Aboriginal prisoners and cognitive impairment: the impact of dual disadvantage on Social and Emotional Wellbeing

BACKGROUND

Negligible information is available regarding the Social and Emotional Wellbeing (SEWB) needs of Aboriginal Australian individuals in custody with cognitive impairment. This is problematic given that Aboriginal people with cognitive impairment often experience dual disadvantage in the context of the justice system. This study sought to ascertain the relationship between cognitive impairment and mental health/cultural needs (SEWB) Aboriginal and Torres Strait Islander people in custody.

METHOD

A sample of 122 Aboriginal and Torres Strait Islander people were administered a culturally themed semi-structured questionnaire in custodial settings in Victoria, Australia. The questionnaire included measures of cognitive impairment, SEWB and forensic needs. Analyses were performed to determine differences in the presence of SEWB and unmet custodial needs by level of cognitive impairment.

RESULTS

Findings revealed a diminished level of wellbeing for cognitively impaired participants across several factors. Cognitive impairment was associated with poorer coping mechanisms, additional experiences of racism, difficulties handling emotions, discomfort around non-Aboriginal people and reduced access to meaningful activities in custody. All participants regardless of their level of impairment recognised the importance of cultural engagement; however, cognitively impaired participants had greater difficulty accessing/practicing cultural activities.

CONCLUSIONS

Culturally responsive disability assistance should be available at all phases of the justice system for Indigenous people with cognitive impairment to ensure that equitable care is accessible and needs are addressed.

Acute toxicity and tissue distributions of malathion in Ambystoma tigrinum

The kinetics of the bioaccumulation of malathion (O,O-dimethyl phosphorodithioate of diethyl mercaptosuccinate) and the biological impact of exposure for tiger salamanders, Ambystoma tigrinum, were assessed through exposure to soil surface contaminated with 50 microg/cm(2) or 100 microg/cm(2 )malathion and ingestion of an earthworm exposed to soil contaminated with 200 microg/cm(2) malathion. Malathion and malaoxon burdens in salamanders sampled at different times after exposure(s) were measured by gas chromatography in four tissue/organ subgroups: liver, epaxial muscle, pooled viscera (except the liver and brain), and pooled avisceral carcass (muscle, skin, and bone). The total tiger salamander xenobiotic burdens were calculated from these data. The malathion/malaoxon burden 1 day after exposure was greatest in the avisceral carcass and 2 days after exposure was greatest in the viscera. Bioconcentration and bioaccumulation factors remained less than unity throughout the experiment and did not support the hypothesis of bioaccumulation of malathion in the tiger salamander. Biological impact was assessed with a colorimetric brain cholinesterase microassay. Brain cholinesterase activities in salamanders exposed to malathion-contaminated soil (50 microg/cm(2) or 100 microg/cm(2 )malathion) were suppressed approximately 50-65% and 90%, respectively, compared to unexposed controls. The exposed animals did not exhibit overt clinical signs of malathion toxicosis.

Elimination rate constants of 46 polycyclic aromatic hydrocarbons in the unionid mussel, Elliptio complanata

Elimination rate constants (k2), biological half-lives (t(1/2)), and the time required to reach 95% of steady-state (t95) are reported for 46 individual polycyclic aromatic hydrocarbons (PAHs) including both parent and alkyl homologues, for the freshwater unionid mussel, Elliptio complanata. Elimination rate constants generally follow first-order kinetics and range from 0.04/day (d) for perylene to 0.26/d for 2,6-dimethylnapthalene, half-lives range from 2.6 to 16.5 d, and t95 values range from 11.3 to 71.3 d. These values compare well with other k2, t(1/2), and t95 values reported in the literature for PAHs and other classes of hydrophobic organic contaminants. A linear regression of k2 versus log Kow demonstrates dependence of PAH elimination on hydrophobicity, as measured by an r2 value of 0.83, and produces the following regression equation: k2 = -0.06 (log Kow) + 0.44. This study provides evidence that mussels experiencing different forms of physiological stress (e.g., handling stress and fungal or bacterial growth) can exhibit large variation in toxicokinetic parameters. These results are particularly relevant to the extrapolation of laboratory results to field situations.

Cost analysis of telehomecare

The demand for home health care has skyrocketed in recent years. The aging population and the push for more efficient delivery of hospital services have fueled this growing demand. However, health care financing reforms have constrained the industry's growth. Home health agencies struggle to deliver high-quality services while staying within the financial limitations imposed by reimbursement changes. Telehomecare is one way to provide cost-effective care in the current environment. Personal computers and video equipment can transmit data over ordinary telephone lines and allow home health providers to monitor patients and provide care at a much lower cost than earlier technologies that required wider bandwidth telephone lines and more complex equipment. But can telehomecare yield cost-savings for home health agencies? This article addresses the costs associated with a telehomecare intervention in a large, urban, home health agency. The purpose of the study was two-fold: (1) to test the effects of telehomecare on clinical outcomes, and (2) to estimate the financial costs associated with providing telehomecare services. Our results show that, while telehomecare imposes additional expenses for care delivery, it contributes substantial savings without compromising quality. Additionally, we found that the financial benefit increases exponentially as the duration of the patient care episode increases.

Dynamics in drug coverage of Medicare beneficiaries: finders, losers, switchers

Although the vast majority of elderly Americans have the stability of basic Medicare benefits, Medicare alone offers no protection from the vicissitudes of the market for outpatient prescription drugs. This paper analyzes the sources and stability of prescription coverage maintained by Medicare beneficiaries in 1995 and 1996. The results show that fewer than half of all beneficiaries had continuous drug coverage over this period, while nearly a third gained, lost, or had spells without coverage.

Species, tissue and gender-related organochlorine bioaccumulation in white-sided dolphins, pilot whales and their common prey in the northwest Atlantic

Organochlorine concentrations were measured in white-sided dolphins, pilot whales, and their prey from the Gulf of Maine and used to identify species, tissue, and gender differences, and trophic transfer trends, in bioaccumulation. Polychlorinated biphenyl concentrations ([PCB]) in dolphin blubber (13 +/- 7.1 micrograms/g fresh wt.) were twice those in pilot whales, but pesticide concentrations (20 +/- 13 micrograms/g fresh) were similar between species. 4,4'-DDE, trans-non-achlor, Cl6(153) and Cl6(138) concentrations were highest. Skin tissues had more recalcitrant organochlorines than the internal organs. Male dolphins bioaccumulated higher concentrations of nonmetabolizable PCBs and hexachlorocyclohexane (HCH) isomers, whereas pilot whales had no gender-related differences in bioaccumulation. Pilot whales, mackerel, and herring had proportionately higher concentrations of DDTs, whereas [PCB] were higher in dolphins and squid. Although these odontocetes feed at the same trophic level and store a similar suite of contaminants, dolphins bioaccumulated higher and potentially hazardous 4,4'-DDE and PCB concentrations from food in their more geographically restricted range.

Separation of acidic solutes by nonaqueous capillary electrophoresis in acetonitrile-based media. Combined effects of deprotonation and heteroconjugation

Nonaqueous capillary electrophoresis (NACE) is a chemical separation technique that has grown in popularity over the past few years. In this report, we focus on the combination of heteroconjugation and deprotonation in the NACE separation of phenols using acetonitrile (ACN) as the buffer solvent. By preparing various dilute buffers consisting of carboxylic acids and tetrabutylammonium hydroxide in ACN, selectivity may be manipulated based on a solute's dissociation constant as well as its ability to form heterogeneous ions with the buffer components. ACN's low viscosity, coupled with its ability to allow for heteroconjugation, often leads to rapid and efficient separations that are not possible in aqueous media. In this report, equations are derived showing the dependence of mobility on various factors, including the pKa of the analyte, the pH and concentration of the buffer, and the analyte-buffer heteroconjugation constant (Kf). The validity of these equations is tested as several nitrophenols are separated at different pH values and concentrations. Using nonlinear regression, the Kf values for the heteroconjugate formation between the nitrophenols and several carboxylate anions are calculated. Also presented in this report are the NACE separations of the 19 chlorophenol congeners and the 11 priority pollutant phenols (used in US Environmental Protection Agency methods 604, 625/1625 and 8270B).

In vitro metabolism of polychlorinated biphenyl congeners by beluga whale (Delphinapterus leucas) and pilot whale (Globicephala melas) and relationship to cytochrome P450 expression

We measured rates of oxidative metabolism of two tetrachlorobiphenyl (TCB) congeners by hepatic microsomes of two marine mammal species, beluga whale and pilot whale, as related to content of selected cytochrome P450 (CYP) forms. Beluga liver microsomes oxidized 3,3',4,4'-TCB at rates averaging 21 and 5 pmol/min per mg for males and females, respectively, while pilot whale samples oxidized this congener at 0.3 pmol/min per mg or less. However, rates of 3,3',4,4'-TCB metabolism correlated with immunodetected CYP1A1 protein content in liver microsomes of both species. The CYP1A inhibitor alpha-naphthoflavone inhibited 3,3',4,4'-TCB metabolism by 40% in beluga, supporting a role for a cetacean CYP1A as a catalyst of this activity. Major metabolites of 3,3',4,4'-TCB generated by beluga liver microsomes were 4-OH-3,3',4',5-TCB and 5-OH-3,3',4,4'-TCB (98% of total), similar to metabolites formed by other species CYP1A1, and suggesting a 4,5-epoxide-TCB intermediate. Liver microsomes of both species metabolized 2,2',5,5'-TCB at rates of 0.2-1.5 pmol/min per mg. Both species also expressed microsomal proteins cross-reactive with antibodies raised against some mammalian CYP2Bs (rabbit; dog), but not others (rat; scup). Whether CYP2B homologues occur and function in cetaceans is uncertain. This study demonstrates that PCBs are metabolized to aqueous-soluble products by cetacean liver enzymes, and that in beluga, rates of metabolism of 3,3',4,4'-TCB are substantially greater than those of 2,2',5,5'-TCB. These directly measured rates generally support the view that PCB metabolism plays a role in shaping the distribution patterns of PCB residues found in cetacean tissue.

The relationship between health care reform and nurses' interest in union representation: the role of workplace climate

Market-based reforms are rapidly changing the landscape of the American health care system. Over the last decade, a great deal of attention has been paid to these reforms, particularly the advent and rapid growth of managed care and the vertical and horizontal integration of provider institutions. The ramifications of these changes on both individual and institutional consumers has also been widely considered by scholars and policymakers. Yet, although these market reforms are driving the massive restructuring of work in hospitals and other health care organizations, comparatively little attention has been paid to the impact these changes have on health care employees and the environment in which they work. This article reports the results of an exploratory study examining the relationship between health care market reforms, nurses' perceptions of the climate for patient care in hospital settings, and nurses' interest in union representation. A model is proposed to help explain nurses' support for union representation in the presence of market-based reforms.

Community-based long-term care for older persons with severe and persistent mental illness in an era of managed care

The authors describe current needs and trends in the mental health care, including long-term care, of older persons with severe and persistent mental illness. The literature suggests that emerging models of managed long-term care hold promise for integrated services but do not currently address the specialized mental health needs of this patient group. The authors review issues in financing long-term mental health care, including controversies over fee-for-service and carve-out and carve-in arrangements. Without mechanisms to adequately finance services, adjust for risk, and measure outcomes, the authors conclude, managed care arrangements will be in conflict with the goal of high-quality care for older adults with severe and persistent mental illness. Proposed directions for future models of care for this group include integration of mental health and medical services, integration of specialized geropsychiatric services with developing community-based long-term care systems, blended financing under shared risk arrangements, and assurance of accountability and outcomes under managed care.

Medicare physician referral patterns

OBJECTIVE

To study patterns of referral between primary and specialty care providers among Medicare beneficiaries and to identify correlates of the probability of referral.

DATA SOURCES

The 1992 and 1993 Medicare Current Beneficiary Survey (MCBS), including associated claims data. MCBS data are linked to the Area Resource File (ARF) and the Physician Identification Master Record (PIMR).

STUDY DESIGN

This is a retrospective design using cross-sectional descriptive and multivariate correlational analysis. Estimates are made for two years. Key variables include two alternative definitions of referrals, patient socio-demographic and health status, physician characteristics, and county-level descriptors.

DATA COLLECTION

The MCBS is a panel survey of a stratified random sample of Medicare beneficiaries begun in 1991. The data are linked to Medicare claims records for survey respondents. The ARF is a health resources data set that contains more than 7,000 variables at the county level, including information on health facilities, health professions, services resources and utilization, and socioeconomic and environmental characteristics. The PIMR is a record of all physicians in the United States and describes their professional characteristics.

PRINCIPAL FINDINGS

The overall rate of physician referrals in the MCBS, approximately 10 percent, is higher than that found in prior research, as is the level of self-referral to specialists at about 70 percent. Depending on the dependent variable definition, between 60 and 85 percent of all Medicare beneficiaries had at least one referral, and the average number of referrals per person per year was greater than two. Referrals show a multi-directional pattern rather than a simple pattern of primary to specialty care, with referrals between primary care physicians, referrals between specialists, and referrals from specialty to primary care being not uncommon. Strong predictors of referral include patient health and patient insurance coverage and income. Physician factors do not contribute much to explaining referrals.

CONCLUSIONS

Medicare referral patterns are similar to those found in other studies. Patient factors appear to be a more important factor in explaining referrals than was estimated from prior research. Additional research is needed to explain the more complex dynamics of referral patterns.

An economic evaluation of energy-absorbing flooring to prevent hip fractures

An economic evaluation of energy-absorbing flooring designed to prevent hip fractures revealed a payback period of 10 1/2 years if only direct costs avoided were evaluated and just over 11 months when direct and indirect costs were included. Cost-effectiveness ratios of less than $0 per hip fracture prevented and life year saved were also estimated.

Altered metabolic elimination of testosterone and associated toxicity following exposure of Daphnia magna to nonylphenol polyethoxylate

The ability of nonylphenol polyethoxylate (nonylphenyl polyethylene glycol, NPPG) to alter the metabolic elimination of testosterone and elicit reproductive toxicity to Daphnia magna was assessed. NPPG (5.0 mg/liter) inhibited the elimination of testosterone as glucose and sulfate conjugates, but had minimal effect on the rate of elimination of oxido-reduced and hydroxylated derivatives of the steroid hormone. This exposure concentration of NPPG also approximated the acute threshold-effect concentration and the chronic value for daphnids. Results demonstrated that NPPG qualitatively elicits similar effects on the metabolic elimination of testosterone by daphnids as previously characterized with its degradation product 4-nonylphenol. Unlike 4-nonylphenol, significant chronic toxicity of NPPG, due to effects on steroid elimination processes, was not evident. Results from the present study provide no indication that concentrations of nonylphenol polyethoxylates typically measured in the environment pose a risk of chronic toxicity to invertebrates.

Metabolism of the aryl hydrocarbon receptor agonist 3,3',4,4'-tetrachlorobiphenyl by the marine fish scup (Stenotomus chrysops) in vivo and in vitro

The metabolism of the polychlorinated biphenyl congener 3,3',4,4'-tetrachlorobiphenyl (TCB) was examined in vitro and in vivo in the marine fish scup (Stenotomus chrysops). Untreated scup liver microsomes catalyzed metabolism of TCB with an estimated KM of 0.7 microM, at a rate < or = 0.13 pmol/min/mg. Metabolism was NADPH-dependent and inhibited by cytochrome c and CO, indicating cytochrome P450 (CYP) involvement. alpha-Naphthoflavone strongly inhibited microsomal TCB metabolism, and treatment of fish with CYP1A inducers increased the rates by approximately 2-fold, suggesting involvement of CYP1A. Scup were injected intraperitoneally with 0.1 or 5 mg TCB/kg and sampled on days 1-16 after treatment (after 3 days without food at each sampling). Concentrations of unmetabolized TCB in liver peaked on day 5 in low dose fish and on day 12 in high dose fish. In both groups the TCB content in the liver had declined 60% or more by day 16, suggesting depuration or redistribution from the liver. GC and MS revealed TCB and TCB metabolites in bile within 24 hr of treatment. The concentrations of TCB and metabolites in bile peaked at the same time that TCB concentrations peaked in the liver. The major metabolites were 5-hydroxy-3,3'4,4'-TCB (5-OH-TCB) and 4-hydroxy-3,3',5,4'-TCB (4-OH-TCB); 2-hydroxy-3,3',4,4'-TCB and 6-hydroxy-3,3',4,4'-TCB were minor metabolites. Animals given the high dose had much less 5-OH-TCB and much more parent TCB in bile than did fish given the low dose. Amounts of 4-OH-TCB in bile did not differ between doses. The reduced excretion of 5-OH-TCB coincided with a suppression of CYP1A in fish given the high dose, that did not occur in low dose fish, consistent with an involvement of CYP1A in TCB metabolism and particularly in formation of 5-OH-TCB. This study provides the first direct demonstration of 3,3',4,4'-TCB metabolism by fish. Data also indicate that these fish are able to eliminate TCB both as parent compound and as metabolites, despite a very slow rate of metabolism in vitro.

Induction and post-transcriptional suppression of hepatic cytochrome P450 1A1 by 3,3',4,4'-tetrachlorobiphenyl

3,3',4,4'-Tetrachlorobiphenyl (TCB) can induce and inhibit cytochrome P450 1A1 (CYP1A1) in vertebrates. TCB may also suppress CYP1A1 protein levels, but the mechanism is unknown. This study examined transcriptional and translational aspects of hepatic CYP1A1 regulation in the fish scup (Stenotomus chrysops) given single intraperitoneal injections of low (0.1 mg/kg) or high (5 mg/kg) doses of TCB, and sampled over 16 days. The low dose strongly induced hepatic CYP1A1 mRNA (25-fold), protein (12-fold), and activity [ethoxyresorufin O-deethylase (EROD)] (15-fold). The high dose also strongly induced CYP1A1 mRNA (29-fold), in a pattern like that at the low dose, but microsomal CYP1A1 protein content was induced only 4-fold and EROD rates were near control levels. Both TCB doses caused similar increases in microsomal cytochrome b5 content, and in rates of NADPH-cytochrome c (P450) reductase and UDP-glucuronosyltransferase (with p-nitrophenol). The contents of CYP forms other than CYP1A1 (putative CYP2B or CYP3A) were only weakly affected by TCB at either dose. The strong and largely specific post-transcriptional suppression of CYP1A1 content was associated with high concentrations of TCB measured in the liver. Incubation of scup hepatic microsomes with TCB plus NADPH led to a time-dependent inactivation of CYP1A1 that was distinct from catalytic inhibition, and appeared not to involve reactive metabolites of TCB. This in vitro result suggests that TCB may inactivate CYP1A1 in vivo, which could account for the apparent antagonistic effect of TCB on CYP1A1 induction.

Separation of polycyclic aromatic hydrocarbons by nonaqueous capillary electrophoresis using charge-transfer complexation with planar organic cations

In this study, we examine the use of charge-transfer interactions between polycyclic aromatic hydrocarbons (PAHs) and planar organic cations in nonaqueous capillary electrophoresis. Since the separations are performed in a purely nonaqueous medium, this method also facilitates the analysis of solutes that have low solubilities in aqueous or mixed media. Presented in this study are the separations of PAHs as well as the quantitative structure-migration relationships that assisted in achieving a better understanding of the forces through which the PAH molecules interact with the acceptor cation. It was found that, in addition to charge-transfer interactions, electrostatic and dispersive forces play an important role in PAH-cation binding.

Separation of fungicides by micellar electrokinetic capillary chromatography

Capillary electrophoresis with ultraviolet detection (CE/UV) of selected fungicides (carbendazim, metalaxyl, propiconazole, and vinclozolin) using different buffer compositions was investigated. Capillary zone electrophoresis (CZE) with 10 mM sodium phosphate (pH 7.0) was not useful in separating the four fungicides used in this study. However, the four fungicides were well resolved by employing micellar electrokinetic capillary chromatography (MEKC). Among the two surfactants tested in MEKC, bile salts provided better separation compared to sodium dodecyl sulfate (SDS). A buffer consisting of 10 mM sodium phosphate with 100 mM sodium cholate and 10% methanol (pH 7.0) gave best results; excellent separation of the four compounds was achieved in less than 15 min. The CE/UV method was validated by analyzing deionized and lake-water samples fortified with known concentrations for the four fungicides. Average recoveries of the fungicides in lake water of 4 micrograms/L level ranged from 42 to 87%.

Analysis of brevetoxins by micellar electrokinetic capillary chromatography and laser-induced fluorescence detection

Micellar electrokinetic capillary chromatography (MEKC) with laser-induced fluorescence (LIF) detection was used to measure four red tide brevetoxins at sub-attomole levels. The separation of four brevetoxins by MEKC was achieved with a sodium borate/sodium dodecyl sulfate buffer at pH 9.3 Brevetoxins with a terminal alcohol group were derivatized with an acyl azide coumarin to form stable, highly fluorescent products. Brevetoxins with a terminal aldehyde group were reduced to the alcohol with sodium borohydride prior to derivatization with the coumarin. Three derivatized brevetoxins (PbTx-3, PbTx- 5, and PbTx-9) were separated by MEKC and detected using He/Cd laser excitation at 354 nm and fluorescence emission at 410 nm. A fourth brevetoxin (PbTx-2) was converted to PbTx-3 prior to derivatization and was then determined by subtraction. Instrumental detection limits for all four toxins were approximately 0.10 fg or about 10(6)-fold more sensitive than existing liquid chromatographic methods. Brevetoxins were isolated from cell cultures and fish tissue using an alumina column/gel-permeation chromatography procedure. Method detection limits for the brevetoxins in fish tissue were approximately 4 pg/g. These method detection limits are at least 100-fold better than previous chromatographic and/or electrophoretic methods. The MEKC-LIF method reported here allows measurement of brevetoxins at the trace levels considered critical for understanding toxin metabolism and mode of action.

Institutional factors of nursing homes that predict the provision of mental health services

This article explores the likelihood of the provision of mental health services in a nursing home as a function of the home's institutional factors. Data from the Institutional Population Component of the National Medical Expenditure Survey were used, and a modified model of equilibrium quality and price in a multivariate logistic framework is employed. The results indicate that meeting the demands for active mental health treatment, as mandated by the Nursing Home Reform Act of 1987, may be more difficult in those institutions that are part of a chain, are small, or contain Medicaid skilled nursing facility beds.

Localization of 102 exons to a 2.5 Mb region involved in Down syndrome

Exon amplification has been applied to a 2.5 Mb region of chromosome 21 that has been associated with some features of Down syndrome (DS). Identification of the majority of genes from this region will facilitate the correlation of the over-expression of particular genes with specific phenotypes of DS. Over 100 gene fragments have been isolated from this 2.5 Mb segment. The exons have been characterized by sequence analysis, comparison with public databases and expansion to cDNA clones. Localization of the exons to chromosome 21 has been determined by hybridization to genomic Southern blots and to YAC and cosmid clones representing the region. This has resulted in a higher resolution physical map with a marker approximately every 25 kb. This integrated physical and transcript map will be valuable for fine mapping of DNA from individuals with partial aneuploidy of chromosome 21 as well as for assessing and ultimately generating a complete gene map of this segment of the genome.

Educational attainment, occupational history, and stratification: determinants of later-life economic outcomes

Determinants of economic well-being among men 25-44, 45-64, and 65+ were examined using data from the 1984 panel of the Survey of Income and Program Participation. A path analysis explored race, education, and occupational history effects on income adjusted for annuitized assets, household composition, and underreporting of unearned income. Direct and total education effects were undiminished among elderly persons, whose income derived mainly from benefits and assets, as compared with the nonelderly subjects whose income was dominated by earnings; education explained more of the variance in adjusted income for the elderly group than for the nonelderly. While Social Security income exerts an equalizing effect across educational attainment groups, private pensions and other important retirement income sources were highly education-dependent, producing a high overall degree of stratification on early-established socioeconomic characteristics.

How are pediatric training programs preparing residents for practice?

The majority of pediatric residents continue to choose a career in practice on completion of their training. Despite knowing residents' career preferences, many training programs have focused on inpatient tertiary care at the expense of primary care. Perhaps this reflects service needs and the significant technology and extensive information resulting in the growth of pediatric subspecialties. To determine the spectrum of didactic and clinical experiences pediatric training programs offer residents to prepare them for managing a practice, we conducted a survey of pediatric training program directors in 1988. Although the majority of residency programs have a practice management curriculum, the number of hours devoted to this area is minimal. In addition, a significant number of residents are not experiencing a community office rotation. This survey indicates the need to develop a practice management curriculum if trainees are to be prepared for choosing the right career and for being competitive in practice.

Cumulative advantage, cumulative disadvantage, and inequality among elderly people

It is often asserted that economic inequality narrows after age 65 when benefit programs replace labor markets as principal income sources. However, analysis of recent Census data suggests inequality is greatest among elderly people. The worst off one-fifth of the elderly (disproportionately unmarried women, minorities, and the physically impaired) receives 5.5% of the elderly's total resources, whereas the best off one-fifth receives 46%. Equalizing effects of Social Security are more than outweighed by private pensions, asset income, and other sources. Findings suggest a process of cumulative economic advantage and disadvantage throughout the life course.

Testicular infarction in the newborn: ultrasound findings

Three patients with neonatal testicular torsion and infarction (two bilateral, one unilateral) are presented with a distinctive sonographic appearance. All five testes appeared inhomogeneously hypoechoic and each was surrounded by a brightly echogenic rim. Whereas surgical exploration was required in the past to establish the diagnosis of testicular infarction in the neonate, sonographic demonstration of the abnormality in the appearance of the testicular parenchyma permits nonoperative diagnosis. Because surgical salvage of the testis in the setting of neonatal extravaginal torsion is thought to be quite rare, the necessity of removing the testis is less clear when the diagnosis is established preoperatively.

Traffic safety effects of sobriety checkpoints and other local DWI programs in New Jersey

We examined the efficacy of three Driving While Intoxicated (DWI) programs in New Jersey from 1980 through 1985, using covariance analysis of county data. Road blocks, the major component of the Strike Force program, were associated with a drop of 10-15 per cent in the single vehicle nighttime crash rate and showed a relatively stable effect over time. DWI Task Force, an education program, was associated with a 6-10 per cent total decline in the crash rate and declining impact over time. SOBER, another education program, was associated with a small effect in the first year and little or no effect thereafter.

Primary and secondary tumors of the facial nerve. A temporal bone study

Of 1400 temporal bones in the collection at the University of Minnesota, Minneapolis, 17 temporal bones from 15 patients were found to have tumors involving the facial nerve. The findings were as follows: one case of facial nerve schwannoma; two cases of invasion of the facial nerve by contiguous tumor; and 14 cases of metastatic tumors involving the facial nerve. Facial nerve paralysis was present in half of the cases (nine of 17). Facial nerve paralysis was present in the case of facial nerve schwannoma, in both cases of invasion of the facial nerve by contiguous tumor, and in six of 14 cases of metastatic tumors involving the facial nerve. The presence of the facial nerve paralysis correlated well with the degree of tumor infiltration into the nerve fibers and the segment of the tumor involvement in the facial nerve. In the patients with metastatic tumors, facial nerve paralysis was a sign of extensive intracranial tumor involvement and was usually accompanied by other cranial nerve palsies, most commonly involving the fifth nerve.

New poly(A)+RNAs appear coordinately during the differentiation of Naegleria gruberi amebae into flagellates

We have examined the nature of the requirement for RNA synthesis during the differentiation of Naegleria gruberi amebae into flagellates (Fulton, C., and C. Walsh, 1980, J. Cell Biol., 85:346-360) by looking for poly(A)+RNAs that are specific to differentiating cells. A cDNA library prepared from poly(A)+RNA extracted from cells 40 min after initiation of the differentiation (40-min RNA), the time when formation of flagella becomes insensitive to inhibitors of RNA synthesis, was cloned into pBR322. Recombinant clones were screened for sequences that were complementary to 40-min RNA but not to RNA from amebae (0-min RNA). Ten of these differentiation-specific (DS) plasmids were identified. The DS plasmids were found to represent at least four different poly(A)+RNAs based on cross-hybridization, restriction mapping, and Northern blot analysis. Dot blot analysis was used to quantify changes in DS RNA concentration. The four DS RNAs appeared coordinately during the differentiation. They were first detectable at 10-15 min after initiation, reached a peak at 70 min as flagella formed, and then declined to low levels by 120 min when flagella reached full length. The concentration of the DS RNAs was found to be at least 20-fold higher in cells at 70 min than in amebae. The changes in DS RNA concentration closely parallel changes in tubulin mRNA as measured by in vitro translation (Lai, E.Y., C. Walsh, D. Wardell, and C. Fulton, 1979, Cell, 17:867-878).

Sensorineural hearing loss in experimental purulent otitis media due to Streptococcus pneumoniae

Sensorineural hearing loss (SNHL) has been described clinically following chronic otitis media with effusion, but to the best of our knowledge, no studies have demonstrated SNHL in an animal model of otitis media. Using the chinchilla model of pneumococcal otitis media, significant SNHL was demonstrated after purulent otitis media, especially at higher frequencies. Animals with otitis media received penicillin G procaine treatment for five days after otitis media with effusion (OME) was first documented; resolution of middle ear infection was confirmed by middle ear effusion culture in all animals. Both the inoculated and uninoculated ears were examined by tone burst-elicited compound action potential at threshold. The inoculated ear showed a marked hearing loss of 13 to 36 dB three to four days after OME was first documented; a hearing loss up to 24 dB persisted two to five weeks after inoculation. The change in the compound action potential was highly significant at all frequencies studied. Conductive losses were largely ruled out because there was no middle ear effusion at death and the tympanogram was normal. Purulent labyrinthitis was ruled out by histopathological study. These results indicate that purulent pneumococcal otitis media in the chinchilla model causes significant SNHL and suggest that the pathogenesis of SNHL associated with chronic OME in humans may be studied in this model.

Changes in cognitive task performance across the menstrual cycle

Menstrual-cycle-related changes in estrogen were expected to differentially affect various cognitive tests. Specifically, the estrogen peak occurring at midcycle in ovulatory women was expected to facilitate performance of highly practiced "automatized" tasks and to impair performance of "perceptual-restructuring" tasks, compared with performance of these tasks in the postovulatory phase of the cycle when progesterone is thought to counteract the action of estrogen. Perceptual-restructuring tasks are defined as tasks in which the initial percepts to obvious stimulus attributes are wrong and must be set aside in favor of percepts to less obvious stimulus attributes. Eight-seven regularly menstruating undergraduate women were studied. Odd-numbered subjects were tested first on or about Day 10 of their cycle and then again on Day 20; even-numbered subjects, in the reverse sequence. Daily basal body temperature records were obtained. These temperature records suggested that 21, or 24%, of the subjects did not ovulate in the cycle(s) studied. No main effect of Day 10 versus Day 20 occurred for any task in the 66 women who did appear to ovulate. However, the magnitude of predicted shifts in performance was significantly correlated with proximity of the "Day 10" testing day to the thermal nadir of the basal body temperature record, the presumed preovulatory estrogen peak; and to the "Day 20" proximity to the basal body temperature thermal peak, the presumed progesterone peak. Subjects tested 3 or fewer days before the thermal nadir and on or after the thermal peak had the predicted significant changes on three of the four administered tasks. No other temporally defined group produced significant changes. The results of the study support the experimental hypotheses and also indicate that precise timing is essential to demonstrate the phenomena.

Passage of albumin from the middle ear to the inner ear in otitis media in the chinchilla

A study of the permeability of the middle ear-inner ear interface for macromolecules was carried out in chinchillas with open and obstructed eustachian tubes utilizing tritiated human serum albumin and immunoelectrophoresis. Tritiated albumin was placed in the round window niche area or normal animals and animals in which the eustachian tubes had been obstructed for 24 hours or 14 days. The tritiated albumin was allowed to remain in the middle ear cavity for 24 hours, Samples of middle ear effusion, perilymph, blood and cerebrospinal fluid were collected and measured for radioactivity. Radioactivity was demonstrated in the perilymph. Samples of middle ear effusions and perilymph were also studied by immunoelectrophoresis with goat antihuman albumin. Albumin placed in the round window niche of an experimental animal could be recovered unchanged in the perilymph. The results suggest a pathophysiologic explanation for the association of otitis media and sensorineural hearing loss or endolymphatic hydrops.

Pneumococcal otitis media following middle ear deflation

Temporal bone histology has been studied in chinchillas following middle ear deflation in the presence of nasopharyngeal colonization with S pneumoniae. All animals sacrificed within one hour following deflation had similar middle ear histology regardless of whether or not the animals had been colonized with S pneumoniae. All animals with negative nasopharyngeal culture for S pneumoniae sacrificed from 3-24 days following - 30 mm Hg negative middle ear pressure had negative middle ear cultures and normal morphology. During the same time period, however, nearly 60% of animals colonized with S pneumoniae developed acute otitis media with positive middle ear cultures for S pneumoniae. Histologic changes in the middle ear included the presence of effusion, leukocytes, granulation tissue, osteoneogenesis, mucosal metaplasia, and hemorrhage. Changes in the inner ear were much less frequent and included some leukocyte infiltration with hyperemia in the scala tympani and and endolymphatic hydrops.

Silent otitis media

There is a traditional view that chronic otitis media and chronic mastoiditis must exist in the presence of a tympanic membrane perforation. Based on a human histopathological study of 123 temporal bones with chronic otitis media out of 333 temporal bones with all forms of otitis media pathology, only 24 patients (36 ears) had symptoms of otological disease recorded on their charts and only 19.5% of these had an associated tympanic membrane perforation. Unsuspected findings of chronic otitis media (active or inactive) are occasionally confirmed at exploratory tympanotomy. Such quiet chronic pathological findings in the middle ear have occurred in association with endolymphatic hydrops and cochlear end organ lesions suggesting the possibility that silent chronic otitis media may help explain sensorineural hearing loss, vertigo, and tinnitus for certain patients. We put forth the hypothesis that clinically undetectable silent otitis media in neonates and infants might help explain why certain children are otitis media prone. Our otopathology laboratory includes 111 ears harvested from neonates and infants (average age 8 months). Histological analysis revealed normal findings in some, whereas significant numbers of others show all forms of otitis media, including purulent otitis media, chronic otitis media, serous otitis media, and mucoid otitis media, with occasional overlap of types. Clinical implications will be discussed with emphasis on silent otitis media and its relationship to the pathogenesis of otitis media and silent chronic otitis media and its possible role in causing insidious labyrinthine changes. A significant outcome of this study was the marked degree of unresolved mesenchyme in the clinically manifest otitis media group or silent otitis media group as compared to a control group. This association and role of mesenchyme is discussed relative to the pathogenesis of infantile otitis media.

Dimensions of the subjective marijuana experience

A Drug History Questionnaire and a Marihuana Effects Questionnaire were completed by 91 male volunteers who were experienced marijuana smokers. A factor analysis was performed on the frequency of occurrence data for the Marihuana Effects Questionnaire. The resultant factors were similar to those reported previously in the literature supporting the existence of a stable, verbally definable marijuana experience. In comparison to the drug history variables of marijuana smokers in the late 1960s, our population showed increased multiple drug use, an earlier age of introduction to cannabis, and heavier use of cannabis. An analysis of the interaction of drug history variables with experienced marijuana effects suggested that the more frequently one uses cannabis, the less pronounced the experienced effects tend to be.

Endolymphatic hydrops and otitis media

Clinical observation of patients with fluctuant sensorineural hearing loss following or occurring with chronic otitis media led to the hypothesis that endolymphatic hydrops can result from chronic otitis media. Illustrative case reports are described. This hypothesis resulted in a temporal bone study of 560 cases in which 109 temporal bones demonstrated the presence of hydrops and 194 evidenced otitis media. Seventy-five cases demonstrated both otitis media and hydrops, of which 20 cases were selected for more detailed histopathological study. An interesting finding was the presence of apical hydrops in every case of the latter group. Statistical interpretation of this data helped rule out a coincidental or chance occurrence. A discussion of this clinical relationship included the significance of subclinical (silent) otitis media as a possible cause of endolymphatic hydrops.

Negative expectancy as a mediating variable in marihuana intoxication

Sixty experienced marihuana smokers participated in a study designed to assess the effect of a negative expectancy on marihuana intoxication. Two different environments, threat of shock and no-threat, were used under the drug conditions of marihuana and placebo. Ss came into the laboratory and adjusted a level of shock received at their fingertips, to a point of mild discomfort. Only those Ss in the threat groups were given the expectation that they would receive the shock at random times during the sessions. Results show that Ss in the marihuana threat group got subjectively less intoxicated, found the environment less pleasant, and yet had higher pulse rates than did Ss in the marihuana no-threat group. The results are discussed in terms of a cognitive component, and specifically that of labelling, in the determination of level of intoxication.

Voluntary heart rate changes and the marihuana "high"

Investigated the interaction of psychological and physiological measures of the marihuana intoxicated state. The subjective measure of intoxication was the "How High" Scale, a rating of percentage of the S's usual "high." The objective measure was pulse rate, which has been found to be the most consistent physiological indicator of marihuana intoxication. By means of biofeedback techniques, Ss in the experimental group were taught to increase voluntarily pulse rate when intoxicated. A control group attended to feedback, but did not manipulate pulse rate. Group comparisons of the dependent measures demonstrated that while both groups experienced a similar subjective "high", the experimental group demonstrated a significantly higher pulse rate. This discrepancy between objective and subjective measures demonstrates the complexity of the intoxicated state.

Ménière's disease in children

Approximately 3% of all patients with Meniere's disease are in the pediatric age group. These children require extensive evaluation. A history of physical or acoustic trauma should be sought and an allergic work-up should be obtained. A search for metabolic disturbances and identification of inflammatory disorders is also necessary. If a treatable etiology is identified, specific therapy should be directed toward its control. If, after careful evaluation, the etiology remains obscure, non-specific therapy should be instituted in an effort to alleviate the symptomatology of Meniere's disease. Surgical decompression of the endolymphatic sac and drainage into the mastoid cavity results in relieving the symptoms, particularly vertigo, and appears to be efficacious in patients who have failed diligent attempts at medical therapy.

Odor and marijuana intoxication

Assigned 48 volunteer adult males to four groups: a marijuana high dose, a marijuana low dose, a placebo, and a coltsfoot group. Each S participated in two 80-minute sessions; one involved listening to music, socializing, and smoking the drug, and the second was identical to the first with the addition of two extra placebo cigarettes which contained finely cut amounts of human hair. The odor of burning hair was rated previously as quite aversive by non-intoxicated Ss. Contrary to expectation, Ss in the odor condition indicated on self-ratings that they became significantly more intoxicated after the smoking of the hair cigarette. The opposite effect was found with a pulse rate measure. An additional 24 Ss were divided into high and low dose marijuana groups and run in an odor session, in which they were informed prior to smoking of the hair content. Heart rate for these Ss decreased significantly more than for the comparable uninformed Ss, although self-ratings continued to reflect increased intoxication.

The effect of marihuana intoxication on blood pressure

Forty-eight experienced marihuana smokers were assigned to one of four groups: coltsfoot, placebo, low dose marihuana and high dose marihuana. While both marihuana groups showed significant increases in subjective ratings of intoxication and pulse rate, blood pressure readings were unaffected or showed a modest decrease. This latter finding is discrepant with previous studies and is explained in terms of a drug X person interaction present in those studies.

The disruption of marijuana intoxication

Ninety-six males Ss were divided into four drug conditions; coltsfoot, placebo, marijuana low dose, and marijuana high dose. Half of the Ss smoked marijuana while listening to music in a relaxing environment, and half smoked marijuana in the same environment but had two 10-min periods of aversive-noise superimposed over the music. A subjective measure of intoxication demonstrated significant drug and environmental group effects with suppression of self-report of intoxication being especially strong for the marijuana low dose noise group. The usual positive correlation between subjective measures and pulse rate measures of marijuana intoxication was interfered with by the noise effect. Although subjective ratings were suppressed, the noise group demonstrated significantly higher pulse rates than the music group. The results are discussed in terms of the effect of extraneous factors on marijuana intoxication, the significance of dosage in this type of research, and the nature of marijuana intoxication.