lambda N antitermination system: functional analysis of phage interactions with the host NusA protein.

Coliphage lambda gene expression is regulated temporally by systems of termination and antitermination of transcription. The lambda-encoded N protein (pN) acting with host factors (Nus) at sites (nut) located downstream from early promoters is the first of these systems to operate during phage development. We report observations on some of the components of this complex system that, in part, address the way in which these elements interact to render RNA polymerase termination-resistant. (1) The isolation of a conditionally lethal cold-sensitive nusA mutation demonstrates that NusA is essential for bacterial growth. (2) The effect on lambda growth in a host in which the Salmonella NusA protein is overproduced suggests that NusA is essential for N-mediated antitermination in phage lambda. (3) A truncated NusA product, representing only the amino two-thirds of the native protein, is active for both bacterial growth and pN action, indicating that the carboxy end of the molecule may not be a functionally important region. (4) lambda pN can function with the heterologous nut region from Salmonella typhimurium phage P22 when lambda pN is overproduced, demonstrating that lambda pN can function with the nut regions of other lambdoid phages. (5) A single base-pair change in the lambda nutR boxA sequence that was selected to permit a lambda derivative to utilize the Salmonella NusA protein restores lambda growth in the Escherichia coli nusA1 host.

Mucocele of the appendix secondary to obstruction by endometriosis.

A mucocele of the appendix secondary to obstruction by endometriosis is reported and the relevant literature reviewed. The theories of the pathogenesis of appendiceal mucocele are reviewed and discussed. To our knowledge, no similar, well documented case has been reported.

Endometrial carcinoma, stage II: route and extent of spread to the cervix.

The spread of endometrial carcinoma to the cervix was studied in 19 hysterectomy specimens from patients with stage II disease. None received preoperative irradiation. The tumor was found to spread in continuity from corpus to endocervix, where it involved only the surface in five patients, the surface and underlying stroma in 13, and only stroma in one case. Surface only involvement tended to correlate with a lower grade of tumor, less myometrial invasion, and a better prognosis than was associated with endocervical stromal invasion. Review of preoperative endocervical curettings, in the ten patients who underwent this fractional procedure, revealed tumor in all specimens. The authors were unable, however, to distinguish stromal involvement from surface only involvement by study of these curettings.

Iatrogenic endometriosis: substantiation of the Sampson hypothesis.

A 31-year-old woman developed unilateral endometriosis at the site of ovarian implantation to a uterine window. This complication of the Estes procedure resembles the experimental endometriosis induced in rhesus monkeys by causing intraabdominal menstruation. This adds support to the Sampson hypothesis of endometriosis development.

Characterization and survival of patients with serous cystadenocarcinoma of the ovaries.

Factors affecting survival of 241 patients with ovarian serous carcinoma diagnosed and/or treated at New York University Medical Center from 1960 through 1980 are analyzed. Characteristics independently correlated with a favorable prognosis include low tumor stage and grade, presenting sign of a mass, and omentectomy. Patients under 50 years of age have a lower mortality rate (corrected for stage and grade) than older women. The presenting complaints of patients with a poor survival include nausea and/or vomiting, anorexia, and abdominal swelling. For patients with stage I disease neither bilaterality (stage Ib versus Ia) nor transcapsular extension of tumor adversely affected prognosis. However, patients with stage I disease with ascites appear to have a survival experience similar to patients with stage III disease.

The effect of prostaglandin F2alpha on corpus luteal function in the rhesus monkey.

An experimental model was set up to show whether PGF2alpha caused luteolysis when adequate chorionic gonadotropin was administered. Four mature female rhesus monkeys were studied for two cycles each. HCG was given after ovulation until day 36. PGF2alpha was given on days 28 and 29 in one cycle, while the other served as control. In five out of the total eight cycles studied, the luteal function was maintained up to day 36. However, gradual decline of serum progesterone was noted after days 22 to 26 despite the continuous administration of hCG. Administration of PGF2alpha on days 28 and 29 did not accelerate CL regression. It was also noted that hCG in doses of 500 IU did not maintain CL function in three of four cycles when surgical stress was added.

Effects of the Progestasert on the menstrual pattern, ovarian steroids and endometrium.

PIP: 193 women were fitted with a progesterone-releasing IUD (Progestasert) and followed for a total of 1823 woman-months (minimum 1 year use); 108 were nulliparous and 84 parous. Patients were examined at 1, 6, and 12 months and were interviewed to assess length of cycle, duration of flow, amount of flow, pain associated with menstruation, and intermenstrual bleeding and pain. Endometrial biopsies were performed on 45 patients and serum estrogens and progesterone measurements were made. There were .5 pregnancies/100 woman-years during the first 12 months of use. Overall expulsion rate was 7.4/100 woman-years; 4.8 and 10.7 corresponding to nulliparous and parous, respectively. 77% of expulsions occurred within 1 month of insertion. Intermenstrual bleeding occurred in small amounts and during the first 2 months of use. Menstrual flow and dysmenorrhea were significantly reduced. The overall continuation rate was 76.0 + or -3.2. Normal ovulatory function continued after insertion. Endometrial biopsies demonstrated glandular atrophy and decidual reaction after 12 months use.^ieng

Histochemical studies of glycogen metabolizing enzymes in normal and abnormal human cervical epithelium.

The stratified squamous epithelium in eleven cervical cone biopsies was studied for localization of glycogen, glycogen synthetase, branching enzyme and amylophosphorylase in areas showing normal, dysplastic epithelium and carcinoma in situ. In the normal cervix glycogen was found to be present in the intermediate and superficial cells, amylophosphorylase activity was present in the basal and parabasal layers and the branching enzyme was found largely in the lower and middle zone of the intermediate layer. As the degree of abnormality increased, a progressive decrease of glycogen and branching enzyme and increasing amylophosphorylase was found, suggesting that amylophosphorylase could be a constitutive enzyme in normal, dysplastic and neoplastic cells. The method for localization of glycogen synthetase activity was not sufficiently reproducible nor sensitive for conclusions to be drawn.

Abnormal Papanicolaou smears found in victims of sexual assault.

Four women, at the time of treatment for rape, were concurrently found to have abnormal Papanicolaou (Pap) smears. It is suggested that all women who seek emergency care after sexual assault have Pap smears taken at that time if there is no record of a negative Pap smear within the preceding six months.

The role of colposcopy in the management of cervical intraepithelial neoplasia during pregnancy and postpartum.

We made a colposcopic study of 149 pregnant patients with suspicious or positive Papanicolaou smears. Characteristic changes in the colposcopic images were noted to be physiologic eversion of the squamocolumnar junction, glandular hypertrophy and decidual reaction. Fourteen percent of the patients with suspicious Papanicolaou smears were normal by colposcopic examination. Sixteen percent of colposcopic interpretations of the pregnant cervix suggested CIN when in fact none was present on tissue specimens obtained by directed biopsies. There was a good correlation between colposcopic clinical diagnosis and directed tissue biopsies (79%). Furthermore, there was a strong correlation between colposcopically directed tissue biopsies and subsequent cone and hysterectomy specimens (29 cases). All cases with suspicious cytology and CIN based on colposcopic findings (130 patients with satisfactory colposcopic examinations) were managed conservatively. No invasive neoplasia was subsequently detected in this group. Morbidity for colposcopically directed biopsies in pregnancy was negligible. No massive hemorrhage, premature labor, abortion or infection occurred. Treatment for CIN was accomplished following the puerperium by cryocauterization (101 cases), conization (8 cases) or hysterectomy (21 cases). Colposcopy cannot be a substitute for histologic diagnosis. However, it supplies enough data to avoid unnecessary cone biopsies. Only 19 diagnostic cone biopsies were performed during pregnancy with the indication of positive cytology and unsatisfactory colposcopy.

On the assessment of children in suspected child sexual abuse in light of Daubert and Frye: limitations of profiles and interviews as scientifically grounded evidence.

Practice with children and families entails the higher probability of encountering forensic issues of child sexual abuse (CSA) assessments for which relatively few psychologists, allied mental health and legal practitioners are sufficiently well equipped. The current paper reviews some of the key psycholegal issues bearing on the assessment of suspected CSA in the contexts of: (a) recent psycholegal precedence and common law rules of reliability and admissibility of CSA profile evidence; (b) the empirical problems with CSA syndromes; and (c) the problems with children's interviews as evidence, and suggestions for valid interviewing guidelines supporting free recall. These psycholegal issues are presented in terms of the Frye standard for expert testimony and the Federal Rules of Evidence, with recent American and Canadian case illustrations, such as Daubert v. Merrell Dow Pharmaceuticals, Hadden v. State of Florida (1997), Bighead v. The United States of America (1997), Diocese of Winona v. Interstate Fire & Cas. Co. (1994), and R. v. Simpson (1996).

In their own words: how hospitals present corporate restructuring in their annual reports.

Hospitals operate in an environment with strong institutional pressures, in which legitimacy is critical to an organization's access to resources. In such an environment, organizations can increase their legitimacy by engaging in activities or discussing them in a manner that signals that the organization adheres to values held by its costituents. One important symbol of organizational actions or intentions is the formal organizational structure. When hospitals began to adopt a corporate structure in the early eighties, the way in which they presented this decision to the public was as important as the technical merits of the decision itself. This study investigates, through an analysis of annual reports, what hospitals signaled about their adoption of a corporate structure. The findings suggest that through restructuring, hospitals signaled that they were in line with practices advocated in the industry and literature (e.g., adhering to business values, protection of assets, or increasing patient services). By presenting multiple reasons for restructuring, hospitals could signal their attention to the needs of various constituents, and by touching only briefly on each reason, they could ignore the potential conflict between demands such as lower hospital cost and increased services. The findings also suggest that the first hospitals to adopt a corporate structure sought to educate constituents about restructuring by devoting a greater share of their annual report to the topic than later adopters and by enumerating a larger number of anticipated benefits from the structure, which would have enhanced the innovation's legitimacy in the early years.

Relational scaffolding of school motivation: developmental continuities in students' and parents' ratings of the importance of school goals.

The authors investigated whether parents and students are consistent, over grade levels, in the importance they assign to school goals. Elementary and high school students (n = 178) and their parents (n = 130) completed a questionnaire addressing the personal importance of students' school goals, defined in terms of school success. Parent-child consistencies in the rating patterns of school goals over grade levels were more common than were inconsistencies. These developmental consistencies support the position that students' school goals are embedded within the parent-child relationship (J. Youniss, 1980; J. Youniss & J. Smollar, 1985) and are scaffolded within it (J. S. Bruner, 1975; L. S. Vygotsky, 1978). Potential sources of relational and phenotypic influences on school goals are discussed, as is the need for effective friendship management and school performance in high school.

Benefits and disadvantages of corporate restructuring--the hospital view.

Many hospitals have adopted a corporate structure to improve management and gain economic benefits. Our study of Massachusetts hospitals found that for only a few had these anticipated advantages materialized, while many found that the new structure entailed added bureaucracy and other disadvantages. The findings suggest that hospitals adopt or keep the structure not only for possible economic reasons but also to sustain their legitimacy in the eyes of important stakeholders.

Total quality management: field of dreams?

Total quality management promises to reconcile cost/quality conflicts, increase customer satisfaction, and improve hospitals' competitiveness as well as operational and financial performance. This article reviews the hospital literature on TQM and concludes that there is little evidence to substantiate these claims. The article concludes with implications for research and management.

The implementation of total quality management in hospitals: how good is the fit?

Total quality management has become popular among hospitals because of its promise to reconcile trade-offs between cost and quality. However, assumptions inherent in TQM may not translate to the hospital environment: hierarchical management control over the technical core and the dominance of rational decision making. This article considers these two assumptions and suggests that the application of TQM to hospitals take them into account because they may compromise its success.

Ambulatory care centers: are they a competitive advantage?

A common assumption found in literature about hospital-sponsored ambulatory care centers is that they increase inpatient admissions and market share. However, little empirical evidence exists to substantiate these assumptions, and it is reasonable to question their accuracy given the nonemergency, routine nature of many of the visits to ambulatory care centers. This study of hospitals in four Massachusetts markets in which at least one hospital sponsored an ambulatory care center questions whether inpatient admissions and market share are affected. The findings indicate that at least in these four markets, ambulatory care centers do not have the desired effects, relative either to past performance or to competing hospitals.