The effects of phototherapy on the numbers of circulating natural killer cells and T lymphocytes in psoriasis.

The innate immune system is believed to be important in the pathogenesis of psoriasis and natural killer (NK) have been found in increased numbers in psoriatic plaques. Alterations in the numbers of NK cells in peripheral blood have been reported. We investigated the effect of phototherapy on levels of peripheral NK cells and lymphocytes in patients with psoriasis. In nine patients whom we followed before, during and after narrowband ultraviolet B (UVB) treatment there were no differences in the numbers of circulating lymphocytes, lymphocyte subsets or cells expressing NK markers and controls. Treatment with narrowband UVB did, however, significantly lower circulating CD4 counts which gradually recovered posttreatment.

The effects of mutations in the rpmB,G operon of Escherichia coli on ribosome assembly and ribosomal protein synthesis.

The rpmB,G operon of Escherichia coli codes for proteins L28 and L33 of the larger (50S) ribosomal subunit. Strains with mutations in this operon can help define the roles of these proteins in ribosome synthesis and function. One such strain, BM108, makes neither protein and is unable to synthesize completed ribosomes; instead ribonucleoproteins accumulate, in the form of '30S material' and '47S particles'. However, when protein L28 is supplied from a plasmid, the growth rate, the kinetics of ribosome synthesis and the coordination of ribosomal protein synthesis are no different from that in wild-type organisms even though protein L33 is missing. This suggests that the latter protein can be redundant for ribosome synthesis and function. Another mutant strain, BM81, has a frameshift mutation that gives rise to an oversized protein L28. This mutant accumulates 30S material and 47S particles during slow exponential growth. The composition of the 47S particles from strains BM81, BM108 and a third mutant strain, TP28, suggests that their defining feature is the absence of L28; this is further evidence for an important role for this protein in ribosome assembly. Accumulation of ribonucleoproteins in strains BM81 and BM108 leads to some loss of the ordinarily precise coordination of synthesis of ribosomal proteins. We describe and discuss the characteristic features of this unbalanced synthesis.

Primary mucinous carcinomas of the skin express TFF1, TFF3, estrogen receptor, and progesterone receptors.

Mucinous carcinoma may present at various sites, including the breast and the gastrointestinal tract. Rarely, such tumors arise within the skin. Comparatively, breast lesions are relatively common and usually associated with a good prognosis. When pure, they are typically estrogen (ER) and progesterone receptor (PR) positive and responsive to tamoxifen. The authors studied 12 mucinous carcinomas of the skin and compared the morphology with that of typical mammary lesions. The authors also evaluated for expression of estrogen receptor, progesterone receptor, and the mucus-associated peptides of the trefoil factor family (TFF), TFF1 (formerly pS2) and TFF2 (formerly SP), using immunohistochemistry. The localization of mRNAs for TFF1, TFF2, and TFF3 (formally ITF) was also studied in a subset of three tumors, using in-situ hybridization with S35 labeled riboprobes. The Grimelius stain was used to look for evidence of neuroendocrine differentiation. Eight resembled type A mucinous carcinomas of the breast, two resembled type B, and one had composite features. The 12th was a papillary neoplasm. The two type B tumors exhibited argyrophilia. All showed strong nuclear staining with the estrogen receptor antibody but a more varied pattern with antibodies to progesterone receptor and TFF1. None labeled for TFF2. The detection of TFF1 in mammalian skin is a novel finding. Cutaneous mucinous carcinoma shows strong similarities to its mammary counterpart, including expression of estrogen receptor, TFF1, and TFF3 mRNA. These observations suggest that some mucinous carcinomas of the skin might respond to antiestrogenic therapies.

Three lay mental models of disease inheritance.

Genetics are coming to play an increasing role in biomedical understanding of common diseases. The implication of such findings is that at-risk individuals may be offered predictive genetic tests. How do individuals make decisions about predictive tests and what information do they need to make informed choices? Richards [Richards, M.P.M., 1993. The new genetics: some issues for social scientists. Sociology of Health and Illness 15, 567-586] has argued the first step in understanding and helping people to make these decisions is to investigate lay beliefs of genetics. This study examined mental models of inheritance in a sample of 72 lay people. Through analysis of open-ended questionnaires we found three mental models which loosely corresponded to three phases of historical development in the science of genetics. These we labelled the Constitutional, Mendelian and Molecular Models. Predictions for individuals holding each model are made for the comprehension of genetic information in a testing situation.

The impact of who you know and where you live on opinions about AIDS and health care.

We hypothesized that public attitudes towards AIDS and the safety of health care in the era of HIV would be more positive for people who knew someone with AIDS. We believed, moreover, that living in areas with high AIDS prevalence would result in more favorable attitudes. To test these hypotheses, we conducted telephone interviews with a random sample of 2000 U.S. adults (response rate = 75%) in summer 1988. Overall 19.5% of respondents said that they knew someone with AIDS or the AIDS virus. Thirteen percent of people who lived in low prevalences areas reported knowing someone with AIDS, compared with 27% of those in areas of high prevalence. Of the total sample, 38% reported knowing someone they believed was at risk. People who knew someone with AIDS were less likely to say they would change physicians or dentists if their provider was HIV infected or was known to be treating people who were infected. Knowing someone with AIDS was also associated with greater tolerance for those with AIDS to continue to work if they were able and with lower perception of risk of transmission in health care settings. Multivariate regression analyses indicated that personal contact was related to more positive attitudes. Counter to our hypothesis, living in a high prevalence area had no independent effect on attitudes. This surprising finding suggests that, after controlling for personal contact with someone with AIDS, where one lives does not influence attitudes. Because bringing people with AIDS into contact with others may have positive outcomes, we suggest implementation of interventions using this strategy.

Public perception of risk of AIDS in health care settings.

Our nationwide telephone survey conducted in 1988 (n = 2,000) reveals that the public perceives a considerable risk of contracting AIDS during routine transactions in health care settings. In addition to previously noted public concerns about getting infected with the AIDS virus through blood transfusions and blood donations, respondents also think that AIDS can be transmitted through contact with HIV-infected health care workers during routine treatment in medical or dental offices and in hospital emergency rooms. Effective education programs must be developed to address these public concerns.

Public acceptance of the Surgeon General's brochure on AIDS.

Public acceptance of the Surgeon General's brochure, "Understanding AIDS," was investigated in a nationwide telephone survey of a representative sample of 2,000 adults generated by random digit dialing. A response rate of 75 percent was achieved. A total of 59 percent of respondents remembered receiving the brochure; of these, 68 percent read most of it and 20 percent read half of it or less. Most respondents reacted positively; 86 percent believed that it was a good use of government money, and only 7 percent would have preferred not getting it. Analysis by demographic characteristics indicated that blacks and young people were less likely to remember receiving the brochure than were whites and retired persons. The public health community can assume that the mailing met with resounding approval and that other public health brochures would be welcomed.

The effects of imagery on attitudes and moods in multiple sclerosis patients.

OBJECTIVE: To determine the efficacy of imagery for influencing attitudes and moods in multiple sclerosis patients. DESIGN: Experimental pretest-posttest, control-group. SETTING: Outpatient group in Central Pennsylvania. PATIENTS: 33 patients with mean ages of 43.93 years in the imagery group and 46.33 years in the control group. All subjects previously were identified with multiple sclerosis. INTERVENTION: Control group subjects followed their typical medical protocol and completed pretest and posttest measures. Imagery group subjects completed pretest and posttest measures and participated in a six-session group process that included brief exposure to relaxation training and ongoing work with biologically oriented imagery. Relaxation training and imagery were practiced on a daily basis. Imagery group subjects also produced imagery drawings, which were assessed after the third and sixth sessions. MAIN OUTCOME MEASURES: Profile of Mood States, State-Trait Anxiety Inventory, Health Attribution Test, Imagery Assessment Tool, and Multiple Sclerosis Symptom Checklist. MAIN RESULTS: Imagery group subjects demonstrated significant reductions in state anxiety and significant alteration in their illness imagery because of feedback obtained during the study. CONCLUSION: Use of the relaxation/imagery protocol led to clinically significant reductions in state anxiety. Imagery may be assessed through drawings that allow for positive modification of the imagery material to increase its utility and power.

Monoclonal antibody Ber-EP4: its use in the differential diagnosis of malignant mesothelioma and carcinoma in cell blocks of malignant effusions and FNA specimens.

Formol sublimate-fixed cell blocks derived from 129 malignant pleural (and some peritoneal) effusions, 8 benign effusions with reactive mesothelial cells, and 23 FNA specimens, were immunostained with monoclonal antibody Ber-EP4 to assess its ability to distinguish malignant mesothelioma (MM) from carcinoma. Only 2 of 44 (4%) well-characterized MM were Ber-EP4+, while none of 8 benign mesothelial proliferations reacted with the antibody. Fifty-seven percent of 23 pulmonary adenocarcinomas (AC) and 60% of 43 pulmonary carcinomas of all other histological types were Ber-EP4+. Of 40 metastatic AC originating from breast, gastrointestinal tract, ovary, endometrium, and kidney, 80% were Ber-EP4+. The predictive value of positive Ber-EP4 staining in distinguishing AC from MM was 96%. The predictive value of a negative Ber-EP4 in excluding MM was 70%, when the differential diagnosis was adenocarcinoma. These results suggest that Ber-EP4 is helpful in differentiating MM and AC if used together with other discriminating antibodies.

Lay representations of genetic disease, and predictive testing.

As research in human genetics advances, genes for familial forms of cancer and heart disease will continue to be identified. The implication of such findings is that at-risk individuals will be offered a predictive genetic test. How do individuals make such decisions and what information do they need to make informed choices? Richards (1993) has argued that the first step in understanding and helping people to make these decisions is to investigate lay beliefs of genetics. This study examined illness representations of genetic disease, and predictive testing in a sample of 20 educated lay people. Through content analysis of open-ended interviews, we discovered that individuals have limited knowledge of late-onset genetic disorders and predictive testing. Most of the sample identified genetic diseases that manifest in childhood, and were more familiar with prenatal testing. They did not mention any treatment options for genetic disorders, which may indicate that lay people are more deterministic about diseases with a genetic component. Finally, they consistently raised concerns about the ethics of genetic testing and research. The implications of our findings for the provision of information in a genetic testing situation are discussed.

AIDS and dental practice.

Dental health care workers (DHCWs) can provide important diagnostic, treatment, and referral services for patients with AIDS and at risk for AIDS. They also have a responsibility to protect all patients in their practices, and themselves, from infectious disease transmission through the use of infection control. To determine the extent to which DHCWs are prepared to assume these responsibilities, a randomized survey of California DHCWs was conducted. Responses were obtained from 297 dentists, 128 hygienists, and 177 dental assistants. DHCWs who expressed a greater willingness to treat people with AIDS or HIV infection also practiced more thorough infection control. Respondents in all groups who perceived a greater percent of their patients to be at risk for AIDS were more likely to use infection control procedures (P less than .0001). They also were more willing to treat such patients (P less than .004) and were more likely to assess patients for AIDS by taking a thorough medical history (P less than .02) and sexual history (P less than .04). Since attitudes toward AIDS and perception of the percent of patients at risk in one's practice affect patient assessment and infection control procedures used by dental health care workers, educational programs designed to enhance DHCWs' response to the HIV epidemic should alert them to the extent of the problem and help them cope with their concerns.

Dental care experience of HIV-positive patients.

Three studies were conducted to assess the experiences of persons with acquired immune deficiency syndrome (AIDS) or risk factors for the disease in seeking dental care in Los Angeles; San Francisco; Seattle; and Tacoma, WA. Given previous reports from surveys of dentists that they would be reluctant to provide care to people from these groups, widespread denial of care was expected. Our two surveys conducted in San Francisco, however, showed that only 1.3% and 10.8% had been denied care by a dentist. These data suggest that dentist reactions to people with AIDS are more favorable than has previously been suggested, although denial of care is still a problem to some extent.

Changing dentists' knowledge, attitudes, and behaviors relating to AIDS: a controlled educational intervention.

The efficacy of an educational intervention designed to improve dentists' knowledge, attitudes, and behaviors about acquired immune deficiency syndrome (AIDS) was tested. The intervention had three components: computerized feedback comparing participants' own knowledge, attitudes, and behaviors with those of fellow participants and with an ideal; periodic bulletins; and telephone conference calls with experts. The group receiving the educational package had better scores than a control group on outcomes of willingness to treat persons with AIDS; identification of human immunodeficiency virus lesions; knowledge of AIDS; and completeness of both intraoral and extraoral examinations. It was concluded that intervention is one approach to increasing dentists' positive response to the AIDS epidemic.

Experiment on aggregation of red cells under microgravity on STS 51-C.

Kinetics and morphology of aggregation of red cells were studied using automatic slit-capillary photo-viscometers, one situated on the middeck of the space shuttle 'Discovery', and the other in the ground laboratory at KSC. Experiments were run simultaneously, blood samples being adjusted to haematocrit of 0.30 using native plasma, at temp. of 25 degrees C, and anticoagulated by EDTA. Donors included patients with myocardial infarction, insulin-dependent diabetes, hyperlipidaemia and hypertension. Macro and microphotographs were obtained during flow and stasis. There was a striking difference in the morphology of aggregates formed in space and on the ground. Aggregates formed under zero gravity showed rouleaux formation, while the same blood samples showed severe clumping on the ground, in all patients blood. Normal blood showed rouleaux on the ground, but a random swarm-like pattern in space. The shape of the red cells remained normal under zero gravity.

An eight-year review of legal cases related to an urban 9-1-1 paramedic service.

INTRODUCTION: An eight year retrospective analysis was conducted to determine the type and outcome of lawsuits related to the provision of 9-1-1 paramedic service in an urban environment. METHODS: For the evaluation period of May 1986 to March 1994, all litigation cases related to Ambulance Service or paramedics were collected and analyzed. This urban 9-1-1 Paramedic Service has an estimated call volume of > 60,000 assignments resulting in > 30,000 patient encounters during the evaluation period. RESULTS: Seven lawsuits were filed against the service. No lawsuits were related to tardy response, failure to transport, or patient care negligence of any kind. All of the litigation was related to motor vehicle collisions (MVC). CONCLUSIONS: The data suggest that motor vehicle collisions are a significant medical-legal risk to the EMS community. In addition, it was found that the use and lack of use of seatbelts was an important component in many of the suits.

Planning, implementation, and evaluation of AIDS education programs for dentists.

Because many dentists were trained before HIV disease was recognized and its implications for dentistry understood, there is a need for effective continuing education programs about the disease for health professionals. Unfortunately, much of the continuing professional education about AIDS in the last few years has been poorly evaluated and the value of continuing education itself has increasingly been called into question. In order to clarify how continuing educational efforts can be designed and evaluated, we report on our continuing educational projects and research which culminated in research on a nationwide educational intervention about AIDS for dentists. We outline and evaluate the steps taken in designing both the intervention and the research. The strengths and weaknesses of the design are discussed and suggestions made about how the design could be improved.

Recent graduates' evaluation of their dental school education.

To assess recent dental graduates' perceptions about the adequacy of their education, a random sample of individuals who graduated between 1980 and 1982 was surveyed. The 362 respondents (56 percent response rate) indicated their perceived level of preparedness and the importance to practice of 75 topics in the dental school curriculum. The means for level of preparedness and importance to practice were plotted for each of the 75 topics. Those topics that new dentists believed to be underemphasized or overemphasized in the curriculum were identified. These findings have implications for planning curricular changes for dental education.

Development of a contextual computer-based nursing simulation.

This paper will present a brief review of the use of simulations in clinical reasoning research and education, followed by a case-study describing the development of a research tool which attempted to elicit the decision-making strategies of novice and competent hospital nurses. The central feature of this simulation was the degree of flexibility and control it gave to the nurse participants over their information seeking strategies. The ability of this interactive multimedia simulation to mimic a real ward environment has a great potential in the teaching of clinical reasoning skills to health professionals.

Factors influencing job satisfaction among nurses.

This article considers the results of an opinion survey of nurses working in Gwynedd, North Wales. Present changes to the structure and function of the NHS are heightening concerns and eroding the strengths of the profession. Action is needed if nursing's move towards enhanced professional status is to be maintained.