Examination of toxicity and collagen linearity after the administration of the protein cross-linker genipin in equine tendon and dermis: a pilot study.

OBJECTIVE: Collagen cross-linking is an attractive therapeutic route aimed at supplementing natural collagen stabilisation. In this study the toxicity of the cross-linker genipin (GP) was examined in avascular (tendon) and vascular (dermis) tissue. METHODS: High doses of GP were injected intratendinously into three yearling horses and evaluated at various time points up to 30 days. A second group of three yearlings were injected into the dermis and evaluated at various time points up to 1 year. Metrics used included lameness, circumferential swelling, ultrasound evaluation, microscopic morphology, collagen production and systemic effect on blood parameters. RESULTS: The tendon injection sites exhibited mild lameness and swelling with no apparent systemic toxicity or stabilisation defects. Treated tendons exhibited increased linear collagen microscopically. Dermal injections showed similar results, with mild swelling at the injection site. Microscopic morphology resulted in a decrease in dermal collagen at 30 days post-injection. Dermis injected at the high dose of 355 mmol/L examined 1 year post-treatment appeared similar to the untreated biopsies; however, there was an increase in mature collagen. CONCLUSION: GP injection appeared to be well tolerated, with transient lameness and mild circumferential swelling when injected into the tendon and local tissue swelling when injected into the dermis. No systemic hypersensitivities or toxicities were observed. Microscopically, GP resulted in increased linear collagen in tendons at 30 days post-injection and overall increased collagen in dermal tissue when evaluated 1 year post-injection.

Examining child sexual abuse evaluations: the types of information affecting expert judgment.

OBJECTIVE: There were two aims: First, to determine to what extent four variables, disclosure, doll play, affect and collateral information, affect the decision-making processes of child sexual abuse experts and lay persons when confronted with an abuse allegation, and second, to see how these two groups of raters might differ from one another. METHOD: A randomized block partially confounded factorial design was used. Participants made abuse likelihood and confidence ratings in response to six hypothetical cases of child sexual abuse, four of which had varying combinations of the four types of information and two of which were constant across all raters. Participants also completed attitudes and knowledge questionnaires. RESULTS: Disclosure and collateral information both had large effects on both rater groups. Doll play and affect had little or no effect on the decisions of either group. Experts were slightly more conservative in their judgments over all than students were. Experts also displayed more knowledge of the sexual abuse literature and more child-believing attitudes than their student counterparts. CONCLUSION: Concrete information such as disclosure statements and collateral information affected abuse decisions while inferential data such as doll play and affect did not. The goal of these evaluations may be the clarification of such concrete information and the inferential data may be used only to guide one's inquiry. This conclusion argues against the concern that experts might jump to conclusions of abuse merely based upon suggestive, symbolic material.

Automating the medical practice--promise and peril.

Pick up any newspaper or news magazine and chances are that an article on health care reform will be prominently featured. While we await the details of the plans for reform, we can divine some major implications. With certainty, one of these will be the need to access and integrate vast amounts of patient and provider data. These medical data, in electronic form, will fuel the interplay between provider, hospital, government organizations, and private health care management. These data will be used: to drive the outcome studies that will examine medical resource consumption; to track prescribing practices; to facilitate patient follow-up; and to monitor wellness programs. In short, data management will be an unseen, but very present, companion to all our practice decisions. The successful medical practitioners in the coming era will be those whose practices have an electronic infrastructure that allows comprehensive medical record keeping, inclusive of patient charting, billing, coding, scheduling, and data reporting to third parties.