Metabolism of preconditioned myocardium: effect of loss and reinstatement of cardioprotection.

Ischemic preconditioning is associated with slower destruction of the adenine nucleotide pool and a slower rate of anaerobic glycolysis during subsequent ischemic stress. Whether this association is causal is uncertain. Using metabolite levels found at baseline and after a 15 min test episode of ischemia, this study tested for concordance, or lack thereof, between the presence or absence of metabolic features v the presence or absence of the preconditioned state. Dogs were assigned to one of four groups: non-preconditioned control (C), full preconditioning (PC) caused by 10 min ischemia (I)+10 min reperfusion (R), dissipated PC (DPC) caused by 10 min I and 180 min R, or reinstated PC in which PC was reinstated in DPC hearts by another 10 min I and 10 min R. At baseline, PC and RPC hearts had a 25% or more decrease in the adenine nucleotide pool (summation operatorAd), a substantial creatine phosphate (CP) overshoot, and a 4-6 times elevation in tissue glucose (G). Of these changes, the decreased summation operatorAd and the CP overshoot persisted during DPC, whereas only G returned to control. Thus, increased G was the only baseline feature, which was concordant with the preconditioned state. The response to ischemic stress in PC and RPC tissue included less lactate production and much less degradation of the summation operatorAd pool to nucleosides and bases than in the C or DPC groups. Thus, slower destruction of the summation operatorAd pool and slower lactate production during ischemia also were concordant with the PC state. The results support the hypothesis that a reduction in energy demand is an essential component of the mechanism of cardioprotection in preconditioned myocardium. However, the mechanism through which ischemic preconditioning results in lower energy demand remains to be established.

Using an exercise-based instrument to detect signs of an eating disorder.

The study employed an innovative exercise-based instrument to identify individuals at risk for eating disorder (ED). The Exercise Orientation Questionnaire (EOQ), a reliable and valid instrument, was used to compare 80 ED patients, 74 obese patients, 99 elite runners, and 214 controls from a previous study. Runners resembled ED patients in scoring high on total EOQ and exercise intensity but differed in that the athletes scored low on self-loathing (SLSS), a sub-scale of the EOQ. SLSS scores clearly distinguished clinical (ED, obese) from non-clinical groups, while other sub-scales (self-control, weight loss, and identity) did not. The study suggests that it is feasible to detect ED risk through assessment of exercise attitudes and behaviors. The SLSS subscale of the EOQ can differentiate clinical from non-clinical groups and anorexic patients from healthy individuals with body mass index within the anorexic range. The SLSS could provide a theoretical bridge between compulsive athleticism and ED.

The past, present and future of health care quality. Urgent need for innovative, external review processes to protect patients.

There are three paths to quality health care standards: the regulatory route, the "learning science" route, and the futuristic "management science" route. The regulatory path leads to punishment and blame. The learning science path splits, with one road leading back to harsh regulations and the other to the halls of academic medicine. And the management science path, while short, will be the road to success as American health care struggles to improve quality and overcome well-publicized and deadly medical errors.

The reflecting team: an innovative approach for teaching clinical skills to family practice residents.

BACKGROUND AND OBJECTIVES: This paper provides a description and evaluation of the reflecting team approach as a teaching method for family practice residents. We have used the reflecting team approach in our longitudinal behavioral health program for 6 years. Our purpose in using this approach is to 1) teach listening and interviewing skills, 2) teach systems-oriented psychosocial interventions, and 3) provide behavioral health consultations for patients. METHODS: A five-item, self-administered, open-ended questionnaire evaluating the reflecting team approach was administered to a sample of family practice residents. RESULTS: Completed questionnaires were received from 18 of the 22 family practice residents participating in the longitudinal behavioral health program (a response rate of 82%). Responses to the questionnaire items indicated that the residents understood the purpose of the reflecting team approach and felt that they had acquired a variety of clinical skills from the approach, including listening and interviewing skills, positive reframing of patients' problems, how to give positive feedback to promote behavioral change, and increased knowledge of psychosocial assessment procedures and treatment methods. CONCLUSIONS: The residents' responses to the questionnaire items indicated that they perceived the reflecting team approach to be a practical and useful method for learning a variety of clinical skills.

Tense and temporality: a comparison between children learning a second language and children with SLI.

This study compares the morphosyntax of children with SLI to the morphosyntax of children acquiring a second language (L2) to determine whether the optional infinitive phenomenon (M. Rice, K. Wexler, & P. Cleave, 1995; K. Wexler, 1994) is evident in both learner groups and to what extent cross-learner similarities exist. We analyzed spontaneous production data from French-speaking children with SLI, English-speaking L2 learners of French, and French-speaking controls, all approximately 7 years old. We examined the children's use of tense morphology, temporal adverbials, agreement morphology, and distributional contingencies associated with finiteness. Our findings indicate that the use of morphosyntax by children with SLI and by L2 children has significant similarities, although certain specific differences exist. Both the children with SLI and the L2 children demonstrate optional infinitive effects in their language use. These results have theoretical and clinical relevance. First, they suggest that the characterization of the optional infinitive phenomenon in normal development as a consequence of very early neurological change may be too restrictive. Our data appear to indicate that the mechanism underlying the optional infinitive phenomenon extends to normal (second) language learning after the primary acquisition years. Second, they indicate that tense-marking difficulty may not be an adequate clinical marker of SLI when comparing children with impairment to both monolingual and bilingual peers. A more specific clinical marker would be more effective in diagnosing disordered populations in a multilingual context.

Effects of diaspirin crosslinked hemoglobin infusion in treadmill-exercised swine.

The hemodynamic and metabolic effects of diaspirin crosslinked hemoglobin (DCLHb) were investigated using graded treadmill exercise in swine (n = 5/group). Swine received DCLHb (10% solution, 5 ml/kg) or oncotically-matched human serum albumin (HSA, 5ml/kg). Baseline metabolic and hemodynamic data were similar. In both groups exercise increased hemodynamic parameters. Exercise increased heart rate (HR) from 139 +/- 12 to 293 +/- 28 bpm with DCLHb and from 136 +/- 13 to 314 +/- 13 bpm with HSA. Exercise increased cardiac output (CO) from 5.7 +/- 0.75 to 15.6 +/- 2.01/min in the DCLHb group and from 5.3 +/- 0.48 to 15.7 +/- 0.881/min in the HSA group. However, CO returned to baseline faster with DCLHb upon stopping exercise. The DCLHb-treated group demonstrated a significantly higher oxygen extraction during exercise (12.04 +/- 0.38 vs 9.48 +/- 0.99 ml O2/100 ml blood) and a lower oxygen delivery throughout recovery (74.6 +/- 6.6 vs 102.2 +/- 7.21 O2/min), indicating enhanced oxygen delivery during exercise in the treatment group. DCLHb infusion did not impair metabolic or hemodynamic functions. These data indicate that DCLHb may increase oxygen delivery to working tissue more efficiently than HSA during treadmill exercise in swine.

Development and evaluation of the McKnight Risk Factor Survey for assessing potential risk and protective factors for disordered eating in preadolescent and adolescent girls.

OBJECTIVE: To describe the development, test-retest reliability, internal consistency, and convergent validity of the McKnight Risk Factor Survey-III (MRFS-III). The MRFS-III was designed to assess a number of potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls. METHOD: Several versions of the MRFS were pilot tested before the MRFS-III was administered to a sample of 651 4th through 12th- grade girls to establish its psychometric properties. RESULTS: Most of the test-retest reliability coefficients of individual items on the MRFS-III were r > .40. Alpha coefficients for each risk and protective factor domain on the MRFS-III were also computed. The majority of these coefficients were r > .60. High convergent validity coefficients were obtained for specific items on the MRFS-III and measures of self-esteem (Rosenberg Self-Esteem Scale) and weight concerns (Weight Concerns Scale). CONCLUSIONS: The test-retest reliability, internal consistency, and convergent validity of the MRFS-III suggest that it is a useful new instrument to assess potential risk and protective factors for the development of disordered eating in preadolescent and adolescent girls.

Factors associated with weight concerns in adolescent girls.

OBJECTIVE: This study examined the association of weight concerns with potential risk factors for the development of eating disorders. METHOD: A self-report survey was given to 103 elementary (Grades 4 and 5) and 420 middle (Grades 6-8) school students in Arizona and California. Of these, 78 elementary and 333 middle school students provided complete data and were used in the analyses. RESULTS: In a multivariate stepwise regression analysis, the importance that peers put on weight and eating was most strongly related to weight concerns in the elementary school girls, accounting for 34% of the variance after adjusting for site differences. Trying to look like girls/women on TV and in magazines as well as body mass index (BMI) entered the final model that accounted for 57% of the variance in weight concerns. In middle school, the importance that peers place on weight and eating was also the strongest predictor accounting for 33% of the variance followed by confidence, BMI, trying to look like girls/women on TV and in magazines, and being teased about weight. Together these variables accounted for 55% of the variance. DISCUSSION: Prevention programs aimed at reducing weight concerns need to address these factors.

Potential risk factors associated with weight control behaviors in elementary and middle school girls.

The purpose of this study was to examine the relationship between weight control behaviors and potential risk factors for disordered eating in a sample of young girls. The McKnight Risk Factor Survey was administered to 523 elementary and middle school girls. In the sample of elementary school girls, results from the multiple regression analyses indicated that frequency/severity of weight control behaviors was associated with body mass index (BMI), self-confidence, peers' weight-related pressures, ethnicity, and the interaction between having divorced/separated parents and BMI. Sensitivity to peers' weight-related pressures and BMI were also associated with weight control behaviors in the middle school girls, along with poor body image, substance use, having divorced/separated parents, and the interaction between having divorced/separated parents and father's pressure for thinness. Longitudinal research is needed to determine how risk factors change over time, beginning in elementary school and continuing through high school.

Attachment style and weight concerns in preadolescent and adolescent girls.

OBJECTIVE: The purpose of this study was to assess the association between attachment style and weight concerns, a major risk factor for eating disorders, in preadolescent and adolescent girls. METHOD: Three hundred and five female elementary and middle school students completed measures of attachment style and weight concerns. RESULTS: Insecurely attached subjects reported higher weight concerns than did securely attached subjects. A greater proportion of insecurely attached subjects obtained "at risk" weight concerns scores than securely attached subjects. DISCUSSION: The findings suggest that attachment style may play an important role in the development of weight concerns, which, in turn, have been shown to be associated with the onset of eating disorders.

Eating disturbances among American minority groups: a review.

OBJECTIVE: The purpose of this paper was to review the research literature related to eating behaviors and disturbances among American minority groups. METHOD: A computer-based literature search was conducted to locate articles pertaining to this topic. RESULTS: This review indicates that, compared to Caucasian females, eating disturbances are equally common among Hispanic females, more frequent among Native Americans, and less frequent among Black and Asian American females. Risk factors for eating disorders (EDs) are greater among minority females who are younger, heavier, better educated, and more identified with White, middle-class values. DISCUSSION: Further studies of EDs among American minority groups are needed, especially studies that are longitudinal and developmental in nature and that focus more specifically on the effects of racism in the development of EDs.

Early passive acquisition in Inuktitut.

Passive structures are typically assumed to be one of the later acquired constructions in child language. English-speaking children have been shown to produce and comprehend their first simple passive structures productively by about age four and to master more complex structures by about age nine. Recent crosslinguistic data have shown that this pattern may not hold across languages of varying structures. This paper presents data from four Inuit children aged 2;0 to 3;6 that shows relatively early acquisition of both simple and complex forms of the passive. Within this age range children are productively producing truncated, full, action and experiential passives. Some possible reasons for this precociousness are explored including adult input and language structure.

The spectrum of eating disturbances.

OBJECTIVE: The purpose of this paper was to review and summarize the research literature on the spectrum of eating disturbances. METHOD: Literature was searched using a computer data base to identify recent articles related to the prevalence and occurrence of disturbed eating patterns as well as full and partial syndrome eating disorders (EDs). RESULTS: This review indicates that the prevalence of partial syndrome EDs in nonclinical populations is at least twice that of full syndrome EDs, and that there is a progression in some individuals from less to more severe disturbances in eating behavior. DISCUSSION: These findings suggest the need for careful, scientific evaluation of risk factors for EDs in both children and adults. A longitudinal research program in progress is described which aims to identify the risk factors for EDs.

Eating attitudes and weight preoccupation among female high school students in Japan.

Eating disorder tendencies in 197 eleventh grade Japanese girls were examined to ascertain whether or not the reported correlates of eating disorder tendencies in North America would be replicated in Japan. The 26-item Eating Attitudes Test was administered along with a set of supplementary questions. As hypothesized, higher levels of eating disturbances were found in the students who: (1) perceived themselves as being overweight, (2) had been encouraged to diet, (3) reported engaging in frequent conversations with their mother about food and dieting. Implications for future cross-cultural research are discussed.

Comparing obligatory to nonobligatory runners.

This study compares "obligatory" runners (runners who continue to run despite clear physical injury or contraindications) to nonobligatory runners. Both groups scored within the normal range on most psychological test indices. The two groups had more similarities than differences. The obligatory runners did present more significant elevations of the Minnesota Multiphasic Personality Inventory scales than did the nonobligatory runners. Based on their responses to the semistructured interview, the obligatory runners were significantly more concerned and rigid about weight control than the nonobligatory runners and the obligatory runners were more likely to prefer being alone. Obligatory runners were more preoccupied with their bodies and reported more positive changes in self-concept and a greater sense of control over their lives since they had begun to run. Female runners reported more satisfaction with and more positive effects from running than did male runners. Strenuous exertion is known to increase prolactin in male and female runners. Clinical research studies suggest that an increase in prolactin is associated with an obsessive preoccupation with diet and/or exercise.

Clinical features of eating disorders and individual psychological functioning.

Relationships between the clinical features of eating disorders and individual psychological functioning were investigated in a population of 114 eating-disordered females, which consisted of 63 bulimics, 9 anorexics, 7 bulimic anorexics, 23 with eating disorders not otherwise specified, and 12 with indications of an eating disorder, but without sufficient data for further differential diagnosis. No significant differences in psychological functioning were found when diagnosis was used to classify the subjects into groups, but significant differences did emerge when subjects were classified by specific clinical features. Among the clinical features associated with greater psychopathology were: low body weight, frequent weight fluctuations, amenorrhea of longer duration, purging via laxatives, frequent exercising, and more frequent binges of longer duration.

Familial aggregation of a developmental language disorder.

This paper investigates the etiology of developmental dysphasia and its linguistic properties. Data are presented that suggest that at least some cases of dysphasia are associated with an abnormality in a single dominant gene. The results of a series of tests on a large three-generation family, in which half of the members have dysphasia, are reported. These results show that abstract morphology is impaired in these subjects. It is argued further that the data are consistent with the hypothesis that the dysphasics learn the feature-marked lexical items of language as unanalyzed lexical items. They do not have the underlying capacity to learn language by constructing paradigms.

Coexistence of bulimia nervosa and mania: a literature review and case report.

A literature review of the relationship between bulimia and affective disorder showed that the evidence from empirical research and case report studies suggests that a sizeable subgroup of bulimics suffer from bipolar disorder as well as bulimia and may benefit from antimanic medications such as lithium. A case report is presented of a bulimic patient with manic symptoms who was successfully treated with lithium. However, the use of lithium should be avoided with any patient who is purging, since it may exacerbate the loss of intracellular potassium, thereby increasing the risk of cardiac toxicity.