Hepatitis C-specific effector and regulatory CD4 T-cell responses are associated with the outcomes of primary infection

Clearance of primary hepatitis C virus (HCV) infection has been associated with strong and broadly targeted cellular immune responses. This study aimed to characterize HCV-specific CD4+ effector and regulatory T-cell numbers and cytokine production during primary infection. Antigen-specific CD4+ T-cell responses were investigated in a longitudinal cohort of subjects from pre-infection to postoutcome, including subjects who cleared [n=12] or became chronically infected [n=17]. A cross-sectional cohort with previously cleared, or chronic infection [n=15 for each], was also studied. Peripheral blood mononuclear cells were incubated with HCV antigens and surface stained for T-effector (CD4+CD25^high CD134+CD39-) and T-regulatory (CD4+CD25^high CD134+CD39+) markers, and culture supernatants assayed for cytokine production. Contrary to expectations, the breadth and magnitude of the HCV-specific CD4+ T-cell responses were higher in subjects who became chronically infected. Subjects who cleared the virus had HCV-specific CD4+ T-cell responses dominated by effector T cells and produced higher levels of IFN-γ, in contrast to HCV-specific CD4+ T-cell responses dominated by regulatory T cells and more IL-10 production in those who became chronically infected. Better understanding of the role of antigen-specific CD4+ T-cell responses in primary HCV will further define pathogenesis and help guide development of a preventative vaccine.

A Comparative Study of Lead Nephrotoxicity and Tissue Deposition Between Rats, Mice, and Pigeons Exposed to Drinking Water Containing 2, 20, or 200 ppm Lead

White Carnaew pigeons were exposed to drinking water containing various concentrations of lead to study the relationship between exposure and tissue deposition and the relationship between the concentrations of lead in kidney and morphologic alterations. The concentration of lead in the blood was the only tissue which showed a linear increase with respect to the concentration of lead in the drinking water. The concentration of lead in the liver, kidney, brain, heart, aorta, and pancreas increased in response to lead in the drinking water; however, these increases were not linear with respect to lead exposure. Similar results were obtained for rats and mice exposed via the drinking water to 2, 20, or 200 ppm lead; however, the concentration of lead in tissues was substantially greater in pigeons. Kidneys from rats and mice appeared normal following the exposure of 200 ppm lead for 4 months, whereas, in kidneys from pigeons exposed to 200 ppm for a similar period of time there was tubular degeneration, fibrosis, and acid fast intranuclear inclusion bodies. These pathoanatomic alterations may be related to the concentration lead found in the kidney in pigeons. The concentration of lead in the kidney was 3,930 μg gram dry weight for pigeons but only 40 and 6 μg for mice and rats respectively. These studies suggest that the pigeon is more responsive to ingested lead than the rat or mouse. The renal lesions induced by chronic lead exposure are similar in pigeons and man suggesting that the pigeon may be useful animal model to study the yet unanswered questions related to chronic nephritis following lead poisoning.

Confirmatory factor analysis of the Strengths and Difficulties Questionnaire in Singaporean kindergartners

BACKGROUND

The Strengths and Difficulties Questionnaire (SDQ) assesses behavioural adjustment in children aged 3 to 16 years. To ascertain the appropriateness of the scale for a specific population, it is important to examine whether the distinctiveness of the scale dimensions can be verified empirically.

AIMS

Confirmatory factor analysis was used to test explicitly which of three models better explain our data, and whether model fit was improved by the addition of method factors.

METHODS

Parents of 411 Singaporean kindergartners completed the SDQ.

RESULTS

A four-factor multi-trait multi-method model (Prosocial, Conduct, Hyperactivity, Internalizing and two method factors) provided the best fit to the data. There was strong evidence for convergent and discriminant validity. However, differences in configural loading pattern indicated gender-related differences in the mapping of the SDQ items.

DISCUSSION

Differences in factor structure across countries and gender may reflect differing conceptions of the underlying dimensions, as well as differences in normative expectations. However, our findings may allow its use as a screening tool to identify Singaporean children at risk of emotional and behavioural difficulties.

Rare occurrence of occult hepatitis C virus in apparently uninfected injecting drug users: a two-centre, masked, case-control study

Occult hepatitis C virus (HCV) is a phenomenon where serum HCV RNA is not detected by sensitive commercial assays, but viral RNA is detected by ultrasensitive techniques. Occult HCV infection has not previously been studied in highly exposed, but apparently uninfected (EU) individuals. Two studies examining occult infection in EU subjects were undertaken - an initial two-centre, masked, case-control study based on cross-sectional samples (n = 35 subjects) and a single-centre confirmatory study based on longitudinal samples (n = 32 subjects). Plasma and peripheral blood mononuclear cells were tested for HCV RNA using an ultrasensitive nested polymerase chain reaction assays. Two EU subjects in the first study (10%) and one in the second study (3%) were found to have consistently detectable HCV RNA. Occult HCV infection occurs in high-risk, apparently uninfected subjects.

Contrasting approaches to end of life and palliative care in end stage kidney disease

With increased numbers of the elderly, including nursing home patients, being accepted for end-stage kidney disease (ESKD) management, there is heightened interest and focus on end of life decisions, advanced care planning and directives, withdrawal from dialysis and palliative care in this setting. Despite this, care at the individual patient level can vary greatly. Here, we present two contrasting cases to highlight the importance of early and ongoing involvement of palliative care in patients with ESKD. In the first case, a high quality of life was preserved before the patient died with dignity, with early interdisciplinary palliative care involvement. In the second case there was a long protracted period of poor quality of life prior to death. This was associated with resistance to the involvement of palliative care, mainly from the family. Addressing end of life care issues early in the chronic kidney disease (CKD) trajectory and ensuring patients, their families and health care providers are well informed, may contribute to a better outcome for the patient and their family.

Oedema in obesity; role of structural lymphatic abnormalities

Oedema is a common finding in obesity and its cause is not always clear. Possible causes include impairment of cardiac, respiratory and/or renal function, chronic venous insufficiency and lymphatic problems. Lymphoscintigraphy is the best method to detect structural lymphatic abnormalities that can cause lymphoedema. We reviewed 49 female subjects with pitting oedema who had undergone lymphoscintigraphy, divided in three groups. The first group was comprised of severely obese patients in whom cardiorespiratory causes for oedema had been excluded. The second group consisted of non-obese patients with recognized causes for oedema and the third group was non-obese patients with 'idiopathic' oedema. A standard classification was used to interpret lymphoscintigraphy results. The frequency and severity of lymphoscintigraphic abnormalities was greatest in patients with clinical diagnoses of oedema related to 'recognized causes' (any abnormality in 50% of legs with obstruction in 22%). Obese patients and those with 'idiopathic'oedema had fewer (P=0.02 for both) and milder lymphoscintographic abnormalities (any abnormality 32 and 25%, respectively, obstruction 5 and 3%, respectively), and although the clinical oedema was invariably bilateral, the lymphoscintigraphy abnormalities were usually unilateral. In conclusion, structural lymphoscintigraphic abnormalities are uncommon in obesity and do not closely correlate with the clinical pattern of oedema.

Specificity of an immunochromato-graphic test for anthrax

OBJECTIVE

To evaluate the specificity of an immunochromatographic test (ICT) for anthrax in cattle.

DESIGN

A comparison of an ICT with blood smear and culture in uninfected cattle.

PROCEDURE

Two hundred and forty blood samples were collected from dead cattle at two knackeries within Victoria and tested on-site with an ICT for the detection of protective antigen (PA) of Bacillus anthracis. Blood smears were prepared on-site and blood samples transported to the laboratory for aerobic and anaerobic culture. The results of the ICT were compared with blood smear and culture. Animals were regarded as not infected with B anthracis if the organism was not detected in a stained blood smear or on culture. Ten healthy yearling cattle were vaccinated with live spore anthrax vaccine and blood samples collected on days 0 to 7 and day 15 were tested in the ICT for the presence of PA.

RESULTS

All blood samples from the 240 knackery cattle were ICT, smear and culture negative. All blood samples from the 10 vaccinated cattle were ICT negative.

CONCLUSION

The ICT is a test with high specificity in cattle (98.5 to 100%; 95% CI) and recent vaccination of cattle does not give rise to positive reactions.

UK laboratory intercomparison on internal dosimetry

A laboratory intercomparison for internal dose assessment from a variety of intake scenarios is described. This is the first UK intercomparison using the revised ICRP Human Respiratory Tract and biokinetic models. Four United Kingdom laboratories participated and six cases were assessed. Overall, the agreement in internal dose assessments between laboratories was considered satisfactory with 79% of the assessed committed effective doses, e(50), for cases within a band of +/- 40% of the median value. The range (highest/lowest) in e(50) estimated by the laboratories was smallest (1.2) for a case involving inhalation of 137Cs. The range was greatest (6.0) for a case involving a wound with, and possible inhalation of, 238Pu, 239Pu and 241Am; the variation between laboratories in assessment of intakes could not be considered to be satisfactory in this case. Judgements on the most appropriate data to use in estimating intakes, choice of parameter values for use with the ICRP models and allowing for the effects of treatment with DTPA were important sources of variability between laboratories.

Executive functioning as a predictor of children's mathematics ability: inhibition, switching, and working memory

Children's mathematical skills were considered in relation to executive functions. Using multiple measures--including the Wisconsin Card Sorting Task (WCST), dual-task performance, Stroop task, and counting span-it was found that mathematical ability was significantly correlated with all measures of executive functioning, with the exception of dual-task performance. Furthermore, regression analyses revealed that each executive function measure predicted unique variance in mathematics ability. These results are discussed in terms of a central executive with diverse functions (Shallice & Burgess, 1996) and with recent evidence from Miyake, et al. (2000) showing the unity and diversity among executive functions. It is proposed that the particular difficulties for children of lower mathematical ability are lack of inhibition and poor working memory, which result in problems with switching and evaluation of new strategies for dealing with a particular task. The practical and theoretical implications of these results are discussed, along with suggestions for task changes and longitudinal studies that would clarify theoretical and developmental issues related to executive functioning.

Clinicians' contributions to healthcare management

Primary tasks for clinical directors are to disseminate information to colleagues, provide feedback to senior professional managers, and to play key roles in strategic planning and resource allocation in health services. These tasks are seen to reduce barriers between clinicians and management. The application of clinical directorates across healthcare organisations is inconsistent and ambiguous. When set clear guidelines, clinical directors can impact on the decision-making process within senior management. As further applications of clinical directors in management occur, development of the role is required to realise the potential.

People's insight into their own behaviour and speech content while lying

The present experiment examined participants' insight into their own behaviour and speech content while lying. It was hypothesized that participants would believe that while lying they show more behaviour stereotypical of lying than they in fact do (Hypothesis 1), whereas they would believe that their own speech content while lying contains fewer stereotypical features than in fact is true (Hypothesis 2). A stereotypical response was defined as a response people generally believe liars usually show. A total of 86 nursing students were interviewed twice about a film they had just seen. During one interview they were asked to tell the truth whereas they had to lie in the other interview. All interviews were videotaped, transcribed and then scored by independent coders. The coders' analyses reveal participants' actual behaviour and speech content. Participants themselves were asked to indicate in a questionnaire how they believed they behaved and what they believed they said in both interviews. To test the hypotheses, comparisons were made between participants' actual responses and their beliefs about their own responses. The results support both hypotheses and implications of these outcomes for the detection of deception are discussed.

The Judd illusion: evidence for two visual streams or two experimental conditions?

In the Judd illusion, observers inaccurately bisect the shaft located between two arrowheads pointing in the same direction. The magnitude of error is greater when verbal judgements are compared to action based responses (reaching out and grasping the centre of the bar). This difference has been attributed to the presence of two visual streams within cortical processing. In contrast, we provide evidence that the improved accuracy in the reaching condition may be due to occlusion of the illusory background during the transport phase of the movement. We suggest that caution is required when interpreting performance differences between two conditions that are not strictly equivalent.

SH Oxidation Stimulates Calcium Release Channels (Ryanodine Receptors) From Excitable Cells

The effects of redox reagents on the activity of the intracellular calcium release channels (ryanodine receptors) of skeletal and cardiac muscle, or brain cortex neurons, was examined. In lipid bilayer experiments, oxidizing agents (2,2'-dithiodipyridine or thimerosal) modified the calcium dependence of all single channels studied. After controlled oxidation channels became active at sub microM calcium concentrations and were not inhibited by increasing the calcium concentration to 0.5 mM. Subsequent reduction reversed these effects. Channels purified from amphibian skeletal muscle exhibited the same behavior, indicating that the SH groups responsible for modifying the calcium dependence belong to the channel protein. Parallel experiments that measured calcium release through these channels in sarcoplasmic reticulum vesicles showed that following oxidation, the channels were no longer inhibited by sub mM concentrations of Mg2+. It is proposed that channel redox state controls the high affinity sites responsible for calcium activation as well as the low affinity sites involved in Mg2+ inhibition of channel activity. The possible physiological and pathological implications of these results are discussed.

Dichloroacetate (DCA) dosimetry: interpreting DCA-induced liver cancer dose response and the potential for DCA to contribute to trichloroethylene-induced liver cancer

Pharmacokinetic studies with dichloroacetate (DCA) provide insights into the likelihood that trichloroethylene-induced liver cancers arise from formation of DCA as a metabolite and the mode of action by which DCA induces liver cancer. A simple physiologically based pharmacokinetic model was developed to analyze DCA blood concentration data from mice unexposed to or pre-treated with DCA. The large first pass metabolism of DCA in the liver is significantly reduced by DCA pretreatment. Because DCA inhibits its own metabolism, large increases in area under the blood concentration curve occur at lower doses than would be predicted from single-dose pharmacokinetic studies with naive mice. The dose metrics associated with the incidence of liver tumors in contrast to the multiplicity of tumors per animal may be different, suggesting potentially different roles in the cancer process for DCA versus its metabolites. By linking a model for trichloroethylene (TCE) pharmacokinetics with the DCA model, maximum levels of DCA potentially produced from TCE were estimated to be at or below the analytical chemistry detection limits. In addition, the predicted levels of DCA would be too small to produce the observed liver cancers following corn oil gavage exposure of mice to TCE.

This little piggy went to market: using a health education market as a learning strategy for preregistration Bachelor of Nursing students

In the academic year 1997/98 at the University of Tasmania, students undertaking the research unit in their second year of the Bachelor of Nursing (BN) took part in producing a health education market for the staff and students on the Launceston campus of the University. The cafeteria and outside grassed areas were transformed into a network of information stalls, displays and activities. The students reported a constant flow of interested and enthusiastic people to their stalls. Integrating research findings, technical and interpersonal skills and creative ability, students were encouraged to synthesize many areas of theory in the nursing programme in order to present high quality, informative and engaging stalls. Formal evaluation of both group and individual work was integrated into the process in such a way as to provide prompt feedback and encouragement, ongoing quality control and to generate a final grade for each student.

Viral ion channels: molecular modeling and simulation

In a number of membrane-bound viruses, ion channels are formed by integral membrane proteins. These channel proteins include M2 from influenza A, NB from influenza B, and, possibly, Vpu from HIV-1. M2 is important in facilitating uncoating of the influenza A viral genome and is the target of amantadine, an anti-influenza drug. The biological roles of NB and Vpu are less certain. In all cases, the protein contains a single transmembrane alpha-helix close to its N-terminus. Channels can be formed by homo-oligomerization of these proteins, yielding bundles of transmembrane helices that span the membrane and surround a central ion-permeable pore. Molecular modeling may be used to integrate and interpret available experimental data concerning the structure of such transmembrane pores. This has proved successful for the M2 channel domain, where two independently derived models are in agreement with one another, and with solid-state nuclear magnetic resonance (NMR) data. Simulations based on channel models may yield insights into possible ion conduction and selectivity mechanisms.

Common causes of leg ulceration

Good treatment of any leg ulcer depends upon an accurate diagnosis of the underlying cause. Most leg ulcers occur secondary to venous or arterial disease but other rarer causes sometimes need to be considered. The treatment of the underlying condition is far more important than the choice of dressing.

Sulfhydryl oxidation modifies the calcium dependence of ryanodine-sensitive calcium channels of excitable cells

The calcium dependence of ryanodine-sensitive single calcium channels was studied after fusing with planar lipid bilayers sarcoendoplasmic reticulum vesicles isolated from excitable tissues. Native channels from mammalian or amphibian skeletal muscle displayed three different calcium dependencies, cardiac (C), mammalian skeletal (MS), and low fractional open times (low Po), as reported for channels from brain cortex. Native channels from cardiac muscle presented only the MS and C dependencies. Channels with the MS or low Po behaviors showed bell-shaped calcium dependencies, but the latter had fractional open times of <0.1 at all [Ca2+]. Channels with C calcium dependence were activated by [Ca2+] < 10 microM and were not inhibited by increasing cis [Ca2+] up to 0.5 mM. After oxidation with 2,2'-dithiodipyridine or thimerosal, channels with low Po or MS dependencies increased their activity. These channels modified their calcium dependencies sequentially, from low Po to MS and C, or from MS to C. Reduction with glutathione of channels with C dependence (native or oxidized) decreased their fractional open times in 0.5 mM cis [Ca2+], from near unity to 0.1-0.3. These results show that all native channels displayed at least two calcium dependencies regardless of their origin, and that these changed after treatment with redox reagents.

Cyclic ADP-ribose activates caffeine-sensitive calcium channels from sea urchin egg microsomes

Adenosine 5'-cyclic diphosphoribose [cyclic ADP-ribose (cADPR)], a metabolite of NAD+ that promotes Ca2+ release from sea urchin egg homogenates and microsomal fractions, has been proposed to act as an endogenous agonist of Ca2+ release in sea urchin eggs. We describe experiments showing that a microsomal fraction isolated from Tetrapigus nyger sea urchin eggs displayed Ca(2+)-selective single channels with conductances of 155.0 +/- 8.0 pS in asymmetric Cs+ solutions and 47.5 +/- 1.1 pS in asymmetric Ca2+ solutions. These channels were sensitive to stimulation by Ca2+, ATP, and caffeine, but not inositol 1,4,5-trisphosphate, and were inhibited by ruthenium red. The channels were also activated by cADP-ribose in a Ca(2+)-dependent fashion. Calmodulin and Mg2+, but not heparin, modulated channel activity in the presence of cADP-ribose. We propose that these Ca2+ channels constitute the intracellular Ca(2+)-induced Ca2+ release pathway that is activated by cADP-ribose in sea urchin eggs.

Eyewitness performance in cognitive and structured interviews

This paper addresses two methodological and theoretical questions relating to the Cognitive Interview (CI), which previous research has found to increase witness recall in interviews. (1) What are the effects of the CI mnemonic techniques when communication techniques are held constant? (2) How do trained interviewers compare with untrained interviewers? In this study, witnesses (college students) viewed a short film clip of a shooting and were questioned by interviewers (research assistants) trained in conducting the CI or a Structured Interview (SI)--similar to the CI except for the "cognitive" components--or by untrained interviewers (UI). The CI and SI groups recalled significantly more correct information compared to the UI group. However they also reported more errors and confabulated details. Theoretical and practical implications of the results are discussed in terms of precisely identifying the CI facilitatory effects and consequent good practice in the forensic setting.

Children's arithmetical difficulties: contributions from processing speed, item identification, and short-term memory

Children's arithmetical difficulties are often explained in terms of a short-term memory deficit. However, the underlying cause of this memory deficit is unclear, with some researchers suggesting a slow articulation rate and hence increased decay of information during recall, while others offer an explanation in terms of slow speed of item identification, indicating difficulty in retrieving information stored in long-term memory. General processing speed is also related to measures of short-term memory but has rarely been assessed in studies of children's arithmetic. Measures of short-term memory, processing speed, sequencing ability, and retrieval of information from long-term memory were therefore given to 7-year-old children. When reading ability was controlled for, arithmetic ability was best predicted by processing speed, with short-term memory accounting for no further unique variance. It was concluded that children with arithmetic difficulties have problems specifically in automating basic arithmetic facts which may stem from a general speed of processing deficit.

[Ethics code of the Chilean Biological Society]

The Chilean Biological Society has approved an ethics code for researchers, elaborated by its Ethic Committee. The text, with 16 articles, undertakes the main ethical problems that researchers must solve, such as institutional, professional or societal ethics, scientific fraud, breaches in collaborative work, relationships between researchers, participation in juries and committees, ethical breaches in scientific publications, scientific responsibility and punishments. This code declares its respect and valorization of all life forms and adheres to international biomedical ethical codes. It declares that all knowledge, created or obtained by researchers is mankind's heritage.

Ca2+- and pH-dependent halothane stimulation of Ca2+ release in sarcoplasmic reticulum from frog muscle

Pages C540-C546: M. Beltrán, R. Bull, P. Donoso, and C. Hidalgo. “Ca2+- and pH-dependent halothane stimulation of Ca2+ release in sarcoplasmic reticulum from frog muscle.” Page C543, because of a printer's error, Fig. 6 was inadvertently published as a repeat of Fig. 5. The correct Fig. 6 appears below.

(See PDF)

Ca(2+)- and pH-dependent halothane stimulation of Ca2+ release in sarcoplasmic reticulum from frog muscle

The effect of halothane on calcium release kinetics was studied in triad-enriched sarcoplasmic reticulum vesicles from frog skeletal muscle. Release from vesicles passively equilibrated with 3 mM 45CaCl2 was measured in the millisecond time range by use of a fast-filtration system. Halothane (400 microM) increased release rate constants at pH 7.1 and 7.4 as a function of extravesicular pCa. In contrast, halothane at pH 6.8 produced the same stimulation of release from pCa 7.0 to 3.0; no release took place in these conditions in the absence of halothane. Halothane shifted the calcium activation curve at pH 7.1, but not at pH 7.4, to the left and increased channel open probability at pH 7.1 in the cis pCa range of 7.0 to 5.0. These results indicate that cytosolic pCa and pH modulate the stimulatory effects of halothane on calcium release. Furthermore, halothane stimulated release in frog skeletal muscle at low pH and resting calcium concentration, indicating that in frog muscle halothane can override the closing of the release channels produced by these conditions, as it does in malignant hyperthermia-susceptible porcine muscle.

Ca2+- and pH-dependent halothane stimulation of Ca2+ release in sarcoplasmic reticulum from frog muscle

Pages C540-C546: M. Beltrán, R. Bull, P. Donoso, and C. Hidalgo. “Ca2+- and pH-dependent halothane stimulation of Ca2+ release in sarcoplasmic reticulum from frog muscle.” Page C543, because of a printer's error, Fig. 6 was inadvertently published as a repeat of Fig. 5. The correct Fig. 6 appears below.

(See PDF)

Calcium dependence of ryanodine-sensitive calcium channels from brain cortex endoplasmic reticulum

Endoplasmic reticulum vesicles isolated from rat brain cortex and fused with lipid bilayers displayed ryanodine-sensitive calcium channels, with three cytoplasmic calcium dependences. A: Channels (n=5) stimulated by Ca2+ (K0.5=1.2 microM and nHill=1.9) and not inhibited up to 0.5 mM Ca2+. B: Channels (n=14) cooperatively activated (K0.5=6.9 microM and nHill=1.8), and inhibited by Ca2+ (K0.5=152 microM and nHill=1.8). C: Low Po (<0.1) channels (n=22), non-cooperatively activated and inhibited with the same K0.5=26.3 microM Ca2+. These three types of responses to cytoplasmic [Ca2+] may underlie separate calcium release pathways in neurons of rat brain cortex.

Psychotherapy and the recovery of memories of childhood sexual abuse: U.S. and British practitioners' opinions, practices, and experiences

Licensed U.S. doctoral-level psychotherapists randomly sampled from the National Register of Health Service Providers in Psychology (Surveys 1 and 2, n = 145; Council for the National Register of Health Service Providers in Psychology, 1992) and British psychologists sampled from the Register of Chartered Clinical Psychologists (Survey 2, n = 57; British Psychological Society, 1993) were surveyed regarding clients' memories of childhood sexual abuse (CSA). The 3 samples were highly similar on the vast majority of measures. Respondents listed a wide variety of behavioral symptoms as potential indicators of CSA, and 71% indicated that they had used various techniques (e.g., hypnosis, interpretation of dreams) to help clients recover suspected memories of CSA. Across samples, 25% of the respondents reported a constellation of beliefs and practices suggestive of a focus on memory recovery, and these psychologists reported relatively high rates of memory recovery in their clients.

Psychotherapy and the recovery of memories of childhood sexual abuse: U.S. and British practitioners' opinions, practices, and experiences

Licensed U.S. doctoral-level psychotherapists randomly sampled from the National Register of Health Service Providers in Psychology (Surveys 1 and 2, n = 145; Council for the National Register of Health Service Providers in Psychology, 1992) and British psychologists sampled from the Register of Chartered Clinical Psychologists (Survey 2, n = 57; British Psychological Society, 1993) were surveyed regarding clients' memories of childhood sexual abuse (CSA). The 3 samples were highly similar on the vast majority of measures. Respondents listed a wide variety of behavioral symptoms as potential indicators of CSA, and 71% indicated that they had used various techniques (e.g., hypnosis, interpretation of dreams) to help clients recover suspected memories of CSA. Across samples, 25% of the respondents reported a constellation of beliefs and practices suggestive of a focus on memory recovery, and these psychologists reported relatively high rates of memory recovery in their clients.

Normal cutaneous microcirculation in gaiter zone (ulcer-susceptible skin) versus nearby regions in healthy young adults

Skin just proximal to the medial malleolus ('gaiter' zone) is the usual site for venous ulceration in later life, whereas shin and dorsum of the foot are generally unaffected. We studied the microcirculation of these regions in 6 healthy young adults to see whether any premorbid, constitutional differences in microvascular physiology or anatomy exist between local leg sites even in normal subjects. Capillary density was assessed by capillaroscopy (native and fluorescein) and local flow by laser Doppler fluxmetry, in supine and upright positions and during reactive hyperaemia. Supine capillary densities in supramedial malleolar skin (SMMS) averaged 31038 mm(-2) (fluorescein and native count means, respectively) and was not statistically significantly different from those in the dorsum of the foot (36.0-36.2 mm(-2) or shin 30-51 mm(-2)). Dependency did not alter the counts significantly, but the fluorescein transport time from antecubital vein to capillary increased by 16-69% (SMMS 40%). In the supine position, red cell flux in SMMS was only 42-43% of the flux in skin over the shin and dorsum of the foot (p<0.04, 2-way analysis of variance) and cumulative reactive hyperaemia in SMMS was also less marked. Basal flux and reactive hyperaemia at all sites fell to closely similar levels in dependency (veni-arteriolar response). In relative terms, however, the posturally induced vasoconstriction was weaker in SMMS (flux reduction by 29% of supine value) than at other sites (reductions 61-61% of supine value). The results showed that even in young healthy legs the cutaneous microcirculation is not physiologically homogeneous, raising the possibility that constitutional factors might influence the siting of overt pathology if chronic venous insufficiency develops in later life.

Clinical nurse specialist: walking the wire

Considered by many to be the panacea for all nursing's problems, the clinical nurse specialist (CNS) has only recently gained widespread recognition as a legitimate role in Australia. The CNS is the equivalent in other states and territories of the clinical nurse consultant, the charge nurse or the nurse unit manager. Implementation of the role has been complicated by inadequately delineated role functions, unrealistic expectations and limited recognition of clinical expertise. Using both quantitative and qualitative exploratory techniques it was found that three critical themes impinged in a negative way on the effectiveness of the CNS. These were role ambiguity, role overload and the 'paradox of power'. Maintaining clinical expertise in the practice setting is essential for high quality cost effective and autonomous nursing care and this can be provided through the effective implementation of the CNS role.