Evidence of patient beliefs, values, and preferences is not provided in osteoporosis clinical practice guidelines.

We examined how patient beliefs, values, and preferences (BVPs) were included and conceptualized in international osteoporosis guidelines. The majority of guidelines did not mention BVPs. When mentioned, BVPs were conceptualized as preference for one medication over another. A broader conceptualization and inclusion of BVPs should be incorporated in osteoporosis guidelines. INTRODUCTION: Our objectives were to determine (1) the extent to which osteoporosis guidelines reflected patients' beliefs, values, and preferences (BVPs); (2) how BVPs were conceptualized; and (3) the methods used to elicit BVPs in the references cited by the guidelines. METHODS: We conducted a document analysis of English-language international osteoporosis guidelines based on the International Osteoporosis Foundation website. We examined each guideline and extracted all instances of statements pertaining to BVPs. The statements were reviewed by two independent researchers. Discrepancies in data extraction were resolved by the first author. We developed categories based on five common elements that represented the BVP statements. RESULTS: Twenty-seven of 70 (39%) guidelines included 95 statements about patient BVPs. Of the 95 statements, 32 statements (14 guidelines) were classified under BVP related to the choice of pharmacotherapy or general treatment, 10 (7 guidelines) under BVP related to adherence to pharmacotherapy or treatment in general, 5 (5 guidelines) under BVP related to financial costs and benefits, 43 (19 guidelines) under other BVP mentioned but not supported by a reference to a primary study or systematic review, and 5 (3 guidelines) under other BVP mentioned and supported by at least one reference to a primary study or systematic review. Twenty-nine references were cited to reflect the BVPs mentioned, including an editorial and quantitative studies. CONCLUSIONS: Twenty-seven (39%) of the guidelines included mention of patients' BVPs. In 19 guidelines, the importance of BVPs was mentioned but these statements were not supported by references to a primary study or systematic review. BVPs were most often (14 guidelines) conceptualized as preference for one medication over another. We suggest that qualitative data be included as evidence of BVPs in guidelines.

Cardiac-gated computed tomography angiography in three alpacas with complex congenital heart disease.

BACKGROUND: The prevalence of congenital heart disease is higher in camelids than in other domestic species and complex defects, often involving the great vessels, are more frequently encountered in llamas and alpacas than in other species. Some of these complex defects can be difficult to accurately characterize via echocardiography, the most commonly used diagnostic imaging technique to evaluate the heart in veterinary patients. Contrast-enhanced, electrocardiogram (ECG)-gated computed tomography (CT) has proven utility for the evaluation of human patients with certain congenital heart defects, including those with conotruncal septation defects and other abnormalities involving the formation of the great vessels. METHODS: Three alpaca crias, 4 days, 5 weeks and 14 months of age were clinically evaluated and subjected to a complete color-flow Doppler echocardiogram and a contrast-enhanced ECG-gated CT. RESULTS: These alpacas exhibited a variety of clinical findings including lethargy, failure to thrive, exercise intolerance, heart murmur, and/or respiratory difficulty. All three crias were subsequently diagnosed with complex cardiac defects including pulmonary atresia with a ventricular septal defect (VSD), a truncus arteriosus with a large VSD, and a double outlet right ventricle with a large VSD and aortic hypoplasia. In each case, the diagnosis was confirmed by postmortem examination. CONCLUSION: Color flow echocardiographic evaluation identified all of the intra-cardiac lesions and associated flow anomalies but contrast-enhanced ECG-gated CT permitted more accurate assessment of the morphology of the extracardiac structures and permitted a more precise determination of the exact nature and anatomy of the great vessels.

Does Dynorphin Play a Role in the Onset of Puberty in Female Sheep?

Puberty onset involves increased gonadotrophin-release (GnRH) release as a result of decreased sensitivity to oestrogen (E2 )-negative feedback. Because GnRH neurones lack E2 receptor α, this pathway must contain interneurones. One likely candidate is KNDy neurones (kisspeptin, neurokinin B, dynorphin). The overarching hypothesis of the present study was that the prepubertal hiatus in luteinising hormone (LH) release involves reduced kisspeptin and/or heightened dynorphin input. We first tested the specific hypothesis that E2 would reduce kisspeptin-immunopositive cell numbers and increase dynorphin-immunopositive cell numbers. We found that kisspeptin cell numbers were higher in ovariectomised (OVX) lambs than OVX lambs treated with E2 (OVX+ E2 ) or those left ovary-intact. Very few arcuate dynorphin cells were identified in any group. Next, we hypothesised that central blockade of κ-opioid receptor (KOR) would increase LH secretion at a prepubertal (6 months) but not postpubertal (10 months) age. Luteinising hormone pulse frequency and mean LH increased during infusion of a KOR antagonist, norbinaltorphimine, in OVX + E2 lambs at the prepubertal age but not in the same lambs at the postpubertal age. We next hypothesised that E2 would increase KOR expression in GnRH neurones or alter synaptic input to KNDy neurones in prepubertal ewes. Oestrogen treatment decreased the percentage of GnRH neurones coexpressing KOR (approximately 68%) compared to OVX alone (approximately 78%). No significant differences in synaptic contacts per cell between OVX and OVX + E2 groups were observed. Although these initial data are consistent with dynorphin inhibiting pulsatile LH release prepubertally, additional work will be necessary to define the source and mechanisms of this inhibition.

National Beef Quality Audit-2011: Survey of instrument grading assessments of beef carcass characteristics.

The instrument grading assessments for the 2011 National Beef Quality Audit evaluated seasonal trends of beef carcass quality and yield attributes over the course of the year. One week of instrument grading data, HCW, gender, USDA quality grade (QG), and yield grade (YG) factors, were collected every other month (n = 2,427,074 carcasses) over a 13-mo period (November 2010 through November 2011) from 4 beef processing corporations, encompassing 17 federally inspected beef processing facilities, to create a "snapshot" of carcass quality and yield attributes and trends from carcasses representing approximately 8.5% of the U.S. fed steer and heifer population. Mean yield traits were YG (2.86), HCW (371.3 kg), fat thickness (1.19 cm.), and LM area (88.39 cm(2)). The YG distribution was YG 1, 15.7%; YG 2, 41.0%; YG 3, 33.8%; YG 4, 8.5%; and YG 5, 0.9%. Distribution of HCW was <272.2 kg, 1.6%; 272.2 to 453.6 kg, 95.1%; and ≥453.6 kg, 3.3%. Monthly HCW means were November 2010, 381.3 kg; January 2011, 375.9 kg; March 2011, 366.2 kg; May 2011, 357.9 kg; July 2011, 372.54 kg; September 2011, 376.1 kg; and November 2011, 373.5 kg. The mean fat thickness for each month was November 2010, 1.30 cm; January 2011, 1.22 cm; March 2011, 1.17 cm; May 2011, 1.12 cm; July 2011, 1.19 cm; September 2011, 1.22 cm; and November 2011, 1.22 cm. The overall average marbling score was Small(49). The USDA QG distribution was Prime, 2.7%; Top Choice, 22.9%; Commodity Choice, 38.6%; and Select, 31.5%. Interestingly, from November to May, seasonal decreases (P < 0.001) in HCW and fat thicknesses were accompanied by increases (P < 0.001) in marbling. These data present the opportunity to further investigate the entire array of factors that determine the value of beef. Data sets using the online collection of electronic data will likely be more commonly used when evaluating the U.S. fed steer and heifer population in future studies.

National Beef Quality Audit-2011: In-plant survey of targeted carcass characteristics related to quality, quantity, value, and marketing of fed steers and heifers.

The 2011 National Beef Quality Audit (NBQA-2011) assessed the current status of quality and consistency of fed steers and heifers. Beef carcasses (n = 9,802), representing approximately 10% of each production lot in 28 beef processing facilities, were selected randomly for the survey. Carcass evaluation for the cooler assessment of this study revealed the following traits and frequencies: sex classes of steer (63.5%), heifer (36.4%), cow (0.1%), and bullock (0.03%); dark cutters (3.2%); blood splash (0.3%); yellow fat (0.1%); calloused rib eye (0.05%); overall maturities of A (92.8%), B (6.0%), and C or greater (1.2%); estimated breed types of native (88.3%), dairy type (9.9%), and Bos indicus (1.8%); and country of origin of United States (97.7%), Mexico (1.8%), and Canada (0.5%). Certified or marketing program frequencies were age and source verified (10.7%), ≤A(40) (10.0%), Certified Angus Beef (9.3%), Top Choice (4.1%), natural (0.6%), and Non-Hormone-Treated Cattle (0.5%); no organic programs were observed. Mean USDA yield grade (YG) traits were USDA YG (2.9), HCW (374.0 kg), adjusted fat thickness (1.3 cm), LM area (88.8 cm2), and KPH (2.3%). Frequencies of USDA YG distributions were YG 1, 12.4%; YG 2, 41.0%; YG 3, 36.3%; YG 4, 8.6%; and YG 5, 1.6%. Mean USDA quality grade (QG) traits were USDA quality grade (Select(93)), marbling score (Small(40)), overall maturity (A(59)), lean maturity (A(54)), and skeletal maturity (A(62)). Frequencies of USDA QG distributions were Prime, 2.1%; Choice, 58.9%; Select, 32.6%; and Standard or less, 6.3%. Marbling score distribution was Slightly Abundant or greater, 2.3%; Moderate, 5.0%; Modest, 17.3%; Small, 39.7%; Slight, 34.6%; and Traces or less, 1.1%. Carcasses with QG of Select or greater and YG 3 or less represented 85.1% of the sample. This is the fifth benchmark study measuring targeted carcass characteristics, and information from this survey will continue to help drive progress in the beef industry. Results will be used in extension and educational programs as teaching tools to inform beef producers and industry professionals of the current state of the U.S. beef industry.

National Beef Quality Audit-2011: Harvest-floor assessments of targeted characteristics that affect quality and value of cattle, carcasses, and byproducts.

The National Beef Quality Audit-2011 (NBQA-2011) was conducted to assess targeted characteristics on the harvest floor that affect the quality and value of cattle, carcasses, and byproducts. Survey teams evaluated approximately 18,000 cattle/carcasses between May and November 2011 in 8 beef processing facilities. Cattle identification methods were lot visual tags (85.7%), individual visual tags (50.6%), electronic tags (20.1%), metal-clip tags (15.7%), other (5.3%), none (2.5%), and wattles (0.5%). Hide colors or breed types were black (61.1%), red (12.8%), yellow (8.7%), Holstein (5.5%), brown (5.0%), gray (5.0%), white (1.4%), and brindle (1.0%). Brand frequencies were none (55.2%), 1 (40.4%), 2 (4.4%), and 3 or more (0.04%) brands, and brands were located on the butt (35.2%), side (9.0%), and shoulder (2.5%). Hide locations of mud or manure were no mud/manure (49.2%), legs (36.8%), belly (23.7%), side (14.9%), top-line (11.0%), and tail region (13.7%). There were 76.2% of cattle without horns, and the majority of those with horns (71.6%) were between 0 cm and 12.7 cm in length. Permanent incisor numbers were zero (87.3%), 1 (1.4%), 2 (8.0%), 3 (0.9%), 4 (1.9%), 5 (0.3%), 6 (0.2%), 7 (0.1%), and 8 (0.02%). Most carcasses (77.0%) were not bruised, 18.7% had 1 bruise, 3.4% had 2 bruises, 0.6% had 3 bruises, and 0.3% had more than 3 bruises. Bruise locations were loin (50.1%), rib (21.3%), chuck (13.8%), round (7.3%), and brisket/flank/plate (7.5%). Condemnation item and incidence were whole carcass (none recorded), liver (20.9%), lungs (17.3%), tongue (10.0%), viscera (9.3%), and head (7.2%). Compared with the NBQA-2005, the NBQA-2011 had an increased percentage of black-hided cattle (56.3 vs. 61.1%), more cattle with brands (38.7 vs. 44.8%), and more cattle with some form of identification (93.3 vs. 97.5%). In addition, there was a lesser percentage of carcasses with bruising in 2011 (23.0%) than in 2005 (35.2%), as well as a smaller percentage of carcasses with more than 1 bruise (2005 = 9.4% vs. 2011 = 4.2%). Compared with the 2005 audit, a similar percentage of the cattle were deemed 30 mo of age or older using dentition (2005 = 2.7% vs. 2011 = 3.3%). The information from NBQA-2011 helps the beef industry measure progress against previous NBQA assessments and provides a benchmark for future educational and research activities.

Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial.

UNLABELLED: We conducted a cluster randomized trial evaluating the effect of a centralized coordinator who identifies and follows up with fracture patients and their primary care physicians about osteoporosis. Compared with controls, intervention patients were five times more likely to receive BMD testing and two times more likely to receive appropriate management. INTRODUCTION: To determine if a centralized coordinator who follows up with fracture patients and their primary care physicians by telephone and mail (intervention) will increase the proportion of patients who receive appropriate post-fracture osteoporosis management, compared to simple fall prevention advice (attention control). METHODS: A cluster randomized controlled trial was conducted in small community hospitals in the province of Ontario, Canada. Hospitals that treated between 60 and 340 fracture patients per year were eligible. Patients 40 years and older presenting with a low trauma fracture were identified from Emergency Department records and enrolled in the trial. The primary outcome was 'appropriate' management, defined as a normal bone mineral density (BMD) test or taking osteoporosis medications. RESULTS: Thirty-six hospitals were randomized to either intervention or control and 130 intervention and 137 control subjects completed the study. The mean age of participants was 65 ± 12 years and 69% were female. The intervention increased the proportion of patients who received appropriate management within 6 months of fracture; 45% in the intervention group compared with 26% in the control group (absolute difference of 19%; adjusted OR, 2.3; 95% CI, 1.3-4.1). The proportion who had a BMD test scheduled or performed was much higher with 57% of intervention patients compared with 21% of controls (absolute difference of 36%; adjusted OR, 4.8; 95% CI, 3.0-7.0). CONCLUSIONS: A centralized osteoporosis coordinator is effective in improving the quality of osteoporosis care in smaller communities that do not have on-site coordinators or direct access to osteoporosis specialists.

Cognitive speed of processing and functional declines in older cancer survivors: an analysis of data from the ACTIVE trial.

It has been suggested that chemotherapy treatment for cancer may contribute to cognitive decline in older cancer survivors. This issue is particularly important given that subtle cognitive impairment, particularly in cognitive processing speed, can affect functional status and quality of life for older adults. Multivariate regression of data from a longitudinal randomized controlled trial of older adults revealed a trend towards decreased performance after cancer treatment with chemotherapy on several functional measures associated with processing speed (as compared with matched individuals who did not have cancer). Additional analyses revealed that a subset of the chemotherapy-treated adults demonstrated a reliable negative change on several measures of processing speed. While inconclusive, this hypothesis generating work suggests that cognitive dysfunction following cancer treatment may contribute to disability observed in older cancer survivors. Further research is needed to determine the significance of the relationship between cognitive and functional impairment in older cancer survivors.

The importance of communication in secondary fragility fracture treatment and prevention.

INTRODUCTION: We report on a Canadian longitudinal qualitative case study of midlife women with fragility fractures, their treating orthopaedic surgeons and family physicians. METHODS: Women and their treating physicians were followed for an average of one year post fracture to investigate the health outcomes and what, if any, follow-up occurred aimed at secondary fracture prevention. The final dataset includes 223 interviews gathered from women aged 40 to 65 with fragility fractures, orthopaedic surgeons and family physicians. RESULTS: The circle of care for those with fragility fractures is disrupted at vital communication junctures: (1) the inconsistent flow of information between acute care institutions and family physicians; (2) unidirectional and inconsistent communication from orthopaedic surgeons to family physicians; and (3) competing demands of the cast clinic environment and patient expectations. It is not the lack of will that is undermining the consistent and detailed communication among patients, physicians and institutions. It is the episodic nature of fracture care that makes communication among involved parties difficult, if not impossible. CONCLUSIONS: Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures.

Sodium channels as macromolecular complexes: implications for inherited arrhythmia syndromes.

Mutations in cardiac ion channels and their auxiliary subunits can lead to life-threatening cardiac arrhythmias. In recent years it has become apparent that ion channels are part of large, multi-protein complexes, comprising not only the ion channels and their auxiliary subunits, but also components of the cytoskeleton, regulatory kinases and phosphatases, trafficking proteins, extracellular matrix proteins, and possibly even other ion channels. Disruption of any member of a particular ion channel complex has the potential to disrupt the function of the associated channels, resulting in paroxysmal disease. Understanding the molecular composition of individual ion channel signaling complexes in heart may yield important insights into the molecular basis of cardiac arrhythmias and may suggest novel therapeutic approaches to treatment of these life-threatening conditions.

Rurality and health: perspectives of mid-life women.

INTRODUCTION: Health researchers have paid scant attention to the role of place in health except as settings where interventions take place, and even less attention has been given to the influence of rural context on health. Explanations of the impact of environment on health status have traditionally been limited to a narrow picture of rural life. Much of the relevant research in health focuses on farming as central to rural living and as such, suggests that rural living is not conducive to optimum health. Using the term 'rural health' in a limited sense (only to mean the health of farmers) is also implicit in rural health research that emphasizes occupational health rather than general health. In this paper we explore the influence of living in a rural area as described by mid-life rural women from different parts of the province of Alberta in Canada. Our analysis focuses on ways in which these rural women understand, talk about, and experience health. Their insights add to our understanding of rural environments not just as a setting for research but also as a social construct (i.e. a range of social relationships and social processes associated with rural environments) that informs the results of research. METHODS: This qualitative research used approaches from ethnography and grounded theory. 'Statistics Canada' criteria were used to define 'rural' as an area with a population of less than 10,000; therefore, small towns were included. Four female rural community interviewers from three geographic regions in the province were hired and trained for the purposes of the study. Participants were recruited through convenience and snowball sampling. Data collection using an interview guide continued until theoretical saturation was reached. All interviews were transcribed verbatim and imported into a software program for summary analysis and to aid in interpretation. Thematic analysis was conducted using memoing and coding as well as immersion and crystallization in conjunction with revisiting relevant literature. RESULTS: Twenty-four women ranging in age from 40 to 65 years were interviewed. The majority was married and the minority had children still living at home. Women held a holistic view of health. They described rural living as very important to their health. Through analysis and interpretation, four important aspects of rurality were revealed: the meaning and symbols of rurality; change and the understanding of rurality; getting away and getting around; and, diversity in rurality. Heterogeneity or difference in rural places was evident in the women's discussions, including their descriptions of what it was like to inhabit a rural place. CONCLUSIONS: The finding of differences in rurality reinforces the work of others and has important implications for researchers and program planners. To ignore this may perpetuate generalizations about rurality that are too simple to be useful and that have the potential to obscure important features of place. The data also challenge assumptions about the detrimental relationship between rurality and health. Myths of rural living should be set aside, and researchers and policy makers would be wise to listen to inhabitants to develop contextually relevant research and policy.

Functional modulation of human brain Nav1.3 sodium channels, expressed in mammalian cells, by auxiliary beta 1, beta 2 and beta 3 subunits.

Voltage-gated sodium channels consist of a pore-forming alpha subunit and two auxiliary beta subunits. Excitable cells express multiple alpha subtypes, designated Na(v)1.1-Na(v)1.9, and three beta subunits, designated beta1, beta2 and beta3. Understanding how the different alpha subtypes, in combination with the various beta subunits, determine sodium channel behavior is important for elucidating the molecular basis of sodium channel functional diversity. In this study, we used whole-cell electrophysiological recording to examine the properties of the human Na(v)1.3 alpha subtype, stably expressed in Chinese hamster ovary cells, and to investigate modulation of Na(v)1.3 function by beta1, beta2 and beta3 subunits. In the absence of beta subunits, human Na(v)1.3 formed channels that inactivated rapidly (tau(inactivation) approximately equals 0.5 ms at 0 mV) and almost completely by the end of 190-ms-long depolarizations. Using an intracellular solution with aspartate as the main anion, the midpoint for channel activation was approximately -12 mV. The midpoint for inactivation, determined using 100-ms conditioning pulses, was approximately -47 mV. The time constant for repriming of inactivated channels at -80 mV was approximately 6 ms. Coexpression of beta1 or beta3 did not affect inactivation time course or the voltage dependence of activation, but shifted the inactivation curve approximately 10 mV negative, and slowed the repriming rate ca. three-fold. beta2 did not affect channel properties, either by itself or in combination with beta1 or beta3. Na(v)1.3 expression is increased in damaged nociceptive peripheral afferents. This change in channel expression levels is correlated with the emergence of a rapidly inactivating and rapidly repriming sodium current, which has been proposed to contribute to the pathophysiology of neuropathic pain. The results of this study support the hypothesis that Na(v)1.3 may mediate this fast sodium current.

Whealth study: women's reports of childhood abuse.

Most samples of adult women will contain a significant proportion who have been or are currently in abusive relationships. While past research has linked childhood abuse of girls to adult health concerns, little is known about the process through which women retrospectively reconcile these experiences. This article reports on data collected in an ongoing project on midlife women's health. Twenty-seven of 50 urban, middle-class participants in this phase of the project reported childhood abuse experiences. In the analysis, several aspects of these experiences were identified: definitions of abuse; recontextualizing abuse; responsibility for abuse; abuse avoidance; and experiences of multiple abuse. The women's discourse reflected a number of ideologies that provide a context in which women negotiate their understandings of these childhood experiences. This article provides insight into our understanding of abuse. It addresses the fundamental issue of promoting a worldview that precludes child abuse while leaving adult survivors with options for "moving on."

Health promotion and preventive measures: interpreting messages at midlife.

In this article, the authors provide important insight into the cultural messages that midlife women receive about preventive health care. Data were collected from 24 rural women as part of an ongoing project on midlife women's health. Kleinman's model of the popular and professional health care sectors was used to examine the data. There is clear evidence of clashes between the orientations and expectations of these sectors. Women's experiences reveal some consistent themes that contextualize their preventive health pursuits: time constraints, claims for expert knowledge, salience of family history, and the inclusion of nonallopathic resources as part of the professional realm. At the macrolevel, messages regarding women's responsibility for their health are ubiquitous. At the microlevel, women must negotiate among competing messages and resources and a health care system that often confounds their efforts. These contradictions must be addressed before there are long-term effects on the health of midlife women.

Immigrant women's health.

The immigration process entails many changes in the lives of those who emigrate including establishing oneself in a new country. There is continuing interest in what happens to the health of those who undergo this process. This qualitative study investigated the perceived health and health-related experiences of a sample of mid-life immigrant women and explored relationships between determinants of health and their experiences connected to immigration. Forty-two women participated in the study. While respondents were relatively well educated, their current socioeconomic status was relatively low. While women defined their health in a holistic manner. personal health focused on their physical health and their ability to function. This functionality was closely related to women's roles as resources for their families' well-being. Several health-related themes were identified that related to their change in homelands as adults: immigration and health, adapting to immigration and rebuilding their lives. Women are unlikely to talk about non-physical aspects of health unless asked about the general context of their lives. The family-centredness of immigrant women's well-being is a mediating factor in all aspects of their health; it is the health of the family unit that is the final point of adjudication for women. Spirituality and religious practices were identified as important resources for health. In addition, the process of immigration needs to be recognized as a determinant of health in and of itself. An understanding of these conceptualizations and health beliefs is an important component of the knowledge to be brought to formulating health promotion strategies and health services delivery that are relevant to and appropriate for this population of mid-life women.

The intracellular segment of the sodium channel beta 1 subunit is required for its efficient association with the channel alpha subunit.

Sodium channels consist of a pore-forming alpha subunit and auxiliary beta 1 and beta 2 subunits. The subunit beta 1 alters the kinetics and voltage-dependence of sodium channels expressed in Xenopus oocytes or mammalian cells. Functional modulation in oocytes depends on specific regions in the N-terminal extracellular domain of beta 1, but does not require the intracellular C-terminal domain. Functional modulation is qualitatively different in mammalian cells, and thus could involve different molecular mechanisms. As a first step toward testing this hypothesis, we examined modulation of brain Na(V)1.2a sodium channel alpha subunits expressed in Chinese hamster lung cells by a mutant beta1 construct with 34 amino acids deleted from the C-terminus. This deletion mutation did not modulate sodium channel function in this cell system. Co-immunoprecipitation data suggest that this loss of functional modulation was caused by inefficient association of the mutant beta 1 with alpha, despite high levels of expression of the mutant protein. In Xenopus oocytes, injection of approximately 10,000 times more mutant beta 1 RNA was required to achieve the level of functional modulation observed with injection of full-length beta 1. Together, these findings suggest that the C-terminal cytoplasmic domain of beta 1 is an important determinant of beta1 binding to the sodium channel alpha subunit in both mammalian cells and Xenopus oocytes.

Risk factors for suicide attempts among African American women.

The aim of this study was to examine psychological and interpersonal risk factors for suicidal behavior in low income, African American women; 285 African American women who reported being in a relationship with a partner in the past year were studied, 148 presented to the hospital following a suicide attempt, and 137 presented for general medical care. Cases were compared to controls with respect to psychological symptoms, alcohol and drug abuse, family violence (intimate partner abuse, childhood trauma), relationship discord, and social support. Psychological risk factors for suicide attempts at the univariate level included psychological distress [Crude Odds Ratio (COR) = 6.5], post traumatic stress disorder (PTSD) symptoms (COR = 3.8), hopelessness (COR = 7.7), and drug abuse (COR = 4.2). Interpersonal risk factors at the univariate level included relationship discord (COR = 4.0), physical partner abuse (COR = 2.5), nonphysical partner abuse (COR = 2.8), childhood maltreatment (COR = 3.2), and low levels of social support (COR = 2.6). A multivariate logistic regression model identified four variables that were strongly and independently associated with an increased risk for suicide attempts: psychological distress, hopelessness, drug abuse, and relationship discord. The model predicted suicide attempt status correctly 77% of the time. The results reveal that African American women who report high levels of psychological distress, hopelessness, drug use, and relationship discord should be assessed carefully for suicidal ideation and referred for appropriate mental health care.

Analysis of Drosophila salivary gland, epidermis and CNS development suggests an additional function of brinker in anterior-posterior cell fate specification.

Salivary glands are simple structured organs which can serve as a model system in the study of organogenesis. Following a large EMS mutagenesis we have identified a number of genes required for normal salivary gland development. Mutations in the locus small salivary glands-1 (ssg-1) lead to a drastic reduction in the size of the salivary glands. The gene ssg-1 was cloned and subsequent sequence and genetic analysis showed identity to the recently published gene brinker. The salivary gland placode in brinker mutants appears reduced along both the anterior-posterior and dorso-ventral axis. Analysis of the brinker cuticle phenotype revealed a similar loss of anterior-posterior as well as lateral cell fates. The abdominal ventral denticle belts show a reduced number of setae in the first denticle row. Furthermore, we observed a preferential loss of lateral neuroblasts in the anterior parasegment. Together, these phenotypes suggest that brinker not only plays a role in dorso-ventral but also in anterior-posterior axis patterning.

Effect of gel re-organization and tensional forces on alpha2beta1 integrin levels in dermal fibroblasts.

Mechanical forces are known to play an important role in regulating cell function in a wide range of biological systems. This is of particular relevance to dermal fibroblast function, given that the skin is known to be held under an intrinsic natural tension. To understand more about the generation of force by dermal fibroblasts and their ability to respond to changes in it, we have studied the role of the beta1 integrin receptors expressed by dermal fibroblasts in their ability to generate tensional forces within a collagen type I matrix and the effect of altered tensional force on integrin expression by dermal fibroblasts. Using a purpose-built culture force monitor, function-blocking antibodies directed towards the beta1 receptors dramatically reduced the tensional forces generated by dermal fibroblasts in a 3D collagen I matrix. However, the specific involvement of alpha1 or alpha2 subunits could not be demonstrated. Analysis of cellular response demonstrated that cells isolated from contracting collagen gels expressed fourfold higher levels of alpha2 mRNA than cells isolated from fully restrained gels. The levels of beta1 messenger RNA were relatively unaffected by reductions in force. Cells exposed to single reductions in force, however, did not exhibit alterations in either alpha1 or beta1 mRNA levels. We propose, therefore that alpha2beta1 integrin receptor levels in dermal fibroblasts are not altered in response to single reductions of gel tension, but do change following a continual change in force and associated matrix re-organization

Experience with procedural sedation in a pediatric burn center.

BACKGROUND: Burn care requires daily debridement, dressing changes, and assessment regarding the need for skin grafting. These procedures are painful and may require an operating room environment. METHODS: The authors reviewed their experience with 912 consecutive procedural sedations (PS) in 220 pediatric burn patients over a 2-year period to identify what influence PS had on patient care. Median patient age was 32 months, and body surface area burn was 7.2%+/-6%. Pharmacological techniques included oral and intravenous medications and N2O. The authors included all sedations given in the burn treatment area and excluded all treatments given in the intensive care unit or emergency unit. RESULTS: PS allowed for early aggressive wound debridement, virtually eliminated the need for operating room debridement (used in only 22 patients), and eliminated patient discomfort and fear often associated with subsequent debridements. Burn wound-related complications occurred in 54 patients and included wound infection (n = 18), graft loss (n = 9), and pneumonia (n = 4). The incidence of PS complications was 7% with the most common problems including decreased arterial saturation (n = 41), emesis (n = 11), and agitation (n = 8). No patient required intubation or transfer to an intensive care unit bed. The average length of stay (LOS) for all patients was 8.7+/-6.2 days, and 6.2+/-3.8 days in the 200 patients not admitted to the intensive care unit. This compares favorably with the 9.5-day LOS of patients treated in 1990. CONCLUSIONS: PS in burn patients allows for early aggressive debridement, decreases the use of the operating room for debridement, and a decrease in length of stay when compared with our previous burn patients. PS has a modest risk of complications, enhances the family's cooperation and satisfaction with health care provided, and should be an integral part of burn care in children.