Practices and attitudes of providers towards continuity of care with patients using prescription contraceptives.

The aim of this study was to explore provider practices and attitudes towards routine follow-up counselling after prescription of contraceptives. An anonymous 16-item survey was pilot-tested and sent to providers of the Internal Medicine, Family Medicine, Pediatrics, and OBGYN departments of Thomas Jefferson University Hospitals (TJUH), an urban academic medical centre in Philadelphia, PA, USA. Frequency and descriptive statistics were used to analyse quantitative data while a framework analysis approach was applied to open-ended questions. Fifty percent of providers said they typically follow up with patients regarding a newly prescribed contraceptive. Only 15.3% said they do for an existing prescription. Eighty-three percent reported that it is important though only 30% believed follow-up guidelines were clear. Ultimately, there is a gap between providers' interest in delivering follow-up care and established direction on how to do so.Impact StatementWhat is already known on the subject? Prescription contraceptive adherence is suboptimal. However, it is known that proactive follow-up has positive effects on prescription contraceptive adherence.What do the results of the study add? Most respondents believe that patients take their prescription contraception as prescribed. In light of this finding, providers are less likely to follow up with an existing prescription contraceptive. Interestingly, most respondents do believe that follow-up is important for patients using prescribed contraception but endorse that guidelines about follow-up are neither established nor clear.What are the implications of these findings for clinical practice and/or further research? Patient adherence to prescription contraceptives can be improved through optimised routine patient follow-up after initial prescription. This must be done in ways that minimise burdens to both patients and providers. Providers could benefit from clear guidelines regarding best practices. Future research is needed to understand how providers can best support patients on their contraceptive journey.

Coronary artery dilatation and aortic outflow tract enlargement in children with unicommissural aortic valves.

We evaluated the aortic outflow tract (AOT) and coronary artery dimensions in pediatric patients with unicommissural aortic valves. A retrospective review of an echocardiographic database identified 37 patients with unicommissural aortic valves. A total of 115 echocardiograms were reviewed, and the right coronary artery (RCA), left main coronary artery (LM), left anterior descending coronary artery aortic valve annulus, aortic root, sinotubular junction (STJ), and ascending aorta were measured and z scores determined. The aortic stenosis peak gradient and the amount of aortic regurgitation (AR) were also measured. The RCA diameter (z score, 1.85 +/- 1.8, p = 0.03) and LM diameter (z score, 1.74 +/- 1.47, p = 0.04) are significantly dilated, as are all the AOT measurements: aortic annulus (2.02 +/- 1.9, p = 0.02), aortic root (2.25 +/- 1.9, p = 0.02), STJ (2.22 +/- 1.74, p = 0.01), and ascending aorta (4.38 +/- 2.03, p < 0.001). Longitudinal follow-up showed that there was no significant variation over time in any variable. The AOT measurements were significantly correlated with each other. A trend was found in which an increasing amount of AR gave an increase in AOT measurements. The aortic gradient was not significantly associated with any measurement. Our study population demonstrated significant dilatation of the RCA and LM as well as the AOT. The dilatation of the AOT structures is likely caused by the same mechanism that accounts for the AOT dilatation in patients with bicommissural aortic valves. Dilatation of the coronary arteries may represent an intrinsic abnormality in the vessel wall. Further studies are needed to define possible changes.

Testing candidate genes for non-syndromic oral clefts using a case-parent trio design.

Markers in five candidate genes were examined on 269 case-parent trios ascertained through a child with an isolated, non-syndromic oral cleft (cleft lip, CL; cleft palate, CP; or cleft lip and palate, CLP). Cases and their parents were ascertained through treatment centers in Maryland. Markers at two of the five candidate genes, transforming growth factor beta3 (TGFbeta3) and MSX1, showed consistent evidence of linkage and disequilibrium due to linkage using several statistical tests (e.g., the global chi-square for TGFbeta3 was 21.1 with 12 df, P = 0.03; that for MSX1 was 8.7 with 3 df, P = 0.03). There was little evidence of heterogeneity in the role of TGFbeta3 between different types of oral clefts, but MSX1 did yield marginal evidence for such heterogeneity. MSX1 also showed evidence for interaction between infant's genotype and maternal smoking, giving a likelihood ratio test for heterogeneity between smoker and non-smoker mothers of 7.16 (2 df, P = 0.03). Using a conditional logistic model to test for gene-gene interaction showed no evidence of interaction between TGFbeta3 and MSX1, with both seeming to contribute independently to risk of isolated, non-syndromic oral clefts.

A case-control study of nonsyndromic oral clefts in Maryland.

PURPOSE: Isolated, nonsyndromic oral clefts cases (n = 171) and unaffected controls (n = 182) were used to identify both genetic and environmental risk factors. METHODS: Infants born in Maryland between 1992 to 1998 with an isolated, nonsyndromic oral cleft [cleft lip (CL), cleft lip and palate (CLP), or cleft palate (CP)] were recruited and exposure plus family history data were collected. Controls were unaffected infants. DNA was collected from all cases and their parents, plus controls. RESULTS: No statistically significant association was found between any of the following: maternal smoking, vitamin use, urinary tract infection, or recreational drug use in either univariate analysis or after adjusting for maternal age and education. More control mothers reported alcohol use during the critical time period of pregnancy (one month before conception through the first trimester) as compared to case mothers. There was a 10-fold increase in risk to siblings of cases as compared to siblings of controls. Markers at four candidate genes were examined: transforming growth factor alpha (TGF alpha), transforming growth factor beta 3 (TGF beta 3), MSX1, and BCL3. Only MSX1 showed significant differences in allele frequencies between CP cases and controls. MSX1 also showed significant evidence of linkage disequilibrium with a susceptibility gene controlling risk for CP. CONCLUSION: Most environmental risk factors examined here gave little evidence of association with risk to isolated, nonsyndromic oral clefts, although any alcohol consumption seemed protective. MSX1 showed evidence of linkage disequilibrium in both case-control and case-parent trio analysis.

Hemispheric dominance of cortical activity evoked by focal electrogustatory stimuli.

Functional magnetic resonance imaging was used to observe cortical hemodynamic responses to electric taste stimuli applied separately to the right and left sides of the tongue tip. In 11 right-handed normal adults activation occurred primarily in the insular cortex, superior temporal lobe, inferior frontal lobe, including premotor regions, and in inferior parts of the postcentral gyrus. Unexpectedly, the location and laterality of activation were largely identical regardless of the side of the tongue stimulated. Activation in the superior insula, the presumed location of primary gustatory cortex, was predominantly, but not exclusively, in the right hemisphere, whereas central (more inferior) insular activations were more evenly bilateral. Right hemispheric dominance of activation also occurred in premotor regions (Brodmann areas 6 and 44), whereas left hemispheric dominance occurred only in the superior temporal cortex (Brodmann areas 22/42). The electric taste-evoked hemodynamic response pattern was more consistent with activation of the gustatory system than activation of somatosensory systems. The results suggest that the sites for cortical processing of electric taste information are dependent on hemispheric specialization.

Survey of genetic counselors and clinical geneticists regarding recurrence risks for families with nonsyndromic cleft lip with or without cleft palate.

Nonsyndromic cleft lip with or without cleft palate (CL/P) is a common congenital malformation affecting about 1/1,000 caucasian infants. Although the familial clustering of CL/P has been studied thoroughly, estimation of recurrence risk for genetic counseling purposes can be difficult. A survey was mailed to 912 board-certified genetic counselors, 542 non-board-certified genetic counselors, and 776 board-certified clinical geneticists to investigate the recurrence risks they would assign to three example families with CL/P. Responses were received from 155 (17%) board-certified genetic counselors, 36 (6.6%) non-board-certified genetic counselors, and 100 (18.5%) board-certified clinical geneticists. No major differences were found in their responses, suggesting that for these three families, geneticists would provide similar estimates of risk, regardless of their amount of experience with oral clefts patients, where they are currently employed, or their board certification status.

Testing for interaction between maternal smoking and TGFA genotype among oral cleft cases born in Maryland 1992-1996.

OBJECTIVE: Infants born in Maryland between June 1992 and June 1996 were used in a case-control study of nonsyndromic oral clefts to test for effects of maternal smoking and a polymorphic genetic marker at the transforming growth factor alpha (TGFA) locus, both of which have been reported to be risk factors for these common birth defects. DESIGN AND SETTING: Cases were infants with an oral cleft ascertained through three comprehensive treatment centers, with additional ascertainment through a registry of birth defects maintained by the Maryland Health Department. Controls were healthy infants. Medical history information on infants and mothers were collected, along with DNA samples. PATIENTS, PARTICIPANTS: Among 286 cases contacted (72% ascertainment), there were 192 nonsyndromic isolated oral clefts (106 M; 86 F) available for this case-control study. MAIN OUTCOME MEASURES: The largest group of 149 Caucasian nonsyndromic cases and 86 controls was used to test for association with maternal smoking and genotype at the Taq1 polymorphism in TGFA. RESULTS: While this modest sample had limited statistical power to detect gene-environment interaction, there was a significant marginal increase in risk of having an oral cleft if the mother smoked (odds ratio = 1.75, 95% CI = 1.01 to 3.02). We could not demonstrate statistical interaction between maternal smoking and TGFA genotype in this study, however, and the observed increase in the C2 allele among cases was not statistically significant. CONCLUSIONS: We could not confirm either the reported association between oral clefts and TGFA genotype or its interaction with maternal smoking. However, these data do show an increased risk if the mother smoked during pregnancy, and this effect was greatest among infants with a bilateral cleft and no close family history of clefts.

Comparison of fluorescent voltage-sensitive dyes for multisite optical recording in hamster cerebral cortex by measurement of bicuculline-induced epileptiform events.

Two fluorescent voltage-sensitive dyes, RH795 and DI-2-ANEPPQ, were compared for in vivo multisite optical recording from the gustatory insular cortex of the golden Syrian hamster, the first reported use of DI-2-ANEPPQ in a mammalian brain preparation. The exposed cortex of the anesthetized hamster was stained with a 500 microM solution of either dye, and the cortical surface was imaged onto a 124-element photodiode array by an epifluorescence microscope equipped with a 2.5x objective (0.08 na) and appropriate excitation and emission filters for each dye. Background fluorescence was recorded with amplifiers in DC-coupled mode, and the bathing solution changed to one containing 100 microM bicuculline methiodide. Large, widespread epileptiform events were recorded optically, and with a surface electrode, within 2 min. Three experiments were carried out with each dye. The 10 recorded events from each experiment (and five detector records from each of these 10) having the largest signals were selected for comparison. Five measures were derived from the data: (1) The ratio of peak signal fluorescence to background fluorescence (delta F/F), (2) signal-to-noise power ratio (S/N), (3) root mean square noise (RMS noise), (4) an amplitude ratio (AR) consisting of the signal height divided by RMS noise, and (5) the peak value of the surface electrode record (SER). The results indicate a twofold increase in delta F/F and a fivefold increase in S/N (twofold increase in AR) with DI-2-ANEPPQ. No significant difference was found between dyes in the RMS noise or SERs. In addition, signals did not decline detectably over time with DI-2-ANEPPQ, but declined about 25%/h with RH795.

A comprehensive analysis of complex traits in problem 2A.

We used descriptive analysis to investigate the relationship between affection status and five quantitative traits (Q1-Q5) in Problem 2A and results suggested the five quantitative traits fall into two groups. The first group comprised three strongly correlated traits, Q1-Q3, which underlie affection status, and the second group comprised Q4 and Q5, which are not directly related to affection status. Segregation and linkage analyses of traits Q1-Q3 and affection status from the first replicate detected one of the major loci for Q1 (MG1) linked to marker 14 on chromosome 5 (D5G14). Because our segregation analysis failed to show evidence of a major locus effect on Q2, and we overlooked the interaction between MG3 and sex, we did not detect either MG2 or MG3. Using Haseman-Elston sib-pair analysis [Haseman and Elston, 1972], we also examined the statistical power of Q1 and type I error rate (using the environmental factor as an index), for the remaining 199 replicates in the context of a genome screen.

Behavior of crayfish rhodopsin and metarhodopsin in digitonin: the 510 and 562 nm "visual pigments" are artifacts.

The visual pigment of the main rhabdom of the crayfish (P533) is unstable in digitonin. While slowly hydrolyzing to N-retinylidene opsin, a portion passes through a long-lived intermediate (P'505) with absorption similar to metarhodopsin but with the retinal still in the cis configuration. Crayfish metarhodopsin (M515) is similarly unstable in digitonin, and a portion converts to M'508 while bleaching slowly in the dark. Both P'505 and M'508 are light sensitive and bleach through an intermediate absorbing at still shorter wavelengths, M'460. The photobleaching of M'508 is likely a two-photon process, possibly involving P'505 as an intermediate. The persistence of these altered forms of the pigment with lambda max near 510 nm has compromised earlier efforts to analyze extracts of crayfish rhodopsin by partial bleaching. First, because of the incomplete decay of M515 (a portion of which liners as M'508), the difference spectrum for a red light exposure followed by dark decay has lambda max at 562 nm, but this difference spectrum does not describe a pigment. Because of the photosensitivity of M'508, a second bleaching exposure reveals the presence of a pigment with lambda max near 510 nm, but it is not a visual pigment and it is not present in the extract initially.

Packaging of rhodopsin and porphyropsin in the compound eye of the crayfish.

The distribution of 3-dehydroretinal (Ral2) in dorsal, middle, and ventral slices of eyes of the crayfish Procambarus clarkii was examined by HPLC. No pronounced differences were found. Similar results were obtained when the eyes were cut into anterior, intermediate, and posterior portions. Dichroic difference spectra were measured in single halves of microvillar layers of isolated rhabdoms and the proportions of rhodopsin (P1) and porphyropsin (P2) estimated by comparison with computer-generated mixtures of these pigments, whose spectra are known from previous work. The fraction of visual pigment that is porphyropsin appears to be uniform throughout individual retinular cells and among the retinular cells of individual rhabdoms, but various substantially among different rhabdoms from the same eye. The interommatidial variation in the amount of P2 greatly exceeds the gross regional variation in Ral2. This means there is an intermingling of ommatidia with different levels of P2. The variability in P2 among ommatidia is not likely to have important implications for the vision of the crayfish but suggests that in the metabolism of retinoids, individual ommatidia are quasi-independent metabolic units. The results are compatible with a single opsin for both crayfish rhodopsin and porphyropsin.

Spectral properties of porphyropsin from an invertebrate.

Winter crayfish (Procambarus clarkii) contain both retinal and 3-dehydroretinal, as first described by Suzuki, Makino-Tasaka and Eguchi (1984). Using the detergent L-1695 we have extracted visual pigments from the rhabdoms of crayfish and have characterized spectrally both rhodopsin (P1) and porphyropsin (P2). Both P1 and P2 are converted by light to relatively stable meta-pigments (M1 and M2). We here show a method for estimating the absorbance spectra of all four pigment species. The spectra of P533(1) and M510(1) agree with previous microspectrophotometric measurements on isolated rhabdoms. P567(2) and M537(2) represent the first 3-dehydroretinal-based visual pigment system to be characterized from an arthropod.

Imbalance of total cellular nucleotide pools and mechanism of the colchicine-induced cell activation.

Treatment with colchicine or vinblastine, both inhibitors of microtubule assembly, renders quiescent 3T3 cells in an "activated state" as evidenced by induction of DNA synthesis and other criteria. Microtubule disassembly caused by colchicine or vinblastine brings about a dramatic expansion of total cellular UTP pools with a concomitant diminution in total cellular ATP pools, thus resulting in a marked imbalance in total cellular nucleotide pools. Colchicine and vinblastine also stimulate total cellular RNA synthesis without enhancing uridine phosphorylation, suggesting that these drugs affect the G1 phase of the cell cycle at a point beyond the enhancement of uridine phosphorylation that usually accompanies mitogenic stimulation of quiescent mammalian cells. The markedly expanded cellular UTP pools appear to be necessary for initiation of the colchicine-stimulated DNA synthesis because decreasing cellular UTP pools by addition of D-glucosamine results in a selective inhibition of DNA synthesis in the colchicine-stimulated, but not control, cells. Furthermore, D-glucosamine exerts its inhibitory effect only when it is present in the cultures within the first 14 hr after colchicine treatment. When added at 21 hr, D-glucosamine still decreases cellular UTP pools, but it is no longer inhibitory for DNA synthesis, which commences 14-16 hr after colchicine stimulation. Taxol, an antitumor drug, prevents microtubule disassembly and also blocks such events as expansion of total cellular UTP pools and stimulation of RNA and DNA synthesis, indicating that microtubule depolymerization acts as a primary event initiating the process of cell activation induced by colchicine.