[Wellbeing and personality pathology in inpatient schematherapy]. / Welbevinden en persoonlijkheidsproblematiek in klinische schematherapie.

BACKGROUND: In treatment of personality disorders, wellbeing is complementary to a focus on reducing symptoms. It is known that symptoms are being reduced and relate to the development of characteristics of personality pathology (schemamodes). AIM: To answer the questions: how does wellbeing develop and how is this development related to the development of schemamodes? METHOD: A naturalistic, prospective, within subjects design was used in the Boerhaven Clinic of Mediant. Respondents received inpatient schema therapy with a focus on symptom reduction as well as increasing functional schema modes and wellbeing. A mixed model analysis was used to assess changes in wellbeing and schema modes at 0, 6, 12 and 18 months. RESULTS: Wellbeing increased significantly during treatment, but declined somewhat at follow-up. A connection was found between increases in wellbeing and increases in functional schema modes and decreases in coping modes. CONCLUSION: Symptoms and wellbeing develop in a different way during and after inpatient schema therapy and they have different relationships with schema modes. A positive psychological approach is recommended besides treatment of symptoms.

Continuous cerebroventricular administration of dopamine: A new treatment for severe dyskinesia in Parkinson's disease?

In Parkinson's disease (PD) depletion of dopamine in the nigro-striatal pathway is a main pathological hallmark that requires continuous and focal restoration. Current predominant treatment with intermittent oral administration of its precursor, Levodopa (l-dopa), remains the gold standard but pharmacological drawbacks trigger motor fluctuations and dyskinesia. Continuous intracerebroventricular (i.c.v.) administration of dopamine previously failed as a therapy because of an inability to resolve the accelerated dopamine oxidation and tachyphylaxia. We aim to overcome prior challenges by demonstrating treatment feasibility and efficacy of continuous i.c.v. of dopamine close to the striatum. Dopamine prepared either anaerobically (A-dopamine) or aerobically (O-dopamine) in the presence or absence of a conservator (sodium metabisulfite, SMBS) was assessed upon acute MPTP and chronic 6-OHDA lesioning and compared to peripheral l-dopa treatment. A-dopamine restored motor function and induced a dose dependent increase of nigro-striatal tyrosine hydroxylase positive neurons in mice after 7days of MPTP insult that was not evident with either O-dopamine or l-dopa. In the 6-OHDA rat model, continuous circadian i.c.v. injection of A-dopamine over 30days also improved motor activity without occurrence of tachyphylaxia. This safety profile was highly favorable as A-dopamine did not induce dyskinesia or behavioral sensitization as observed with peripheral l-dopa treatment. Indicative of a new therapeutic strategy for patients suffering from l-dopa related complications with dyskinesia, continuous i.c.v. of A-dopamine has greater efficacy in mediating motor impairment over a large therapeutic index without inducing dyskinesia and tachyphylaxia.

Endothelial function and the regulation of muscle protein anabolism in older adults.

Sarcopenia, the loss of skeletal muscle mass and function with aging, is a major contributor to frailty and morbidity in older adults. Recent evidence has emerged suggesting that endothelial dysfunction and insulin resistance of muscle protein metabolism may significantly contribute to the development of sarcopenia. In this article we review: 1) recent studies and theories on the regulation of skeletal muscle protein balance in older adults; 2) the link between insulin resistance of muscle protein synthesis and endothelial dysfunction in aging; 3) mechanisms for impaired endothelial responsiveness in aging; and 4) potential treatments that may restore the endothelial responsiveness and muscle protein anabolic sensitivity in older adults.

Supraphysiological hyperinsulinaemia is necessary to stimulate skeletal muscle protein anabolism in older adults: evidence of a true age-related insulin resistance of muscle protein metabolism.

AIMS/HYPOTHESIS: The physiological increase in muscle protein anabolism induced by insulin is blunted in healthy, glucose-tolerant older adults. We hypothesised that the age-related defect in muscle protein anabolism is a true insulin resistance state and can be overridden by supraphysiological hyperinsulinaemia. METHODS: We used dye dilution, stable isotopic and immunoblotting techniques to measure leg blood flow, muscle protein synthesis, protein kinase B/mammalian target of rapamycin (Akt/mTOR) signalling, and amino acid kinetics in 14 healthy, glucose-tolerant older volunteers at baseline, and during an insulin infusion at postprandial (PD, 0.15 mU min(-1) 100 ml(-1)) or supraphysiologically high (HD, 0.30 mU min(-1) 100 ml(-1)) doses. RESULTS: Leg blood flow, muscle protein synthesis, and Akt/mTOR signalling were not different at baseline. During hyperinsulinaemia, leg blood flow (p < 0.01) and muscle protein synthesis increased in the HD group only (PD [%/h]: from 0.063 +/- 0.006 to 0.060 +/- 0.005; HD [%/h]: from 0.061 +/- 0.007 to 0.098 +/- 0.007; p < 0.01). Muscle Akt phosphorylation increased in both groups, but the increase tended to be greater in the HD group (p = 0.07). The level of p70 ribosomal S6 kinase 1 (S6K1) phosphorylation increased in the HD group only (p < 0.05). Net amino acid balance across the leg improved in both groups, but a net anabolic effect was observed only in the HD group (p < 0.05). CONCLUSIONS/INTERPRETATION: We conclude that supraphysiological hyperinsulinaemia is necessary to stimulate muscle protein synthesis and anabolic signalling in healthy older individuals, suggesting the existence of a true age-related insulin resistance of muscle protein metabolism.

Regulation of the Amount of Starch in Plant Tissues by ADP Glucose Pyrophosphorylase.

Starch, a major storage metabolite in plants, positively affects the agricultural yield of a number of crops. Its biosynthetic reactions use adenosine diphosphate glucose (ADPGlc) as a substrate; ADPGlc pyrophosphorylase, the enzyme involved in ADPGlc formation, is regulated by allosteric effectors. Evidence that this plastidial enzyme catalyzes a rate-limiting reaction in starch biosynthesis was derived by expression in plants of a gene that encodes a regulatory variant of this enzyme. Allosteric regulation was demonstrated to be the major physiological mechanism that controls starch biosynthesis. Thus, plant and bacterial systems for starch and glycogen biosynthesis are similar and distinct from yeast and mammalian systems, wherein glycogen synthase has been demonstrated to be the rate-limiting regulatory step.

Awareness and knowledge of hepatitis C among health care providers and the public: A scoping review.

BACKGROUND: The Global Viral Hepatitis Strategy aims to eliminate hepatitis as a public health threat by 2030. The hepatitis C virus (HCV) can be difficult to detect as infection can remain asymptomatic for decades. Individuals are often neither offered nor seek testing until symptoms develop. This highlights the importance of increasing awareness and knowledge among health care providers and the public to reach the viral hepatitis goals. OBJECTIVES: To conduct a scoping review to characterize current awareness and knowledge among health care providers and the public regarding HCV infection, transmission, prevention and treatment and to identify knowledge gaps that public health action could address. METHODS: A literature search was conducted using Embase, Medline and Scopus to find studies published between January 2012 and July 2017. A search for grey literature was also undertaken. The following data were extracted: author, year of publication, study design, population, setting, country, method of data collection, and knowledge and awareness outcomes. Commentaries, letters to the editor and narrative reviews were excluded. RESULTS: Nineteen studies were included in this review. The definition of awareness and knowledge varied across studies; at times, these terms were used interchangeably. Health care providers identified injection drug use or blood transfusions as routes of HCV transmission more frequently than other routes of transmission such as tattooing with unsterile equipment and sexual transmission. Among the general public, misconceptions about HCV included believing that kissing and casual contact were routes of HCV transmission and that a vaccine to prevent HCV was available. Overall, there was a lack of data on other high-risk populations (e.g., Indigenous, incarcerated). CONCLUSION: Continued public and professional education campaigns about HCV could help support HCV risk-based screening and testing. Future research could assess the awareness of other populations at increased risk and include consistent definitions of awareness and knowledge.

Barriers to and facilitators of hepatitis C virus screening and testing: A scoping review.

BACKGROUND: As part of the global effort to eliminate hepatitis C virus (HCV), it is important to understand the barriers to and facilitators of HCV screening and testing. OBJECTIVE: To examine the barriers and facilitators experienced by health care providers offering HCV screening and testing and patients seeking HCV testing. METHODS: A literature search was conducted using Embase, Medline and Scopus databases to collect studies published between January 2012 and July 2017. We extracted the following data: author, year of publication, study design, population, setting, country, method of data collection, and knowledge and awareness outcomes. RESULTS: A total of 16 articles were identified. Barriers to HCV screening and testing among patients included low self-perceived risk of acquiring HCV, perceived stigma and fear of a positive result. Facilitators of HCV screening and testing, as reported by patients, included increased knowledge of transmission and manifestations of HCV infection and having HCV testing included as part of routine care with or without HIV testing. Barriers to offering HCV screening and testing included time constraints, lack of specific knowledge about HCV and discomfort in asking about risk behaviours. Facilitators of offering HCV screening and testing included testing reminders and working in locations with a higher HCV caseload. CONCLUSION: Lack of knowledge and fear of stigma and discrimination remain barriers to HCV testing at the patient level and lack of time, knowledge and discomfort in asking about risk behaviours remain barriers to offering HCV testing by health care providers. This identifies potential areas for future public health action.

Evidence for optimal HIV screening and testing intervals in HIV-negative individuals from various risk groups: A systematic review.

BACKGROUND: Human immunodeficiency virus (HIV) testing plays a crucial role in Canada's HIV prevention and treatment efforts and is the first step to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; however, how often Canadians, including populations at increased risk of HIV exposure, should be tested is unclear. We conducted a systematic literature review to determine the optimal HIV screening and testing intervals. OBJECTIVE: To examine the current evidence on HIV testing intervals in HIV-negative individuals from various risk groups and to assess the potential harms and patients' values and preferences associated with different testing frequencies. METHODS: We searched MEDLINE/PubMed, Scopus, Embase, the Cochrane Library, PsychINFO and EconLit for studies on different frequencies of HIV testing published between January 2000 and September 2016. An additional search was conducted for grey literature published between January 2000 and October 2016. Data extraction included study characteristics, participants, exposure, outcomes and economic variables. The quality of the studies was assessed and results summarized. RESULTS: Of the 2,702 articles identified from the searches, 27 met the inclusion criteria for review. This included assessments of HIV testing intervals among the general population, men who have sex with men, people who use injection drugs and sex workers. Optimal testing intervals across risk groups ranged from one-time testing to every three months. Data from modelling studies may not be representative of the Canadian context. Few studies identified potential harms of increased screening, specifically an increase in both false positive and false negative results. There were only two studies that addressed patient values and preferences concerning HIV screening, which suggested that the majority of participants were amenable to routine screening through their primary care provider. CONCLUSION: There was insufficient evidence to support optimal HIV screening and testing intervals for different populations. Context-specific factors, such as budget allocation, human resources, local epidemiology, socioeconomic factors and risk behaviours, along with clinical judgement, inform whom and how often to screen, suggesting the need for research specific to Canada. Research on patient preferences as well as the benefits and harms of more frequent screening are also indicated.

MRI of the cervical spinal cord predicts respiratory dysfunction in ALS.

For patients with amyotrophic lateral sclerosis (ALS), the primary therapeutic goal is to minimize morbidity. Non-invasive ventilation improves survival. We aim to assess whether Magnetic Resonance Imaging (MRI) of the cervical spinal cord predicts the progression of respiratory disorders in ALS. Brain and spinal MRI was repeatedly performed in the SOD1G86R mouse model, in 40 patients and in healthy controls. Atrophy, iron overload, white matter diffusivity and neuronal loss were assessed. In Superoxide Dismutase-1 (SOD1) mice, iron accumulation appeared in the cervical spinal cord at symptom onset but disappeared with disease progression (after the onset of atrophy). In ALS patients, the volumes of the motor cortex and the medulla oblongata were already abnormally low at the time of diagnosis. Baseline diffusivity in the internal capsule was predictive of functional handicap. The decrease in cervical spinal cord volume from diagnosis to 3 months was predictive of the change in slow vital capacity at 12 months. MRI revealed marked abnormalities at the time of ALS diagnosis. Early atrophy of the cervical spinal cord may predict the progression of respiratory disorders, and so may be of value in patient care and as a primary endpoint in pilot neuroprotection studies.

Assessing uptake of national HIV screening and testing guidance-Part 1: Awareness, use and usefulness.

BACKGROUND: In 2013, the Public Health Agency of Canada released the HIV Screening and Testing Guide (the Guide) to support routine HIV screening and testing practices of health care providers in Canada and promote early detection of new HIV cases. Little was known regarding health care providers' awareness and use of the Guide. OBJECTIVE: To determine Canadian health care providers' awareness, use and perceived usefulness of the Guide. METHODS: An open, anonymous online survey, including questions on awareness, use and usefulness, was developed with stakeholders, validated and pre-tested. It was then disseminated to a convenience sample of health care providers across Canada between June and August 2016. RESULTS: A total of 1,075 participants representing all Canadian provinces and territories responded to the survey, with the majority being nurses (54%) and physicians (12%). About two-thirds of respondents (65%) were aware of the Guide; of those, approximately half used it. Thirty-five percent of participants were not aware of the Guide, including none of the 173 health care providers in primary care (family/general practice). Among participants who were aware of and used the Guide, over 80% reported incorporating recommendations from the Guide into their practice and 77% reported frequently or always being able to find information they were looking for. CONCLUSIONS: The HIV Screening and Testing Guide appears to be very useful for those who are aware of it and use it; however, awareness of the Guide appears to be low in primary care. Although these results need to be interpreted in light of the convenience sample, it suggests broader dissemination efforts may be needed to reach all of the potential users of the Guide.

Assessing uptake of national HIV screening and testing guidance-Part 2: Knowledge, comfort and practice.

BACKGROUND: The Public Health Agency of Canada's (PHAC) HIV Screening and Testing Guide (the Guide) provides guidance to health care providers regarding who, when and how often to screen for HIV. HIV screening and testing is important in meeting the Joint United Nations Programme on HIV/AIDS' (UNAIDS) 90-90-90 targets towards HIV elimination. OBJECTIVE: To determine health care providers' levels of knowledge about and comfort with aspects of HIV testing, and to determine whether their HIV testing practices are consistent with the recommendations in the Guide. METHODS: An open, anonymous online survey that included questions on knowledge, comfort and HIV testing practices was developed with stakeholders, validated and pre-tested. It was then disseminated to a convenience sample of health care providers across Canada between June and August 2016. RESULTS: A total of 1,075 participants representing all Canadian provinces and territories responded to the survey, with the majority being nurses (54%) and physicians (12%). Overall, knowledge related to HIV testing was substantial, but 37% of respondents underestimated the percentage of people living with HIV in Canada who are unaware of their HIV status and only 32% of respondents knew that HIV patients are frequently symptomatic during the acute infection. Most participants were comfortable with HIV testing and approximately 50% reported offering HIV testing regularly. CONCLUSIONS: Although overall knowledge and practice were consistent with PHAC's HIV Screening and Testing Guide, some health care providers may underestimate the magnitude of undiagnosed HIV cases in Canada and may misinterpret the symptoms of acute HIV infection. While the amplitude of these results need to be interpreted in light of the convenience sample, addressing these knowledge gaps may facilitate earlier diagnosis of HIV among those who are unaware of their HIV status.

Evidence for optimal HIV testing intervals in HIV-negative individuals from various risk groups: a systematic review protocol.

BACKGROUND: Evidence-based recommendations for HIV testing are essential for health care providers. However, it is unclear whether there is sufficient evidence to support recommendations for HIV testing frequencies in a variety of HIV risk groups. OBJECTIVE: The aim of this document is to outline the methodological protocol of a systematic review that would gather evidence for the optimal frequency of HIV testing among individuals in various HIV risk groups with respect to personal and public health outcomes and cost-effectiveness. METHODS: This protocol adheres to the PRISMA-P reporting items, and the review is registered with PROSPERO. The target population includes individuals who may have undiagnosed HIV infection. Different frequencies of HIV testing will be compared and outcomes to do with personal and public health, patient values/preferences and costs will be examined. The search strategy will encompass searches in MEDLINE/Pubmed, Scopus, Embase, Cochrane, PsychINFO, and EconLit, as well as grey literature sources. Articles will be screened by title/abstract, and subsequently by full-text, in duplicate. Extraction of pertinent data from the screened references will be carried out by one reviewer and verified by a second. Multiple critical appraisal tools will be used to assess individual study quality, and the GRADE approach will be used to appraise the overall quality of the evidence. Data will be synthesized narratively, and the results will be published in a peer-reviewed journal. DISCUSSION: This systematic review, designed with extensive input from content experts, will help to identify key evidence to inform recommendations for HIV testing frequency.

Canadian and international recommendations on the frequency of HIV screening and testing: A systematic review.

BACKGROUND: In 2014, the Public Health Agency of Canada estimated that 21% of the people living with HIV in Canada were unaware of their infection. Increased screening and testing for HIV is crucial to reducing the number of undiagnosed infections. To ensure the best use of available resources, it is important to determine the optimal intervals for HIV screening and testing. OBJECTIVE: To conduct a systematic review of the recommendations for the frequency of HIV screening and testing in different populations. METHODS: To identify eligible guidelines, a comprehensive two-tiered search strategy of journals and websites of governments and non-governmental organizations and a three-tiered screening strategy (title, abstract and full content screen) were used. Guidelines were eligible for inclusion if they, a) were published between 2000 and 2015 in English or French, and b) provided guidance on HIV screening/testing intervals for at least one population. RESULTS: Of the 609 documents retrieved from the search, 34 guidelines met the eligibility criteria. The most frequently mentioned populations were pregnant women, men who have sex with men (MSM) and the general population. Overall, there was consensus on at least annual testing for MSM, intravenous drug users, individuals with HIV-positive sex partners, individuals with multiple partners, sex workers and their clients, migrants from HIV-endemic countries and indigenous peoples. Of the 20 guidelines that provided recommendations for pregnant women, the most common recommendation (n=9) was to test as early as possible during each pregnancy; four guidelines recommended screening during the first prenatal visit; three recommended routine HIV testing; and four suggested retesting in the third trimester regardless of maternal risk of HIV infection. Consensus on HIV testing of the general public, incarcerated people and individuals diagnosed with other sexually transmitted infections (STIs) was lacking. Four guidelines cited a lack of data for not providing specific recommendations in the general population. CONCLUSIONS: Additional evidence is needed to refine the recommendations for pregnant women and inform the optimal timing of HIV testing, especially in the general population, individuals diagnosed with other STIs and incarcerated people.

An overview of recent evidence on barriers and facilitators to HIV testing.

BACKGROUND: To address the issue of undiagnosed HIV infections, the Public Health Agency of Canada released the Human Immunodeficiency Virus-HIV Screening and Testing Guide in 2012, which identified several barriers and facilitators for HIV testing. OBJECTIVE: The objective of this overview is to summarize the most recent evidence regarding barriers and facilitators to HIV testing, to expand upon the research conducted for the HIV Screening and Testing Guide. METHODS: A review of the literature published between 2010 and 2014 was conducted using Scopus, PubMed (MEDLINE), and the Cochrane Library; websites of groups such as the Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, Australian Department of Health, and New Zealand Ministry of Health were searched for recent reports. Studies were categorized based on the barrier or facilitator identified, and the results were summarized. RESULTS: In addition to the known barriers of lack of perceived risk, lack of comfort or knowledge, provider time constraints, and fear of the diagnosis, stigma and discrimination, new studies have identified additional barriers including: fear regarding disclosure or lack of confidentiality, lack of access, lack of compensation of providers, and lack of human resources to carry out testing. In addition to the known facilitators of increased awareness and normalization of HIV screening and testing, opt-out testing was identified as a facilitator in recent studies. CONCLUSION: Since 2010, research has advanced our knowledge of barriers and facilitators and can be applied to help decrease the number of undiagnosed HIV infections.

Soy-dairy protein blend and whey protein ingestion after resistance exercise increases amino acid transport and transporter expression in human skeletal muscle.

Increasing amino acid availability (via infusion or ingestion) at rest or postexercise enhances amino acid transport into human skeletal muscle. It is unknown whether alterations in amino acid availability, from ingesting different dietary proteins, can enhance amino acid transport rates and amino acid transporter (AAT) mRNA expression. We hypothesized that the prolonged hyperaminoacidemia from ingesting a blend of proteins with different digestion rates postexercise would enhance amino acid transport into muscle and AAT expression compared with the ingestion of a rapidly digested protein. In a double-blind, randomized clinical trial, we studied 16 young adults at rest and after acute resistance exercise coupled with postexercise (1 h) ingestion of either a (soy-dairy) protein blend or whey protein. Phenylalanine net balance and transport rate into skeletal muscle were measured using stable isotopic methods in combination with femoral arteriovenous blood sampling and muscle biopsies obtained at rest and 3 and 5 h postexercise. Phenylalanine transport into muscle and mRNA expression of select AATs [system L amino acid transporter 1/solute-linked carrier (SLC) 7A5, CD98/SLC3A2, system A amino acid transporter 2/SLC38A2, proton-assisted amino acid transporter 1/SLC36A1, cationic amino acid transporter 1/SLC7A1] increased to a similar extent in both groups (P < 0.05). However, the ingestion of the protein blend resulted in a prolonged and positive net phenylalanine balance during postexercise recovery compared with whey protein (P < 0.05). Postexercise myofibrillar protein synthesis increased similarly between groups. We conclude that, while both protein sources enhanced postexercise AAT expression, transport into muscle, and myofibrillar protein synthesis, postexercise ingestion of a protein blend results in a slightly prolonged net amino acid balance across the leg compared with whey protein.

Resistive exercise blunts LPS-stimulated TNF-alpha and Il-1 beta.

To examine the influence of acute resistive exercise and "hormone status" on cytokine profile, 35 postmenopausal women (72 +/- 6.2 yr) underwent a moderate-high-intensity resistive exercise bout or rested. There were 4 groups: no hormone replacement (NHR, n = 9), hormone replacement (HRT, n = 12), selective estrogen receptor modulator (SER, n = 7), or resting control (no hormone replacement, CON, n = 7). NHR, HRT, and SER exercised (3 sets, 10 exercises @ 80 % 1RM). Blood was collected pre-exercise (PR), postexercise (PO), and two hours (2H) postexercise (same times for CON). Blood was diluted 1 : 10 in culture medium and incubated (37 degrees C, 5 % CO2, 24 h) with lipopolysaccharide (LPS, 25 microg . ml (-1)). Serum and supernatant from LPS-stimulated blood were analyzed for IL-6, IL-1 beta, and TNF-alpha using ELISA. Resistive exercise increased PO serum IL-6, and PO LPS-stimulated IL-6 and IL-1 beta in the exercise groups (HRT, NHR, SER collapsed; EX, n = 28). LPS-stimulated IL-1 beta remained elevated at 2H in EX and was significantly higher than PR in CON at 2H. Expressed per monocyte, EX had significantly lower IL-1 beta and TNF-alpha LPS-stimulated production at PO and 2H compared to CON, indicating an exercise-induced blunting of an apparent diurnal response on cytokine production. In postmenopausal women, acute resistive exercise increased circulating IL-6, but reversed an apparent diurnal increase in LPS-stimulated IL-1 beta and TNF-alpha production with no influence of hormone replacement or raloxifene.

Complete sequence of IS3.

We have determined the nucleotide sequence of IS3. Our IS3 isolate has 39 bp inverted repeats (IR's) with 6 mismatches, and is 1258 bp long. IS3 contains a large open reading frame (ORF) of 288 codons with a smaller, partially overlapping ORF of 91 codons on the opposite strand in codon-codon register. The large ORF is preceded by and has a 4 bp overlap with a 99 codon ORF that has potential transcriptional and translational start signals. Thus, IS3 could encode a bicistronic mRNA. The Shine-Dalgarno sequence for this 99 codon ORF could be sequestered in a stem-loop structure, but only if the transcript began outside IS3, as was first seen with IS10. This could be a means for preventing fortuitous activation of IS3 by outside promoters. No DNA sequence homology was found between IS3 and other prokaryotic IS elements, but there is slight amino acid sequence homology and significant conservation of hydropathicity patterns between the putative transposases of IS3 and IS2.

Characterization and heterospecific expression of cDNA clones of genes in the maize GSH S-transferase multigene family.

We have isolated from a constructed lambda gt11 expression library two classes of cDNA clones encoding the entire sequence of the maize GSH S-transferases GST I and GST III. Expression of a full-length GST I cDNA in E. coli resulted in the synthesis of enzymatically active maize GST I that is immunologically indistinguishable from the native GST I. Another GST I cDNA with a truncated N-terminal sequence is also active in heterospecific expression. Our GST III cDNA sequence differs from the version reported by Moore et al. [Moore, R. E., Davies, M. S., O'Connell, K. M., Harding, E. I., Wiegand, R. C., and Tiemeier, D. C. (1986) Nucleic Acids Res. 14:7227-7235] in eight reading frame shifts which result in partial amino acid sequence conservation with the rat GSH S-transferase sequences. The GST I and GST III sequences share approximately 45% amino acid sequence homology. Both the GST I and the GST III mRNAs contain different repeating motifs in front of the initiation codon ATG. Multiple poly(A) addition sites have been identified for these two classes of maize GSH S-transferase messages. Genomic Southern blotting results suggest that both GST I and GST III are present in single or low copies in the maize (GT112 RfRf) genome.

Antibiotic usage in a pediatric medical center.

Antibiotic usage in a large pediatric teaching hospital was evaluated during a three-month period. A total of 1,067 patients received antibiotics and 295 patient records were reviewed. One hundred sixty-nine courses of antibiotics were administered to surgical patients, 77% for surgical prophylaxis. One hundred forty-seven antibiotic courses administered to medical patients were therapeutic in 61.2% and in 35.3% were given because of suspicion of infection. Ampicillin was the most commonly used antibiotic; cephalosporins were used for surgical prophylaxis. Aminoglycosides were used commonly for suspected infection in medical patients. Antibiotic management was inappropriate in 66% of surgical patients and in 21% of medical patients. Not obtaining appropriate studies prior to and during therapy were common infractions on all services. Surgical prophylaxis was freqently inappropriate by reason of no indication, wrong drug or dose, or inappropriate timing.