The influence of candidates' physical attributes on patient ratings in simulated assessments of clinical practice.

BACKGROUND: We have previously shown that clinical examiners' scoring is not negatively impacted when a candidate has a tattoo, unnatural hair colour, or a regional accent. We investigated whether these physical attributes in exam candidates impact patient scoring. METHODS: Simulated/real patients were randomly assigned to watch five videos of simulated candidate performances of a cranial nerve examination: clear fail, borderline, good, 'clear pass' without an attribute, and 'clear pass' with one of the attributes (tattoo, purple hair, accent). Participants scored domains of communication and professionalism. We compared scores for the clear pass candidates with and without attributes. RESULTS: One hundred and eighty three patients participated. The total scores for the candidates with tattoos and purple hair were higher than the candidate with no physical attribute (p < 0.001). For the candidate with a Liverpool English accent no difference was identified (p = 0.120). CONCLUSIONS: The presence of certain physical attributes (tattoos or purple hair) was associated with higher scores given by patients to candidates in a simulated physical examination station.

Sexual motives, gender, and sexual behavior.

The roles of gender and the sexual motives of Love, Pleasure, Conformity, Recognition, Dominance, and Submission in numerous usual and unusual sexual behaviors were investigated. In a survey of 191 college undergraduates it was found that Love, Pleasure, Conformity, and Recognition motives, often in interaction with gender, were all important predictors of sexual behavior. Gender was the best predictor of initiating usual sexual behavior, whereas the Love motive was the best predictor of actually engaging in usual sexual behavior. Pleasure and Recognition in interaction with gender were the best predictors of engaging in unusual sexual behavior. None of the sexual motives predicted initiating unusual sexual behavior. Findings suggest that a variety of sexual motives may underlie sexual behavior.

Cross reactivity between IA-2 and phogrin/IA-2beta in binding of autoantibodies in IDDM.

Patients with insulin-dependent diabetes mellitus (IDDM) possess antibodies to the cytoplasmic domains of two closely related tyrosine phosphatase-like proteins, IA-2 and phogrin, previously detected as 40 kDa and 37 kDa tryptic fragments, respectively. A higher proportion of IDDM patients possess antibodies to IA-2 than to phogrin, and autoimmunity to phogrin might arise through cross-reactivity with the highly homologous IA-2. In this study, we have investigated the major regions of IA-2 recognized by antibodies in IDDM patients and examined the ability of phogrin to block antibody binding to these regions as a measure of cross-reactivity. Analysis of antibody binding to in vitro transcribed and translated polypeptides representing different regions of the cytoplasmic domain of IA-2 identified five different patterns of reactivity with antibodies in IDDM. Protein footprinting analysis, whereby polypeptide fragments generated on protease treatment of immune complexes are studied, indicated considerable heterogeneity in antibody recognition of IA-2, even between sera with similar reactivity to deletion mutants. Blocking studies with recombinant phogrin indicated that IA-2 antibodies recognize epitopes that are both unique to IA-2 and shared with phogrin. The amino-terminal 150 amino acids of the cytoplasmic domain of IA-2 encompass epitopes that are not represented on phogrin, whereas shared epitopes are localized within the carboxy-terminal 220 amino acids. The results demonstrate considerable heterogeneity between IDDM patients in autoantibody recognition of IA-2 in IDDM, whereas antibody recognition of phogrin is restricted in most patients to epitopes also present on IA-2.

Validity of screening for individuals at risk for type I diabetes by combined analysis of antibodies to recombinant proteins.

OBJECTIVE: To determine whether screening for the presence of multiple antibody markers for IDDM is effective at identifying individuals with high risk for disease development. RESEARCH DESIGN AND METHODS: Antibodies to GAD and the tyrosine phosphatase-like protein 1A-2 were determined in sequential serum samples from 44 first-degree relatives of IDDM patients, identified as possessing islet cell antibody (ICA) and/or insulin autoantibody (IAA), who were followed prospectively for IDDM development, ICA, IAA, and antibodies to GAD and 1A-2 were also determined in 93 cases of new-onset nonfamilial IDDM. RESULTS: The presence of two or more antibodies in addition to ICA or IAA conferred high risk (61%) for development of IDDM within 5 years of entry into the study and identified 89% of those who have developed IDDM on current follow-up. None of the relatives positive for ICA or IAA alone, in the absence of other antibody markers, have developed IDDM. Antibodies to islet antigens could both appear and disappear in follow-up samples obtained after entry into the study. The majority (60%) of young (< 16 years), sporadic cases of IDDM had multiple antibodies to islet antigens, but this proportion was lower in older patients (37%). CONCLUSIONS: A screening strategy based on the analysis of antibodies to multiple islet antigens can predict IDDM at high sensitivity and specificity in families, and such a strategy may also be applicable to identify young individuals in the general population with high disease risk. Since appearance of antibodies to different antigens occurs sequentially rather than simultaneously, accurate assessment of diabetes risk based on the presence of multiple antibodies will require follow-up over a number of years after the first evidence of islet autoimmunity.

Premarital sexual standards among U.S. college students: comparison with Russian and Japanese students.

The study of the sexual permissiveness of young adults has been popular topic in sociology and social psychology, especially since the empirical and theoretical work of Reiss. We extended previous research on premarital sexual standards by examining the degree of sexual permissiveness and the endorsement of the traditional double standard in a large sample of young adults in the United States (N = 1043). In addition, comparative data were collected from young adults in two other countries: Russia (N = 401) and Japan (N = 223). American subjects expressed more acceptance of premarital sex than did the Russian and Japanese subjects. Men were more sexually permissive than women in the U.S. and in Russia but not in Japan. The degree to which the double standard was endorsed also depended on culture and gender. Russian subjects were more likely to endorse the double standard than Japanese and American subjects. However, American men were most likely to endorse the traditional double standard concerning sex early in the dating relationship.

Mate selection preferences: gender differences examined in a national sample.

Social psychologists have devoted considerable theoretical and empirical attention to studying gender differences in traits desired in a mate. Most of the studies on mate preferences, however, have been conducted with small, nonrepresentative samples. In this study, we analyzed data collected from single adults in a national probability sample, the National Survey of Families and Households. Respondents were asked to consider 12 possible assets or liabilities in a marriage partner and to indicate their willingness to marry someone possessing each of these traits. These data extended previous research by comparing men's and women's mate preferences in a heterogeneous sample of the national population and by comparing gender differences in different sociodemographic groups. The gender differences found in this study were consistent with those secured in previous research (e.g., youth and physical attractiveness were found to be more important for men than for women; earning potential was found to be less important for men than for women) and were quite consistent across age groups and races. However, the various sociodemographic groups differed slightly in the magnitude of gender differences for some of the mate preferences.

Control of sodium excretion in patients with cranial diabetes insipidus maintained on desamino-[8-D-arginine]vasopressin.

1. We have studied the response of six patients with cranial diabetes insipidus and six age-matched control subjects to dietary sodium restriction during constant administration of the synthetic vasopressin analogue desamino-[8-D-arginine]vasopressin. 2. Urine flow increased on the first low salt day in the normal control subjects but not in the patients with cranial diabetes insipidus. Body weight fell 1.35 kg in the control subjects but was constant in the patients with cranial diabetes insipidus. 3. Urinary sodium excretion fell at the same rate in both groups. Diurnal variation of urinary sodium excretion and creatinine clearance was present in the control subjects but not in the patients with cranial diabetes insipidus. 4. Changes in plasma sodium concentration and osmolality were similar. Plasma protein concentration increased more in the control subjects (from 69.1 +/- 1.5 to 73 +/- 1.2 versus from 71.7 +/- 1 to 73.2 +/- 1.1 milligrams). The responses of plasma atrial natriuretic peptide, plasma renin activity and salivary aldosterone concentration were similar between the two groups. Salivary aldosterone concentration levels were consistently higher in the patients with cranial diabetes insipidus. 5. We confirm that the low salt diuresis is triggered by release from the antidiuretic activity of arginine vasopressin. In the patients with cranial diabetes insipidus extracellular fluid osmoregulation appeared to be achieved by the movement of water out of and sodium into the extracellular fluid. 6. Absent posterior pituitary function and hypothalamic disturbances did not alter renal sodium conservation.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy of plain abdominal radiography in patients with gastrointestinal bleeding.

To assess the value of plain abdominal radiography in cases of gastrointestinal hemorrhage, the records of 100 such consecutive patients were reviewed. Seventy-eight of the patients had presented to the emergency department, and 22 were inpatients. The radiologic and clinical records were scrutinized to determine the actual effect of the radiologic examination on management of the patient. Three patients had pneumoperitoneum attributed to bowel perforation, and two had confirmed bowel obstruction. In each, the clinical findings suggested the diagnosis. We found no instance of silent gastrointestinal bleeding in which plain radiography contributed important diagnostic information. We conclude that gastrointestinal bleeding is not, in itself, a valid indication for abdominal radiography.

Passionate love/sexual desire: can the same paradigm explain both?

Two decades ago, experimental social psychologists became interested in the emotion of passionate love, "the desire for union with another." Recently, sex researchers have begun to focus on sexual desire, "the desire for sexual union with another," or the loss thereof. In this paper we review what experimental social psychologists have learned about the nature of passionate love in the last two decades and contrast their view of passion with that of sex researchers, especially with regard to the role that anxiety plays in the intensification/diminution of passion. Finally, we suggest that researchers might probably use the same paradigm to study these heretofore separate phenomena.

Measuring passionate love in intimate relationships.

Theorists such as Farber argue that in adolescence passionate love first appears in all its intensity. Both adolescence and passion are "intense, overwhelming, passionate, consuming, exciting, and confusing". As yet, however, clinicians have been given little guidance as to how to deal with adolescents caught up in their passionate feelings. Nor has there been much research into the nature of passionate love. In Section I of this paper, we define passionate love, explain the necessity of developing a scale to measure this concept, and review evidence as to the nature of passionate love. In Section 2, we report a series of studies conducted in developing the Passionate Love Scale (the PLS). We present evidence as to the PLS's reliability, validity, and relationship to other factors involved in close relationships. We end by describing how we have used this scale in family therapy to open conversations about the nature of passionate love/companionate love/and intimacy... and discussing profitable directions for subsequent research.

Effects of ruminal exposure on the amino acid profile of heated and formaldehyde-treated soybean meal.

Rumen cannulated Holstein steers, fed corn silage and a corn-soybean grain mixture twice a day, were used to compare the effectiveness of heat and formaldehyde treatments in preserving the amino acid profile of soybean meal exposed to ruminal fermentation for 12 h. Formaldehyde treatments were 0, .3, .6, and .9 g/100 g soybean meal. Defatted soybean flakes treated at 250, 250, 215, and 180 degrees C for 30, 20, 20, and 25 min, respectively, and unheated soybean meal comprised the heat treatments. The in situ polyester bag technique was used to obtain estimates of ruminal degradation of the treated and untreated soybean meals and to obtain undegraded residues from the soybean meals following 12 h of rumen exposure. Diaminopimelic acid was used to assess the extent of bacterial contamination. Significant amounts of apparent diaminopimelic acid were detected in unexposed samples (2.0 to 7.6% of soybean nitrogen) and in residues (4.8 to 12.7% of residue nitrogen). Significant differences in amino acid contents were detected between untreated and heat-treated soybean meals and their respective residues. Formaldehyde treatment was effective in preserving the original amino acid profile of soybean meal.

Nitrogen utilization and ruminal fermentation in steers fed soybean meal treated with formaldehyde.

Four rumen-fistulated steers averaging 400 kg in body weight were used in a 4 X 4 Latin square arrangement with 18-d periods to investigate the effect of treating soybean meal (SBM) with formaldehyde on nitrogen (N) utilization and ruminal fermentation. Experimental diets, on a dry matter basis, consisted of 42% corn silage, 48.5% cracked corn-mineral mixture and 9.5% SBM treated with 0, .3, .6 or .9% formaldehyde by weight. Dry matter and organic matter digestibilities were not affected by treatment. Formaldehyde treatment of SBM resulted in a linear decrease in N digestibility (P less than .005) and urinary N excretion (P less than .01) and a quadratic increase (P less than .05) in N retention. The depression in apparent N digestibility was small when SBM was treated with .3% formaldehyde. This level of formaldehyde treatment also had little effect on in vitro enzymatic hydrolysis of SBM. Ruminal ammonia-N concentrations were lower (P less than .05) in steers fed formaldehyde-treated SBM. Ruminal pH was lower (P less than .05) at 6 and 8 h postfeeding while volatile fatty acid concentrations were higher (P less than .05) at 8 and 12 h postfeeding for steers fed untreated SBM. Propionic acid (mol/100 mol) decreased linearly (P less than .05) with increasing level of formaldehyde treatment. Urea-N concentrations in plasma were decreased (P less than .001) and plasma-free essential amino acid concentrations were increased (P less than .10) by formaldehyde treatment. Ruminal disappearance of N from polyester bags containing the SBM supplements was greatly reduced (P less than .005) by formaldehyde treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Interaction between nickel and copper in the rat.

Two 42-d experiments were conducted with weanling male rats to study interactions between nickel and copper. In Experiment 1, a low-copper basal diet was supplemented with copper at 0 or 30 ppm and nickel at 0 or 30 ppm. Copper was added in Experiment 2 to a basal copper-deficient diet at a level of 0 or 15 ppm and nickel was supplemented at 0, 15, or 225 ppm. Responses to dietary nickel were dependent upon copper nutriture and experimental duration. Nickel had little effect on growth during the first 21 d of either study when added at low levels (15 or 30 ppm) to copper-deficient diets. Nickel supplementation depressed gains between 21 and 42 d in rats fed copper-deficient, but not copper-adequate, diets. Hematocrits and hemoglobin concentrations were not significantly affected by dietary nickel at 21 d. Nickel supplementation decreased hematocrits and hemoglobin values in copper deficient rats at 42 d in Experiment 1, but not in Experiment 2. Absorption of copper apparently was not reduced by nickel, since tissue copper concentrations were generally not decreased by increasing dietary nickel. Nickel supplementation increased lung and heart copper concentrations in Experiment 2. Liver iron was not affected by nickel, but spleen iron concentrations were reduced by nickel supplementation in copper-deficient rats in Experiment 2. The present studies suggest that nickel acts antagonistically to copper in certain biological processes.

How important is marital fairness over the lifespan?

Do marital relationships become more equitable over time? Is a sense of fairness or equity in marriage equally important at different points across the lifespan? To answer these and related equity/intimacy questions, a sample of middle-aged and older married women was asked to describe the level of equity in their marriages at eight points across their lifespan and their feelings about the equity/inequity at each point. The aggregated results suggested women begin a marriage with a sense of overbenefit, move into a period of underbenefit during their middle years, and finally feel fairly treated in late middle age. The disaggregated data revealed three distinct patterns of equity/inequity over the lifespan. Women's reactions to the level of equity at each stage followed the predicted curvilinear pattern.