIRSPEC) on the Keck II telescope of the high-redshift radio galaxy MRC 2025-218 (z=2.63). These observations represent the deepest infrared spectra of a radio galaxy to date and have allowed for the detection of Hbeta, [O iii] lambdalambda4959, 5007, [O i] lambda6300, Halpha, [N ii] lambdalambda6548, 6583, and [S ii] lambdalambda6716, 6713. The Halpha emission is very broad (FWHM=9300 km s-1) and luminous (2.6x1044 ergs s-1), and it is very comparable to the line widths and strengths of radio-loud quasars at the same redshift. This strongly supports active galactic nucleus unification models linking radio galaxies and quasars, although we discuss some of the outstanding differences. The line [O iii] lambda5007 is extremely strong and has extended emission with large relative velocities toward the nucleus. We also derive that if the extended emission is due to star formation, each knot has a star formation rate comparable to a Lyman-break galaxy at the same redshift.

Development of an Infrequency-Psychopathology scale for the MMPI-A: the Fp-A Scale

This article describes the development and initial validation of the Infrequency-Psychopathology scale, Fp-A, for the MMPI-A (Butcher et al., 1992). The scale parallels the Infrequency-Psychopathology scale, F(p), that has been developed for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Results demonstrated that the 40-item Fp-A scale is superior to the F scale at discriminating between faking-bad and accurate reports of psychopathology, although the improvement over F was modest, particularly when compared to the improvement found for the F(p) scale. The difference seemed to reflect the superiority of the MMPI-A F scale to the MMPI-2 F scale. Even so, the findings suggest that the identification of overreporting on the MMPI-A could potentially be enhanced by using Fp-A as an adjunct to the F scale.

Culturally sensitive social work practice with Arab clients in mental health settings

Several culturally specific practical considerations should inform social work interventions with ethnic Arab peoples in Arab countries or in Western nations. These include taking into account gender relations, individuals' places in their families and communities, patterns of mental health services use, and, for practice in Western nations, the client's level of acculturation. Such aspects provide the basis for specific guidelines in working with ethnic Arab mental health clients. These include an emphasis on short-term, directive treatment; communication patterns that are passive and informal; patients' understanding of external loci of control and their use of ethnospecific idioms of distress; and, where appropriate, the integration of modern and traditional healing systems.

Effects of nutrient intake and number of oestrous cycles on in vitro development of preimplantation pig embryos

The effects of nutrient intake and insemination of gilts at first versus third oestrus on the in vitro development of preimplantation pig embryos were investigated. Standard swine management involves ad libitum feeding of gilts at first oestrus and restricted feeding of gilts at third oestrus. According to previous research, gilts inseminated at first oestrus demonstrate greater embryonic mortality than gilts inseminated at third oestrus, and it is possible that differences in nutrient intake between gilts inseminated at first versus third oestrus affect the viability of eggs or embryos. In the present study, experimental gilts were assigned to three treatments: animals designated 1A were inseminated at first oestrus and fed ad libitum; animals designated 3R were inseminated at third oestrus and were fed a restricted diet; and 3A animals were inseminated at third oestrus and fed ad libitum. Embryos collected from each treatment group were cultured in vitro, and data were evaluated according to cell stage at collection. Comparison of treatments 1A and 3R supported the contention of increased embryo mortality in gilts inseminated at first oestrus under normal management conditions. When cultures were initiated at the one- to two-cell or two- to four-cell stages, the percentage of 1A embryos developing to the morula stage (50.9%, 68.0%) was significantly lower than that of 3R embryos (88.9%, 90.9%; P < 0.05). Comparison of treatments 1A and 3A addressed effects due to the number of oestrous cycles. Significantly more two- to four-cell embryos from gilts inseminated at third oestrus and fed ad libitum reached the morula and expanded blastocyst stages of development (87.0%, 41.3%) compared with embryos from gilts inseminated at first oestrus and fed ad libitum (68.0%, 20.3%; P < 0.05). Finally, the effects of ad libitum feeding were determined by comparing treatments 3A and 3R. These data were inconclusive, as both positive and negative effects were observed. More one- to two-cell embryos from treatment 3R developed to the morula stage (88.9%) compared with 3A embryos collected at the same stage (64.7%), whereas a greater number of 3A embryos in the two- to four-cell category reached the expanded blastocyst stage (41.3%) than 3R embryos (21.2%; P < 0.05). These results support the hypothesis of lower in vitro developmental capacity for embryos collected from gilts inseminated at first oestrus. Furthermore, the findings indicate that differences in embryo viability between gilts inseminated at first versus third oestrus are related to the number of oestrous cycles and possibly to differential nutrition.

Gender and biomedical/traditional mental health utilization among the Bedouin-Arabs of the Negev

Twenty Bedouin-Arab non-psychotic subjects in Israel (10 male, 10 female) utilized biomedical and traditional healing mental health care systems. Common patterns of utilization were observed: first to family/friends, then to a general practitioner, next to a traditional healer, and finally to a psychiatrist. Men were more familiar with the biomedical system, and women with the traditional. Women, more than men, made group utilization decisions; men, more than women, saw traditional healers outsider their home communities. Gender differences were found in symptomatology and in patient construction of etiology. The biomedical system successfully addressed physical symptoms. The traditional system struck a stronger therapeutic alliance, tended to diagnose more comprehensibly, and was perceived by many patients as being more clinically beneficial. Biomedical practitioners can learn from traditional healers how to read a client's ecological map, incorporate the family/community in treatment, and communicate in the patient's cultural idiom. In their search for models of traditional/biomedical system integration, scholars should turn to patients themselves, who are currently living such integration.

Social work intervention with Bedouin-Arab children in the context of blood vengeance

Blood vengeance is a culturally specific phenomenon that can place Bedouin-Arab children at high risk of neglect. This case study examines the psychological and social implications of vengeance on children, the children's coping strategies, and the role of social work. The social work function includes nonauthoritarianism, strategies for forming a positive helping alliance, and various forms of culturally sensitive assessment and intervention. The study therefore yields insight into bridging the emic-etic gap in conceptualizing and responding to child neglect in a non-Western society.

Long-term stability of MMPI-A scales

Adolescents (24 boys, 37 girls) from public school settings were given the MMPI-A on 2 occasions with approximately 1 year between testing sessions. Long-term stability of validity, clinical, content, supplementary, and the new Psychopathology Five scales are examined and correlation coefficients are presented. The reliabilities of the MMPI-A scales are consistent with previously reported data. In addition, improvements made during development of the MMPI-A may have led generally to modest increases in stability of the clinical scales for adolescents. Given the importance of both short-term and long-term test-retest data in the evaluation of the validity of an assessment instrument, this study represents an important step in evaluating the validity of the MMPI-A for assessment of personality.

MADD, a novel death domain protein that interacts with the type 1 tumor necrosis factor receptor and activates mitogen-activated protein kinase

The death domain of the type 1 tumor necrosis factor receptor (TNFR1) mediates interactions with several proteins involved in signaling the downstream effects of TNF. We have used the yeast interaction trap to isolate a protein, MADD, that associates with the death domain of TNFR1 through its own C-terminal death domain. MADD interacts with TNFR1 residues that are critical for signal generation and coimmunoprecipitates with TNFR1, implicating MADD as a component of the TNFR1 signaling complex. Importantly, we have found that overexpression of MADD activates the mitogen-activated protein (MAP) kinase extracellular signal-regulated kinase (ERK), and expression of the MADD death domain stimulates both the ERK and c-JUN N-terminal kinase MAP kinases and induces the phosphorylation of cytosolic phospholipase A2. These data indicate that MADD links TNFR1 with MAP kinase activation and arachidonic acid release and provide further insight into the mechanisms by which TNF exerts its pleiotropic effects.

The healing significance of the Negev's Bedouin Dervish

Among the Bedouins of the Negev desert, Israel, there are Dervish healers specializing in what are now called psychiatric disorders. Five Dervish (three male, two female) were interviewed and observed with reference to concepts of etiology, symptom classification, diagnosis, stages of treatment, and aftercare. The conclusion examines reasons why Bedouins might want to seek treatment from a Dervish, rather than a modern health care practitioner.

Detecting Fake-Bad MMPI-A Profiles

This study examined the extent to which the validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) could identify adolescents who were faking-bad. This study also examined the extent to which the validity scales could differentiate between nonclinical adolescents instructed to fake-bad and both clinical and nonclinical adolescents who received standard instructions. Participants were 58 male and 80 female high school students and 58 male and 80 female adolescents from clinical settings. Results indicated that the mean profiles resembled those previously reported for adults on the MMPI (Graham, 1987) and MMPI-2 (Graham, Watts, & Timbrook, 1991) and for adolescents on the original MMPI (Archer, Gordon, & Kirchner, 1987). Accurate identification of students who were faking-bad was achieved. It was possible to differentiate between the clinical adolescents and nonclinical adolescents who were faking, and it was possible to differentiate between nonclinical adolescents who were faking and nonclinical adolescents with standard instructions; however, different cutoff scores were needed for these two discriminations. Optimal cutoff scores were presented.

Leber's hereditary optic neuropathy plus dystonia is caused by a mitochondrial DNA point mutation

A novel point mutation in the ND6 subunit of complex I at position 14,459 of the mitochondrial DNA (MTND6*LDY T14459A) was identified as a candidate mutation for the highly tissue-specific disease. Leber's hereditary optic neuropathy plus dystonia. Since the MTND6*LDYT14459A mutation was identified in a single family, other pedigrees with the mutation are needed to confirm its association with the disease. Clinical, biochemical, and genetic characterization is reported in two additional pedigrees. Leber's hereditary optic neuropathy developed in two family members in one pedigree. The daughter had clinically silent basal ganglia lesions. In a second pedigree, a single individual presented with childhood-onset generalized dystonia and bilateral basal ganglia lesions. Patient groups that included individuals with Leigh's disease, dystonia plus complex neurodegeneration, and Leber's hereditary optic neuropathy did not harbor the MTND6*LDYT14459A mutation, suggesting that this mutation displays a high degree of tissue specificity, thus producing a narrow phenotypic range. These results confirm the association of the MTND6*LDYT14459A mutation with Leber's hereditary optic neuropathy and/or dystonia. As the first genetic abnormality that has been identified to cause generalized dystonia, this mutation suggests that nuclear DNA or mitochondrial DNA mutations in oxidative phosphorylation genes are important considerations in the pathogenesis of dystonia.

The fragment R collision: W. M. Keck telescope observations of SL9

The W. M. Keck telescope was used to observe the impact of comet Shoemaker-Levy 9 (SL9) fragment R at a wavelength of 2.3 micrometers on 21 July 1994. The data showed three outbursts. The first flash lasted about 40 seconds and was followed 1 minute after its peak by a second flash that lasted about 3 minutes. A third, longer lasting flare began 6 minutes after the first flash and lasted for 10 minutes. At its maximum brightness, the flare outshone Jupiter. The two short flashes are probably associated with the initial meteor trail and the subsequent fireball, respectively. The bright flare occurred when the impact site rotated into view. These data show that the explosion ejected material at least 1300 kilometers above the visible cloud tops. The luminosity of the impact site during the long bright flare was probably maintained by the release of gravitational potential energy, as this material fell back onto the lower atmosphere.

Temporal pattern of rat small intestinal gene expression with refeeding

Studies were carried out to elucidate the molecular mechanisms underlying small intestinal epithelial growth. Adult rats were fasted for 4 days and then refed a chow diet for up to 48 h. Histological examination confirmed the sequential occurrence of mucosal atrophy and hyperplasia. Northern blot analyses of RNA derived from small intestinal mucosal scrapings revealed a striking pattern of alterations in the expression of two different categories of genes. There were very early increases in the expression of c-fos and c-jun, reflecting the mitogenic response to refeeding that occurs within the crypt compartment. Studies using the protein synthesis inhibitor cycloheximide suggest that c-fos and c-jun are part of the "immediate-early" response of the small intestine. At later time points after the refeeding stimulus, differential changes occurred in the expression of the brush-border enzymes, lactase, and intestinal alkaline phosphatase (IAP). Refeeding caused a decrease in lactase gene expression and an increase in the expression of the 3.0-kb IAP mRNA species, reflecting a return of the villus phenotype to the normal fed state. Thus we have demonstrated a complex and temporally related pattern of gene expression within the small intestinal epithelium upon refeeding. The results provide insight into the relationship between the processes of intestinal growth and differentiation.

The meaning of low scores on MMPI-2 clinical scales of normal subjects

Low scores often have been ignored in validity research on the MMPI, yet these statistically significant deviations from the norm may be valuable sources of information and occur frequently enough to merit further investigation. The meaning of low scores on the MMPI-2 was examined for 822 male-female partner pairs in the MMPI-2 restandardization sample. Subjects were divided by MMPI-2 scale scores into high-, medium-, and low-score groups. Analyses of variance were performed with score level as the independent variable and partner ratings as dependent variables. Significant differences were found between the low- and medium-score groups with low scorers rated as better adjusted that medium scorers. More significant differences were found between the high-score and medium-score groups than between the low-score and medium-score groups; this suggested that high scores on MMPI-2 clinical scales are associated with poorer adjustment.

Detecting fake-good and fake-bad MMPI-2 profiles

This study examined the extent to which the validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) could identify subjects who were faking bad or faking good and differentiate between psychiatric patients and normal subjects who were faking bad. Subjects were 106 undergraduate college students and 50 psychiatric patients. Results indicate that the mean profiles and optimal cutoff scores resembled those previously reported for the original MMPI. Accurate identification of persons who were faking bad or faking good was achieved. It was possible to differentiate between the psychiatric patients and normal persons who were faking bad, but different cutoff scores were needed to differentiate between normals taking the test under standard instructions and those instructed to fake bad. Optimal cutoff scores were suggested.

The Masculinity-Femininity Scale of MMPI-2: is it useful with normal men?

Using ratings provided by significant others, we examined characteristics of 819 normal men whose scores on the Masculinity-Femininity scale (Scale 5) of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) ranged from low to high. Also examined were the possible effects of educational level as a moderator variable. Only one external characteristic was correlated with Scale 5 scores at a level of significance that could not be attributed to chance, and that correlation was negative, whereas previous literature indicated a positive relationship. The findings were essentially the same whether or not the effects of education were controlled. Regardless of Scale 5 scores and the higher the men's educational levels, the more positive were ratings by their partners. In general, the results do not support the usefulness of Scale 5 in describing the personalities and behaviors of normal men.

Three methods of developing MMPI taxonomies of sexual offenders

In a sample of 261 state hospital sexual offenders, Minnesota Multiphasic Personality Inventory (MMPI) profiles did not differ for offenders with adult victims versus offenders with child victims when offender age was controlled. MMPI 2-point analyses for the whole sample revealed five common codes that were independent of victim maturity. The sample was randomly divided in half and subjected to a cluster-analytic procedure which revealed two MMPI clusters. The first cluster was unelevated, with Scale 4 as its high point. The second cluster had multiple elevations, with Scales 8, 4, 2, and 7 as the highest scales. These clusters were replicated in a cluster analysis of the second half of the sample. However, when the sample was recombined, the two clusters were not externally validated basis on demographic and criminological variables. The results suggest that common psychological variables among sexual offenders may have more discriminative value than victim maturity in developing sexual offender taxonomies.