Regulation of leptin and leptin receptor in baboon pregnancy: effects of advancing gestation and fetectomy.

Leptin, a product of both adipose tissue and the placental syncytiotrophoblast and a potential regulator of primate conceptus development, increases in the maternal circulation with advancing gestation. This increase may be potentiated by estrogens, which also increase as pregnancy progresses. In the present study adipose tissue was collected from nonpregnant (n = 5) baboons (Papio sp) and in baboons during early (days 58-62; n = 5), mid (days 98--102; n = 5), and late (days 158-162; n = 5) pregnancy (term, approximately 184 days). Additionally, placental estrogen production was inhibited in pregnant baboons by the removal of fetal androgen precursors via fetectomy at midgestation, with tissues collected from fetectomized (n = 5) baboons approximately 60 days later. Leptin, estrogens, and androgens were quantitated in maternal serum by RIA. Leptin (LEP) and leptin receptor (LEP-R(L) and LEP-R(S) isoforms) messenger ribonucleic acids (mRNAs) were quantitated by competitive RT-PCR, and leptin concentrations were determined by RIA in maternal adipose and placental villous tissues. Although LEP transcript abundance in adipose tissues was unchanged as a result of pregnancy or with advancing gestation, the leptin protein level was higher (P < 0.02) in pregnant baboons in early gestation than in nonpregnant baboons and increased with gestational age (P < 0.04). Maternal serum estrogens (estradiol and estrone) and androgens (androstenedione and testosterone) were lower (P < 0.0001) in fetectomized baboons than in intact controls. Serum leptin concentrations were unchanged by fetectomy, but the abundance of LEP mRNA transcripts was lower (P < 0.003) in sc adipose tissue and 3-fold higher (P < 0.05) in placenta. Similarly, the leptin protein level declined (P < 0.05) in sc adipose tissue and increased (P < 0.05) in placenta in fetectomized baboons. Although LEP-R(L) mRNA levels were unchanged after fetectomy, placental LEP-R(S) transcript abundance was lower (P < 0.04) than in pregnancy-intact baboons matched for gestational age. Results suggest that both adipose tissue and the placenta may contribute to maternal hyperleptinemia during normal primate pregnancy. Furthermore, the withdrawal of placental steroids results in the enhanced placental leptin production that is commensurate with a decline in production by sc adipose tissue.

Factors associated with a good response to lithium in aggressive mentally handicapped subjects.

Twenty-five (25) mentally handicapped in-patient adults with persistent aggressive behaviour took part in a double-blind crossover trial lasting 5 months comparing the effects of lithium with placebo on aspects of aggressive behaviour. All patients were receiving neuroleptic and/or anticonvulsant drugs which were continued during the trial. Seventeen (17) of the patients showed greater improvement during the lithium phase compared to placebo. Multiple regression analysis was carried out to determine which of 17 background variables were related to outcome. The following factors were associated with a good response to lithium: less than one aggressive episode per week before starting treatment, overactivity, stereotypic behaviour, female sex and epilepsy. No patient became toxic during the investigation although lithium levels were maintained within the therapeutic range (0.5-0.8 mmol/l).

Plastic surgeons: a gender comparison.

This study surveyed plastic surgeons for the purpose of identifying gender-related differences within the specialty. A confidential 108-item questionnaire was mailed to all female members and candidates of the American Society of Plastic and Reconstructive Surgeons (ASPRS) and to an equal number of male colleagues. The survey was conducted between September of 1992 and October of 1993 using a modified Dillman five-step computerized method. The response rate was 73 percent for women (157 of 216) and 57 percent for men (124 of 216). Of those who responded, 65 percent of women and 89 percent of men were married (p < 0.01). Fifty-two percent of women and 86 percent of men had biologic children (p < 0.001). The majority of surgeons surveyed (97 percent) were in full-time surgical practice. Many women reported delaying childbearing until they had begun full-time practice of plastic surgery (p < 0.001). No significant gender-related differences were noted with respect to medical school rank, training history, advanced degrees, subspecialty practiced, hospital affiliation, or hours worked. Women surgeons in academic practice held lower rank than men and were less likely to be tenured (p < 0.04). Gross annual income was lower for women (p < 0.001). In contrast to men (27 percent), most women (89 percent) perceived sexual discrimination and harassment (p < 0.001). The majority of plastic surgeons were satisfied with their financial situation (80 percent), work (94 percent), and family life (76 percent). Over 90 percent of both women and men were happy with their career choice and would encourage medical students to become surgeons. Plastic surgeons do not differ in training or professional practice characteristics. Discrimination and harassment and unequal promotion and remuneration of women in the university environment are problems that need to be eliminated.

FASB 95--a tool for identifying cash flow problems.

Increasing expenditures and longer collection periods for receivables are symptoms of the cash flow problem that many not-for-profit healthcare organizations face. The FASB 95 provisions for a cash flow statement could help many of these organizations deal with their cash flow crises. The statement allows managers to evaluate their institution's financial performance, providing timely information that may make the difference in the struggle to maintain an adequate cash position.

The changing role of internal auditors in health care.

Two surveys of directors of internal auditing in health care conducted in 1990 and 1998 found that healthcare internal auditors are spending proportionately more time on management and operational improvement activities and less time on traditional financial/compliance activities. The average staff size has remained relatively constant, but salaries at all levels of experience have risen. More importantly, the tenure of healthcare internal auditors has increased significantly since 1990. The profile of the healthcare internal auditing director also has changed. The director is older, more experienced, and has held the position for twice as long as was the case in 1990. On the other hand, the director is more stressed and less satisfied with compensation.

Financial reserve. Hospitals leery of credit lines, factoring receivables.

Opening lines of credit and factoring (selling) accounts receivable are two ways to generate operating cash that non-healthcare industries have long used successfully. A recent survey of hospital officials across the nation, however, showed these techniques are used infrequently in health care. Among the 281 hospitals responding: Only 45 percent use lines of credit; Less than 5 percent pursue accounts receivable factoring; and Only 12 percent plan to begin factoring receivables in the future. As hospitals look for ways to offset depleted cash reserves, these percentages may increase.

Characterization and growth response of bacteria in soil following application of carbofuran.

Enhanced biodegradation of carbofuran (2, 3-dihydro-2, 2 dimethyl-7-benzofuranyl methyl carbamate) is an economically significant, but poorly understood, microbial phenomenon in soil. A series of experiments was conducted to examine short term changes in soil bacterial populations stimulated by carbofuran application at field rates. In the field experiment, commercially formulated carbofuran and butylate (S-ethyl diisobutyl carbamothioate) were applied at 5.6 kg ai ha-1 and 8.4 kg ai ha-1, respectively, on a soil (Putnam silt loam) exhibiting enhanced degradation of carbofuran. In laboratory studies, technical grade carbofuran (20 mg kg-1 soil) was applied to samples of the field soil. Bacterial populations were estimated using non-selective (tryptic soy agar) and selective media containing carbofuran or butylate. Largest population increases in pesticide-treated soil were observed between 7 and 15 days after treatment (DAT) compared to populations in non-treated soil. Significant increases (P less than 0.05) in total bacterial populations and presumed carbofuran-degraders due to carbofuran application were associated with increased populations of Pseudomonas spp. and Flavobacterium spp. Application of carbofuran appeared to provide a competitive advantage to these species over actinomycetes persisting beyond 20 DAT. Growth responses of bacteria to carbofuran in the Putnam soil were compared to those in a native prairie soil (Mexico silt loam), which exhibited a much slower rate of carbofuran degradation. Bacterial population response to carbofuran was measurable, but small and short-lived. Perpetuation of the enhanced degradation phenomenon may lie in a persistent pesticide-induced competitive advantage given to a very small segment of the microbial population. This advantage may not be detectable after 20 days using conventional plating techniques.

Cash budgeting: an underutilized resource management tool in not-for-profit health care entities.

Cash budgeting is generally considered to be an important part of resource management in all businesses. However, respondents to a survey of not-for-profit health care entities revealed that some 40 percent of the participants do not currently prepare cash budgets. Where budgeting occurred, the cash forecasts covered various time frames, and distribution of the document was inconsistent. Most budgets presented cash receipts and disbursements according to operating, investing, and financing activities--a format consistent with the year-end cash flow statement. By routinely preparing monthly cash budgets, the not-for-profit health care entity can project cash inflow/outflow or position with anticipated cash insufficiencies and surpluses. The budget should be compared each month to actual results to evaluate performance. The magnitude and timing of cash flows is much too critical to be left to chance.

Leptin receptor expression in fetal lung increases in late gestation in the baboon: a model for human pregnancy.

Leptin produced by both adipose tissue and the placental trophoblast, has been proposed to regulate numerous aspects of human conceptus development. Although recent animal studies have suggested an additional role for the polypeptide in fetal lung maturation, no evidence has been reported in primates. Therefore, we employed the baboon (Papio sp.), a well-characterized primate model for human pregnancy, to determine the presence and ontogeny of leptin receptor in fetal lung with advancing gestation. Lungs were collected from fetal baboons, early in gestation (days 58-62, n = 4), at mid gestation (days 98-102, n = 4), and late in gestation (days 158-165, n = 4) (term 184 days). mRNA transcripts for leptin (LEP) and both long and short intracellular domain isoforms of the leptin receptor (LEP-R(L) and LEP-R(S)) were assessed by RT-PCR. leptin receptor protein was evaluated by immunoblotting and cell types expressing leptin receptor were identified in late pregnancy by immunohistochemistry. Fetal serum leptin concentrations, determined by RIA, remained relatively unchanged at 5.7 +/- 1.1 ng/ml (mean +/- s.e.m.) in mid pregnancy and 8.4 +/- 3.0 ng/ml in late pregnancy (P > 0.05). Although leptin were detectable in fetal lung, no changes in transcript abundance were apparent with advancing gestation. However, transcripts for both LEP-R(L) and LEP-R(S) receptor isoforms increased several-fold (P < 0.05) in fetal lung between mid and late gestation, while leptin receptor protein was detectable only in late pregnancy. leptin receptor was localized in distal pulmonary epithelial cells, including type II pneumocytes. In conclusion, leptin is present in the fetal baboon and its receptor is enhanced during late gestation in cells responsible for the synthesis of pulmonary surfactant. Collectively, these and past findings may suggest a modulatory role for the polypeptide in pulmonary development and/or may identify leptin receptor as a physiological marker of primate fetal lung maturity.

How representative is the population covered by the RCGP spotter practice scheme? Using Geographical Information Systems to assess.

BACKGROUND: The Royal College of General Practitioners Weekly Returns Service (WRS) is a network of sentinel general practices providing weekly data on illnesses diagnosed in general practice across England and Wales. The WRS contributes to the surveillance of infectious disease, most notably influenza. We use Geographical Information Systems (GIS) techniques to establish whether the practice populations of the current WRS are representative of the general population. METHODS: This study compares the practice population with the general population using the Department of the Environment, Transport and Regions (DETR) Indices of Deprivation 2000 scores for English wards. RESULTS: Comparisons at the national level reveal that the WRS population is less deprived than the general population. At a supra-regional level the WRS practice population shows the same North-South differences as the national population, but the proportions of patients in the more deprived and least deprived wards are more exaggerated in the WRS population. A supplementary analysis reveals that the WRS has no patients in the most deprived wards of London. CONCLUSION: The differences have implications for the future recruitment of practices to the WRS. Previous studies have demonstrated the effect of socio-economic deprivation on GP consultation rates. To ensure that the consultation rates reported by the WRS will better reflect consulting patterns in the general population the WRS will need to recruit practices with patients in the most deprived areas of the South and less deprived areas in the North of England. This study demonstrates the value of GIS in the establishment of surveillance systems.