In search of the CPR

In 1991, the National Academy of Sciences' Institute of Medicine defined, endorsed, and called for the implementation of the computerized patient record (CPR) by 2001. Seven years later, in 1998, health care is still arguing about what a CPR is, how it's to be implemented, and when. This article discusses the origins of the CPR and its initial development efforts. It explores the roadblocks that stalled its development and how managed care may have jump-started the process. Finally, it explains current CPR development efforts and what's on the horizon.     

In search of childbirth knowledge

My purpose in writing this article is to describe the various ways expectant women acquire childbirth knowledge. The data presented here form a small section of a bigger study that examined how expectant women from two cultures prepare for childbirth. The aims of the study were to explore the reasons why some expectant women choose to attend preparation classes run by non-health-care professionals and to describe the ways childbirth knowledge was disseminated to women at the preparation classes. Interviews containing structured and open-ended questions were used to obtain data. The first interview followed completion of a series of eight preparation classes and the second was conducted one month after delivery. Observation techniques were used to collect data on the teaching strategies and the content of classes. Ninety-five expectant women participated in the study. Data analysis included frequency counts and percentages on all structured questions. The open-ended questions were analyzed using the constant comparative method to identify major categories and themes. These were reviewed by a panel of childbirth educators for reliability. Frequencies were calculated for the number of responses in each category. Findings show that women acquire childbirth knowledge in various ways at the classes. They used this information to negotiate their care with health care professionals.     

Large-scale identification of virulence genes from Streptococcus pneumoniae

Streptococcus pneumoniae is the major cause of bacterial pneumonia, and it is also responsible for otitis media and meningitis in children. Apart from the capsule, the virulence factors of this pathogen are not completely understood. Recent technical advances in the field of bacterial pathogenesis (in vivo expression technology and signature-tagged mutagenesis [STM]) have allowed a large-scale identification of virulence genes. We have adapted to S. pneumoniae the STM technique, originally used for the discovery of Salmonella genes involved in pathogenicity. A library of pneumococcal chromosomal fragments (400 to 600 bp) was constructed in a suicide plasmid vector carrying unique DNA sequence tags and a chloramphenicol resistance marker. The recent clinical isolate G54 was transformed with this library. Chloramphenicol-resistant mutants were obtained by homologous recombination, resulting in genes inactivated by insertion of the suicide vector carrying a unique tag. In a mouse pneumonia model, 1.250 candidate clones were screened; 200 of these were not recovered from the lungs were therefore considered virulence-attenuated mutants. The regions flanking the chloramphenicol gene of the attenuated mutants were amplified by inverse PCR and sequenced. The sequence analysis showed that the 200 mutants had insertions in 126 different genes that could be grouped in six classes: (i) known pneumococcal virulence genes; (ii) genes involved in metabolic pathways; (iii) genes encoding proteases; (iv) genes coding for ATP binding cassette transporters; (v) genes encoding proteins involved in DNA recombination/repair; and (vi) DNA sequences that showed similarity to hypothetical genes with unknown function. To evaluate the virulence attenuation for each mutant, all 126 clones were individually analyzed in a mouse septicemia model. Not all mutants selected in the pneumonia model were confirmed in septicemia, thus indicating the existence of virulence factors specific for pneumonia.     

In search of a mutational hotspot

In vitro selection was used to define sequence contexts that significantly enhanced the mutagenic potential of 7, 8-dihydro-8-oxoguanine (8-oxoG). Contexts that simultaneously reduced the efficiency of 8-oxoG cleavage by formamidopyrimidine DNA N-glycosylase and increased the efficiency of misincorporating A opposite the lesion by DNA polymerase were isolated from a pool of 4(8) random octanucleotide sequences. Kinetic analysis showed that the combined effects of poor repair and high miscoding resulted in 10(2)- to 10(3)-fold increase in the mutagenic potential of 8-oxoG. Furthermore, the isolated sequence contexts correlated strongly with G --> T transversion hotspots in spontaneous mutational spectra reported for the Escherichia coli lacI and human p53 and factor IX genes. We present an example directly linking the interplay between DNA repair and replication to a "high risk sequence" for base substitution.     

In search of the links.

Reviews the book, Cognition, metacognition, and reading by D. L. Forrest-Pressley and T. G. Waller (1984). In the introduction to this monograph the authors point out that, in spite of receiving much recent attention, metacognition is only vaguely defined in the literature, and its relationship to cognition and cognitive activities such as reading is particularly unclear. Further, they claim that the difficulties that researchers have encountered in understanding reading is attributable to their failure to understand properly the complexity of the reading process. The solution offered by the authors is to assign metacognition a central role in reading by defining the reading process as the interaction of at least three skills--decoding, comprehension, and mature reading strategies--each of which has a cognitive and metacognitive component. The potential contribution of this volume depends upon the extent to which this approach succeeds in clarifying the concept of metacognition and advancing our understanding of the cognitive basis of reading. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In search of the 'back mouse'

The "back mouse" is a tender, fibrous, fatty subcutaneous nodule found in the lumbosacral area in up to 16% of people. It can be a treatable cause of low back pain that may be unrecognized by both specialists and generalists.     

A genome-wide search for schizophrenia susceptibility genes

We completed a systematic genome-wide search for evidence of loci linked to schizophrenia using a collection of 70 pedigrees containing multiple affected individuals according to three phenotype classifications: schizophrenia only (48 pedigrees; 70 sib-pairs); schizophrenia plus schizoaffective disorder (70 pedigrees; 101 sib-pairs); and a broad category consisting of schizophrenia, schizoaffective disorder, paranoid or schizotypal personality disorder, psychosis not otherwise specified (NOS), delusional disorder, and brief reactive psychosis (70 pedigrees; 111 sib-pairs). All 70 families contained at least one individual affected with chronic schizophrenia according to DSM-III-R criteria. Three hundred and thirty-eight markers spanning the genome were typed in all pedigrees for an average resolution of 10.5 cM (range, 0-31 cM) and an average heterozygosity of 74.3% per marker. The data were analyzed using multipoint nonparametric allele-sharing and traditional two-point lod score analyses using dominant and recessive, affecteds-only models. Twelve chromosomes (1, 2, 4, 5, 8, 10, 11, 12, 13, 14, 16, and 22) had at least one region with a nominal P value <0.05, and two of these chromosomes had a nominal P value <0.01 (chromosomes 13 and 16), using allele-sharing tests in GENEHUNTER. Five chromosomes (1, 2, 4, 11, and 13) had at least one marker with a lod score >2.0, allowing for heterogeneity. These regions will be saturated with additional markers and investigated in a new, larger set of families to test for replication.     

In search of the typical eyewitness.

G. L. Wells (see record 1993-39684-001) convincingly argued that the experimental work on eyewitness identification can be generalized to real cases of identification. He systematically developed arguments for the use of certain procedures that optimize accurate identification rates. However, Wells's arguments for generalization require that certain assumptions are made about the "typical" eyewitness situation. The consequences of such assumptions are considered. It is concluded that generalizations about eyewitness identification must be qualified, particularly when they are made in the context of the legal setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In search of a relational theory.

The author searched for empirically based theories and models with an interpersonal and relational focus. This search was conducted in spite of academic and professional psychology’s general avoidance of theory building coupled with an exaggerated reliance on empirical evidence, producing a chaotic proliferation of models unrelated to each other. Requirements for any theory are verifiability, applicability, redundancy, and fruitfulness. Many two-factor relational theories and models derive from the two assumptions of space and time. From these models and theories two stand out: attachment theory and relational competence theory (RCT). Both theories attempt to link heretofore separate fields: research and practice. The major asset of attachment theory has been a multitude of studies in the English-speaking world. The major shortcoming of RCT is that research to support the validity of its models has been conducted only in Italy. However, many test instruments, enrichment programs, and interactive practice exercises for some models of RCT are available in English. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attenuation of virulence by disruption of the Mycobacterium tuberculosis erp gene

The virulence of the mycobacteria that cause tuberculosis depends on their ability to multiply in mammalian hosts. Disruption of the bacterial erp gene, which encodes the exported repetitive protein, impaired multiplication of M. tuberculosis and M. bovis Bacille Calmette-Guérin in cultured macrophages and mice. Reintroduction of erp into the mutants restored their ability to multiply. These results indicate that erp contributes to the virulence of M. tuberculosis.     

In search of better route guidance instructions

Safety concerns have prompted designers of in-vehicle route guidance and information systems (IVRGIS) to make more use of an 'audible interface' to convey guidance instructions. Previous research has shown that, contrary to expectations, detailed guidance instructions can have a detrimental effect upon wayfinding performance, particularly for elderly individuals. In response to these findings a second series of experiments was carried out to try to improve the effectiveness of route guidance. Using the same procedure, 40 male and 40 female drivers aged 18-35 years watched video footage of journeys through an unfamiliar area, while hearing guidance that linked direction instructions to landmarks visible at the decision point. Results showed that those who heard these amended instructions performed significantly better than other groups at a wide range of tasks designed to measure the spatial knowledge that they had acquired. This group performed better than groups who heard nothing, and groups who heard full guidance. The results support the view that, whereas full guidance instructions can have a negative impact upon wayfinding performance, less complex instructions that link landmarks to directions have the capacity to enhance wayfinding performance. This is because instructions of this form strengthen the associations made between directions to be taken and the spatial location of these turns, resulting in the formation of a strong representation of the route. The results also showed that those who had been driving for 1 year or less were significantly less accurate at these tasks than those with more driving experience. This result has important implications for the widespread implementation and use of IVRGIS: suggesting that, for newly qualified drivers, who have not yet developed the ability to attend to and process information while controlling the vehicle, attending to route guidance instructions might have a detrimental effect upon driver safety.     

In search of the pioneers of nurse-led care

Nurse-led services are becoming more common in the UK. The first of three articles comparing developments in the USA and the UK, this looks at the origins of nurse-led units to discover what lessons may be learnt for the changes that have affected the Loeb Center in New York, a pioneer in the field.     

Drug-resistant strains of Mycobacterium tuberculosis exhibit a range of virulence for mice

A panel of clinical isolates of Mycobacterium tuberculosis, several of which were resistant to one or more antimycobacterial drugs, were tested for their capacity to give rise to active disease following aerogenic infection of normal immunocompetent mice. The panel exhibited a range of virulence in this model, which followed no clear trend in terms of geographical source, degree of drug resistance, or rate of growth in vitro. Several isolates grew very quickly over the first 20 days in mouse lungs before being contained by emerging immunity. In view of this latter observation, we hypothesize that it is possible that such so-called fast growers may be responsible for the rapid fatality sometimes seen in immunocompromised patients with tuberculosis. Moreover, the results of the study do not support the belief that increased drug resistance usually associates with loss of virulence of the isolate.