Management of life-threatening haemoptysis in an area of high tuberculosis incidence.

BACKGROUND: Emergency admissions with life-threatening haemoptysis in an area of high tuberculosis (TB) incidence at the University of Stellenbosch and Tygerberg Academic Hospital, South Africa. It is unclear if lung resection is regularly indicated to prevent recurrence following bronchial artery embolisation (BAE). OBJECTIVE: To prospectively evaluate risk factors for recurrence as selection criteria for surgery following embolisation: lack of complete cessation of haemoptysis, need for blood transfusion, presence of aspergilloma and absence of active TB. DESIGN: Prospective interventional study with 1-year follow-up. RESULTS: Within a 7-month period, 101 consecutive patients were admitted. Seven were excluded and 12 died shortly after admission. Haemoptysis ceased on medical treatment alone within 24 h in 21 of the remaining 82 patients. Their 1-year mortality was 10%. Eleven of 61 patients referred for emergency embolisation died before discharge. Of the 50 patients remaining at risk of recurrence, 38 (76%) were at low risk and 12 (24%) at high risk. Five of these patients (10% of those at risk) underwent surgery. Patients at low risk and operated patients had an uneventful course over 1 year, but two deaths occurred among the seven inoperable patients at high risk. CONCLUSION: Lung resection surgery following successful BAE for life-threatening haemoptysis can safely be avoided in patients at low risk of recurrence.

The effects of glucose on nonmemory cognitive functioning in the elderly.

The present study evaluated the role of glucose in the performance of a series of memory and nonmemory neuropsychological tasks. Each of the 28 healthy (no evidence of diabetic or dementing disease), elderly (mean age = 73), subjects participating in the study were tested under each of two conditions (50 g glucose or 27.3 mg saccharin) in a counterbalanced fashion. While actively manipulating glucose levels in participants, blood glucose (BG) levels were monitored to evaluate the effectiveness of individual subject's regulation of ingested glucose. It was hypothesized that glucose would enhance performance on a memory measure (Rey/Taylor Figure) as well as other nonmemory measures (e.g. design fluency, trail making test, etc.). A repeated measures, counterbalanced design was used to evaluate the direct manipulation of glycemic condition. Results reveal an enhancement effect on both the recall of the Rey/Taylor Figure as well as verbal fluency and figural fluency. A significant correlation between glycemic regulation and performance on a test of divided attention (dichotic listening) was also evident (r = -0.47). These findings suggest that a specific facilitation of retrieval mechanisms may account for enhancement of both memory and fluency performance.

Reappraisal of empyema thoracis. Surgical intervention when the duration of illness is unknown.

The timing of surgical treatment of empyema remains controversial. Traditionally, thoracotomy is performed either within three weeks of diagnosis or delayed until presumed pleurodesis occurs. Often, these patients are moribund and the duration of illness impossible to determine. We report our surgical results in seven patients with a deteriorating clinical course and multiple loculations which persisted after tube thoracostomy and would not have responded to multiple thoracostomies. Five patients required decortication. One required lobectomy for an abscess which developed on the contralateral side six weeks after discharge. There were no deaths or recurrences of empyema. Average times from surgery to tube removal and to discharge were six to 12 days, respectively. We conclude that one can safely and cost-effectively treat these patients surgically even when the duration of illness and presence of pleurodesis are unknown, and that the postoperative course will be uncomplicated.

Assessment of coping with high-risk situations for exercise relapse among healthy women.

Twenty-nine healthy women's coping responses to situations interfering with planned exercise and subsequent patterns of relapse were evaluated. Participants adopted exercise without formal intervention; their activity was monitored prospectively for 14 weeks. Cardiovascular fitness was assessed at baseline, 3 months, and 9 months. At 1-week exercise activity lapse was experienced by 66% of participants, and 41% experienced a 3-week relapse episode. Relapsers initially reported significantly fewer behavioral and cognitive coping strategies in response to high-risk situations compared with nonrelapsers, controlling for baseline level of self-motivation. Coping responses also predicted short-term fitness. These data demonstrate the importance of coping or problem-solving ability in exercise and suggest that relapse may result from ineffective coping with exercise barriers.

Social support networks among families of children with craniofacial anomalies.

Investigated the social support available to families of children born with craniofacial anomalies and the perceived degree of satisfaction derived from these relationships. Thirty-six children (1 month to 5 years old) born with craniofacial deformities (FD) were matched by age and sex to 36 children with no significant physical or behavioral problems. The Social Support Questionnaire-Revised, the Revised Denver Developmental Screening Test, and a semistructured interview were administered. Results indicated that parents of FD children reported less available social support and were significantly less satisfied with their support. Parents of children who had more severe physical impairments and were rated as less attractive reported having less available and less satisfying social support. In particular, the social competence of the child was the most important predictor of parental social support. This result is interesting as the parents of FD children appeared to underreport the presence of behavioral-psychological problems in their children.

A review of methods and instruments for assessing externalizing disorders: theoretical and practical considerations in rendering a diagnosis.

This review addresses the most current and widely used methods of assessing childhood and adolescent externalizing disorders. Interviews, rating scales, and self-report instruments are described, and their strengths and weaknesses are discussed. Direct observational techniques in naturalistic and analogue settings are also reviewed. Throughout the article, commentary is offered regarding the psychometric adequacy and clinical validity of these instruments. It is suggested that, although the instruments presently used to assist in diagnosing externalizing disorders generally possess adequate reliability and representational validity, evidence of elaborative validity is lacking. Clinicians and researchers are encouraged to adopt a broader conceptualization of the diagnostic process, to question existing standards for establishing validity, and to consider alternative means of demonstrating diagnostic utility.

Effect of dietary copper deficiency on the distribution of dopamine and norepinephrine in mice and rats.

Dietary copper deficiency was produced in Swiss albino mice and Sprague Dawley rats to determine the organ specificity of alterations in norepinephrine (NE) and dopamine (DA) concentrations and the relationship with organ copper levels. A 5-week dietary treatment was used, which started 1 week after birth for mice, initially via dams, and 3 weeks after birth for rats. Mice offspring (6 weeks of age) and rats (8 weeks of age) maintained on a copper-deficient (-Cu) treatment were compared with copper-adequate (+Cu) controls. Compared with +Cu animals, -Cu mice and rats were anemic and had low (<1% of +Cu) ceruloplasmin activities but normal body weights. The -Cu mice had organ copper concentrations ranging between 30% and 65% of +Cu values for eight organs studied, with the thymus being the least depleted. For -Cu rats, the range was 15% to 65%. Significant reductions in NE concentration were observed in the heart, pancreas, and spleen of -Cu mice. Elevated DA levels were observed in all organs except the brain. For -Cu rats, the NE level was lower in the heart and the DA level was higher in both the heart and spleen compared with +Cu rats. Dopamine elevation in the heart and spleen for both -Cu mice and rats was four- and fivefold higher, respectively. Adrenal catecholamine levels were only slightly changed by copper deficiency in mice or rats. Urinary levels of both NE and DA were higher in -Cu rats and mice. Plasma and heart tyrosine levels were not altered in -Cu mice. Elevated DA in -Cu rodents may be due to limiting dopamine-beta-monooxygenase. Higher urinary NE and lower organ NE may be due to a combination of decreased synthesis and enhanced turnover. The magnitude of decreased organ copper was not predictive of altered catecholamine pool size.

Childhood depression and aggression: a covariance structure analysis.

The purpose of the present study was to: (a) evaluate the comorbidity of depression and aggression in a community sample of school-age children; (b) demonstrate the use of confirmatory factor analysis as a statistical tool in the assessment of the construct validity of childhood depression and aggression measures; and (c) using multisample analysis and structural equation modeling, examine the generalizability of comorbidity across two potential moderating or mediating variables (i.e. gender and peer unpopularity). A series of hypothetical models was tested to identify the number of factors represented by the data, the convergent and discriminant validity of the measures, the relationship between the latent variables of childhood depression and aggression, the influence of method-specific variation, and structural relationships among the latent constructs. Results supported a two-factor comorbidity model (childhood depression and aggression) and the presence of method effects (i.e. rater bias). Though the basic measurement model identified substantial comorbid symptoms and was generally invariant across gender, boys' self-reports of symptomatology evidenced poor validity. The structural equation models supported the independent effects of peer aggression and unpopularity on depression for both boys and girls, though aggression may be somewhat more strongly related to unpopularity among girls. Results were consistent with psychiatric investigations of comorbid depressive and aggressive disorders and emerging developmental psychopathology research on the socioemotional development of aggression and depression in youth.

Caregivers of Alzheimer's disease and stroke patients: immunological and psychological considerations.

Demands of caregiving for Alzheimer's Disease (AD) patients have been reported to affect the psychological and immunological health of the caregivers. The question of whether the observed psychological and immunological changes were unique to AD caregivers was addressed in this study. The subjects were 25 caregivers of AD patients, 25 caregivers of stroke patients, and 25 noncaregiving individuals. Comparisons of all subjects made on several psychologic and immunologic indices indicated that the AD caregiving group was more psychologically distressed than the stroke group, and both of these groups were more psychologically distressed than a control group. With respect to immunologic function, there were no differences among the three groups. Implications of the findings are discussed.

The impact of alcohol and alcohol expectancies on male perception of female sexual arousal in a date rape analog.

The impact of alcohol and alcohol expectancies on men's perception of female sexual arousal and men's ability to discriminate accurately female sexual intentions in a dating situation was examined. In a 2 (alcohol) x 2 (expectancy) balanced placebo design, men were exposed to an audiotape of a date rape and asked to signal when the man should stop making sexual advances. On 4 occasions during the vignette, participants rated how sexually aroused the woman on the tape was at that moment. Relative to controls, participants who consumed alcohol or expected to consume alcohol took significantly longer to identify the inappropriateness of the man's sexual behavior toward his date. Similarly, alcohol participants also rated the woman's arousal level significantly higher at the first 2 refusals. Implications of the results are discussed.

Surgical management of synchronous coronary artery disease and multiple aortic stenosis: a case report with brief review of the literature.

One-stage surgery was successfully performed in a 44-year-old hypertensive man with uncontrolled angina, multiple coarctations of the thoracic and abdominal aorta, and a previous subtotal gastrectomy. There was a gradient of 120 mm Hg between the thoracic and abdominal aorta. A graft was placed retroperitoneally from the infrarenal aorta to the ascending aorta and was followed by a coronary artery bypass graft. Twenty-four months postoperatively, the patient was free of angina, and his hypertension was easily controlled.

HLA DQA1 and Polymarker validations for forensic casework: standard specimens, reproducibility, and mixed specimens.

This study describes the testing performed by the Minnesota Forensic Science Laboratory (MFSL) to validate the Amplitype DQA1 and Amplitype Polymarker (PM) PCR Amplification and Typing Kits before implementation for casework. All studies were based on the analysis of mock forensic case samples, which were assembled from various biological samples from individuals at the MFSL. To address the validation of standard specimens, DNA was isolated from semen, vaginal secretions, saliva, urine, and blood samples. Typing results from all tissues from a particular individual yielded the same typing results using both the DQA1 and PM systems. Reproducibility between laboratories was evaluated by having duplicate samples analyzed by a second laboratory. The Roche Biomedical Laboratories (RBL) were sent a duplicate set of mock cases and all analyses including extraction, quantitation, amplification, and typing were performed at the RBL using their established testing procedures. All typing results for both laboratories, from the approximate 30 single source samples analyzed, were in agreement. Mixed specimens were evaluated by examining the results obtained from semen/vaginal, semen/saliva, semen/blood, semen/ urine, and semen/vaginal/blood mixtures. All typing results of these mixtures for both laboratories were in agreement. It was determined that by incorporating a wash step of the sperm cell pellet, a complete separation of the nonsperm cell fraction was more likely to be attained. After completing the above studies, as well as population studies, environmental insult studies, and proficiency testing, the MFSL determined that both kits were suitable for use on forensic casework.

Parental correlates of socially neglected, rejected, and average children. A laboratory study.

The present study examined the relationship between parent-child interaction and a child's social status. A sample of children was screened to identify three groups rated as neglected, rejected, or average by both peer and teacher nomination. Children were observed interacting with their mothers while working on a cooperative task. Parent behaviors were coded for commands, suggestions, explanations, questions, and praise. Results indicated that relative to parents of neglected and rejected children, parents of average youngsters emitted significantly more commands, suggestions, explanations, questions, and praise. These findings suggest that a relationship may exist between parent behavior and children's social status. Implications of these findings are discussed.

Child sociometric status and parent behaviors. An observational study.

The relationship between parent-child interaction and child sociometric status was examined. Third- and fourth-grade children rated as socially neglected, rejected, or average by both peer and teacher nomination were videotaped working on a task with their parents. Parents of children identified as neglected engaged in fewer overall interactions with their children than parents of both rejected and average children. Mothers of neglected and rejected boys issued more commands than mothers of average children. Fathers of neglected boys issued more negative statements than fathers of either rejected or average children. Moreover, mothers and fathers of neglected and rejected children exhibited greater differences between one another in their use of commands than parents of average children. Mothers and fathers of rejected children exhibited greater differences between parents in their use of questions than parents of neglected or average children. The implications of these findings are discussed.

Validation studies for the genetic typing of the D1S80 locus for implementation into forensic casework.

A series of validation experiments were designed to evaluate, according to the Technical Working Group on DNA Analysis Methods (TWGDAM) guidelines, the analysis of the D1S80 locus for casework implementation. Approximately 400 samples from three different populations (Minnesota Caucasian, Minnesota African Americans, and Minnesota Native Americans) were typed to determine allele frequencies. Simulated forensic type specimens (blood, saliva, hair and semen, or vaginal secretions) were typed to demonstrate that deoxyribonucleic acid (DNA) extracted from various tissues of an individual yield the same D1S80 type. Dilution studies were performed and it was determined that a wide range of input DNA (0.5 ng to 40.0 ng) will consistently yield typeable results. The evaluation of DNA from various animals showed that the D1S80 locus is specific to human DNA within the limits of the parameters tested. The reproducibility of the system was tested by duplicate analysis of approximately 200 population samples. Duplicate samples were analyzed on both horizontal and vertical gel systems. In addition, simulated forensic specimens were analyzed by two independent laboratories: the Minnesota Forensic Science Laboratory (MFSL) and the Roche Biomedical Laboratories (RBL). All analyses, including extraction, quantitation, amplification and typing, were performed independently. All typing results for both laboratories were in agreement. By the analysis of mixtures from various simulated casework type mixtures, it was demonstrated that the D1S80 typing system is suitable for analyzing mixtures. In addition to the simulated casework, evidentiary samples from several adjudicated cases previously analyzed by restriction fragment length polymorphism (RFLP) analysis and/or DQA1 were typed at the D1S80 locus. The D1S80 results were consistent with previous RFLP and/or DQA1 results regarding inclusions/exclusions.

The effect of luminol on presumptive tests and DNA analysis using the polymerase chain reaction.

This study was designed to test the following factors involved with processing luminol treated bloodstained evidence: 1) The reactivity of other presumptive chemical color tests, phenolphthalin (PT) and tetramethylbenzidine (TMB), following the application of the light emitting luminol presumptive test. 2) The effect of different cleanings of various bloody substrates on the luminol test. 3) The effect of different cleanings of various bloody substrates on the ability to obtain DNA suitable for PCR testing. 4) The ability to extract DNA from luminol treated bloodstained substrates using three extraction techniques. 5) The effect of spraying washed and unwashed bloodstains on various substrates with luminol on the ability to correctly type the DNA using PCR. Our findings indicated that luminol did not adversely effect the PCR testing and did not interfere with the PT and TMB presumptive tests for blood. It was determined that the substrate and the method of cleaning were the major factors affecting DNA yield and the ability to type the bloodstains using PCR based technologies.

Thumbsucking as related to placement and acoustic aspects of /s, z/ and lingual rest postures.

Three hundred seventy-one second graders in rural public schools were evaluated for thumbsucking, rest and swallow postures of the tongue, and articulatory placement and acoustic aspects of /s,z/. Significant relationships were observed between thumbsucking and lower dental or interdental rest and swallow postures as well as acoustic errors for /s,z/. The implications of these relationships are discussed.

Open mouth posture and cross-sectional nasal area in young children.

A biracial sample of two-hundred ninety-six children were assessed for open-mouth posture (OMP) in the natural environment. In addition, rhinometry was performed on 288 of the youngsters. Means were computed for percent OMP and cross-sectional nasal airway. Results indicated that in general these children exhibited relatively high rates of OMP. Boys displayed significantly greater OMP than girls. However, children exhibiting OMP on 80% of the observation intervals had significantly smaller cross-sectional nasal areas than the youngsters who displayed OMP on fewer than 20% of observation intervals. The implications of the findings were discussed.

Females' perception of date rape: an examination of two contextual variables.

PIP: This study examined the role of perceived token resistance and previous sexual contact on women's ability to discriminate when a female wants her partner to stop his sexual advances. Participants included 101 White female undergraduate students and were randomly assigned to one of the four conditions: 1) perceived resistance with genital contact; 2) no resistance with genital contact; 3) perceived resistance with no genital contact; and 4) no resistance without genital contact. Subjects listened to an audiotaped date rape after being informed of the couple's sexual history based on the condition assigned to them. They were also informed that the couple had been on five previous dates, in which the man had manipulated the woman's breasts or genitals. In addition, the woman did not object to this contact, or the woman initially objected to the contact but subsequently stopped resisting contact. Participants in the perceived token resistance conditions took significantly longer to determine when the man should refrain from attempting further sexual contact. The findings of this study could be used to increase information on date rape, to educate individuals about the responses associated with date rape, and to reinforce rules concerning appropriate sexual behavior.^ieng

Myofunctional and dentofacial relationships in second grade children.

One hundred and thirty-three second graders in rural public school were assessed on a number of dental, skeletal, and oral muscle function measures. Correlational analyses were conducted in order to determine whether specific myofunctional variables were associated with dentofacial development. Significant relationships were observed between open mouth posture and a narrow maxillary arch and long facial height. Labial and lingual rest and swallow patterns were also related to poor coordination of lip and tongue movements.