Pyeloplasty may reverse the effect of growth delay from ureteropelvic junction obstruction in infants

PURPOSE

To determine if children with UPJO demonstrate a clinically significant change in somatic growth following pyeloplasty.

METHODS

We retrospectively evaluated the growth chart data of infants with SFU grade 3 or 4 congenital hydronephrosis at our institution from 2015 to 2022. Of those, 35 patients underwent pyeloplasty and 66 had no surgical intervention. Patients met criteria if they had SFU 3 or 4 hydronephrosis and MAG3 renal scan. If patients underwent surgery, height and weight percentiles were recorded from the pre-op and 6-16-month follow-up visits. In non-surgery patients, measurements were taken near the median age of surgery in the intervention group and 6-16 months later. Interval changes in group height and weight percentiles are compared for significant changes.

RESULTS

The surgery and non-surgery groups did not differ in terms of gender (71% vs 74% Male), starting age (296 vs 244 days), starting weight (58th vs 52nd percentile), or time between measurements (255 vs 260 days), though the surgery group had significantly less height in the pre-operative period (43rd vs 55th percentile, p = 0.050) and were more likely to have delayed drainage on renal scan (83% w/delay vs 35%). The surgery group showed a significant increase in height (18.9 percentiles; 95% CI 11-27) and weight (6.0 percentiles; 95% CI 0.50-12) after intervention.

CONCLUSIONS

Patients with congenital hydronephrosis due to UPJO that underwent pyeloplasty showed a significant increase in weight and height at 6-16 months postoperatively compared to those that were managed with close observation. This suggests UPJO might lead to growth delay in infants.

How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial

BACKGROUND

We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms.

METHODS

We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression.

RESULTS

All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior.

CONCLUSIONS

Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes.

Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures

OBJECTIVE

We explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS).

METHODS

We undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation.

RESULTS

Moderator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group. Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a "logical" treatment (MCS). Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant.

CONCLUSION

Patient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.

Utilizing eye tracking to assess electronic health record use by pharmacists in the intensive care unit

DISCLAIMER

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

A study was conducted using high-fidelity electronic health record (EHR)-based simulations with incorporated eye tracking to understand the workflow of critical care pharmacists within the EHR, with specific attention to the data elements most frequently viewed.

METHODS

Eight critical care pharmacists were given 25 minutes to review 3 simulated intensive care unit (ICU) charts deployed in the simulation instance of the EHR. Using monitor-based eye trackers, time spent reviewing screens, clinical information accessed, and screens used to access specific information were reviewed and quantified to look for trends.

RESULTS

Overall, pharmacists viewed 25.5 total and 15.1 unique EHR screens per case. The majority of time was spent looking at screens focused on medications, followed by screens displaying notes, laboratory values, and vital signs. With regard to medication data, the vast majority of screen visitations were to view information on opioids/sedatives and antibiotics. With regard to laboratory values, the majority of views were focused on basic chemistry and hematology data. While there was significant variance between pharmacists, individual navigation patterns remained constant across cases.

CONCLUSION

The study results suggest that in addition to medication information, laboratory data and clinical notes are key focuses of ICU pharmacist review of patient records and that navigation to multiple screens is required in order to view these data with the EHR. New pharmacy-specific EHR interfaces should consolidate these elements within a primary interface.

Mediators of increased self-harm and suicidal ideation in sexual minority youth: a longitudinal study

BACKGROUND

Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships.

METHOD

In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30-57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling.

RESULTS

Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43-3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex.

CONCLUSIONS

Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.

Deep Learning Based on Standard H&E Images of Primary Melanoma Tumors Identifies Patients at Risk for Visceral Recurrence and Death

PURPOSE

Biomarkers for disease-specific survival (DSS) in early-stage melanoma are needed to select patients for adjuvant immunotherapy and accelerate clinical trial design. We present a pathology-based computational method using a deep neural network architecture for DSS prediction.

EXPERIMENTAL DESIGN

The model was trained on 108 patients from four institutions and tested on 104 patients from Yale School of Medicine (YSM, New Haven, CT). A receiver operating characteristic (ROC) curve was generated on the basis of vote aggregation of individual image sequences, an optimized cutoff was selected, and the computational model was tested on a third independent population of 51 patients from Geisinger Health Systems (GHS).

RESULTS

Area under the curve (AUC) in the YSM patients was 0.905 (P < 0.0001). AUC in the GHS patients was 0.880 (P < 0.0001). Using the cutoff selected in the YSM cohort, the computational model predicted DSS in the GHS cohort based on Kaplan-Meier (KM) analysis (P < 0.0001).

CONCLUSIONS

The novel method presented is applicable to digital images, obviating the need for sample shipment and manipulation and representing a practical advance over current genetic and IHC-based methods.

A deep learning approach for real-time detection of sleep spindles

OBJECTIVE

Sleep spindles have been implicated in memory consolidation and synaptic plasticity during NREM sleep. Detection accuracy and latency in automatic spindle detection are critical for real-time applications.

APPROACH

Here we propose a novel deep learning strategy (SpindleNet) to detect sleep spindles based on a single EEG channel. While the majority of spindle detection methods are used for off-line applications, our method is well suited for online applications.

MAIN RESULTS

Compared with other spindle detection methods, SpindleNet achieves superior detection accuracy and speed, as demonstrated in two publicly available expert-validated EEG sleep spindle datasets. Our real-time detection of spindle onset achieves detection latencies of 150-350 ms (~two-three spindle cycles) and retains excellent performance under low EEG sampling frequencies and low signal-to-noise ratios. SpindleNet has good generalization across different sleep datasets from various subject groups of different ages and species.

SIGNIFICANCE

SpindleNet is ultra-fast and scalable to multichannel EEG recordings, with an accuracy level comparable to human experts, making it appealing for long-term sleep monitoring and closed-loop neuroscience experiments.

Conformationally restricted calpain inhibitors

Oxidised α-mercaptoacrylic acid derivatives are potent conformationally restricted calpain-I inhibitors that mimic the endogenous inhibitor calpastatin.

The cysteine protease calpain-I is linked to several diseases and is therefore a valuable target for inhibition. Selective inhibition of calpain-I has proved difficult as most compounds target the active site and inhibit a broad spectrum of cysteine proteases as well as other calpain isoforms. Selective inhibitors might not only be potential drugs but should act as tools to explore the physiological and pathophysiological roles of calpain-I. α-Mercaptoacrylic acid based calpain inhibitors are potent, cell permeable and selective inhibitors of calpain-I and calpain-II. These inhibitors target the calcium binding domain PEF(S) of calpain-I and -II. Here X-ray diffraction analysis of co-crystals of PEF(S) revealed that the disulfide form of an α-mercaptoacrylic acid bound within a hydrophobic groove that is also targeted by a calpastatin inhibitory region and made a greater number of favourable interactions with the protein than the reduced sulfhydryl form. Measurement of the inhibitory potency of the α-mercaptoacrylic acids and X-ray crystallography revealed that the IC₅₀ values decreased significantly on oxidation as a consequence of the stereo-electronic properties of disulfide bonds that restrict rotation around the S–S bond. Consequently, thioether analogues inhibited calpain-I with potencies similar to those of the free sulfhydryl forms of α-mercaptoacrylic acids.

Customers' recall of information given in community pharmacies

Three studies are reported in which the giving of information to customers, orally, in community pharmacies was tape recorded, and the customers were interviewed the following day. Customers' recall of information, including instructions considered to be essential, was low. In study 1, involving 44 customers in two pharmacies, a mean of 11 items of information was given to customers, but on average only three were recalled. Customers who took a more active part in discussion with the pharmacist (who were more likely to purchase self-medication than to be prescription customers) tended to be given more new information and more repeated information, to recall more but also to forget more than passive customers. In study 2, 42 customers of three pharmacists were interviewed to determine the influence of a number of variables on recall. Whether customers reported feeling ill or in a hurry, or reported having received the information already from their general practitioner, or having had prior experience of the medication, were all unrelated to the amount of information recalled. The few customers who reported that the information provided by the pharmacist was not welcome were particularly poor at recalling it. In Study 3, the amount of information given or recalled was found to be unaffected by whether customers talked to a pharmacist in the busy sales area (n=25) or in a quiet counselling area (n=27). If pharmacists are to be effective providers of information about health and illness, attention must be paid to ways of improving customers' retention of information given.

Lay public's understanding of equipoise and randomisation in randomised controlled trials

OBJECTIVES

To research the lay public's understanding of equipoise and randomisation in randomised controlled trials (RCTs) and to look at why information on this may not be not taken in or remembered, as well as the effects of providing information designed to overcome barriers.

DESIGN

Investigations were informed by an update of systematic review on patients' understanding of consent information in clinical trials, and by relevant theory and evidence from experimental psychology. Nine investigations were conducted with nine participants.

SETTING

Access (return to education), leisure and vocational courses at Further Education Colleges in the Midlands, UK.

PARTICIPANTS

Healthy adults with a wide range of educational backgrounds and ages.

INVESTIGATIONS

Participants read hypothetical scenarios and wrote brief answers to subsequent questions. Sub-samples of participants were interviewed individually to elaborate on their written answers. Participants' background assumptions concerning equipoise and randomisation were examined and ways of helping participants recognise the scientific benefits of randomisation were explored.

MAIN OUTCOME MEASURES

Judgments on allocation methods; treatment preferences; the acceptability of random allocation; whether or not individual doctors could be completely unsure about the best treatment; whether or not doctors should reveal treatment preferences under conditions of collective equipoise; and how sure experts would be about the best treatment following random allocation vs doctor/patient choice. Assessments of understanding hypothetical trial information.

RESULTS

Recent literature continues to report trial participants' failure to understand or remember information about randomisation and equipoise, despite the provision of clear and readable trial information leaflets. In current best practice, written trial information describes what will happen without offering accessible explanations. As a consequence, patients may create their own incorrect interpretations and consent or refusal may be inadequately informed. In six investigations, most participants identified which methods of allocation were random, but judged the random allocation methods to be unacceptable in a trial context; the mere description of a treatment as new was insufficient to engender a preference for it over a standard treatment; around half of the participants denied that a doctor could be completely unsure about the best treatment. A majority of participants judged it unacceptable for a doctor to suggest letting chance decide when uncertain of the best treatment, and, in the absence of a justification for random allocation, participants did not recognise scientific benefits of random allocation over normal treatment allocation methods. The pattern of results across three intervention studies suggests that merely supplementing written trial information with an explanation is unlikely to be helpful. However, when people manage to focus on the trial's aim of increasing knowledge (as opposed to making treatment decisions about individuals), and process an explanation actively, they may be helped to understand the scientific reasons for random allocation.

CONCLUSIONS

This research was not carried out in real healthcare settings. However, participants who could correctly identify random allocation methods, yet judged random allocation unacceptable, doubted the possibility of individual equipoise and saw no scientific benefits of random allocation over doctor/patient choice, are unlikely to draw upon contrasting views if invited to enter a real clinical trial. This suggests that many potential trial participants may have difficulty understanding and remembering trial information that conforms to current best practice in its descriptions of randomisation and equipoise. Given the extent of the disparity between the assumptions underlying trial design and the assumptions held by the lay public, the solution is unlikely to be simple. Nevertheless, the results suggest that including an accessible explanation of the scientific benefits of randomisation may be beneficial provided potential participants are also enabled to reflect on the trial's aim of advancing knowledge, and to think actively about the information presented. Further areas for consideration include: the identification of effective combinations of written and oral information; helping participants to reflect on the aim of advancing knowledge; and an evidence-based approach to leaflet construction.

Can one written word mean many things? Prereaders' assumptions about the stability of written words' meanings

Results of three experiments confirmed previous findings that in a moving word task, prereaders 3 to 5 years of age judge as if the meaning of a written word changes when it moves from a matching to a nonmatching toy (e.g., when the word "dog" moves from a dog to a boat). We explore under what circumstances children make such errors, we identify new conditions under which children were more likely correctly to treat written words' meanings as stable: when the word was placed alongside a nonmatching toy without having been alongside a matching toy previously, when two words were moved from a matching toy to a nonmatching toy, and when children were asked to change what the print said. Under these conditions, children more frequently assumed that physical forms had stable meanings as they do with other forms of external representation.

When can children handle referential opacity? Evidence for systematic variation in 5- and 6-year-old children's reasoning about beliefs and belief reports

Five- and 6-year-olds (N=51) heard stories in which a character sorted items into two locations. Either the character had a false belief about one of the items (e.g., thought a tin contained biscuits, not Lego), or was only partially informed of an item's dual identity (e.g., did not know that a tie was a present). Children found it easier to reject a report of the character's belief that described the true state of affairs when the character had a false belief (e.g., Is Fred's uncle thinking "where shall I put this Lego?"), than to reject one in which an object known to the character was described using a term of which she was ignorant (e.g., Is Mum thinking "where shall I put this present?"). Similarly, children found it easier to predict the character's incorrect sorting of the target items for false belief (with food not toys) than for dual identity (in the wardrobe not with things to take on a visit). Correct reasoning about beliefs and reports of beliefs that misrepresent an object does not imply mastery of the fact that beliefs represent an object in a particular way.

Children's suggestibility in relation to their understanding about sources of knowledge

In the experiments reported here, children chose either to maintain their initial belief about an object's identity or to accept the experimenter's contradicting suggestion. Both 3- to 4-year-olds and 4- to 5-year-olds were good at accepting the suggestion only when the experimenter was better informed than they were (implicit source monitoring). They were less accurate at recalling both their own and the experimenter's information access (explicit recall of experience), though they performed well above chance. Children were least accurate at reporting whether their final belief was based on what they were told or on what they experienced directly (explicit source monitoring). Contrasting results emerged when children decided between contradictory suggestions from two differentially informed adults: Three- to 4-year-olds were more accurate at reporting the knowledge source of the adult they believed than at deciding which suggestion was reliable. Decision making in this observation task may require reflective understanding akin to that required for explicit source judgments when the child participates in the task.

Five-year-olds' handling of reference and description in the domains of language and mental representation

Children's concurrent success on false belief tasks and their handling of two labels for one object (e.g., bunny/rabbit) has been interpreted as demonstrating understanding about the essential features of representation. Three experiments reveal the limitations in 5-year-olds' understanding for both mental and linguistic representations. We report relatively poor performance on a task involving two labels for one object (e.g., dice/eraser) which required children to treat another's knowledge as representing only some of the feature of its real referent: Dice but not eraser. Five year olds who made errors also had difficulty handling the fact that a written word 'dice' referring to such a dice/eraser, can also be applied to a standard dice but not to a standard eraser. These children lacked metalinguistic awareness of words as entities that both refer and describe.

Children's ability to make tentative interpretations of ambiguous messages

Consistent with prior research, 5- and 6-year-old children overestimated their knowledge of the intended referent of ambiguous messages. Yet they correctly revised their interpretations of ambiguous messages in light of contradicting information that followed immediately, while maintaining their initial interpretations of unambiguous messages (Experiment 1). Children of this age were able to integrate information over two successive ambiguous messages to identify the intended referent (Experiment 2). However, unlike 7- and 8-year-olds, they were no more likely to search for further information following ambiguous messages compared with unambiguous ones (Experiment 3). We conclude that although 5- and 6-year-olds' interpretations of ambiguous messages are not tentative at the outset, they can use source monitoring skills to treat them as tentative retrospectively, at least over short time spans.

Children's difficulties handling dual identity

Thirty-nine 6-year-old children participated in a longitudinal study using tasks that required handling of dual identity. Pre- and posttest sessions employed tasks involving a protagonist who was partially informed about an object or person; for example, he knew an item as a ball but not as a present. Children who judged correctly that the protagonist did not know the ball was a present (thereby demonstrating some understanding of the consequences of limited information access), often judged incorrectly (1) that he knew that there was a present in the box, and (2) that he would search as if fully informed. Intervening sessions added contextual support and tried to clarify the experimenter's communicative intentions in a range of ways. Despite signs of general improvement, the distinctive pattern of errors persisted in every case. These findings go beyond previous studies of children's handling of limited information access, and are hard to accommodate within existing accounts of developing understanding of the mind.

Information presentation and decisions to enter clinical trials: a hypothetical trial of hormone replacement therapy

We examined recruitment to an imaginary trial of hormone replacement therapy (HRT) following two different styles of information about HRT. We predicted that for treatments which, like HRT, are available outside a trial, people offered the facts as currently known would be less likely to remain unsure about the relative costs and benefits, and so less likely to agree to enter a randomised trial. In contrast, when the information provided reflected the current state of uncertainty which justified the trial, we predicted that people would be less likely to form a preference for one treatment arm over the other, and so more likely to agree to enter a trial. One hundred women aged 25-40 years were informed about HRT via a video and an information leaflet. For half the participants the information was framed in a way which emphasised the current state of uncertainty about the relative costs and benefits of HRT, and in that respect it reflected the justification for a trial. This version was considered to be similar in style to information commonly provided to potential trial participants. For half the participants the same information was framed in a way which offered explicit numerical detail about currently known facts, and in that respect it was considered to be similar in style to information commonly available to doctors prior to a trial. Women learned as much about HRT in the two conditions, but women given the explicit versions were more likely (i) to hold a stronger view about whether or not they would take HRT (ratings were not elicited from the first 30 participants in this condition. N = 20, p < 0.05 1 tailed) and (ii) to refuse entry to the trial (N = 50, p < 0.05 2 tailed). Those who, given the explicit version, agreed rather than refused to enter the trial, scored higher on believing that others control their health (p < 0.01 2 tailed).

High rates of infant macrosomia: a comparison of a Canadian native and a non-native population

The Cree of James Bay have the highest ever reported mean birth weight and a high prevalence of infant macrosomia. This study was designed to examine independent risk factors for infant macrosomia among the Cree, to compare these to risk factors among non-Native Canadians and to determine if ethnic differences persist after adjusting for differences in the distribution of other risk factors. Macrosomia was defined as birth weight >90(th) percentile for gestational age of a reference population. Independent determinants of macrosomia were examined in 385 Cree and 5644 non-Native women. The potential effect of ethnicity (Cree vs. non-Native) was determined after statistically adjusting for age, parity, pregravid weight, height, net rate of weight gain, gestational diabetes mellitus (GDM) and smoking status. The prevalence of macrosomia among the Cree was 34.3% vs. 11.1% among non-Natives. Although GDM significantly increased the risk for macrosomia among the Cree (odds ratio: 4.46, 95% CI: 2.24-9.26), it was not a significant risk factor among non-Natives (odds ratio: 1.15, 95% CI: 0.79-1.65). The risk for infant macrosomia remained elevated among the Cree compared with non-Natives after adjusting for other risk factors (odds ratio: 3.64, 95% CI: 2.69-4.90). In conclusion, the Cree have a high prevalence of macrosomia despite controlling for important differences in pregravid weight and GDM. Some of this variation may be due to genetic differences in fetal growth. The differential impact of GDM on macrosomia in the two ethnic groups may be due to differences in treatment strategies for GDM.

Interaction of body weight and ethnicity on risk of gestational diabetes mellitus

BACKGROUND

The James Bay Cree of Canada have one of the highest recorded rates of gestational diabetes mellitus (GDM) among aboriginal people worldwide; the reasons for this elevated risk remain to be documented.

OBJECTIVE

Our objective was to compare predictors and risk of GDM between the James Bay Cree and non-Native Canadians.

DESIGN

Risk for GDM was compared between Cree and non-Native women by 1) adjusting statistically for differences in age, parity, pregravid weight, and smoking status (n = 402 Cree, 7718 non-Natives), and 2) matching Cree women with non-Native women for age and pregravid weight (n = 394 Cree, 788 non-Natives). Dietary and physical activity information was available for a subset of Cree women (n = 152).

RESULTS

Age and pregravid weight were independent predictors of GDM in both Cree and non-Native women. After these predictors were controlled for, normal-weight (</=77 kg) Cree women were not at increased risk of GDM (OR: 1.42; 95% CI: 0.67, 2.71) but overweight Cree women had a higher risk than did overweight non-Native women (OR: 2.25; 95% CI: 1.32, 3.80).

CONCLUSIONS

Overweight Cree women are at increased risk of GDM. Given the high prevalence of pregravid overweight among the Cree, the burden of GDM is higher than among non-Native Canadians.

Realist errors in children's responses to pictures and words as representations

In three experiments we examined the judgments made by 3- to 4- year-old children about out-of-date physical representations which no longer matched their referents. The referent was a doll wearing a sticker, and the sticker was swapped for a different one after a picture had been drawn of the initial state of affairs (Experiments 1 and 2) or after the name of the doll and its original sticker had been written down (Experiment 3). We confirmed previous findings of realist errors in identity judgments for pictures and showed also that children tended to misidentify the name of a sticker in a written list to match a change to its referent. Thus, realist errors are not confined to representations which are iconically similar to their referents. Furthermore, children also judged incorrectly that the pictures and words had actually been changed, indicating that realist errors to external representations extend to operations performed on their referents as well as to their identities.

Children's understanding that utterances emanate from minds: using speaker belief to aid interpretation

Children interpreted an utterance made by a protagonist with a false belief, such as, 'I would like the car in the garage.' Calculating the speaker's belief in conjunction with the literal meaning of the utterance would lead to the correct interpretation that the intended referent is the car on the track, given that the car in the garage swapped places with the one on the track. In Experiments 1 and 2, many children aged around 4 and 5 years wrongly indicated the car in the garage. In contrast, many correctly indicated the car on the track when it was unnecessary to consider the speaker's belief because the utterance was, 'the car I put in the garage'. Six-year-olds found both kinds of utterance equally easy in Experiment 1, while 3-year-olds had equal difficulty with both. In Experiments 2 and 3, the speaker gave an ambiguous utterance and many children aged between 3 and 6 years successfully used information about the speaker's belief to identify which of several candidate referents was intended. We discuss the results in relation to characteristics of utterance comprehension and consider implications for developments in understanding the mind by children beyond 4 years.

Children's ability to infer utterance veracity from speaker informedness

Children between the ages of 3 years 7 months and 6 years 5 months experienced a contradiction between what they knew or guessed to be inside a box and what they were told by an adult. The authors investigated whether children believed what they were told by asking them to make a final judgment about the box's content. Children tended to believe utterances from speakers who were better informed than they themselves were and to disbelieve those from less well-informed speakers, with no age-related differences. This behavior implies an understanding of the speaker's knowledge and suggests that children can learn from oral input while being appropriately skeptical of its truth. Children also gave explicit knowledge judgments on trials on which no utterances were given. Performance on knowledge trials was less accurate than, and unrelated to, performance on utterance trials. Research on children's developing explicit theory of mind needs to be broadened to include behavioral indexes of understanding the mind.

Membrane topology and cellular location of the Treponema pallidum glycerophosphodiester phosphodiesterase (GlpQ) ortholog

Recent reports that isolated Treponema pallidum outer membranes contain an ortholog for glycerophosphodiester phosphodiesterase (GlpQ) (D. V. Shevchenko, D. R. Akins, E. J. Robinson, M. Li, O. V. Shevchenko, and J. D. Radolf, Infect. Immun. 65:4179-4189, 1997) and that this protein is a potential opsonic target for T. pallidum (C. E. Stebeck, J. M. Shaffer, T. W. Arroll, S. A. Lukehart, and W. C. Van Voorhis, FEMS Microbiol. Lett. 154:303-310, 1997) prompted a more detailed investigation of its physicochemical properties and cellular location. [14C]palmitate radiolabeling studies of a GlpQ-alkaline phosphatase fusion expressed in Escherichia coli confirmed the prediction from DNA sequencing that the protein is lipid modified. Studies using Triton X-114 phase partitioning revealed that the protein's amphiphilicity is due to lipid modification and that a substantial portion of the polypeptide is associated with the T. pallidum peptidoglycan sacculus. Three different approaches, i.e., (i) proteinase K treatment of intact treponemes, (ii) indirect immunofluorescence analysis of treponemes encapsulated in agarose beads, and (iii) opsonophagocytosis of treponemes incubated with antiserum against recombinant GlpQ by rabbit peritoneal macrophages, confirmed that GlpQ is entirely subsurface in T. pallidum. Moreover, rabbits hyperimmunized with GlpQ were not protected against intradermal challenge with virulent treponemes. Circular dichroism spectroscopy confirmed that the recombinant form of the polypeptide lacked discernible evidence of denaturation. Finally, GlpQ was not radiolabeled when T. pallidum outer membranes were incubated with 3-(trifluoromethyl)-3-(m-[125I]iodophenyl)-diazarene, a photoactivatable, lipophilic probe which promiscuously labels both proteins and lipids within phospholipid bilayers. Taken as a whole, these studies indicate that the T. pallidum GlpQ ortholog is a periplasmic protein associated predominantly with the spirochete's peptidoglycan-cytoplasmic membrane complex.

Children's ability to infer utterance veracity from speaker informedness

Children between the ages of 3 years 7 months and 6 years 5 months experienced a contradiction between what they knew or guessed to be inside a box and what they were told by an adult. The authors investigated whether children believed what they were told by asking them to make a final judgment about the box's content. Children tended to believe utterances from speakers who were better informed than they themselves were and to disbelieve those from less well-informed speakers, with no age-related differences. This behavior implies an understanding of the speaker's knowledge and suggests that children can learn from oral input while being appropriately skeptical of its truth. Children also gave explicit knowledge judgments on trials on which no utterances were given. Performance on knowledge trials was less accurate than, and unrelated to, performance on utterance trials. Research on children's developing explicit theory of mind needs to be broadened to include behavioral indexes of understanding the mind.

Basal cells are progenitors of luminal cells in primary cultures of differentiating human prostatic epithelium

BACKGROUND

Human prostatic epithelium consists mainly of basal and secretory luminal cells: the origin of these phenotypes from a common stem cell, within the basal compartment, has been proposed but not yet demonstrated.

METHODS

Analyses by light and electron microscopy, immunocytochemistry, and flow cytometry were used to determine lineage. The criteria for identifying the different phenotypes were characteristic morphology, and organization and expression of luminal- and basal-specific markers.

RESULTS

After organoids attached, outgrowths appeared with cells maintaining close cell-to-cell associations. The dividing cell compartment contained a subpopulation of cells with stem-cell characteristics and a major population that may correspond to amplifying cells. The characteristics of the stem-cell phenotype included reactivity with antibodies CKbasal, CK14, and Ki67. The amplifying cells were characterized as an intermediate phenotype between basal and luminal, as reactivity was demonstrated with CKbasal, CK14, and CK18. As outgrowths eventually merged, multilayering was apparent and cells on the uppermost layer had numerous secretory vacuoles and reacted strongly with antibodies CK18 and CK19, androgen receptor, and prostate-specific antigen, which is characteristic of secretory luminal cells in vivo. In passaged cultures, loss of reactivity with CKbasal was detected; we postulate that this population contains the stem-cell fraction.

CONCLUSIONS

These findings demonstrate that basal and luminal cells are of the same lineage and are derived from a common stem cell. Moreover, the progenitor stem cells reside within the basal compartment.

'Theory of mind' skills during an acute episode of psychosis and following recovery

BACKGROUND

A neuropsychological formulation of schizophrenia has suggested that problems with meta-representation underpin both positive and negative symptoms. This study tested Frith's account by asking patients experiencing an acute episode of psychosis to complete a set of tasks that involved Theory of Mind (ToM) skills.

METHODS

Fourteen patients who fulfilled criteria for schizophrenia, 10 deluded patients who were suffering from psychotic disorders other than schizophrenia and 12 depressed patients completed second-order false belief tasks, a test which involved substitution of a co-referential term in a linguistic description of an event, and metaphor and irony tasks. The battery of tests was completed during the acute phase and following recovery. Selection of these patient groups allowed comparisons to be made between schizophrenia patients and non-schizophrenia patients and between patients with and without persecutory delusions.

RESULTS

Schizophrenia patients, who had a multiplicity of positive and negative symptoms, performed significantly worse than non-schizophrenia patients on some of the ToM tasks during an acute episode. Patients with delusions of persecution and reference did not perform significantly worse than non-deluded patients on ToM tasks. There was no significant difference between groups in performance on any of the tasks at recovery.

CONCLUSIONS

The results provide at best weak support for Frith's account and it remains unclear whether the ToM deficits demonstrated are genuine deficits or are a result of information-processing overload. However, it is clear that difficulties interpreting interpersonal contexts, as shown by some schizophrenia patients, are state rather than trait characteristics.

Children's mental representation of referential relations

We identify a surprising discrepancy in children's performance in two tasks which appear superficially to require handling of the same properties of the representational mind. Four- to six-year-olds made judgements about the knowledge of a protagonist who had only partial information about an object: the child knew that an object in a box had two descriptions, X and Y (e.g. dice and eraser), but the protagonist had access to only one of these, X. In Experiment 1, children who passed a standard false-belief task also judged correctly that the protagonist did not know the X was Y, but often judged wrongly that he did know there was a Y in the box. In Experiment 2, children predicted wrongly where the protagonist would look for a Y: the problem was not purely linguistic. We argue that success on standard theory-of-mind tasks can be supported by a more basic representing ability than is assumed in current theories, and that children's mental representation of referential relations between the world and the mind subsequently undergoes important change.

Identification of homologs for thioredoxin, peptidyl prolyl cis-trans isomerase, and glycerophosphodiester phosphodiesterase in outer membrane fractions from Treponema pallidum, the syphilis spirochete

In this study, we characterized candidate rare outer membrane (OM) proteins with apparent molecular masses of 19, 27, 38, and 38.5 kDa, which had been identified previously in OM fractions from Treponema pallidum (J. D. Radolf et al., Infect. Immun. 63:4244-4252, 1995). Using N-terminal and internal amino acid sequences, a probe for the 19-kDa candidate was PCR amplified and used to screen a T. pallidum genomic library in Lambda Zap II. The corresponding gene (tlp) encoded a homolog for periplasmic thioredoxin-like proteins (Tlp), which reduce c-type cytochromes. A degenerate oligonucleotide derived from the N terminus of the 27-kDa protein was used to PCR amplify a duplex probe from a T. pallidum genomic library in pBluescript II SK+. With this probe, the corresponding gene (ppiB) was identified and found to code for a presumptive periplasmic cyclophilin B-type peptidyl prolyl cis-trans isomerase (PpiB). We postulate that PpiB assists the folding of proteins within the T. pallidum periplasmic space. The N terminus of the 38-kDa candidate was blocked to Edman degradation. However, internal sequence data revealed that it was basic membrane protein (Bmp), a previously characterized, signal peptidase I-processed protein. Triton X-114 phase partitioning revealed that despite its name, Bmp is hydrophilic and therefore likely to be periplasmic. The final candidate was also blocked to Edman degradation; as before, a duplex probe was PCR amplified with degenerate primers derived from internal sequences. The corresponding gene (glpQ) coded for a presumptively lipid-modified homolog of glycerophosphodiester phosphodiesterase (GlpQ). Based upon findings with other treponemal lipoproteins, the hydrophilic GlpQ polypeptide is thought to be anchored by N-terminal lipids to the periplasmic leaflet(s) of the cytoplasmic membrane and/or OM. The discovery of T. pallidum periplasmic proteins with potentially defined functions provides fresh insights into a poorly understood aspect of treponemal physiology. At the same time, however, these findings also raise important issues regarding the use of OM preparations for identifying rare OM proteins of T. pallidum.

Effects of a new 5 alpha reductase inhibitor (epristeride) on human prostate cell cultures

BACKGROUND

Inhibitors of 5 alpha reductase (5 alpha R), the enzyme that converts testosterone to dihydrotestosterone (DHT), have been shown to retard the growth of hyperplastic prostates. This study evaluates the effects of the 5 alpha R inhibitor, epristeride, on cultured stromal and epithelial cells from benign, hyperplastic adult prostates.

METHODS

[3H]-thymidine incorporation was used as a measure of proliferation. Prostate-specific antigen (PSA) was quantified by ELISA and reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTS

Stromal cell proliferation in response to testosterone was dose-dependently inhibited by epristeride (1 x 10(-9) -3 x 10(-7) M, P < 0.05). However, epristeride had no effect on DHT-induced growth or the growth of androgen-unresponsive stroma. Upregulation of PSA secretion from epithelial cells by androgens was downregulated by epristeride (3 x 10(-9) M, P < 0.05) in testosterone-treated cells. Transforming growth factor beta-1 (TGF beta-1) secretion was downregulated by testosterone treatment and increased following treatment with epristeride (3 x 10(-9) M, P < 0.05).

CONCLUSIONS

This demonstrates that epristeride specifically blocks testosterone-induced effects on prostatic cultures. TGF beta-1 may be a marker of 5 alpha reductase activity.

Measurement of polyethylene wear in acetabular components inserted with and without cement. A randomized trial

We measured the three-dimensional wear of polyethylene after total hip arthroplasty with a titanium metal-backed Mallory-Head prosthesis that was inserted with cement in sixty-nine patients (sixty-nine hips) and with a press-fit titanium metal-backed Mallory-Head prosthesis that was inserted without cement in seventy patients (seventy hips). A modular titanium femoral head was used in all of the hips. The patients in the present study were part of a larger double-blind randomized trial comparing the result of total hip arthroplasty performed with cement with that of the same procedure performed without cement in 250 patients. The criterion for inclusion in the study of polyethylene wear was a minimum duration of follow-up of four years, which was met by 148 patients. As adequate radiographs for digitization were not available for nine patients, 139 patients were included in the present study. The age of the patient, the postoperative Harris hip score, the diameter of the femoral head, the thickness of the liner in the polar region of the acetabular component, and the duration of follow-up were similar for the two groups. The mean rate of volumetric wear of the polyethylene was significantly greater in the prostheses that had been inserted without cement than in those that had been inserted with cement (155.1 cubic millimeters per year compared with 98.5 cubic millimeters per year; p = 0.000008). Thirty-four (49 per cent) of the seventy hips in which the prosthesis had been inserted without cement had evidence of osteolysis on radiographs, compared with twelve (17 per cent) of the sixty-nine hips in the other group (p = 0.0002). Osteolysis was associated with an increased rate of polyethylene wear only in the hips in which the prosthesis had been inserted without cement.

When speech conflicts with seeing: young children's understanding of informational priority

In a series of investigations we found that children between 3 and 5 years of age judged that an utterance (such as, "There's milk in the jug") would be ignored by a listener who had previously seen something contradictory (orange juice in the jug). However, children judged that the listener would believe the message "There's milk in the jug" when he had not previously seen inside. In these various conditions, child participants had not seen for themselves what was inside the jug, so it was impossible for their own directly perceived knowledge to contaminate their judgments of what the protagonist believed. Under these conditions, even many false-belief failers did not assume that the listener would believe whatever they themselves thought was true. Moreover, the results of control conditions suggested that children's success could not be attributed to low-level strategies. These results seem to indicate an early understanding of how people prioritize information, with the consequence that they acknowledge that one and the same message would be believed in one context but not in another.

Benign prostatic stromal cells are regulated by basic fibroblast growth factor and transforming growth factor-beta 1

The current study was undertaken, using cultures of prostatic epithelial and stromal cells, to determine the functional interactions between androgens, basic fibroblast growth factor (FGF2) and transforming growth factor-beta 1 (TGF beta 1) and their importance in maintaining stromal homeostasis. Treatment of stromal cells with TGF beta 1 significantly increased intracellular FGF2 and FGF2 sequestered to the extracellular matrix. FGF2 was also detected in stromal conditioned medium (SCM), but at levels 70-fold less than found in cell lysates. TGF beta 1 (0.1 ng/ml) treatment caused an initial increase of 86% in secreted FGF2 levels, but high concentrations of TGF beta 1 (5 ng/ml) decreased FGF2 levels by 38%, relative to the untreated control. Further studies showed that epithelial conditioned medium (ECM), androgen-treated, stromal conditioned medium (ASCM), but not SCM were mitogenic for stromal cells. Both ECM and ASCM caused a threefold increase in DNA synthesis. FGF2 may be the mediator of these interactions, since the mitogenic effect of both ECM and ASCM was significantly reduced by the addition of anti-FGF2 neutralising antibody. We hypothesise that the lack of response of stromal cells to SCM is due to TGF beta 1 blocking the mitogenic effect of FGF2. Thus down-regulation of TGF beta 1 synthesis, by androgens, results in stromal proliferation by ASCM.

Contamination in reasoning about false belief: an instance of realist bias in adults but not children

Children aged around 5 and 9 years and adults were presented with stories and videos about a protagonist who heard a message purporting to provide factual information. Observing subjects knew whether the message was true or false. In some cases, this message contradicted the listener's existing belief based on what he or she had seen previously. Subjects judged whether the listener would believe or disbelieve the message. Child subjects frequently judged that a contradicting message would be disbelieved, irrespective of whether they (the child subjects) knew it to be true or false. In contrast, adult subjects made judgements that were contaminated by their own privileged knowledge of the truth. For three different scenarios, adult subjects judged more frequently that the message would be believed if they (but not the listener protagonist) knew it to be true, than if they thought it was false.

Osteolysis in cemented versus cementless acetabular components

A prospective, randomized, double-blind, clinical trial comparing cemented with cementless total hip arthroplasty was performed to compare the prevalence and pattern of acetabular osteolysis. Both groups were similar before surgery. Acetabular components were metal-backed, titanium implants. Twenty-eight-millimeter modular femoral heads with titanium femoral stems were used. At a minimum 2-year and mean 4-year follow-up period (range, 2-6 years), 224 patients had clinical and radiographic data available. There was no significant difference in the prevalence of acetabular osteolysis between cemented (5%) and cementless (9%) fixation. With or without cement, the use of a titanium femoral head led to osteolysis within a relatively short period after surgery in almost all of the cases, although this was not significant. The pattern of acetabular osteolysis was different. Progressive osteolysis occurred predominantly in acetabular zone 1 in the cemented group and zone 2 in the cementless group. Cementless fixation of acetabular components has been advocated in an attempt to minimize osteolysis that may occur in cemented total hip arthroplasty. This study found no difference in the prevalence of acetabular osteolysis between the two groups.

Catastrophic osteolysis in total knee replacement. A report of 17 cases

One hundred eighty-five total knee revisions were done by the 2 senior authors from 1988 to 1994. Of these, 17 patients were identified as having severe osteolysis. The average age was 62.7 years, and the average weight was 90.8 g. All patients had osteoarthritis. Preoperative aspiration was negative in all patients. Eight patients had a metal-backed patella, 8 had a cementless implant, 4 had a cemented implant, and 5 had a hybrid implant. The average time interval from the index surgery to radiographic evidence of lysis was 56 months. Radiographic review showed gross polyethylene wear in 10 patients, loose tibial implants in 8, fractured baseplates in 2, and evidence of a metallic synovitis in 2. Retrieved polyethylene liners had a average thickness of 7 mm, and none were conforming. Osteolytic defects were defined and classified according to Engh's criteria. The histology showed a foreign body reaction with intracellular refractile polyethylene particles. Four cases had metallic debris. The exposure at the time of revision required a rectus snip in 4, V-Y-quadricepsplasty in 2, and tibial tubercle osteotomy in 1. Posterior stabilized implants were used in 65% and a constrained implant in 30%. Lytic defects were reconstructed with cement only in 47% of knees, allograft in 30%, and metallic wedges in 35%. Based on this report, the authors conclude that younger, overweight patients seem to be at higher risk of implant failure and that osteolysis is not restricted to cementless implants. Furthermore, because review of the radiographs leads to a constant underestimation of the lytic defect, the surgeon must be prepared to deal with complex revisions.

Characterization of outer membranes isolated from Treponema pallidum, the syphilis spirochete

Previous freeze-fracture electron microscopy (EM) studies have shown that the outer membrane (OM) of Treponema pallidum contains sparse transmembrane proteins. One strategy for molecular characterization of these rare OM proteins involves isolation of T. pallidum OMs. Here we describe a simple and extremely gentle method for OM isolation based upon isopycnic sucrose density gradient ultracentrifugation of treponemes following plasmolysis in 20% sucrose. Evidence that T. pallidum OMs were isolated included (i) the extremely low protein/lipid ratio of the putative OM fraction, (ii) a paucity of antigenic and/or biochemical markers for periplasmic, cytoplasmic membrane, and cytosolic compartments, and (iii) freeze-fracture EM demonstrating that the putative OMs contained intramembranous particles highly similar in size and density to those in native T. pallidum OMs. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis revealed that the OMs contained a relatively small number of treponemal proteins, including several which did not appear to correspond to previously characterized T. pallidum antigens. Interestingly, these candidate rare OM proteins reacted poorly with syphilitic sera as determined by both conventional immunoblotting and enhanced chemiluminescence. Compared with whole cells, T. pallidum OMs were deficient in cardiolipin, the major lipoidal antigen reactive with antibodies in syphilitic sera. Also noteworthy was that other lipoidal constituents of OMs, including the recently discovered glycolipids, did not react with human syphilitic sera. These latter observations suggest that the poor antigenicity of virulent T. pallidum is a function of both the lipid composition and the low protein content of its OM.

Measurement of polyethylene wear in metal-backed acetabular cups. II. Clinical application

The new 3-dimensional technique was applied to the radiographs of 141 patients who had received Porous Coated Anatomic total hip prostheses. Values were obtained for the position of the acetabular cup, the 3-dimensional distance and direction of femoral head displacement, and the minimum volume of polyethylene debris produced. Mean age of the patients at the time of replacement was 61 years old; mean followup was 5.6 years (range, 4-7.2 years). Change in the position of the femoral head between initial and long-term followup films was assumed to represent polyethylene wear, and formulas were used to calculate the minimal volume of polyethylene debris produced. The overall rate of 3-dimensional femoral head displacement was 0.264 mm per year, almost twice that usually quoted in the current literature for 2-dimensional linear wear. A significant contribution to this value was made by anterior and posterior displacement. Two-dimensional femoral head displacement (measured in the plane of anteroposterior radiographs) on the same patients was 0.149 mm per year. The mean minimum volume of polyethylene debris produced after 5.6 years was 0.448 cm3 (range, 0.00-2.83 cm3), giving a mean rate of 0.079 cm3 polyethylene debris produced each year. Thirteen patients in this series had radiologic osteolysis and a significantly greater femoral head displacement and polyethylene volumetric wear than those with no osteolysis. Patients with a 32-mm femoral head diameter and a polyethylene linear < 1 cm thick had a significantly greater amount of polyethylene wear. This series gives previously unavailable data on 3-dimensional femoral head displacement and is the first report that correlates the minimum volume of polyethylene wear produced with radiologic osteolysis.

Young children's treating of utterances as unreliable sources of knowledge

In two investigations (N = 62 and 59), three- and four-year-old children sometimes disbelieved what they were told about the unexpected contents of a deceptive box, even when they had seen the adult speaker look inside the box before s/he told them what s/he saw, and despite being able to recall the utterance: utterances were treated as unreliable sources of knowledge compared with seeing directly. Those who did believe the utterance were no better at recalling their prior belief about the box's contents (now treated as false), than those who saw inside the box. However using a narrative procedure, we replicated Zaitchik's (1991) result that children are more likely to acknowledge another's belief when they are told about reality, than when they see reality for themselves. We argue that these children were acknowledging alternative rather than false belief.

Intern candidates who withdraw from contracts: incidence and internal medicine program directors' attitudes

OBJECTIVE

To study the prevalence of intern candidates accepted through the National Resident Matching Program (NRMP) or after the match who subsequently withdraw and the attitudes of program directors regarding this issue.

DESIGN

Mailed survey.

SETTING

Four hundred fifty-four internal medicine program directors.

MEASUREMENTS

Questionnaires assessing program directors' attitudes toward interns who contract for positions after having verbal or written agreements elsewhere (and the program directors who accept them), the importance of this problem, and the incidence of this problem.

MAIN RESULTS

Fifty-five programs (of the 221 responding) experienced intern withdrawals. Programs with larger numbers of open positions after the match had more intern withdrawals (p = 0.03). Eleven of the program directors knew of the prior commitment of the intern, and in all cases the other program director was called for permission to accept the intern. Program directors had negative feelings about both the interns who withdrew and the program directors who accepted them. Community, municipal, and Veterans Affairs hospital program directors were significantly less negative than those in university and university-affiliated hospitals toward interns who withdrew from written commitments (p = 0.001) and the program directors who accepted them (p < 0.05).

CONCLUSION

Problems with intern candidate withdrawals from offered/matched programs affect a significant proportion of programs, especially those with larger numbers of unmatched positions. Program directors are generally disapproving.

Children's interpretation of messages from a speaker with a false belief

In 5 investigations we examined a new procedure for assessing children's understanding that messages arise from speakers' internal representations. 3- and 4-year-olds watched the enactment of a message-desire discrepant story in which a speaker doll, who believed wrongly that bag A was in location 1 and that bag B was in location 2, gave a message referring to the bag in location 1. In a message-desire consistent control condition, the speaker had a correct belief about the bags' locations. Children frequently judged correctly in the discrepant story that the speaker (who specified location 1) wanted the bag in location 2, and judged correctly in the consistent story that the speaker wanted the bag in location 1. That is, young children attended to the speaker's internal representations, and not just the real-world referent of the message, when judging what the speaker wanted. In one of the investigations, children performed better on the message-desire discrepant task than on a false belief task. We discuss why they might find it particularly easy to take into account false belief when inferring desire on the basis of behavior.

Evaluation of a community health representative program among the Cree of northern Quebec

The James Bay Cree Community Health Representative (CHR) program was implemented in 1984 to train persons from the Cree population of northern Quebec to act as health care advocates and educators, as intermediaries between the Cree population, health services and local organizations, and as participants in assessing health needs. A formative evaluation was initiated which included quantitative analysis of the daily tasks of CHRs and a qualitative component based on documentary research, observation and semi-structured interviews. The evaluation revealed that CHRs actively participated in the ongoing community health programs mainly through health education; the people interviewed showed a high level of satisfaction. However, direct supervision, sufficient continuing education for the CHRs and better integration into health care teams are long-term goals which need to be emphasized in the program.

Dietary iron overload in southern African rural blacks

A survey conducted in rural southern African black subjects indicated that dietary iron overload remains a major health problem. A full blood count, erythrocyte sedimentation rate, serum concentrations of iron, total iron-binding capacity, ferritin, C-reactive protein (CRP), gamma-glutamyltransferase (GGT) and serological screening for hepatitis B and human immunodeficiency virus (HIV) infections were carried out in 370 subjects (214 inpatients and 156 ambulatory Mozambican refugees). The fact that the geometric mean (SD range) serum ferritin concentration was much higher in the male hospital patients than in subjects living in the community [1,581 micrograms/l (421-5,944 micrograms/l) and 448 micrograms/l (103-1,945 micrograms/l) respectively] suggested that dietary iron overload was not the only factor raising the serum ferritin concentration. The major additional factor appeared to be inflammation, since the geometric mean (SD range) serum CRP was significantly higher in male hospital patients [21 mg/l (8-53 mg/l)] than in subjects in the community [3 mg/l (1-5 mg)]. Alcohol ingestion, as judged by history and by serum GGT concentrations, was also associated with significantly raised serum ferritin concentrations. This finding was ascribed to the fact that traditional brews are not only associated with alcohol-induced hepatic damage but are also a very rich source of highly bio-available iron. The role of iron overload in the genesis of the raised serum ferritin concentrations are confirmed in the diagnostic liver biopsy study. The majority of biopsies showed heavy siderosis, with varying degrees of hepatic damage.(ABSTRACT TRUNCATED AT 250 WORDS)