Coupled social and ecological change drove the historical extinction of the California grizzly bear (Ursus arctos californicus)

Large carnivores (order Carnivora) are among the world's most threatened mammals due to a confluence of ecological and social forces that have unfolded over centuries. Combining specimens from natural history collections with documents from archival records, we reconstructed the factors surrounding the extinction of the California grizzly bear (Ursus arctos californicus), a once-abundant brown bear subspecies last seen in 1924. Historical documents portrayed California grizzlies as massive hypercarnivores that endangered public safety. Yet, morphological measurements on skulls and teeth generate smaller body size estimates in alignment with extant North American grizzly populations (approx. 200 kg). Stable isotope analysis (δ13C, δ15N) of pelts and bones (n = 57) revealed that grizzlies derived less than 10% of their nutrition from terrestrial animal sources and were therefore largely herbivorous for millennia prior to the first European arrival in this region in 1542. Later colonial land uses, beginning in 1769 with the Mission era, led grizzlies to moderately increase animal protein consumption (up to 26% of diet), but grizzlies still consumed far less livestock than otherwise claimed by contemporary accounts. We show how human activities can provoke short-term behavioural shifts, such as heightened levels of carnivory, that in turn can lead to exaggerated predation narratives and incentivize persecution, triggering rapid loss of an otherwise widespread and ecologically flexible animal.

Gastroesophageal junction adenocarcinoma 1-year after sleeve gastrectomy

Gastroesophageal malignancy after sleeve gastrectomy is rare. A 70-year-old male with a BMI of 46 underwent laparoscopic sleeve gastrectomy with normal endoscopy. By 10 months postop, the patient had reduced BMI to 30.5. Eleven months postop, he presented with emesis and endoscopy showed severe stenosis at the gastroesophageal junction with EUS showing a circumferential mass. Patient had adenocarcinoma of the distal esophagus HER 3+ and MMR proficient, clinical T2N1. He underwent esophageal stent placement followed by FOLFOX switched to carboplatin-Taxol with radiation therapy complicated by a localized perforation requiring antibiotics. After PET scan of esophageal mass indicated response, he underwent an open distal esophagectomy, total gastrectomy with Roux-en-Y esophagojejunostomy, and placement of feeding tube. Pathology revealed poorly differentiated invasive adenocarcinoma with negative margins. In the USA, this represents only the second adenocarcinoma following a sleeve gastrectomy and the first in a non-immune compromised patient.

Regional Networks of Biological Field Stations to Study Climate Change

Field stations are platforms for documenting patterns and processes in ecosystems and are critical for understanding how anthropogenic climate change reshapes nature. Although networks of field stations have been used to identify patterns at continental to global scales, these broad, sparsely distributed networks miss variation in climate change at local and regional scales. We propose that regional-scale research networks are essential for addressing the myriad of ecological and evolutionary challenges—including management and mitigation options—that cannot be answered by more broadly distributed networks or by individual field sites. We discuss our experiences leveraging natural areas throughout California at the Institute for the Study of Ecological and Evolutionary Climate Impacts. We then explore benefits and challenges of networking research at spatial scales congruent with regional patterns of climate variation and climate change, the challenges of sustained infrastructure and research support, and opportunities for future regional-scale research networks.

Analogies for a No-Analog World: Tackling Uncertainties in Reintroduction Planning

Species reintroductions involve considerable uncertainty, especially in highly altered landscapes. Historical, geographic, and taxonomic analogies can help reduce this uncertainty by enabling conservationists to better assess habitat suitability in proposed reintroduction sites. We illustrate this approach using the example of the California grizzly, an iconic species proposed for reintroduction.

Bilateral variations of brachial plexus involving the median nerve and lateral cord: An anatomical case study with clinical implications

During the routine dissection of upper limbs of a Caucasian male cadaver, variations were observed in the brachial plexus. In the right extremity, the lateral cord was piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited the passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal insertion into the medial surface of the body of humerus. A variation in the course and branching of the nerve might lead to variant or dual innervation of a muscle and, if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both clinical diagnosis and surgical practice.

Exploration of CYP450 and drug transporter genotypes and correlations with nevirapine exposure in Malawians

AIM

Genetic polymorphisms have the potential to influence drug metabolism and vary among ethnic groups. This study evaluated the correlation of genetic polymorphisms with nevirapine pharmacokinetics exposure in Malawians.

MATERIALS & METHODS

CYP450 2B6, 2D6, 3A4 and 3A5, ABCB1 and constitutive androstane receptor and pregnane X receptor, were analyzed for polymorphisms in 26 subjects.

RESULTS

Allele frequencies (variant) were: CYP2B6 514G>T (0.31) CYP2D6*4 (0.02); CYP2D6*17 (0.35); CYP3A4*1B (0.77); CYP3A5*3 (0.25); ABCB1 2677G>T (0.0), ABCB1 3435C>T (0.21), NR1I3 13711152T>C (0.02), NR1I2 44477T>C (0.10), NR1I2 63396C>T (0.33), NR1I2 6-bp indel (del: 0.17). CYP2B6 516G>T (non-wild-type/wild-type) correlated with nevirapine pharmacokinetic parameters; geometric mean ratios (95% CI): 1.75 (1.27-2.40) for area under the concentration time curve (AUC)(0-12 h), 1.58 (1.03-2.42) for C(0), and 0.53 (0.31-0.91) for clearance. In a multivariable model, nevirapine AUC increased by 1.5% per year of age (p < 0.0001), CYP2B6 516 T allele increased AUC by 92% (p < 0.0001), and CYP3A5*3 decreased AUC by 31% (p = 0.0027).

CONCLUSION

Allele frequencies were similar to other sub-Saharan African populations. The T allele for CYP2B6 516 was significantly associated with nevirapine exposure.

Single and multiple dose pharmacokinetics of maraviroc in saliva, semen, and rectal tissue of healthy HIV-negative men

BACKGROUND

Antiretroviral pharmacology in seminal plasma (SP) and rectal tissue (RT) may provide insight into antiretroviral resistance and the prevention of sexual transmission of human immunodeficiency virus (HIV). Saliva may be of utility for noninvasively measuring adherence.

METHODS

A pharmacokinetic study was performed in 12 HIV-negative men receiving maraviroc 300 mg twice daily for 8 days. Seven time-matched pairs of blood plasma (BP) and saliva samples were collected over 12 h on day 1 (PK1) and days 7 and 8 (PK2). One RT sample from each subject was collected during PK1 and PK2. Two SP samples were collected from each subject during PK1, and 6 SP samples were collected from each subject during PK2.

RESULTS

SP AUCs were ∼50% lower than BP. However, protein binding in SP ranged from 4% to 25%, resulting in protein-free concentrations >2-fold higher than BP. RT AUCs were 7.5- to 26-fold higher than BP. Maraviroc saliva AUCs were ∼70% lower than BP, but saliva concentrations correlated with BP (r(2) = 0.58).

CONCLUSIONS

More pharmacologically available maraviroc was found in SP than BP. High RT concentrations are promising for preventing rectal HIV acquisition. Saliva correlation with BP suggests that this may be useful for monitoring adherence.

CLINICAL TRIALS REGISTRATION

NCT00775294.

Mechanism of the rhodium porphyrin-catalyzed cyclopropanation of alkenes

The rhodium porphyrin-catalyzed cyclopropanation of alkenes by ethyl diazoacetate (EDA) is representative of a number of metal-mediated cyclopropanation reactions used widely in organic synthesis. The active intermediate in these reactions is thought to be a metal carbene complex, but evidence for the involvement of metal-olefin pi complexes has also been presented. Low-temperature infrared and nuclear magnetic resonance spectroscopies have been used to characterize a rhodium porphyrin-diazoalkyl adduct that results from the stoichiometric condensation of the catalyst and EDA. Optical spectroscopy suggests that this complex is the dominant steady-state species in the catalytic reaction. This compound decomposes thermally to provide cyclopropanes in the presence of styrene, suggesting that the carbene is indeed the active intermediate. Metal-alkene pi complexes have also been detected spectroscopically. Kinetic studies suggest that they mediate the rate of carbene formation from the diazoalkyl complex but are not attacked directly by EDA.

Variability in drug metabolizing enzyme activity in HIV-infected patients

AIMS

To evaluate variability in cytochrome P450 (CYP) 1A2, CYP2D6, CYP3A, N-acetyltransferase 2 (NAT2), and xanthine oxidase (XO) activity in HIV-infected patients and compare this with data from uninfected, healthy volunteers.

METHODS

Ten HIV-infected men and seven women on medication affecting CYP enzyme activity were phenotyped four times over 2 months using caffeine, dextromethorphan, and midazolam. Urinary caffeine and dextromethorphan metabolite ratios were used to phenotype CYP1A2, NAT2, XO, and CYP2D6 activity and midazolam plasma clearance was used to phenotype CYP3A activity. Plasma and urine samples were analyzed by validated LC/UV or LC/MS methods for midazolam, caffeine, and dextromethorphan. Noncompartmental pharmacokinetics and nonparametric statistical analyses were performed, and the data compared with those of healthy volunteer historic controls.

RESULTS

Compared with age and sex-matched healthy volunteers, HIV-infected subjects had 18% lower hepatic CYP3A4 activity, 90% lower CYP2D6 activity, 53% lower NAT2 activity, and 22% higher XO activity. No significant difference was found in CYP1A2 activity. Additionally, 25% genotype-phenotype discordance in CYP2D6 activity was noted in HIV-infected subjects. Intraindividual variability in enzyme activity increased by 42-62% in HIV-infected patients for CYP1A2, NAT2, and XO, and decreased by 33% for CYP2D6. Interindividual variability in enzyme activity increased by 27-63% in HIV-infected subjects for CYP2D6, CYP1A2, and XO, and decreased by 38% for NAT2. Higher plasma TNFalpha concentrations correlated with lower CYP2D6 and CYP3A4 activity.

CONCLUSIONS

Infection with HIV or stage of HIV infection may alter Phase I and II drug metabolizing enzyme activity. HIV infection was related to an increase in variability of these drug-metabolizing enzymes. Altered metabolism may be a consequence of immune activation and cytokine exposure.

Dynamic NMR spectroscopy of three 2,2'-dialkyl/aryl-1-picrylhydrazines in liquid solution

We have studied and compared the proton nuclear magnetic resonance spectra of a series of three 2,2'-di(alkyl/aryl)-1-(2,4,6-trinitrophenyl)hydrazines at 500 MHz in liquid toluene-d(8), with a view to learning details of the internal conformation changes taking place, as a function of temperature. Herein "alkyl" denotes 'methyl', and "aryl" denotes 'phenyl'. The synthesis and characterization of 2-phenyl,2'-methyl-1-picrylhydrazine is reported. One goal of the present study was to afford a comparison with the oxidation products, i.e., the three corresponding hydrazyl free radicals - which show striking differences. All the hydrazine molecules in liquid solution occur as interconverting enantiomorphic pairs (atropisomers). Advanced techniques for obtaining the relevant activation energies and pseudo-thermodynamic parameters (Arrhenius and Eyring) have been utilized, and these parameters are listed and discussed. The three hydrazines turn out be very similar with respect to their internal dynamics.

Drug interactions with new and investigational antiretrovirals

More than 20 individual and fixed-dose combinations of antiretrovirals are approved for the treatment of human immunodeficiency virus (HIV) infection. However, owing to the ongoing limitations of drug resistance and adverse effects, new treatment options are still required. A number of promising new agents in existing or new drug classes are in development or have recently been approved by the US FDA. Since these agents will be used in combination with other new and existing antiretrovirals, understanding the potential for drug interactions between these compounds is critical to their appropriate use. This article summarizes the drug interaction potential of new and investigational protease inhibitors (darunavir), non-nucleoside reverse transcriptase inhibitors (etravirine and rilpivirine), chemokine receptor antagonists (maraviroc, vicriviroc and INCB 9471), integrase inhibitors (raltegravir and elvitegravir) and maturation inhibitors (bevirimat).

Dynamic NMR spectroscopy of 2,2′-dimethyl-1-picrylhydrazine in various solvents

We have studied the 1H NMR spectra of 2,2′-dimethyl-1-(2,4,6-trinitrophenyl)hydrazine at 300 and 500 MHz in seven liquid solvents, with a view to learning details of the internal conformational changes taking place as a function of temperature and of the solvent. These molecules in liquid solution occur as interconverting enantiomorphic pairs (atropisomers). Advanced techniques for obtaining the correct activation energies and pseudo-thermodynamic parameters have been utilized, and these parameters are listed and discussed. Our results point to a transformation between the pair of atropisomers that is not quite as complicated as one might have encountered in that the solvent does not affect ΔG‡ in any major fashion. Molecular orbital calculations clarified some of the chemical shifts observed for both 1H and 13C. One goal of this study was to enable a detailed comparison with similar results available for 2,2′-diphenyl-1-(2,4,6-trinitrophenyl)hydrazine.Key words: dynamic NMR, dimethylpicrylhydrazine, hindered rotation, atropisomers, activation parameters.

Effect of state workplace safety laws on occupational injury rates

The purpose of this study was to evaluate the effect of four common types of mandatory state-level workplace safety regulations on injury severity rates during the period 1992 to 1997 for the manufacturing sector. The full Poisson regression model showed safety committee regulations to have a highly significant reducing effect on injury rates, chi 2 (1, n = 3286) = 10.1774, P = 0.0014. Safety program regulations were significant at the alpha = 0.10 level, chi 2 (1, n = 3286) = 3.5676, P = 0.0589. The effect of insurance carrier loss control regulations in the full model was nonsignificant. However, insurance carrier loss control regulations were highly significant (alpha = 0.01) in the final reduced model. Targeting initiatives were nonsignificant in both the full and reduced models (alpha = 0.05). The study results are important to state and federal agencies considering adopting workplace safety regulations that are similar to the four types evaluated in this study.

Novel inter-protein cross-link identified in the GGH-ecotin D137Y dimer

In the presence of a suitable oxidizing agent, the Ni(II) complex of glycyl-glycyl-histidine (GGH) mediates efficient and specific oxidative protein cross-linking. The fusion of GGH to the N terminus of a protein allows for the cross-linking reagent to be delivered in a site-specific fashion, making this system extremely useful for analyzing protein-protein contacts in complicated mixtures of biomolecules. Tyrosine residues have been postulated to be the primary amino acid target of this reaction, and using the dimeric serine protease inhibitor ecotin, we previously demonstrated that engineering a tyrosine at the protein interface of a dimer dramatically increased cross-linking efficiency. Cross-linking increased four-fold for GGH-ecotin D137Y in comparison to wild-type GGH-ecotin, presumably through bityrosine formation at the dimer interface. Here we report the first complete structural analysis of the cross-linked GGH-ecotin D137Y dimer. Using a combination of mass spectrometric and chemical derivatization methods, a sole novel cross-link between the N-terminal glycine residues and the engineered tyrosine at position 137 has been characterized. The dimer cross-link is localized to a single site without other protein modifications, but different reaction pathways produce structurally related products. We propose a mechanism that involves covalent bond formation between the protein backbone and a dopaquinone moiety derived from a specific tyrosine residue. This finding establishes that it is not necessary to have two tyrosine residues within close proximity in the protein interface to obtain high protein cross-linking yields, and suggests that the cross-linking reagent may be of more general utility than previously thought.

New approaches for cell-specific targeting: identification of cell-selective peptides from combinatorial libraries

Peptides that recognize specific cell types promise to be valuable tools both in research and clinical applications. Cell-specific peptides can be useful as drug delivery vehicles, diagnostic agents, affinity reagents for cell purification, gene therapy delivery agents, and research tools to probe the nature of a cell's surface. Recently, cell-specific targeting-peptides have been identified by phage-display selections against purified cell-surface markers, whole cells in tissue culture, and even tissues within live animals. These methods for identifying cell-targeting peptides will certainly increase the tools available to the scientist for cell-specific targeting.

Achievable benchmarks of care: the ABCs of benchmarking

Benchmarking is generally considered to be an important tool for quality improvement. Traditional approaches to benchmarking have relied on subjective identification of 'leaders in the field'. We derive an objective, reproducible and attainable Achievable Benchmark of Care (ABC) by measuring and analysing performance on process-of-care indicators. Three characteristics of the ABC that we deem essential are: (1) benchmarks represent a measurable level of excellence; (2) benchmarks are demonstrably attainable; (3) benchmarks are derived from data in an objective, reproducible and predetermined fashion. From these characteristics it follows that (4) providers with high performance are selected to define a level of excellence in a predetermined fashion, but (5) providers with high performance on small numbers of cases do not influence unduly benchmark levels. We use the 'pared mean' to operationalize the ABC. Roughly, the pared mean summarizes the performance of top-ranked providers whereby at least 10% of the patient pool across all providers is included. Bayesian estimators for adjustment of performance of providers with small sample sizes are used to rank providers. Randomized controlled trials to assess the independent effect of the ABC in quality improvement projects are under way. We have developed a methodology objectively and reproducibly to derive a level of excellent, attainable performance, based on measured performance by a group of providers. The ABC can be applied to groups of providers in communities, to institutions and departments within them, or to individual practitioners.

The structure and some molecular properties of acetone-picrylhydrazone

Various physical measurements and quantum-mechanical computations to characterize molecular 2-propanone(2,4,6-trinitrophenyl)hydrazone, alias acetone-picrylhydrazine (AH), are reported, including an X-ray diffraction structural determination, an1H and13C NMR study of its internal hindered reorientation, and a theoretical (SCF-MO) interpretation of these observations. The structure of AH was determined by X-ray crystallography. The space group is Pbar over 1, with a = 10.1768(9) Å, b = 7.7968(18) Å, c = 8.0018(5) Å, α = 92.102(6)°, β = 99.919(7)°, γ = 105.926(6)°, Z = 2, wR2(F2) = 0.1995 based on all 2748 unique reflections. The (picryl) proton NMR thermal work yielded a Gibbs activation energy ΔG‡= 46.9 ± 0.4 kJ mol-1in acetone-d6and 48.1 ± 0.2 kJ mol-1in chloroform-d, whereas13C NMR (two pairs in the picryl ring) yielded 46.6 ± 1.0 and 46.4 ± 1.0 kJ mol-1in acetone-d6. The SCF-MO computations yielded a detailed model of the conformerization path. Various model conformations and tautomers of AH have been considered, as has removal of H+or of H0from its hydrazinic linkage.Key words: dynamic NMR, picrylhydrazone, hindered rotation, activation parameters, SCF-MO model.

Measurement of mammography rates for quality improvement

To determine the best source of high-quality data related to mammography rates, a study was undertaken to compare chart audit and claims data from the Health Care Financing Administration's Ambulatory Quality Improvement Project. Because claims data captured a higher percentage of mammograms than chart audit data in this study, quality improvement projects should consider utilizing claims data only to ascertain mammography rates.

Health risk influence on medical care costs and utilization among 2,898 municipal employees

INTRODUCTION

Although worksite health promotion programs are credited with stabilizing medical benefits costs, research is needed to characterize the medical costs of cohorts with selected health risk factors. The purpose of this study was to compare medical cost outcomes in City of Birmingham, Alabama, employees who differ on selected health risk factors.

METHODS

Health risk appraisal and medical claims cost data were examined in 2,898 employees participating in health screening during 1992 and 1993. Probit analysis was employed to test the null hypotheses that there are no differences in (1) probability of medical service utilization and (2) probability of medical service cost quartile (high, moderate, and low) between groups characterized by risks. Age, gender, race, education, marital status, and diabetes were included as covariates in each model examined. In addition, smoking habits was included as a covariate in models involving risk taking behavior and psychosocial risk.

RESULTS

Significant differences in medical care utilization and costs were found between risk groups based on psychosocial risk, cardiovascular disease risk, and total risk. No association was found between risk-taking behavior and utilization and costs.

CONCLUSION

Subjects reporting psychosocial, cardiovascular disease, and total risk factors were more likely to use medical services and to be in the high or high/moderate cost categories.

Protein cross-linking mediated by metalloporphyrins

A biomimetic protein cross-linking reaction is described which employs oxidatively-activated manganese and iron porphyrins as the reactive species. A wide range of proteins cross-link under these conditions, but only if they are intimately associated in solution. The reaction is rapid, efficient, and will be useful for the suprastructural analysis of multiprotein complexes.

Spontaneous resolution of a plasma cell granuloma in a 9-year-old

A previously healthy 9-year-old white boy presented with a 13-lb weight loss over a period of 4 weeks and a 4.5-cm mass in the right lung. Histology was compatible with a plasma cell granuloma, which is the most common benign childhood lung tumor. Surgical management with segmental or wedge resection is the usual standard of care in this situation. However, it has been suggested that with a confirmed histologic diagnosis surgical resection is not warranted. This patient was managed conservatively. Repeat computed tomography scan 6 weeks later revealed significant resolution of the lesion, and at 7 months the lesion had totally resolved. Spontaneous resolution of this lesion has been rarely described in pediatric populations.

Determining protein-protein interactions by oxidative cross-linking of a glycine-glycine-histidine fusion protein

The Ni(II) complex of the tripeptide NH2-glycine-glycine-histidine-COOH (GGH) mediates efficient protein-protein cross-linking in the presence of oxidants such as oxone and monoperoxyphthalic acid (MMPP). Here we demonstrate that GGH fused to the amino terminus of a protein can still support cross-linking. The tripeptide was expressed at the amino terminus of ecotin, a dimeric macromolecular serine protease inhibitor found in the periplasm of Escherichia coli. In the presence of Ni(OAc)2 and MMPP, GGH-ecotin is cross-linked to give a species that has an apparent molecular mass of a GGH-ecotin dimer with no observable protein degradation. The cross-linking reaction occurs between two ecotin proteins in a dimer complex. Furthermore, GGH-ecotin can be cross-linked to a serine protease target, trypsin, and the reaction is specific for proteins that interact with ecotin. The cross-linking reaction has been carried out on small peptides, and the reaction products have been analyzed by matrix-assisted laser desorption/ionization mass spectrometry. The target of the reaction is tyrosine, and the product is bityrosyl cross-links. The yield of the cross-linking is on the order of 15%. However, the reaction efficiency can be increased 4-fold by a single amino acid substitution in the carboxy terminus of ecotin that places an engineered tyrosine within 5 A of a naturally occurring tyrosine. This cross-linking methodology allows for the protein cross-linking reagent to be encoded for at the DNA level, thus circumventing the need for posttranslational modification.

Nonrandomized evaluation of pelvic lymph node irradiation in localized carcinoma of the prostate

PURPOSE

A great deal of controversy exists regarding the potential benefit of pelvic lymph node irradiation compared with treatment to the prostate only in patients with localized prostate cancer. Despite numerous reports, including a randomized study, this issue has not been completely elucidated.

METHODS AND MATERIALS

A total of 963 patients with histologically proven localized adenocarcinoma of the prostate treated with definitive radiation therapy alone were analyzed. Median follow-up was 6.5 years (minimum: 2 years, maximum: 22 years). Pelvic lymph nodes received 40 to 55 Gy with anteroposterior/posteroanterior and sometimes lateral stationary portals in 1.8 Gy daily fractions; an additional dose was delivered to the prostate with 120 degrees bilateral are rotation to complete doses of 65 to 68 Gy for Stage A2 and B tumors and 68 to 71 Gy for Stage C tumors. The same total doses were delivered with smaller fields when the prostate only was treated.

RESULTS

In Stage A2 (T1b,c) the 10-year clinical pelvic failure rate was 16% regardless of the volume irradiated or tumor differentiation. With Stage B (T2) well- or moderately differentiated tumors, the 10-year pelvic failure rates were 22% when pelvic lymph nodes were irradiated and 32% when prostate only was irradiated (p = 0.41). With Stage A2 (T1b,c) and B (T2) poorly differentiated tumors, the 10-year pelvic failure rates were 32% and 7%, respectively (p = 0.72). With clinical stage C (T3) well-differentiated tumors treated with 50 to 55 Gy to pelvic lymph nodes, the pelvic failure rate was 22% compared with 37% in those receiving 40 to 45 Gy (p < or = 0.07). A significant reduction in pelvic failures was noted with Stage C poorly differentiated tumors when the pelvic lymph nodes received doses higher than 50 Gy (23%) compared with lower doses (46%) (p < or = 0.01). Volume or doses of irradiation did not influence incidence of distant metastases in any stage or tumor differentiation group. Disease-free survival did not correlate with volume treated in any clinical stage or tumor differentiation group. In 317 patients on whom pretreatment prostate-specific antigen levels were available, there is a suggestion that those treated to the pelvic lymph nodes had a higher chemical disease-free survival than those receiving prostate irradiation only. Follow-up is short, and differences are not statistically significant in any of the groups. Morbidity of therapy was slightly higher in patients treated to the pelvic lymph nodes, but in Stages A2 (T1b,c) and B (T2) differences are not statistically significant (4 to 6%). Stage C patients treated to the pelvic lymph nodes with 50 Gy had a 12% incidence of Grade 2 rectosigmoid morbidity compared with 6% in those treated with 40 Gy (p = 0.26).

CONCLUSIONS

In this retrospective analysis, pelvic lymph node irradiation did not influence local/pelvic tumor control, incidence of distant metastases, or disease-free survival in patients with clinical Stage A2 (T1b,c) or B (T2) localized carcinoma of the prostate. In patients with Stage C (T3) disease, irradiation of the pelvic lymph nodes with doses of 50 to 55 Gy resulted in a lower incidence of pelvic recurrences and improved disease-free survival. Morbidity of therapy was acceptable, although patients with Stage C disease had a somewhat higher incidence of Grade 2 rectosigmoid morbidity. Pelvic lymph node irradiation is being elucidated in properly designed prospective, randomized protocols.

Personal health-risk predictors of occupational injury among 3415 municipal employees

Little information exists about the effectiveness of health-promotion programs in reducing occupational injury rates. A historical cohort study was conducted to examine the relationship between personal health-risk factors and risk of occupational injury. Workers were grouped on the basis of nonoccupational risk-taking behaviors, psychosocial risks, cardiovascular risk factors, and a total risk-factor variable. All analyses were controlled for sex, smoking status, age, and job classification. An increased risk of occupational injury (P < .0001) was found to be significantly associated with nonoccupational risk-taking behavior. This association may be the result of continued risk-taking behavior in the occupational environment, or assignment of risk-taking individuals to more hazardous job tasks. Psychosocial, cardiovascular, and total risk-factor variables were not associated with an increased risk of occupational injury.

Highly specific oxidative cross-linking of proteins mediated by a nickel-peptide complex

The Ni(II) complex of the tripeptide NH2-Gly-Gly-His-COOH is shown to mediate efficient protein-protein cross-linking in the presence of oxidants such as oxone and monoperoxyphthalic acid. Only proteins that associate specifically in solution are cross-linked under these conditions. Preliminary probes of the mechanism of the reaction suggest that the active intermediate may be a high-valent metal complex that attacks aromatic amino acids.

The impact of a comprehensive medical benefit cost management program for the city of Birmingham: results at five years

Double digit annual increases in the cost of medical benefits represent one of the major financial challenges for many private and public sector employers. Gaining greater control is a top priority. Since the procurement, administration, and delivery of employee/dependent medical care is a highly complex venture, it is unlikely that any one activity will contain costs effectively. This report examines a comprehensive cost management effort for the municipal government of the city of Birmingham, Alabama, which included health promotion, medical plan redesigning, managed care, and "how to use the medical system" education programs. The $3 million project was funded by the National Institutes of Health and the employer and conducted from 1985 to 1990. In 1985, medical benefits expenses for the 3,586 employees were $2,047 per employee which was about $400 above the state of Alabama per employee average. In 1990, for 4,000 employees, it was $2,075 which was $922 below the state average. While the project design does not permit a precise evaluation of the exact impact of each of the cost containment activities, attempts are made to estimate their impact. Several health promotion activities, which may be unique to this project, including the all-employee medical screen, are presented and evaluated.

Cost-effectiveness of a back school intervention for municipal employees

This study investigated the effect of a back school rehabilitation program on lost work time, lost time cost, medical cost, and number of injuries in municipal employees. Seventy back-injured workers who participated in a 6-week back school were compared on the dependent variables with 70 randomly selected back-injured city employees who had not participated in a back school. Back school participants demonstrated a significant decrease on all dependent variables. Back school participants had significantly fewer injuries in the 6-month postintervention period. No statistically significant differences were found between groups on the time and cost variables. Actual dollars saved in lost time and medical costs between groups was of practical value to the city. Study findings offer support for the back school as a cost-effective measure.

Industrial workers on a rotating shift pattern: adaptation and injury status

Over 11 million Americans work some type of shift pattern. Numerous health and safety issues result when workers follow a rotating shift schedule. Over 5 million work-related injuries occur annually in the United States at a cost of almost $48 billion. Disrupted circadian rhythms and fatigue from rotating shifts have been implicated as a cause of traumatic injuries. This study revealed that factors related to circadian type, effects of the work environment, and coping styles explained over 51% of the variance in adaptation scores for this group of rotating shiftworkers. Adaptation levels were not significantly different for the injured and non-injured groups of shiftworkers. Findings of this research suggest that education on the effects of circadian rhythm disruption and more effective ways of coping may be justified. Also, additional research related to adaptation and injuries is needed.

A community health nursing curriculum and Healthy People 2000

The School of Nursing at the University of Alabama at Birmingham recently revised its graduate level community health nursing curriculum based on the priority areas and health objectives in Healthy People 2000. Health priority areas are presented as class topics and provide direction for the students' fieldwork. This paper provides background on the national strategy used to develop the national health objectives, suggestions on how nursing can be at the forefront of influencing the health of the nation, and specifics involved in implementing a community health nursing curriculum using the year 2000 health objectives.

Health locus of control and helpfulness of prayer

The purpose of this study was to examine the relationship between health locus of control and helpfulness of prayer as a direct-action coping mechanism in patients before having cardiac surgery. The Multidimensional Health Locus of Control Scales and the investigator-developed Helpfulness of Prayer Scale were issued to 100 subjects 1 day before cardiac surgery. Ninety-six subjects indicated that prayer was used as a coping mechanism in dealing with the stress of cardiac surgery, and 70 of these subjects gave it the highest possible rating on the Helpfulness of Prayer Scale. No relationship was found between health locus of control and helpfulness of prayer. Individuals of each locus orientation perceived prayer to be helpful. Findings suggest that prayer is perceived as a helpful, direct-action coping mechanism and warrants support by health personnel. It is recommended that further research explore the effect of prayer on patients' ability to cope with stressful situations.

Cardiovascular disease risk factor reduction and the occupational health nurse

The occupational health nurse should be attuned to issues and research regarding prevention of CVD. Risk reduction programs in industry should adhere to the recommendations of groups such as the Adult Treatment Panel of the National Cholesterol Education Program, the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, and the American Health Association. Despite significant reductions in CVD mortality, continued research is needed to further our knowledge of CVD risk factors among high risk populations.

A flexibility intervention to reduce the incidence and severity of joint injuries among municipal firefighters

The present study of 469 municipal firefighters examined the effect of flexibility training on the incidence and severity of joint injuries. Both flexibility measures and costs (lost time and medical care costs) were investigated in this study. Significant differences were found in flexibility scores of the experimental and control subjects with overall flexibility increased in the experimental group. Although incidence of injury was not significantly different for the experimental and control groups, injuries sustained by the experimental group resulted in significantly less lost time costs. Findings indicate that the flexibility training program had a beneficial effect on reducing the severity and costs of joint injuries in this firefighter population.

National survey of infection control practitioners' educational needs

The purpose of this study was to conduct a nationwide survey to determine the number of master's-prepared infection control practitioners (ICPs) and those eligible for admission to graduate programs. Continuing education needs also were assessed to determine whether they might best be met through formal education or in a continuing education format. ICPs at 3765 health care facilities listed by the American Hospital Association as having more than 100 beds were invited to participate, and 2197 usable responses were received. Respondents' perceived educational needs were categorized into the eight sections outlined by the Educational Committee of the Association for Practitioners in Infection Control (APIC). Whenever possible, demographic characteristics of subjects were compared with the findings of the 1976-1977 Study on the Efficacy of Nosocomial Infection Control; apparent shifts have occurred in age, basic educational preparation, and numbers of practitioners with advanced degrees. The major perceived educational needs of the respondents were in the areas of Management and Communication, followed by Infectious Diseases and Epidemiology and Statistics. Nationwide generalization of the results may be hampered by the skewed regional distribution of responses. ICPs, however, expressed a multiplicity of perceived educational needs in each of APIC's eight sections, which may indicate that many ICPs believe that their performance and effectiveness are hampered by knowledge deficits.

Otitis media. Incidence, duration, and hearing status

The middle ear status and hearing sensitivity in 483 normal infants have been closely monitored as part of the Dallas Cooperative Project, University of Texas at Dallas, effort to assess the effect of early otitis media with effusion on speech and language development. At least one episode of otitis media with effusion occurred in 73.5% of the children between the ages of 6 and 18 months. Almost a quarter of these were discovered at "well-baby" checkups and were appropriately classified as "silent." The hearing levels, the methods of hearing assessment, and the implications of these data are described.

The effect of progressive muscle relaxation on stress among clerical workers

Stressors such as the lack of challenge and opportunities for advancement, and the inability to influence the organization help explain why clerical work is considered a demanding and stressful occupation. One stress management technique which may be effectively implemented on the job for clerical workers is progressive muscle relaxation. In primary prevention, nursing intervention strives to reduce the effects of harmful stress by identifying and assessing stressors and then implementing measures to strengthen lines of defense.