Tissue-selective mast cell reconstitution and differential lung gene expression in mast cell-deficient Kit(W-sh)/Kit(W-sh) sash mice.

BACKGROUND: Mast cell-deficient Kit(W)/Kit(W-v) mice are an important resource for studying mast cell functions in vivo. However, because they are compound heterozygotes in a mixed genetic background and are infertile, they cannot be crossed easily with other mice. OBJECTIVE: To overcome this limitation, we explored the use of Kit(W-sh)/Kit(W-sh) mice for studying mast cell biology in vivo. RESULTS: These mice are in a C57BL/6 background, are fertile and can be bred directly with other genetically modified mice. Ten-week-old Kit(W-sh)/Kit(W-sh) are profoundly mast cell-deficient. No mast cells are detected in any major organ, including the lung. Gene microarrays detect differential expression of just seven of 16,463 genes in lungs of Kit(W-sh)/Kit(W-sh) mice compared with wild-type mice, indicating that resting mast cells regulate expression of a small set of genes in the normal lung. Injecting 10(7) bone marrow-derived mast cells (BMMC) into tail veins of Kit(W-sh)/Kit(W-sh) mice reconstitutes mast cell populations in lung, stomach, liver, inguinal lymph nodes, and spleen, but not in the tongue, trachea or skin. Injection of BMMC into ear dermis or peritoneum reconstitutes mast cells locally in these tissues. When splenectomized Kit(W-sh)/Kit(W-sh) mice are intravenously injected with BMMC, mast cells circulate longer and are found more often in the liver and inguinal lymph nodes, indicating that the spleen acts as a reservoir for mast cells following injection and limits migration to some tissues. CONCLUSION: In summary, these findings show that mast cell-deficient Kit(W-sh)/Kit(W-sh) mice possess unique attributes that favour their use for studying mast cell functions in vivo.

Human development in the United States and Japan: new ways to think about continuity across the lifespan.

The work of Rothbaum and colleagues integrates more than 200 studies conducted in two countries over four stages of development. Their method of integrating studies provides a promising way to overcome some of the most vexing methodological difficulties of cross-cultural research.

High-altitude effects on respiratory gases, acid-base balance and pulmonary artery pressures in equids.

Arterial and venous blood were analysed at rest and post exercise for pH, PCO2, and PO2, and bicarbonate ([HCO3-]), base excess (BE), and strong ion difference (SID) were calculated in response to a 10 day sojourn to 3800 m. Pulmonary artery pressures (PAP) were measured at rest. Post exercise samples were restricted to venous blood. The equids (n = 6) experienced a profound hypoxia-hypocapnia and a respiratory alkalosis. PaO2 decreased 42% and PaCO2 41%. PaCO2 increased to 80% of initial values after 8 days at altitude. Arterial [HCO3-] decreased by 34%; however, it returned to normal by Day 4. Base excess decreased initially, but increased at altitude with time. Strong ion difference was decreased during the altitude exposure and continued to be depressed even after return to low altitude. Pulmonary artery pressure increased 63% on Day 1 of exposure (from 27.9 +/- 2 to 45.4 +/- 3 mmHg); Days 2 and 6 averaged 36.3 +/- 3 and 37.5 +/- 3 mmHg. Thirty-six hours after return to 225 m, most variables (except [SID] and post exercise BE) returned to normal. The most profound changes in the indicators of gas exchange, at altitude, occurred during the first 3 days and only [HCO3-] returned to normal during the subsequent acclimatization to altitude.

Parental report of pediatric tracheostomy care.

OBJECTIVE: There are little data on the actual care given pediatric tracheostomy patients in their homes. Information on the use of supplies and on techniques and frequency of care is valuable for a better understanding of the needs of this population. DESIGN: Questionnaires were distributed by mail or at clinic visits from May 1995 to June 1996 to a convenience sample of tracheotomized patients at the University of Michigan Pediatric Physical Medicine and Rehabilitation clinic. SETTING: Tertiary care clinic. RESULTS: Clean technique for suctioning was reported by 96.7% of subjects and the rest reported sterile technique. Fifty percent of subjects reported reusing suction catheters. Cleaning solutions used to clean suction catheters for reuse varied. Tracheostomy tube reuse was reported by 55% of subjects. Sixty percent of those who reused tracheostomy tubes had had pneumonia within the previous year, whereas only 25% of those who never reused the tracheostomy tube had pneumonia in the same time period. CONCLUSIONS: Suctioning frequency, suction catheter, and tracheostomy tube reuse and cleaning methods are variables that warrant further investigation of safety and efficacy.

Home care for medically fragile children: urban versus rural settings.

The development of managed care programs has allowed children who are medically fragile and technology-dependent to be discharged back to their home communities. Rural and urban settings each have unique characteristics that can affect home care. A number of home-care problems are common to both urban and rural settings, including nursing coverage, respite care, school services, coordination of medical resources, and emergency response protocols. Although the problems may be similar, the solutions often differ and should be adapted to the unique urban or rural settings in which they occur. Approaches to these problems are offered on the basis of experience in providing care management to these children in the Specialized Home Care Program in Michigan. Also explored are the problems of the lack of resources available to children who are medically fragile but not technology-dependent.

Care management for children who are medically fragile/technology-dependent.

Care management is a nursing role that has received more attention over the past decade as the number of children with special health-care needs has increased. The particular role of the specialized care manager within the Michigan Department of Public Health is described in the following article. The purpose is to highlight how the role emerged from a philosophy of care and how families receive the care management services. Future challenges for the state-supported role of care manager are described.

Psychosocial problems during child health supervision visits: eliciting, then what?

An explicit goal of child health supervision visits is to gather information and provide guidance about the psychosocial problems of children and families. The purpose of this study was to determine the extent to which parents had opportunities to express psychosocial concerns and the nature of physicians' responses to these concerns during health supervision visits. The authors analyzed videotapes of child health supervision visits by 34 children aged 5-12 years to 34 pediatric and family medicine residents. Coding systems with acceptable interobserver reliability were developed to assess (1) the nature of opportunities provided to express concerns, (2) categories of psychosocial problems expressed by parents and children, and (3) the nature of physicians' responses. In 88% of the child health supervision visits, opportunities were created by the physician to discuss psychosocial concerns or were spontaneously raised by the parent or child. In half of the visits, parents or children expressed a total of 30 psychosocial concerns. Psychosocial problems raised included conduct/behavior problems (47%), insecurity (13%), family, sibling, or social problems (13%), learning difficulties (10%), somatization (7%), and other (10%). Physicians' responses to these psychosocial concerns were as follows: 17% ignored the concern; 43% asked further exploratory questions but provided no information, reassurance, or guidance; 3% reassured the parent; 27% responded with psychosocial information and/or action; 3% responded with medical information and/or action; and 7% responded with a combination of these latter two modes of actions. Pediatric residents were more likely to respond to more disruptive behavioral concerns (r = .60, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

A quest for accuracy and reproducibility. Design of a simulation record.

This paper describes a simulation record that has been designed for use in most radiation therapy centers. The format is such that it can be used for all machine types and can be transferred easily between centers. The simulation record is separate from the treatment documentation record. It can be reused for several simulations with the addition of one or two inserts. All information needed to reproduce the treatment setup (i.e., positioning, immobilization technique, use of blocks, and photographs of the patient) is well documented. The record prompts the simulation technologist to record field and patient parameters, which are necessary for dose calculations along the central axis and at any other points of interest.

Increasing patient knowledge, satisfaction, and involvement: randomized trial of a communication intervention.

A brief educational intervention to promote effective communication between physicians, children, and parents during pediatric office visits was designed and tested. A randomized clinical trial involving 141 children (5- to 15-year-olds) tested the effectiveness of the intervention to improve the process and outcome of medical care. The intervention was contained in three brief videotapes (one each for parents, physicians, and patients) and in accompanying written materials. Materials were designed to build skills and motivation for increased child competence and participation during pediatric medical visits. Control subjects saw health education videotapes and received materials comparable in length with those of experimental subjects. Postintervention medical visit process was analyzed using videotapes of visits. Visit outcomes, assessed with standardized instruments and interviews, included children's rapport with physicians, children's anxiety, children's preference for an active health role, children's recall of information, parents' satisfaction with the medical visit, and physician satisfaction. Results indicated that physicians in the intervention group, compared with their counterparts in the control group, more often included children in discussions of medical recommendations (50% vs 29%, t = 2.39, P less than .05); that children in the intervention group, compared with control children, recalled more medication recommendations (77% vs 47%, P less than .01) and reported greater satisfaction and preference for an active health role; and that the intervention and control groups did not differ in parent satisfaction, physician satisfaction, or child anxiety. The results suggest that a brief educational intervention administered during waiting room time can positively impact physician-child rapport and children's preference for an active role in health and their acquisition of medical information.

Assessment of children's health status. Field test of new approaches.

The assessment of children's health status presents unique difficulties. These include parent-child differences in reports of functioning, knowledge of what constitutes age-appropriate functioning, obtainment of accurate information for child, and demonstration of the predictivity of health status measures. Recent measures (the Functional Status II-R and instruments from the RAND Health Insurance Experiment) address physical, social, and psychologic domains of children's health. The authors modified these instruments to develop short (7 and 14 items) questionnaires (RAND, FSQ) to assess child health. Scoring on these questionnaires was compared with traditional measures of illness severity and medical service utilization. The authors also evaluated coding illness-specific and general health limitations (FSQ-S and FSQ-G, respectively). Patients included the parents of 113 children with chronic illness (100 asthmatics). Measure stability was evaluated over a 6-month period in a subset of patients. Internal consistency (Cronbach's alpha) of the seven-item RAND measure was .78, the FSQ-S .78, and the FSQ-G .73 to .89 during repeated samplings over 6 months. The FSQ-S and Rand seven-item measure were moderately correlated (.47, P less than .001). The authors observed significant correlations among alternate codings of the FSQ and RAND and between the FSQ-S, FSQ-G, RAND, and severity measure with traditional indices of medical service utilization. Parents were more likely to attribute certain functional status problems (e.g., being tired) to illness than they were other problems (e.g., moodiness or interest in things). The findings demonstrate that these measures have acceptable psychometric properties and provide preliminary evidence of construct validity in a group of young children with asthma. Using general and specific measures will provide differing pictures of a child's functioning. No single measure completely taps the impact of illness as measured by a panel of traditional indicators of illness burden and medical service utilization.

Measuring the impact of medical care on children.

To assess the impact of medical care on children we have developed a conceptual model based on both theoretical considerations and empirical research. Child health is viewed as the ability to participate fully in developmentally appropriate activities and requires physical, psychological, and social energy. The medical system influences health through interventions addressing these domains. Many methodologic issues are unique to the measurement of medical care processes and outcomes for children. Problems in measuring the process of medical interviews include developing systems that capture the dynamics of interactions, assess the cognitive appropriateness and metaphorical interpretation of language, and reflect the emotional impact of certain incidents. Issues that confound measurement of children's views include position bias, acquiescence response bias, and limited understanding of negatively worded items. Further, the concordance between parent and children reports or health constructs varies widely, which suggests the need to include children's reports to obtain a comprehensive view of their health.

Minors' competence to consent to abortion.

PIP: In the light of legal restrictions in some states, the psychological evidence for whether adolescents are competent to give informed consent to abortion is reviewed. It would be important to know whether competence to decide on pregnancy outcome reflects maturity to be a parent; further, whether degrees of maturity can be traced throughout adolescence. Research shows that parents, not peers, are major sources of advice for minors' abortion decisions. Younger and less competent minors are more likely to consult parents than older, mature minors. There is no evidence that adolescent issues or developmental tasks influence pregnancy decisions. Decision making competence does not differ from that of adults, except as affected by the living situation of the adolescent. Decision performance does differ: minors are more likely to consider their present family's opinion, and not consider future risks, than are adults. The sparse research available on this problem provides no basis for restricting minors' decision making on the ground of competence alone.^ieng

Parent satisfaction with children's medical care. Development, field test, and validation of a questionnaire.

Research on both adult patients and parents of pediatric patients has demonstrated that satisfaction with medical encounters predicts such important outcomes as compliance with medical regimen. The authors developed a questionnaire to measure parent satisfaction with children's medical encounters, administered it to 104 parents of pediatric patients (field trial 1), and revised it. The revised Parent Medical Interview Satisfaction Scale (P-MISS) was then tested on a new sample of parents whose medical visits were videotaped (field trial 2). On field trial 2, the P-MISS showed a high alpha reliability (0.95). The four factor-based subscales identified by field trial 1 showed high alpha reliabilities on field trial 2: physician communication with the parent (0.81); physician communication with the child (0.93); distress relief (0.85); and adherence intent (0.86). With the exception of the distress relief subscale, the subscales appear to measure distinct dimensions of satisfaction. Objective ratings of physicians' interpersonal skills to parents during medical interviews correlated significantly with parents' total satisfaction scores as well as with all four satisfaction subscale scores, providing preliminary evidence of the construct validity of the P-MISS.

The effect of aldicarb on nematode population and its persistence in carrots, soil and hydroponic solution.

Aldicarb, Temik 15 G, was incorporated in furrows at 3.37 and 6.73 kg ai (active ingredient)/ha and carrots (Daucus carota L.) were directly seeded on the same day. The numbers of nematode larvae were significantly suppressed in the treated plots; averages were 249, 74, and 51/50 cc soil samples for control (0), 3.37 and 6.73 kg ai/ha, respectively. Aldicarb treatment resulted in a 28% yield increase as compared to the untreated. Aldicarb residue in carrots was 28 ppb for the low treatment and 46 ppb for the high. Residual levels in soil of high treatment declined from 61 to 31 ppb during two weeks prior to harvest, meanwhile, those in the low decreased slightly from 13 to 12 ppb. Carrots placed in hydroponic solution containing aldicarb 14.5 ppm for 6 days, had an aldicarb residue of 10.26 ppb and the hydroponic solution, 2.7 ppb. Persistence of aldicarb residue was in carrot greater than in soil greater than in hydroponic solution.