Molecular and morphological supertrees for eutherian (placental) mammals.

A large body of diverse comparative data now exists for a major phylogenetic synthesis of the higher-level relationships among eutherian (placental) mammals. We present such a phylogenetic synthesis using the composite trees or supertrees from the combined and separate analyses of their published molecular and morphological source phylogenies. Our combined and separate supertrees largely support the same suprafamilial taxa and orders, but different interordinal clades. These similarities and differences reinforce the continuing contributions of morphological studies, while highlighting the growing influence of molecular information on the field. As current summaries of past research, our supertrees emphasize opportunities for future work, while providing a step toward the eventual integration of the data and characters themselves.

Pediatric cardiac catheterization with same-day discharge.

A system was developed for cardiac catheterization in children without overnight hospital stay (called same-day discharge). Over a 4 year period, 233 children (aged 5 weeks to 20 years) had catheterization with same-day discharge staying an average of 11.8 hours in the hospital. In all but 1, no problems occurred after hospital discharge; 1 child required readmission for psoas tendinitis after retrograde aortography. Same-day discharge was safely applied regardless of the patient's age, diagnosis, and use of systemic heparinization, large-bore sheaths, retrograde arterial catheterization, or cineangiography. The hospital-related cost of pediatric cardiac catheterization was reduced 29% compared with that of the standard 42 hour hospital stay. Same-day discharge provides attractive elements to the physician and institution involved in cardiac catheterizations, for example: (1) improved medical care by a decrease in the length of hospitalization, (2) a significant reduction in medical costs, and (3) elimination of time pressure in training and teaching as well as therapeutic decision-making. Critical factors for the successful application of same-day discharge are coordination of multiple health care professionals and physician judgment of the patient's clinical status. We speculate that reassessment of other hospital-oriented procedures may foster the development of methods for improving medical care or reducing cost, or both.

Hepatic hyaline globules associated with passive congestion.

We describe the presence of hyaline globules in liver associated with hepatic congestion. These globules were present in hepatocytes in 15% of 100 adult autopsies. They are periodic acid-Schiff (PAS)-positive and diastase-resistant by light microscopy, and in one case examined by electron microscopy, contained microfibrillar material with occasional rod-shaped inclusions. The majority of them stained positively for fibrinogen and alpha 1-antitrypsin by immunohistochemical methods. Of possible etiologies, the globules appear most probably as phagosomes containing imbibed serum proteins under conditions of increased sinusoidal pressure with passive congestion. They are more common than generally realized, when compared with other reported forms of nonglycogenic hyaline globules in liver. They must be distinguished from alpha 1-antitrypsin-disease globules.

Crystallization and preliminary X-ray diffraction studies of an inactive mutant aspartate transcarbamoylase from Escherichia coli.

A mutant aspartate transcarbamoylase, ATCase231, has been crystallized at neutral pH. The mutant enzyme has a single substitution of aspartic acid in place of glycine within the catalytic chain and shows not only the loss of enzyme activity but also marked changes in the chemical reactivity of several amino acid residues and weakening of interaction between regulatory and catalytic subunits. Despite these differences, the mutant enzyme crystals have the same space group and cell parameters as the wild type crystals grown at pH 5.9.

Effect of phospholipase C on lymphocyte responses to mitogen.

Peripheral lymphocytes treated with phospholipase C (phosphatidylcholine cholin phosphohydrolase E [3.1.4.3]) were examined for their response to mitogen and rosette formations. High levels of phospholipase C (greater than 0.01 unit) showed significant toxic effects on the peripheral lymphocytes as examined by the trypan blue exclusion test. This was attributable to "impurities" in the Cl. perfringens phospholipase C preparation since recovery of the mitogen responses were incomplete after heat inactivation of the enzyme. Active phospholipase C at 0.005 unit significantly (50%) suppressed the PHA response with little or no effect on the PWM stimulation. Similarly, a significant suppression of E rosette formation occurred with phospholipase C (0.005 u) treated lymphocytes. Suppression of similarly treated lymphocytes to EAC rosette was slight. It is suggested that the removal of phosphorylated amines from membrane surfaces affects T-cells more than B-cells and that the use of phospholipase C is a useful means of examining membrane functions of the lymphoid system.

A physician survey of the effect of drug sample availability on physicians' behavior.

OBJECTIVE: Pharmaceutical companies often use drug samples as a marketing strategy in the ambulatory care setting. Little is known about how the availability of drug samples affects physicians' prescribing practices. Our goal was to assess: (1) under what circumstances and why physicians dispense drug samples, (2) if drug samples lead physicians to use medications other than their preferred drug choice, and (3) the physician characteristics that are associated with drug sample use. DESIGN: Cross-sectional survey. SETTING: University-based clinics at one academic medical center. PARTICIPANTS: 154 general medicine and family physicians. MEASUREMENTS AND MAIN RESULTS: Physicians' self-reported prescribing patterns for 3 clinical scenarios, including their preferred drug choice, whether they would use a drug sample and subsequently prescribe the sampled medication, and the importance of factors involved in the decision to dispense a drug sample. A total of 131 (85%) of 154 physicians responded. When presented with an insured woman with an uncomplicated lower urinary tract infection, 22 (17%) respondents reported that they would dispense a drug sample; 21 (95%) of 22 sample users stated that they would dispense a drug sample that differed from their preferred drug choice. For an uninsured man with hypertension, 35 (27%) respondents reported that they would dispense a drug sample; 32 (91%) of 35 sample users indicated that they would dispense a drug sample instead of their preferred drug choice. For an uninsured woman with depression, 108 (82%) respondents reported that they would dispense a drug sample; 53 (49%) of 108 sample users indicated that they would dispense a drug sample that differed from their preferred drug choice. Avoiding cost to the patient was the most consistent motivator for dispensing a drug sample for all 3 scenarios. For 2 scenarios, residents were more likely to report using drug samples than attendings (P <.05). When respondents who chose a drug sample for 2 or 3 scenarios were compared to those who never chose to use a drug sample, or chose a drug sample for only one scenario, only younger age was independently associated with drug sample use. CONCLUSION: In self-reports, the availability of drug samples led physicians to dispense and subsequently prescribe drugs that differ from their preferred drug choice. Physicians most often report using drug samples to avoid cost to the patient.