Masters Athlete Screening Study (MASS): incidence of cardiovascular disease and major adverse cardiac events over five years of screening

Background

The long-term implications of cardiovascular disease (CVD) in masters athletes, and whether screening decreases their risk of major adverse cardiac events (MACE) is unknown.

Purpose

To evaluate the incidence of CVD and MACE over five years of a screening study.

Methods

Masters athletes (≥35 years) from a variety of sports without previous history of coronary artery disease (CAD) underwent yearly cardiovascular screening. The screen consisted of anthropometrics, blood pressure, resting electrocardiogram, modified American Heart Association 14-element recommendations, cardiovascular event questionnaire, physical examination (year 1) and Framingham Risk Score (years 1–3). Participants with an abnormal screen according to the European Association of Cardiovascular Prevention and Canadian Cardiology Society Guidelines underwent further evaluations (computed coronary tomography angiography was not included for all athletes but based on clinical assessment). Participants who withdrew during the study received a follow-up questionnaire to determine MACE and vital status.

Results

In the first year of the Masters Athlete Screening Study, 798 masters athletes (62.7% male, 54.6±9.5 years) were screened; 91 (11.4%) of the cohort were found to have CVD. CAD was the most common diagnosis (69.2%). During the following four years, there were an additional 89 CVD diagnoses with an incidence rate of 3.58/100, 4.14/100, 3.74/100, 1.19/100, for years two to five, respectively. Fifteen participants had more than one diagnosis. The most common diagnoses over the five years were arrhythmias (n=33; 37.1%), aortic dilatation (n=20; 22.5%), CAD (n=18; 20.2% (5 obstructive, 13 non-obstructive)) and other (n=7; 7.9%) (myocarditis (n=2), myocardial bridging (n=1), cerebrovascular disease (n=1), dilated cardiomyopathy (n=1), probable Long QT syndrome (n=1), papillary fibroelastoma (n=1)). A total of 10 MACE occurred (two cardiovascular deaths, five myocardial infarctions and three cerebrovascular accidents). All events occurred in male athletes (63.6±12.5 years). Out of the 136 participants that received the lost to follow-up questionnaire, 101 (74.3%) completed it. Of those, one male athlete underwent percutaneous coronary intervention. The incidence of MACE over the study period was 0.30/100 athletes per year.

Conclusion

Yearly cardiovascular screening of masters athletes identified ∼3 new diagnoses per 100 athletes per year. Ten MACE occurred despite yearly screening and high CV fitness of masters athletes.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): MITACs and CIHR

Evaluating the use of educational videos to support the tuberculosis care cascade in remote Madagascar

SETTING: Access to information about tuberculosis (TB) is vital to ensure timely diagnosis, treatment, and control among vulnerable communities. Improved approaches for distributing health education materials to remote populations are needed.OBJECTIVE: To evaluate the impact of two comprehensive video training curricula in improving patient, community member, and community health worker knowledge of TB in a remote area of Madagascar.DESIGN: A pre-test/post-test design was used to measure knowledge acquisition. Educational videos were short, culturally appropriate films presented at critical moments in the TB cascade of care.RESULTS: Of the total 146 participants, 86 (58.9%) improved their score on the post-test, 50 (34.2%) obtained the same score, and 10 (6.8%) received a worse score. A statistically significant difference was observed between the pre- and post-test scores, wherein scores increased by a median of 10.0% (interquartile range 0.0-20.0) after viewing the videos (P < 0.001). There was a significant difference between the number of correct answers on the pre-test and the number of correct answers on the post-test (P < 0.001).CONCLUSION: Educational videos were found to significantly improve TB knowledge among a low-literacy, remote population in Madagascar. Our findings suggest educational videos could be a powerful, low-cost, and sustainable tool to improve access to TB education materials globally.

Toilet hygiene-review and research needs

The goal of good toilet hygiene is minimizing the potential for pathogen transmission. Control of odours is also socially important and believed to be a societal measure of cleanliness. Understanding the need for good cleaning and disinfecting is even more important today considering the potential spread of emerging pathogens such as SARS‐CoV‐2 virus. While the flush toilet was a major advancement in achieving these objectives, exposure to pathogens can occur from failure to clean and disinfect areas within a restroom, as well as poor hand hygiene. The build‐up of biofilm within a toilet bowl/urinal including sink can result in the persistence of pathogens and odours. During flushing, pathogens can be ejected from the toilet bowl/urinal/sink and be transmitted by inhalation and contaminated fomites. Use of automatic toilet bowl cleaners can reduce the number of microorganisms ejected during a flush. Salmonella bacteria can colonize the underside of the rim of toilets and persist up to 50 days. Pathogenic enteric bacteria appear in greater numbers in the biofilm found in toilets than in the water. Source tracking of bacteria in homes has demonstrated that during cleaning enteric bacteria are transferred from the toilet to the bathroom sinks and that these same bacteria colonize cleaning tools used in the restroom. Quantitative microbial risk assessment has shown that significant risks exist from both aerosols and fomites in restrooms. Cleaning with soaps and detergents without the use of disinfectants in public restrooms may spread bacteria and viruses throughout the restroom. Odours in restrooms are largely controlled by ventilation and flushing volume in toilet/urinals. However, this results in increased energy and water usage. Contamination of both the air and surfaces in restrooms is well documented. Better quantification of the risks of infection are needed as this will help determine what interventions will minimize these risks.

The Mobile Surgical Outreach Model for women with genital fistula in the Democratic Republic of Congo

Aims: To describe the PH Mobile Surgical Outreach (MSO) model of care delivery for women with GF and to present data highlighting the program’s scope and clinical impact in 2011-2017. Methods: PH created the MSO program to deliver health services to women with genital fistula (GF) living in remote areas in DRC. The MSO model facilitates reintegration through community education about GF, leveraging local staff in all aspects of care. Outreach trips are organized annually/bi-annually per site, depending on case volume and funding. Site selection is a two-step process: (1) identification of accessible, strategically located hospitals; (2) initial site visit and readiness assessment. This paper presents 2011-2017 MSO activities, including geographic scope, patient and provider outcomes. Results: The MSO team has worked with 43 clinic sites across 12 provinces. Since 2011, they have conducted 77 site visits and provided surgical care for 2,017 women. Table1 summarizes surgeries conducted annually by province, 2011-2017.Table 2 provides a clinical snapshot of 2017 case mix. Conclusions: The MSO model demonstrates feasibility and indicates program successes for capacity-building in skilled medico-surgical care and enhancing community awareness of GF. Training serves to improve local provider skills, strengthens health workforce and offers scalable, sustainable solutions to prevention and treatment.

Selective method for identification and quantification of Bifidobacterium animalis subspecies lactis BB-12 (BB-12) from the gastrointestinal tract of healthy volunteers ingesting a combination probiotic of BB-12 and Lactobacillus rhamnosus GG

AIM

To develop a novel validated method for the isolation of Bifidobacterium animalis ssp. lactis BB-12 (BB-12) from faecal specimens and apply it to studies of BB-12 and Lactobacillus rhamnosus GG (LGG) recovered from the healthy human gastrointestinal (GI) tract.

METHODS AND RESULTS

A novel method for isolating and enumerating BB-12 was developed based on its morphologic features of growth on tetracycline-containing agar. The method identified BB-12 correctly from spiked stool close to 100% of the time as validated by PCR confirmation of identity, and resulted in 97-104% recovery of BB-12. The method was then applied in a study of the recovery of BB-12 and LGG from the GI tract of healthy humans consuming ProNutrients^® Probiotic powder sachet containing BB-12 and LGG. Viable BB-12 and LGG were recovered from stool after 21 days of probiotic ingestion compared to baseline. In contrast, no organisms were recovered 21 days after baseline in the nonsupplemented control group.

CONCLUSIONS

We demonstrated recovery of viable BB-12, using a validated novel method specific for the isolation of BB-12, and LGG from the GI tract of healthy humans who consumed the probiotic supplement.

SIGNIFICANCE AND IMPACT OF THE STUDY

This method will enable more detailed and specific studies of BB-12 in probiotic supplements, including when in combination with LGG.

Tumor registry versus physician medical record review: A head-to-head comparison of malignant pancreatic neuroendocrine tumor (mPNET) cases

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Background: Researchers have underutilized single-institution tumor registry (TR) data, instead using researcher medical record review and/or personal, departmental or institutional databases to identify patients with particular malignancies. However, TR data is becoming increasingly prominent on a national level through broader use of the National Cancer Database (NCDB). We selected mPNETs as example to compare the accuracy of TR identification of these tumors with physician medical record review (MD Review). Methods: For MD Review, the health information services department of a single academic medical center was queried for all patients with pancreatic ICD9 codes (157.0–157.9; 211.6–211.7) January 2000-August 2008. A single physician reviewer analyzed computerized and paper medical records and identified mPNET cases. For TR data, mPNET patients were identified using the TR database with assistance of TR staff by two separate strategies. From January 2000-December 2006, patients were identified by using diagnosis codes from manual review of admission, discharge, clinic and pathology reports. From January 2007-August 2008 the TR used an automated case finding program (CAL by C/NET, California, USA) that downloaded cases with terms and codes related to malignancy. All MD Review- and TR-identified mPNET cases were reviewed by a second investigator blinded to identification strategy to assure consistency of mPNET definitions. Results: Using MD Review, 1194 pts with pancreatic ICD9 codes were identified. After MD Review, 42 mPNET patients were identified and confirmed. In comparison, TR identified 17 patients, of whom 5 were not identified by MD Review. Of the 47 patients identified by either strategy, TR identified 17/47 (32.6%) patients, whereas MD Review identified 42/47 (89.4%). TR identification rate in time periods 1 and 2 were 30% and 40%, respectively. Conclusions: Analysis of an academic tumor registry demonstrates that a substantial proportion of mPNET cases are missed when compared to ICD-9 identification and physician medical record review. Since MD review is imperfect, the TR may be even less effective at identifying PNETs than our data suggest. This may be applicable to other tumor registries and TR-based national studies.

No significant financial relationships to disclose.

Is START a switch?

The cell cycle in Saccharomyces cerevisiae is controlled by regulation of START in late G1. The CLN1, CLN2 and CLN3 family of cyclin homologues is required for cells to pass START. They probably act by activating the CDC28 protein kinase. Expression of CLN1 or CLN3 under the control of an inducible promoter shows that transcription of either gene is sufficient for cyclin-deficient strains arrested in G1 to traverse START. A model of START regulation involves activation of CDC28 kinase by any CLN protein, leading to activation of CLN1 and CLN2 transcription in a positive feedback loop and passage through START. The cell cycle-dependent transcriptional regulators SWI4 and SWI6 may be components of the feedback loop. Cell cycle commitment entails resistance to the inhibitory action of mating factor, which correlates with peak levels of CLN1 and CLN2 mRNAs. FAR1 encodes an alpha-factor-dependent inhibitor of CLN function whose expression is markedly reduced at the time of START. The interplay of all these factors may sharpen the START transition such that it is close to an all-or-nothing switch event. This may be important for several START-dependent events to be activated at the same time, leading to coordinated cell cycle progression.

A programmable Fresnel transform pulse shaper

We demonstrate the first reprogrammable Fresnel transform pulse shaper based on a modified direct space-to-time pulse shaping apparatus. In our approach, the pulse shaping lens and mask are implemented by a dual-layer liquid crystal spatial light modulator. The input mask subsequently undergoes a free-space Fresnel transform which causes quadratic dispersion of the output temporal waveform. When used as a spectrometer, we demonstrate that the passband function of the apparatus (determined by the Fourier transform of the input spatial mask) may be chosen to exhibit a user-defined scale. Here we present the theory of operation, as well as experimental verification in both the time- and frequency-domains.

Engineering of the passband function of a generalized spectrometer

To our knowledge, we demonstrate a new scheme for passband engineering of a grating spectrometer. Through spatial masking of the input beam and translation of the optical components we present shaping, shifting, and scaling of the passband in optical frequency. Specifically, we demonstrate the relationship between the applied spatial masking function and the spectrometer passband may be tuned from an exact Fourier transform to a direct scaling through longitudinal displacement of the spectrometer lens and sampling slit and that this operation is independent of the choice of spectrometer center frequency.

Conformation of the substrate and pterin cofactor bound to human tryptophan hydroxylase. Important role of Phe313 in substrate specificity

Tryptophan hydroxylase (TPH) carries out the 5-hydroxylation of L-Trp, which is the rate-limiting step in the synthesis of serotonin. We have prepared and characterized a stable N-terminally truncated form of human TPH that includes the catalytic domain (Delta90TPH). We have also determined the conformation and distances to the catalytic non-heme iron of both L-Trp and the tetrahydrobiopterin cofactor analogue L-erythro-7,8-dihydrobiopterin (BH2) bound to Delta90TPH by using 1H NMR spectroscopy. The bound conformers of the substrate and the pterin were then docked into the modeled three-dimensional structure of TPH. The resulting ternary TPH-BH2-L-Trp structure is very similar to that previously determined by the same methods for the complex of phenylalanine hydroxylase (PAH) with BH2 and L-Phe [Teigen, K., et al. (1999) J. Mol. Biol. 294, 807-823]. In the model, L-Trp binds to the enzyme through interactions with Arg257, Ser336, His272, Phe318, and Phe313, and the ring of BH2 interacts mainly with Phe241 and Glu273. The distances between the hydroxylation sites at C5 in L-Trp and C4a in the pterin, i.e., 6.1 +/- 0.4 A, and from each of these sites to the iron, i.e., 4.1 +/- 0.3 and 4.4 +/- 0.3 A, respectively, are also in agreement with the formation of a transient iron-4a-peroxytetrahydropterin in the reaction, as proposed for the other hydroxylases. The different conformation of the dihydroxypropyl chain of BH2 in PAH and TPH seems to be related to the presence of nonconserved residues, i.e., Tyr235 and Pro238 in TPH, at the cofactor binding site. Moreover, Phe313, which seems to interact with the substrate through ring stacking, corresponds to a Trp residue in both tyrosine hydroxylase and PAH (Trp326) and appears to be an important residue for influencing the substrate specificity in this family of enzymes. We show that the W326F mutation in PAH increases the relative preference for L-Trp as the substrate, while the F313W mutation in TPH increases the preference for L-Phe, possibly by a conserved active site volume effect.

Inhibition of Escherichia coli viability by external guide sequences complementary to two essential genes

Narrow spectrum antimicrobial activity has been designed to reduce the expression of two essential genes, one coding for the protein subunit of RNase P (C5 protein) and one for gyrase (gyrase A). In both cases, external guide sequences (EGS) have been designed to complex with either mRNA. Using the EGS technology, the level of microbial viability is reduced to less than 10% of the wild-type strain. The EGSs are additive when used together and depend on the number of nucleotides paired when attacking gyrase A mRNA. In the case of gyrase A, three nucleotides unpaired out of a 15-mer EGS still favor complete inhibition by the EGS but five unpaired nucleotides do not.

Clathrin in gastric acid secretory (parietal) cells: biochemical characterization and subcellular localization

Clathrin from H-K-ATPase-rich membranes derived from the tubulovesicular compartment of rabbit and hog gastric acid secretory (parietal) cells was characterized biochemically, and the subcellular localization of membrane-associated clathrin in parietal cells was characterized by immunofluorescence, electron microscopy, and immunoelectron microscopy. Clathrin from H-K- ATPase-rich membranes was determined to be comprised of conventional clathrin heavy chain and a predominance of clathrin light chain A. Clathrin and adaptors could be induced to polymerize quantitatively in vitro, forming 120-nm-diameter basketlike structures. In digitonin-permeabilized resting parietal cells, the intracellular distribution of immunofluorescently labeled clathrin was suggestive of labeling of the tubulovesicular compartment. Clathrin was also unexpectedly localized to canalicular (apical) membranes, as were alpha-adaptin and dynamin, suggesting that this membrane domain of resting parietal cells is endocytotically active. At the ultrastructural level, clathrin was immunolocalized to canalicular and tubulovesicular membranes. H-K-ATPase was immunolocalized to the same membrane domains as clathrin but did not appear to be enriched at the specific subdomains that were enriched in clathrin. Finally, in immunofluorescently labeled primary cultures of parietal cells, in contrast to the H-K-ATPase, intracellular clathrin was found not to translocate to the apical membrane on secretagogue stimulation. Taken together, these biochemical and morphological data provide a framework for characterizing the role of clathrin in the regulation of membrane trafficking from tubulovesicles and at the canalicular membrane in parietal cells.

Clathrin in mitotic spindles

Subconfluent cultures of Madin-Darby canine kidney (MDCK) and CV-1 cells were immunostained with two monoclonal antibodies (MAbs), MAb X-22 and MAb 23, against clathrin heavy chain and with polyclonal antiserum against a conserved region of all mammalian clathrin light chains. In interphase MDCK and CV-1 cells, staining by all three antibodies resulted in the characteristic intracellular punctate vesicular and perinuclear staining pattern. In mitotic cells, all three anti-clathrin antibodies strongly stained the mitotic spindle. Staining of clathrin in the mitotic spindle was colocalized with anti-tubulin staining of microtubular arrays in the spindle. Staining of the mitotic spindle was evident in mitotic cells from prometaphase to telophase and in spindles in mitotic cells released from a thymidine-nocodazole block. In CV-1 cells, staining of clathrin in the mitotic spindle was not affected by brefeldin A. On Western blots, clathrin was detected, but not enriched, in isolated spindles. The immunodetection of clathrin in the mitotic spindle may suggest a novel role for clathrin in mitosis. Alternatively, the recruitment of clathrin to the spindle may suggest a novel regulatory mechanism for localization of clathrin in mitotic cells.

Recombinant bacillus Calmette-Guérin as a potential vector for preventive HIV type 1 vaccines

In August 1997, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) convened an expert working group to discuss current strategies for the development of HIV type 1 vaccines. Based on the recent findings of investigators from Japan's National Institute of Infectious Diseases (NIID) in Tokyo using recombinant bacillus Calmette-Guérin (rBCG) as a potential vectored vaccine for HIV, a recommendation was made that further work in this area is a priority. As a result, the working group reconvened in September 1998 to discuss the progress to date with this vaccine approach, as well as areas of related research to assess the feasibility of a BCG-vectored HIV vaccine. This report summarizes the discussions addressing the available scientific data on the potential use of rBCG as a vector for preventive HIV vaccines, the work necessary to move such candidate vaccines into Phase 1 clinical trials, and recommendations targeted at facilitating the long-term development of rBCG-vectored HIV vaccines.

Prevalence of antibodies to Sarcocystis neurona, Toxoplasma gondii and Neospora caninum in horses from Argentina

Sera from 76 horses from Argentina were examined for antibodies to Sarcocystis neurona, Toxoplasma gondii and Neospora caninum. Antibodies to S. neurona were found in 27 (35.5%) of 76 horses using immunoblots with culture derived merozoites as antigen. Antibodies to T. gondii were found in 10 (13.1%) of 76 horses by using the modified agglutination test with formalin-fixed tachyzoites and mercaptoethanol; titers were 1:25 (two horses), 1:50 (six horses), 1:100 (two horses), and 1:200 (one horse). Antibodies to N. caninum were not found in any of the 76 horses by the use of N. caninum agglutination test. This is the first report of S. neurona infection in horses in Argentina.

Identification of a STAT4 binding site in the interleukin-12 receptor required for signaling

The specificity of the various STAT SH2 domains for different tyrosine-containing peptides enables cytokines to activate different signaling pathways and to induce distinct patterns of gene expression. We show that STAT4 has a unique peptide specificity and binds to the peptide sequence pYLPSNID (where pY represents phosphotyrosine). This motif is found at tyrosine residue 800 in the beta2 subunit of the interleukin-12 receptor and is required for DNA binding and transcriptional activity of STAT4. Our data demonstrate that transfection of interleukin-12 receptor beta1 and beta2 subunits is sufficient for STAT4 activation but not for STAT1 or STAT3 activation.

The MHSIP mental health report card. A consumer-oriented approach to monitoring the quality of mental health plans. Mental Health Statistics Improvement Program

Health care report cards have been endorsed as a mechanism for efficiently comparing key quantifiable aspects of performance across a range of health systems or plans. There are challenges in determining what to measure; how to gather and analyze data; and how to report, interpret, and use findings. Mental health has received little attention, and a consumer perspective is typically not included. The proposed MHSIP mental health report card (MMHRC) addresses these concerns. General issues for report cards are discussed, and the MMHRC is described in terms of content, data sources and quality, and analysis and reporting.

Battered women's perceptions of loss and health

The article reports a study investigating whether a positive relationship exists between a battered women's perceptions of loss and her perceptions of health. The study further investigated whether a period of time away from the abusive situation would change the battered women's perceptions of loss and her perceptions of health. A convenience sample of 20 women who had experienced battering and abuse and had sought help at a protective shelter was studied. Questionnaires on perception of loss, health response, and demographics were used for the collection of data. The findings indicated that a significant relationship exists between a battered women's perceptions of loss and her perception of health. Perceptions of loss and health were shown to decline after a period of 5 days away from the abusive situation. Additional qualitative data obtained from in-depth interviews were also found to be consistent with the quantitative results and supported the literature documented in this study.

Implementing a local area network for nursing in a large teaching hospital

The authors describe the assessment, planning, implementation, and benefits of a local area network (LAN) for the nursing service of a 504-bed urban teaching hospital. The major goals of the network were to increase the efficiency and effectiveness of the nursing administrative areas and improve communication systems. A network of more than 90 workstations, spanning 12 buildings, was installed. The network provides access to multiple programs that support clinical, managerial, and research activities. Gateways provide access to the hospital's two mainframe computers. Network benefits identified by nursing management include: improved communication and access to information; increased accuracy, efficiency and timeliness of data; and improved computer literacy.

Occupational therapists in private practice

Although increasing numbers of occupational therapists are choosing to work in private practice, little data exist describing this sector of the profession. In the present study, experienced occupational therapists were asked about their moves into private practice, including (a) their motivation, (b) their preparation, and (c) their perceptions of the move's risks and benefits before and after the move. A survey was sent to a national random sample of 105 occupational therapists, 74 of whom responded. According to the survey, autonomy was the most important motivating factor for occupational therapists moving into private practice. However, once they were in private practice, the occupational therapists noted that increased income was a major benefit. These occupational therapists had planned for the risks of reimbursement, referral sources, and overhead but had not anticipated problems with staffing shortages. Incomes increased for occupational therapists who moved into private practice. The survey compared the incomes of occupational therapists before and after they entered private practice. It also compared their income and educational levels. Other comparisons included income and work experience, income and work role, and income and geographic location. Autonomy and financial considerations appear to be the overriding issues for occupational therapists choosing careers in private practice. Almost unanimously, the survey respondents said that private practice was a good career choice.

Disabling cerebral transient ischemic attacks

The surgical management of an emerging clinical entity, namely disabling transient cerebral ischemic attacks, is described. A series of 19 patients treated in a 2-year period (12 with anterior circulation dysfunction and seven with posterior insufficiency) met the following criteria: 1) stereotypical recurrent episodes of transient neurological dysfunction related to the anterior or posterior circulation distribution; 2) failure of maximum medical therapy to control the transient neurological dysfunction; 3) four-vessel cerebral angiography demonstrating an isolated vascular territory corresponding to patient symptoms; 4) inhalation xenon cerebral blood flow studies with at least three of eight probe-pairs showing significant asymmetries in the initial slope index, localizing an area of relative oligemia to the symptomatic hemisphere (anterior circulation only); and 5) severe restriction of lifestyle due to transient ischemic attacks (TIA's). Seventeen patients underwent surgical bypass therapy: deep sylvian superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in nine; surface STA-MCA bypass in three; STA-superior cerebellar artery bypass in three; STA-posterior cerebral artery bypass in one; and aorta-carotid artery bypass in one. There was one perioperative death and four perioperative strokes (two ipsilateral and two contralateral to the operated side). The average follow-up period was 14 months. Of the 16 surviving surgically treated patients, 13 (81%) have had an excellent to good outcome with complete resolution of TIA's and minimal neurological deficits. Three patients had a poor outcome with either a significant persistent neurological deficit or continued TIA's. The two patients not treated surgically continue to have vertebrobasilar insufficiency episodes while receiving oral anticoagulation medication. The overall mortality rate (5.5%) and stroke morbidity rate (22.2%) of surgical therapy for disabling TIA's are high in this neurologically unstable group of patients, but are associated with an 81% excellent to good response. Although the natural history of disabling TIA's is not known, these patients present with significant to total disability due to their symptoms. It is concluded that disabling TIA's respond to surgical revascularization and may represent an indication for cerebral revascularization surgery.

Implementation of a local area network for nursing management

This paper describes the planning and implementation of a Local Area Network (LAN) for the nursing service of a 504-bed urban teaching hospital. The major goals of the network were: support for nurse executives, nurse managers, and the departmental assistants assigned to administrative offices; increased efficiency and effectiveness of the nursing administrative areas; and improved communication systems. Collaboration between the nursing service and the Computer Information Center (CIC) resulted in a network of over 70 workstations, spanning 11 buildings. The network provides access to multiple programs that support clinical, managerial, and research activities. Gateways provide access to the hospital's two mainframes.

Histone H1 subtype-specific consensus elements mediate cell cycle-regulated transcription in vitro

In this study we used nuclear extracts from centrifugally elutriated cell populations to study histone H1 transcriptional regulation during the cell cycle. Analysis of mutations within the H1 promoter establish that both of the H1 subtype-specific consensus elements participate in induction of transcription upon entry into S phase. The DNA binding activity of H1TF2, which specifically interacts with the H1 proximal subtype-specific element, is increased in S-phase nuclear extracts, whereas no increase in DNA binding is observed for the H1 distal subtype-specific DNA transcription factor H1TF1 or the H2b subtype-specific factor OTF1. These data strongly support the idea that histone gene subtype-specific transcription factors are important for S-phase-dependent expression of histone genes. Further studies of these factors will be important for increased understanding of the transition from G1 to S phase of the mammalian cell cycle.

An evaluation of labeling-then-doing with moderately handicapped persons: acquisition and generalization with complex tasks

We conducted two experiments in which moderately mentally retarded persons were trained first to label and then to enter characters into a computer, calculator, or checkbook (label-then-do) within a multiple baseline design. In Experiment 1, 5 young adults were trained to enter statistical programs into computers in an office setting. Following training, all subjects' use of verbal labels and key-entry skills generalized across tasks (programs) and settings (offices and computer terminals). In Experiment 2, 3 junior high school students were trained with self-labeling procedures to complete a key-entry task and to balance a checkbook. The performance of all students generalized across tasks and settings, and the use of labels generalized for 2 of the students. Results are discussed relative to mediated generalization and to establishing verbal control over behavior.