Synchronous metastatic renal cell carcinoma to the genitourinary tract: two rare case reports and a review of the literature.

Synchronous metastasis of renal cell carcinoma (RCC) to the ureter or the bladder represents an extremely rare event. We report one case of synchronous metastasis of RCC to the ipsilateral ureter and one case of solitary synchronous metastasis of RCC to the urinary bladder. We review the literature and discuss possible mechanisms of dissemination. We discuss the surgical management of metastases from RCC as well as the surgical options in the treatment of these rare occurrences.

Comparison of electronic microarray to enzyme hybridization assay for multiplex reverse-transcriptase PCR detection of common respiratory viruses in children.

A new assay, composed of the NGEN RVA (Nanogen, Inc., San Diego, CA; Prodesse, Inc., Waukesha, WI), which is a pair of analyte-specific reagents that allow the multiplex reverse transcriptase polymerase chain reaction (RT-PCR) and electronic microarray detection of influenza virus A and B, respiratory syncytial virus A and B, and human parainfluenza virus types 1, 2, and 3, was evaluated in comparison with the Hexaplex (Prodesse), a multiplex RT-PCR-enzyme hybridization assay. Comparisons included the detection of respiratory viruses from whole-virus stocks (ATCC) and from frozen pediatric respiratory specimens collected at Children's Hospital of Wisconsin between 1991 and October 1998. After the retesting of six indeterminants and 20 discrepants, overall agreement improved to 96% on the positives and 100% on negatives, with only eight specimens still discrepant. The RVA reagents allow a rapid, sensitive, and specific assay for detecting seven of the most common respiratory viruses in children.

Rapid, high fidelity analysis of simple sequence repeats on an electronically active DNA microchip.

We describe a method for the discrimination of short tandem repeat (STR) alleles based on active microarray hybridization. An essential factor in this method is electronic hybridization of the target DNA, at high stringency, in <5 min. High stringency is critical to avoid slippage of hybrids along repeat tracts at allele-specific test sites in the array. These conditions are attainable only with hybridization kinetics realized by electronic concentration of DNA. A sandwich hybrid is assembled, in which proper base stacking of juxtaposed terminal nucleotides results in a thermodynamically favored complex. The increased stability of this complex relative to non-stacked termini and/or base pair mismatches is used to determine the identification of STR alleles. This method is capable of simultaneous and precise identification of alleles containing different numbers of repeats, as well as mutations within these repeats. Given the throughput capabilities of microarrays our system has the potential to enhance the use of microsatellites in forensic criminology, diagnostics and genetic mapping.

Predictive value for coronary heart disease of baseline high-density and low-density lipoprotein cholesterol among Fredrickson type IIa subjects in the Helsinki Heart Study.

In the Helsinki Heart Study 2,590 subjects (63.5% of total) had a type IIa hyperlipoproteinemia at screening. Baseline low-density lipoprotein (LDL) cholesterol (mean 193 mg/dl; 5 mmol/liter) and high-density lipoprotein (HDL) cholesterol (mean 50.2 mg/dl; 1.3 mmol/liter) showed no statistical correlation (r = 0.046). Both the placebo (1,293 patients) and gemfibrozil groups (1,297 patients) were divided into tertiles by baseline HDL and LDL cholesterol to determine the relative predictive risk of developing coronary artery disease. In a population with elevated LDL cholesterol, it is significant that the lipoprotein fraction with the greatest predictive value was HDL cholesterol. The severity of LDL cholesterol elevation did not provide any differential predictive value for coronary artery disease.

Quinapril and hydrochlorothiazide combination for control of hypertension: assessment by factorial design. Quinapril Investigator Group.

A factorial design method was applied in this multicentre trial of the angiotensin-converting enzyme inhibitor quinapril hydrochloride (Accupril) in combination with the diuretic hydrochlorothiazide (HCTZ) to assess the additive effects of the combination versus monotherapy, to characterise the dose-response relationship of each drug in the presence of the other and to determine if quinapril would attenuate the hypokalemic effect of HCTZ. Following a two to four week placebo-baseline period, 460 qualifying patients with a DBP > or = 100 mmHg and < or = 115 mmHg were randomised to an eight week double-blind phase with one of 16 parallel treatments: placebo, one of three doses of quinapril monotherapy, one of three doses of HCTZ monotherapy or one of nine possible corresponding combinations of quinapril and HCTZ. Mean reductions in sitting SBP/DBP at trough with combination therapy ranged from 7.8 mmHg/7.2 mmHg to 19.6 mmHg/15.1 mmHg (n = 458). Results of the response surface analyses indicate that the effects of the two drugs were additive and that the maximum antihypertensive effect of quinapril in combination with HCTZ within the doses studied is achieved approximately at a dose of 26 mg quinapril and 25 mg HCTZ. The degree of attenuation of the hypokalemic effect of HCTZ was directly related to the dose of quinapril. At 40 mg quinapril, the HCTZ dose-related decreases of serum potassium were not apparent and overall hypokalemic effects were attenuated by quinapril. Thus, the combination of quinapril and HCTZ given once daily provided additive antihypertensive effects of predictable degrees and the addition of quinapril attenuated the hypokalemic effect of HCTZ.

Computer-assisted instruction for decision making in food systems management.

Although effectiveness of the CAI case study simulations was not immediately made evident by the results of the objective measurements used, students and faculty members involved responded positively to the CAI experience and expressed interest in continuation and expansion of the CAI method. The use of CAI in a dietetic education program was feasible for this coordinated dietetics program. Further research is recommended on the use of CAI to meet both cognitive and affective competencies in a dietetic education program. Research in evaluation of effectiveness of CAI is essential when objectives to be met are affective in nature.

Mentoring: implications for career development.

Mentoring can be viewed as a set of behaviors applied toward a relationship that provides guidance and support in career development. This article reviews some of the current literature on mentoring and presents concepts that may benefit persons in the profession of dietetics. The process of mentoring provides mentors with career and psychosocial rewards, while protégés benefit from a wide variety of career and/or social opportunities made available through the relationship. Rewards for each member of the dyad appear dependent on the age and needs of each person. An alternative to mentoring, known as the patron system, has been proposed; that system places mentoring at the end point of a continuum which includes peer pals, guides, and sponsors. Networking, a crucial aspect of career development, broadens opportunities for prospective mentors or sponsors and protégés to meet and interact. Entry-level dietitians can benefit from mentor-protégé relationships which groom young professionals for leadership positions. The question to be answered is how such relationships can be supported in our various work settings. A model of the mentoring process in dietetics is proposed.

Analysis of the decision to select a conventional or cook-chill system for hospital foodservice.

OBJECTIVE: The objectives of this study were to determine what variables hospital foodservice directors consider when selecting a conventional or cook-chill system, to determine the importance of each variable considered, and to compare decision variables by type of foodservice system. DESIGN: Survey questionnaire. SUBJECTS/SETTING: Hospital foodservice directors in general, medical-surgical hospitals who had been involved in the decision to select a conventional or cook-chill system (N = 127). STATISTICAL ANALYSIS: Analysis of variance and chi 2. RESULTS: The decision process used by foodservice directors who selected a conventional system appears to differ significantly from the process used by directors who selected cook-chill systems. However, directors in this study who selected a cook-chill system were more likely than those who selected conventional systems to consider more issues in the decision process, visit other operations, place more importance on return on investment and projected labor costs, calculate more values, consider both conventional and cook-chill options, and use nonfoodservice personnel such as manufactures' representatives and consultants. APPLICATIONS: Results of this research suggest that the decision process to select a foodservice system in hospitals is complex and is one that foodservice directors will likely be involved in several times throughout their careers. Directors who have made such decisions appear to consider many issues, both quantitative and qualitative, when selecting either a conventional or cook-chill system. Regardless of the system chosen, directors indicated that numerous issues were important in the decision.

Profitability and acceptability of fat- and sodium-modified hot entrees in a worksite cafeteria.

OBJECTIVES: To compare the acceptability of fat- and sodium-modified entrees before and after implementation of a marketing program and to determine the effect offering and marketing these healthful entrees had on total cafeteria and entree sales in a worksite cafeteria. DESIGN: The research was conducted in five phases, including sales data collection, acceptance testing of unmodified hot entrees, acceptance testing of modified entrees, and implementation of a marketing campaign for promoting low-fat, sodium-controlled food selections. SETTING: The Kansas Farm Bureau and Affiliated Services (KFB) employee cafeteria. SUBJECTS: KFB employees who ate lunch in the employee cafeteria and were willing to participate in the study. MAIN OUTCOME MEASURES: Sales data (percent of customers purchasing a modified entree and sales of modified entree as a percent of total sales); nutrient analysis data (energy, grams of total fat, percent of energy from fat, milligrams of cholesterol, and milligrams of sodium); and acceptability data (11 characteristics were measured using a seven-point hedonic scale). STATISTICAL ANALYSIS PERFORMED: General linear model analysis of variance was used to compare sales data from phases 1 to 5 and to compare acceptability data from phases 2 to 4. RESULTS: No significant differences in sales data were observed during the 7-month study. No significant changes in overall acceptability were found for any entree. However, customers tended to rate overall acceptability higher when entrees were marketed as lower in fat and sodium. APPLICATIONS/CONCLUSIONS: Customers in worksite cafeterias may be more willing to tolerate changes in flavor attributes when modified entrees are marketed as "healthful" and nutrition information is available.

Comparative mutagenicity of aliphatic epoxides in Salmonella.

37 aliphatic epoxides comprising 6 subclasses (unsubstituted aliphatic epoxides, halogenated aliphatic epoxides, glycidyl esters, glycidates, glycidyl ethers and diglycidyl ethers) were tested, under code, for mutagenicity in Salmonella strains TA98, TA100, TA1535 and TA1537 and/or TA97 with and without metabolic activation using a standardized protocol. The 4 halogenated aliphatic epoxides and the 4 diglycidyl ethers were all mutagenic. The 2 glycidates were negative in all strain/activation systems used while all 5 glycidyl esters were mutagenic. 3 of the 8 unsubstituted aliphatic epoxides and 11 of the 12 glycidyl ethers were mutagenic. Glycidol also was mutagenic whereas 9,10-epoxyoctadecanoic acid, 2-ethylhexyl ester was not mutagenic. Of the 28 mutagenic compounds, all but neodecanoic acid, 2,3-epoxypropyl ester and 2-ethylhexyl glycidyl ether were detected in TA100 without activation. The latter two were detected only with activation in TA100 and TA1535. The majority of the other 26 chemicals were also mutagenic in TA1535 without activation. Good intra- and interlaboratory reproducibility was seen in the results of each of the 4 chemicals tested in more than one set of experiments. The current results confirm and extend the observations of other investigators regarding structural effects on the mutagenicity of members of the aliphatic epoxide class of chemicals.

The safety profile of quinapril: is there a difference among ACE inhibitors?

The safety of quinapril hydrochloride, a new nonsulfhydryl angiotensin-converting enzyme (ACE) inhibitor with an intermediate duration of action, has been evaluated in 3,031 patients with hypertension and congestive heart failure (CHF) and has been compared with other ACE inhibitors. A comparison of double-blind studies showed quinapril to have a lower incidence of adverse effects and withdrawals than reported for captopril or enalapril. Analysis of onset of adverse events or withdrawals did not show either a time-dependent or dose-dependent relationship with quinapril. The proportion of patients who experienced orthostatic hypotension was less than that of patients on captopril or enalapril. Double-blind, long-term, and open-label studies with quinapril showed no increase in the incidence of events reported in patients with CHF compared with hypertensive patients. Quinapril produced minimal adverse effects on renal function in both patients with normal renal function and in those with pre-existing renal impairment. Age analysis of data from all studies showed no increase in total reporting of adverse events in older patients who did not take concomitant diuretics.

The effect of the meaning of buildings on behaviour.

The development of three semantic scales to appraise the physical environment is described. The scales were generated from the reactions of subjects to drawings but it is shown that the scales are valid in real situations. Using these scales the authors demonstrate how features of buildings can be assessed, and the importance which two groups of subjects assign to these variables can be revealed. From a further study, into the behavioural effects of two different rooms, a hypothesis is suggested about the appropriateness of physical setting for an activity.

The future of man-machine interface research: a discussion and a framework for research.

The British Government's decision to fund research, through the Alvey Programme, into the Man-Machine Interface (MMI) has challenged the ergonomics community to respond with an appropriate short-term research plan. Most significant of the many reasons why this response has been largely ineffective is the inability of ergonomists to come up with a coherent statement of the major research issues and to present a strategy for examining them. Some frameworks have been suggested elsewhere in the literature but here we present one which is tailored specifically to the needs of information handling systems. The approach involves a three-tiered conceptualisation of the problem area, the three levels being (from lowest to highest): 1. Traditional 'knod and dials' ergonomics. 2. The cognitive ergonomics of programme design. 3. The ergonomics of information and knowledge structures.

Prior convictions of child molesters.

Both the stereotypes held by investigating officers and the clinical literature assume that child molesters have distinct characteristics. these are generally expected to be reflected in a prior offence history of assaults on children and sexually deviant behaviour. A further assumption is that there is an escalation of offending, less serious crimes being precursors to more serious ones. To test these assumptions the criminal convictions, if any, prior to the offence were examined for all 416 detected offenders who had committed sexual offences upon children aged between 5 and 12 years, in the Lancashire Police area, during 1987, 1988 and 1989. Of the 183 (44%) of offenders who had previous convictions, 72 involved indecency, 17% of the total sample. Only 9 (2%) of offenders had an exclusive conviction history in respect of indecency. Previous convictions for theft, burglary and violence were all much more frequent. The results also do not generally support the hypothesis that serious offenders have progressed from less serious offences against children. A criminal opportunist model is proposed as of more value for guiding investigations than the existing stereotypes.

Linking commercial burglaries by modus operandi: tests using regression and ROC analysis.

This paper uses statistical models to test directly the police practice of utilising modus operandi to link crimes to a common offender. Data from 86 solved commercial burglaries committed by 43 offenders are analysed using logistic regression analysis to identify behavioural features that reliably distinguish between linked and unlinked crime pairs. Receiver operating characteristic analysis is then used to assign each behavioural feature an overall level of predictive accuracy. The results indicate that certain features, in particular the distances between burglary locations, lead to high levels of predictive accuracy. This study therefore reveals some of the important consistencies in commercial burglary behaviour. These have theoretical value in helping to explain criminal activity. They also have practical value by providing the basis for a diagnostic tool that could be used in comparative case analysis.

Differentiation of malicious and non-malicious fire-alarm calls using multidimensional scaling.

A pilot study was carried out to determine whether malicious and non-malicious fire alarm calls could be distinguished on the basis of their psycholinguistic attributes. Eight malicious and eight non-malicious calls were compared in terms of the number of speech errors of various kinds in the call. Using multi-dimensional scalogram analysis (MSA-I), it was possible to differentiate the two types of call on the basis of the over-all configuration of speech behaviour within the call.

Ambulatory blood pressure monitoring can play an integral role in patient selection, dosage adjustment and efficacy assessment in clinical trials of antihypertensive agents.

OBJECTIVE: To evaluate the efficacy and duration of action of the angiotensin converting enzyme inhibitor quinapril hydrochloride by using ambulatory blood pressure monitoring. DESIGN: Eleven centers in the USA and Canada entered 155 patients with previously diagnosed hypertension into a 4-week placebo-baseline phase. Twenty patients (13%) with elevated diastolic blood pressure (DBP) only by cuff measurement were excluded from entry into a double-blind test based on ambulatory blood pressure monitoring, and 135 patients with a mean waking blood pressure of 155/100 mmHg were assigned randomly to receive either quinapril or placebo once a day for 8 weeks, with optional titration to a higher dose after 4 weeks, based on the DBP response assessed by repeat ambulatory blood pressure monitoring only. RESULTS: Quinapril therapy produced highly significant decrease in mean daytime DBP compared with placebo. The antihypertensive effect of quinapril was evident over 24 h, with 50% of the peak effect remaining at the trough. After 4 weeks of treatment 49% of the patients in the quinapril group were titrated to the higher dose compared with 86% of the patients who had been receiving placebo. More than 70% of the patients in the quinapril group who remained at the low dose would have been titrated to the higher dose based solely on the clinic DBP measurements. CONCLUSIONS: The use of ambulatory blood pressure monitoring in the present study reduced the false-positive response to placebo and lessened the likelihood of titrating patients to the higher dose of quinapril in comparison with the number that would have been so treated based on clinic blood pressure measurements alone. More importantly, our results suggest that the convenience, ease and relatively low cost of traditional cuff blood pressure measurement should be weighed against the potential shortcomings of the method.