Nanoporous antireflection coating for high-temperature applications in the infrared

Antireflection (AR) coatings are essential to the performance of optical systems; without them, surface reflections increase significantly at steep angles and become detrimental to the functionality. AR coatings apply to a wide range of applications from solar cells and laser optics to optical windows. Many times, operational conditions include high temperatures and steep angles of incidence (AOIs). The implementation of AR coatings is extremely challenging in these conditions. Nanoporous coatings made from high-temperature-tolerant materials offer a solution to this problem. The careful selection of materials is needed to prevent delamination when exposed to high temperatures, and an optimal optical design is needed to lower surface reflections at both the normal incidence and steep AOIs. This paper presents nanoporous silicon dioxide and hafnium dioxide coatings deposited on a sapphire substrate using oblique angle deposition by electron beam evaporation, a highly accurate deposition technique for thin films. Developed coatings were tested in a controlled temperature environment and demonstrated thermal stability at temperatures up to 800°C. Additional testing at room temperature demonstrated the reduction of power reflections near optimal for AOIs up to 70° for a design wavelength of 1550 nm. These findings are promising to help extend the operation of technology at extreme temperatures and steep angles.

What does an MRI scan cost?

Historically, hospital departments have computed the costs of individual tests or procedures using the ratio of cost to charges (RCC) method, which can produce inaccurate results. To determine a more accurate cost of a test or procedure, the activity-based costing (ABC) method must be used. Accurate cost calculations will ensure reliable information about the profitability of a hospital's DRGs.

Antenna gain of actively compensated free-space optical communication systems under strong turbulence conditions

Current Strehl ratio models for actively compensated free-space optical communications terminals do not accurately predict system performance under strong turbulence conditions as they are based on weak turbulence theory. For evaluation of compensated systems, we present an approach for simulating the Strehl ratio with both low-order (tip/tilt) and higher-order (adaptive optics) correction. Our simulation results are then compared to the published models and their range of turbulence validity is assessed. Finally, we propose a new Strehl ratio model and antenna gain equation that are valid for general turbulence conditions independent of the degree of compensation.

Fiscal strategy in an era of reform

In a reform environment, hospitals and health systems should be able to control-rather than simply understand-their costs. Senior managers and line managers throughout a healthcare organization should be solidly behind-and deeply involved in-the organization's cost-control efforts. Physicians also should be heavily engaged in cost control, as they are the only ones who can both establish clinical pathways and monitor their colleagues' use of them.

Bumps along the ACO road

The success of ACOs will depend on whether they can avoid difficulties inherent in six areas: Measuring costs. Computing expected costs. Managing prevention and wellness. Managing resources per case type. Managing the direct cost of resource units and fixed costs. Addressing conflicting incentives.

High-sensitivity DPSK receiver for high-bandwidth free-space optical communication links

A high-sensitivity modem and high-dynamic range optical automatic gain controller (OAGC) have been developed to provide maximum link margin and to overcome the dynamic nature of free-space optical links. A sensitivity of -48.9 dBm (10 photons per bit) at 10 Gbps was achieved employing a return-to-zero differential phase shift keying based modem and a commercial Reed-Solomon forward error correction system. Low-noise optical gain was provided by an OAGC with a noise figure of 4.1 dB (including system required input loses) and a dynamic range of greater than 60 dB.

Using bundled prices and deep discounts to obtain managed care contracts: seller beware!

To achieve the potential of bundled pricing, and thereby help align the incentives of your medical staff and hospital, keep in mind the following points: *Balancing risk, reward, and control; *Aligning responsibility with control; *Linking costs and features; *Developing appropriate information.

Profit centers in clinical care departments: an idea whose time has gone

If a hospital is to use profit centers successfully, it should resolve several philosophical, organizational, and accounting matters, including: How much decisionmaking latitude clinical care chiefs should have. Whether to take a cross-subsidization approach. What role clinical care departments should take in a service line strategy.

The folly of using RCCs and RVUs for intermediate product costing

Two measures for computing the cost of intermediate projects--a ratio of cost to charges and relative value units--are highly flawed and can have serious financial implications for the hospitals that use them. Full-cost accounting, using the principles of activity-based costing, enables hospitals to measure their costs more accurately, both for competitive bidding purposes and to manage them more effectively.

Strategic decision-making in healthcare organizations: it is time to get serious

New and continuing environmental demands and competitive forces require healthcare organizations to be increasingly careful in thinking about their strategies. They must do so in a highly unusual (multi-actor) marketplace where a variety of system interdependencies complicate decision-making. A good strategy requires an attempt to understand the real, as distinct from the perceived, environment, and is characterized by explicit tradeoffs along three dimensions: service or program variety, patient needs, and patient access. The quality of these tradeoffs can be assessed in terms of whether the strategy is (a) attuned to critical success factors in the organization's environment, (b) highly focused, (c) linked to the organization's capabilities, and (d) accompanied by an activity set that is difficult for competitors to imitate. An organization also must be capable of adapting appropriately to changes in its environment. Thus, even the best strategy must be reviewed constantly if it is to remain viable. A strategy's sustainability can be adversely affected by increased buyer or supplier power, lowered barriers to entry, growing rivalry, the threat of substitutes, and increased slack in resource usage. By thinking more creatively in the future than they have in the past, healthcare organizations can make tradeoffs and choose a focused strategic position. They then can design an activity set that is appropriate for that position, and that will assist them to achieve both financial viability and superior programmatic performance. A well-designed activity set also will assist them to sustain their performance in the face of changing environmental demands and competitive forces.

Missing elements in the healthcare debate

Financial flows in the U.S. healthcare system could be restructured in several ways to ensure that individuals and institutions pay their fair share: Eliminate subsidies for people with preventable illnesses and/or large families. Require not-for-profit hospitals to donate their tax exemptions to a state fund to help pay for care for the uninsured. Require health insurance companies to pay a percentage of their total premium revenue into a fund for graduate medical education. Eliminate copayments for pharmaceuticals, but require patients to pay the brand-generic cost difference if they wish to use brand-name drugs when generic drugs are available.

Strategic decision making: it's time for healthcare organizations to get serious

To get serious about its strategic decision making, a healthcare organization needs to know what it does not intent to be. Organizations make trade-offs along three dimensions: service or customer needs, and customer access. Strategic trade-offs also should be assessed in terms of competitive scope and pricing policy.

Improving operating room performance in a center of excellence

The financial success of centers of excellence typically depends on effective utilization of the OR. Therefore, it's important to align the strategy, structure, information and reporting systems, culture, and behavior of both entities. Moving from management based on anecdote to a data-driven process can enhance the quality of decision-making.

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups

OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries.

CLINICAL SETTING

Nurseries, health centres and dental clinics in 17 countries.

PARTICIPANTS

2822 children aged 3 to 4 years and their parents.

MAIN OUTCOME MEASURES

Dental examination of children and questionnaire to parents.

RESULTS

Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group.

CONCLUSIONS

This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

GME: at what cost?

Current computing methods impede determining the real cost of graduate medical education. However, a more accurate estimate could be obtained if policy makers would allow for the application of basic cost-accounting principles, including consideration of department-level costs, unbundling of joint costs, and other factors.

Validation of a novel high-sensitivity radioimmunoassay procedure for measurement of total thyroxine concentration in psittacine birds and snakes

OBJECTIVE

To validate a novel high-sensitivity radioimmunoassay (RIA) procedure developed to accurately measure the relatively low serum total thyroxine (T4) concentrations of birds and reptiles and to establish initial reference ranges forT4 concentration in selected species of psittacine birds and snakes.

ANIMALS

56 healthy nonmolting adult psittacine birds representing 6 species and 42 captive snakes representing 4 species.

PROCEDURE

A solid-phase RIA designed to measure free T4 concentrations in dialysates of human serum samples was used without dialysis to evaluate total T4 concentration in treated samples obtained from birds and reptiles. Serum T4 binding components were removed to allow assay of undialyzed samples. Assay validation was assessed by determining recovery of expected amounts of T4 in treated samples that were serially diluted or to which T4 was added. Intra- and interassay coefficient of variation (CV) was determined.

RESULTS

Mean recovery of T4 added at 4 concentrations ranged from 84.9 to 115.0% and 95.8 to 119.4% in snakes and birds, respectively. Intra- and interassay CV was 3.8 and 11.3%, respectively. Serum total T4 concentrations for 5 species of birds ranged from 2.02 to 768 nmol/L but ranged from 3.17 to 142 nmol/L for blue-fronted Amazon parrots; concentrations ranged from 0.21 to 6.06 nmol/L for the 4 species of snakes.

CONCLUSIONS AND CLINICAL RELEVANCE

This new RIA method provides a commercially available, accurate, and sensitive method for measurement of the relatively low serum T4 concentrations of birds and snakes. Initial ranges for the species evaluated were established.

Beyond health care cost containment: creating collaborative arrangements among the stakeholders

The causes of escalating healthcare costs in the United States and many other industrial countries are well documented. Less evident are the structural factors that underlie the increases and their implications for the future. This paper discusses these structural factors, puts them in the context of the healthcare marketplace, and proposes a way to address them using a collaborative arrangement among all stakeholders in a healthcare system, called value-based partnering. To be successful, the effort must include not only final purchasers (such as employers or Medicare in the USA) but all stakeholders in a healthcare system. Each stakeholder must develop a value equation in terms that are meaningful to the others, and must identify opportunities for value-enhancing partnerships. The paper also identifies some of the impediments to value-based partnering and discusses ways to overcome them, including the need for senior management intervention within some stakeholder groups, and the importance of collaborative discussions among all stakeholders.

The extra domain A of fibronectin activates Toll-like receptor 4

Cellular fibronectin, which contains an alternatively spliced exon encoding type III repeat extra domain A (EDA), is produced in response to tissue injury. Fragments of fibronectin have been implicated in physiological and pathological processes, especially tissue remodeling associated with inflammation. Because EDA-containing fibronectin fragments produce cellular responses similar to those provoked by bacterial lipopolysaccharide (LPS), we examined the ability of recombinant EDA to activate Toll-like receptor 4 (TLR4), the signaling receptor stimulated by LPS. We found that recombinant EDA, but not other recombinant fibronectin domains, activates human TLR4 expressed in a cell type (HEK 293 cells) that normally lacks this Toll-like receptor. EDA stimulation of TLR4 was dependent upon co-expression of MD-2, a TLR4 accessory protein. Unlike LPS, the activity of EDA was heat-sensitive and persisted in the presence of the LPS-binding antibiotic polymyxin B and a potent LPS antagonist, E5564, which completely suppressed LPS activation of TLR4. These observations provided a mechanism by which EDA-containing fibronectin fragments promote expression of genes involved in the inflammatory response.

Value-based partnering in healthcare: a framework for analysis

Value-based partnering is designed to move the healthcare system beyond cost-based competition. It recognizes that the healthcare "product" is not a commodity and that much of the value in the system comes from relationships between and among four stakeholders: consumers, providers, health plans, and employers. Given the difficulty of measuring such benefits as quality of care, improved health status, and increased employee productivity, stakeholders within the system traditionally have focused on easily measurable financial considerations such as premium rates. This focus has led to a system that defines relationships in purely financial terms. In contrast, the value-based partnering model presented in this article recognizes the range of factors that stakeholders consider in their relationships with each other. This approach has the potential to change the nature of competition and presents opportunities for those organizations that can effectively partner with other stakeholders and demonstrate value, rather than just lower cost. Moreover, by recognizing the interdependencies among stakeholder groups, the approach creates a strategic reason for employers, health plans, providers, and consumers to exchange information and create long-term alliances.

Value-based partnering in health care

Many companies are beginning to focus on value in their health care purchasing decisions, and some are going beyond value-based purchasing to value-based partnering. Value-based partnering recognizes the interdependencies among stakeholder groups in the health care system and creates a strategic reason for them to exchange information and create long-term strategic alliances. This article discusses the principles of value-based partnering, impediments to practicing it and its future role in the health care system.

Aligning physician financial incentives in a mixed-payment environment

Under a shadow-pricing approach to physician compensation, physicians who deliver healthcare services to a mix of fee-for-service (FFS) and capitated patients are compensated for services via a payment schedule that treats all patients as if they were capitated. By encouraging physicians to adopt the same care-management approach for all patients, shadow pricing helps a group practice prepare for a larger share of revenues to be derived from capitation, thereby making the organization more attractive to many managed care payers. An apparent drawback of shadow pricing is that it gives physicians an incentive to reduce FFS utilization, resulting in a loss of potential revenue to the healthcare organization. This loss can be strategically justified, however, as an investment in the organization's ability to remain viable under capitation and to retain patients for whom payment may shift from FFS to capitation. In developing a shadow-pricing compensation approach, healthcare organizations can include incentives that encourage physicians to meet specific utilization targets, establish review procedures to identify physicians who deviate from the targets, and account for differences in acuity levels among different physicians' patient panels.

Cellular events mediated by lipopolysaccharide-stimulated toll-like receptor 4. MD-2 is required for activation of mitogen-activated protein kinases and Elk-1

Lipopolysaccharide (LPS) stimulates multiple signaling events, including nuclear factor-kappaB (NF-kappaB) activity and the mitogen-activated protein (MAP) kinases, ERK, JNK, and p38 in LPS-responsive cells, resulting in transcriptional activation and cytokine generation. LPS-induced signaling via toll-like receptor 4 (TLR4) results in the activation of the transcription factor NF-kappaB. Since LPS activates other signaling cascades in responsive cells, the objective of this study was to determine whether such events are mediated by TLR4 in response to LPS. We generated human embryonic kidney cells (HEK293) that stably express TLR4 (HEK-TLR4) and examined their responsiveness to LPS by measuring NF-kappaB activity and production of interleukin-8 (IL-8). A trans-reporting system was used to measure the activity of Elk-1, an ETS-domain transcription factor targeted by MAP kinase pathways. LPS stimulated NF-kappaB reporter activity and IL-8 production but not Elk-1 activity in HEK-TLR4 cells. When MD-2, a protein associated with the extracellular domain of TLR4, was expressed in these cells, there was a marked increase in Elk-1 activity as well as ERK, JNK, and p38 MAP kinase phosphorylation in response to LPS. TLR4-mediated NF-kappaB reporter activity and IL-8 production was enhanced by the expression of MD-2. This study demonstrates that expression of both TLR4 and MD-2 is required for LPS to activate or augment the MAP kinase pathways, Elk-1 stimulation, and IL-8 generation.

Toll-like receptor-4 mediates lipopolysaccharide-induced signal transduction

TLR4 is a member of the recently identified Toll-like receptor family of proteins and has been putatively identified as Lps, the gene necessary for potent responses to lipopolysaccharide in mammals. In order to determine whether TLR4 is involved in lipopolysaccharide-induced activation of the nuclear factor-kappaB (NF-kappaB) pathway, HEK 293 cells were transiently transfected with human TLR4 cDNA and an NF-kappaB-dependent luciferase reporter plasmid followed by stimulation with lipopolysaccharide/CD14 complexes. The results demonstrate that lipopolysaccharide stimulates NF-kappaB-mediated gene expression in cells transfected with the TLR4 gene in a dose- and time-dependent fashion. Furthermore, E5531, a lipopolysaccharide antagonist, blocked TLR4-mediated transgene activation in a dose-dependent manner (IC50 approximately 30 nM). These data demonstrate that TLR4 is involved in lipopolysaccharide signaling and serves as a cell-surface co-receptor for CD14, leading to lipopolysaccharide-mediated NF-kappaB activation and subsequent cellular events.

Two-part transfer pricing improves IDS financial control

To help coordinate patient care services across its various provider entities, an integrated delivery system (IDS) must address two financial control matters: design of responsibility centers and selection of an appropriate transfer pricing methodology. Although designating an HMO as a profit center is appropriate, such a designation is inappropriate for an IDS's provider entities. Instead, these entities are more appropriately designated as standard expense centers. Further, an HMO owned and operated by an IDS should purchase patient care from the delivery entities by means of two-part transfer prices, that is, having fixed costs paid for in a lump sum and variable costs paid for on the basis of the actual volume and mix of services provided. The IDS's management must recognize, however, that both case mix and volume lie largely outside a hospital's control and that financial controls should focus on a combination of the hospital's fixed costs and variable costs associated with resources per case, efficiency of resource delivery, and factor prices.

Effect of storage conditions on cortisol, total thyroxine, and free thyroxine concentrations in serum and plasma of dogs

OBJECTIVE

To determine for dogs stability of cortisol, thyroxine (T4), and free thyroxine (fT4) in plasma and serum stored in glass or plastic tubes at -20, 4, 25, and 37 C.

DESIGN

Prospective study.

ANIMALS

Phase I, 7 Greyhounds; Phase II, 6 mixed-breed dogs.

PROCEDURE

Phase I: blood was obtained after administration of thyroid-stimulating hormone and adrenocorticotropin. Serum and plasma samples from each dog were divided into 8 aliquots, 4 in glass and 4 in plastic tubes. A pair of aliquots, 1 in plastic and 1 in glass, were stored at -20, 4, 25, or 37 C for 5 days and then assayed for hormones. Phase II: blood was obtained without prior stimulation. For fT4 determination, serum from each dog was placed in plastic or glass tubes, assayed immediately, stored at -20 C for 5 days, and reassayed. Aliquots from each dog were also stored for 1 day at 4 or 25 C and then assayed. Samples for cortisol determination were handled as in phase I.

RESULTS

Phase I: there was no effect of tube type (glass vs plastic) on cortisol. Cortisol concentrations decreased after storage in serum at 4, 25, and 37 C, and in plasma at 37 C, compared with storage at -20 C. There was no effect of sample type (serum or plasma) on T4. Thyroxine concentrations increased after storage at 37 C in glass, compared with storage at -20 C. The fT4 concentrations were lower in serum than plasma after storage at -20 C. Concentrations of fT4 increased after storage at 37 C in glass, compared with storage at -20 C. Phase II: the fT4 concentrations did not change after storage in any condition. There was no effect of tube type on cortisol concentrations. Serum cortisol concentrations decreased after storage at 37 C, compared with storage at -20 C.

CLINICAL IMPLICATIONS

For cortisol, cooling of plasma is not necessary, but serum should be shipped cold. For T4 and fT4, serum is sufficient; contained within plastic tubes, samples can be shipped without cooling if assayed within 5 days.

Clinical diagnosis of ocular sarcoidosis

PURPOSE

To assess the value of raised serum angiotensin converting enzyme (ACE) levels in making a clinical diagnosis of ocular sarcoidosis in patients with intraocular inflammation, compatible with sarcoidosis, in whom tissue biopsy is either not practical or not possible.

METHODS

The ocular manifestations and clinical course of 22 patients with intraocular inflammation compatible with sarcoidosis and elevated ACE level (including 11 patients with abnormal chest radiograph) were compared with those of a group of 18 patients with intraocular inflammation due to biopsy-proven sarcoidosis. The mean follow-up (+/- SD) was 4.5 +/- 3.4 years in the presumed ocular sarcoidosis group and 7.8 +/- 5.3 years in the biopsy-proven sarcoidosis group.

RESULTS

There was no difference in sex, race and age distribution between the two groups. No statistically significant difference could be found between the ocular manifestations seen in each group. The most common finding was retinal vasculitis with panuveitis, seen in 86.4% of the presumed ocular sarcoidosis group and in 83.3% of the biopsy-proven sarcoidosis group.

CONCLUSIONS

These results suggest that intraocular inflammation compatible with sarcoidosis in conjunction with raised ACE levels would be accordant with a diagnosis of sarcoidosis in patients in whom histological diagnosis is either not practical or not possible.

CNS malformation in a child with Kabuki (Niikawa-Kuroki) syndrome: report and review

Kabuki (Niikawa-Kuroki) syndrome (KS) comprises characteristic facial changes, developmental delay, skeletal anomalies, mental retardation, and abnormal dermatoglyphics. We report on a 5-year-old Caucasian boy with KS who required surgery for a giant left temporoparietal subarachnoid cyst at age 5 1/2 years. Review of the 143 published cases shows that while malformations may be found in the endocrine, cardiac, genitourinary and skeletal systems, this is the first case of Kabuki syndrome with a major central nervous system malformation.

Simple choristoma of the anterior segment containing brain tissue

We report an unusual case of a simple choristoma of the anterior segment that contained only brain tissue. The clinical characteristics and findings of pathological examination of this unusual ocular malformation were reviewed. A newborn girl was seen with a fleshy, highly vascular cystic mass arising from the inferior limbus and extending across the cornea. On a computed tomographic scan, gross disruption of the anterior segment was present, with subluxation of the lens into the cyst. Excision of the abnormal tissue was followed by evisceration; polyglactin (Vicryl) ball implantation; patch graft of the globe; and, later, prosthetic fitting. Pathologic findings showed a choristomatous malformation, containing only mature brain tissue. To our knowledge, a choristoma in which the sole constituent is brain tissue has not previously been reported.

Modulation of the Rev-RRE interaction by aromatic heterocyclic compounds

The HIV-1 Rev protein regulates the nucleocytoplasmic distribution of viral precursor RNAs that encode HIV-1 structural proteins. Rev-mediated viral RNA expression requires a sequence-specific interaction between Rev and a viral RNA sequence, the Rev responsive element (RRE). Because the Rev-RRE interaction is essential for HIV-1 replication, anti-viral agents that selectively block this interaction may be effective anti-HIV-1 therapeutics. Here, we show that certain aromatic heterocyclic compounds, in particular, a tetracationic diphenylfuran, AK.A, can block binding of Rev to its high-affinity viral RNA binding site. AK.A abolishes Rev-RRE interactions at concentrations as low as 0.1 microM. Inhibition appears to be selective and results from competitive binding of the drug to a discrete region within the Rev binding site. Interestingly, the molecular basis for the AK.A-RNA interaction, as well as the mode of RNA binding differs from previously described aminoglycoside Rev inhibitors. Analysis of a variety of aromatic heterocyclic compounds and their derivatives reveals stereo-specific features required for the inhibition. Our results further demonstrate the feasibility of identifying and designing small molecules that selectively block viral RNA-protein interactions.

Managing clinical integration in integrated delivery systems: a framework for action

An integrated delivery system (IDS) in healthcare must coordinate patient care across multiple functions, activities, and operating units. To achieve this clinical integration, senior management confronts many challenges. This paper uses a cross-functional-process (CFP) framework to discuss these challenges. There are ten CFPs that fall into three categories: planning processes (strategy formulation, program adaptation, budget formulation), organizational processes (authority and influence, client management, conflict resolution, motivation, and cultural maintenance), and measurement and reporting processes (financial and programmatic). Each process typically spans several functional units. Senior management must consider how to improve both the functioning of each CFP, as well as its "fit" with the other nine. The result can be greater clinical integration, improved cost management, and more coordinated care for enrollees.

Distinctive Menkes disease variant with occipital horns: delineation of natural history and clinical phenotype

To delineate further the clinical spectrum of Menkes disease, an X-linked recessive disorder of copper transport, we studied 4 related males, ranging in age from 4-38 years, with a unique phenotype that combines manifestations of classical and mild Menkes disease and occipital horn syndrome (OHS). The propositus, and 18-year-old man, was evaluated following an intracerebral hemorrhage at age 15 years and was noted to have marked hypotonia, motor delay with mental retardation, bladder diverticula, failure to thrive, and diarrhea from infancy; seizures from age 3 years; and abnormal hair (pili torti) and face, cutis laxa, and multiple joint dislocations. Radiographic abnormalities included occipital exostoses, tortuous cerebral blood vessels with multiple branch occlusions, and hammer-shaped clavicles. Biochemical studies demonstrated reduced copper and ceruloplasmin levels in serum, and abnormal plasma catecholamine ratios. We reported previously the molecular defect in this family, a splice-site mutation that predicts formation of approximately 20% of the normal Menkes gene product [Kaler et al., 1994: Nat Genet 18:195-202]. Here, we detail the clinical course and physical features and radiographic findings in these 4 individuals, and compare their phenotype with classical and mild Menkes and OHS. Unusual Menkes disease variants such as this may escape recognition due to anomalies that appear inconsistent with the diagnosis, particularly prolonged survival and later onset of seizures. Males with mental retardation and connective tissue abnormalities should be evaluated for biochemical evidence of defective copper transport.

Urine cortisol:creatinine ratio in healthy and sick cats

Urine cortisol:creatinine ratios (UCCR) were determined from single urine samples obtained by cystocentesis in 47 cats allotted into 2 groups: 31 healthy cats and 16 sick, hospitalized cats with assorted clinical illnesses. The mean (+/- standard deviation) UCCR for healthy cats was 5.9 +/- 7.0 (median, 3.2; range, 0.6 to 27.8). Age or gonadal status had no significant effect on the magnitude of UCCR within this group. However, sick cats had significantly higher UCCR (P = .002) when compared with healthy cats. The mean UCCR for sick cats was 19.6 +/- 19.2 (median, 14.8; range, 1.7 to 75.1). This report establishes a reference range for UCCR in 31 normal cats and provides evidence that health status affects UCCR in cats.

Autoantibodies to triiodothyronine and thyroxine in a golden retriever

A golden retriever presented with signs of hypothyroidism occurring in conjunction with autoantibodies to both triiodothyronine (T3) and thyroxine (T4). The autoantibodies caused the apparent concentrations of total T3, total T4, and free T4 by analog assay to be high. However, free T4 concentration was nondetectable when measured using a dialysis assay. The dog's clinical condition markedly improved in response to L-thyroxine therapy, and the free T4 concentration by dialysis assay increased into the normal range. Thyroid hormone autoantibodies can confuse the diagnostic evaluation for suspected hypothyroidism. In dogs with autoantibodies to T4, measurement of free T4 by dialysis assay is useful for both diagnostic and therapeutic monitoring purposes.

Family images of hospitalized adolescents: the failure to generate shared understandings

Family factors have been implicated clinically in the nonpsychotic psychopathology of adolescents (Berkowitz et al. 1974; Feldman and Guttman 1984; Gunderson et al. 1980; E. Shapiro et al. 1989; R. Shapiro 1989b). The internal images of the adolescent held by family members appear to reflect healthy as well as pathological functioning of adolescent-family systems (Feldman and Guttman 1984; E. Shapiro 1982; Young 1991).