Influencing physician response to prenatal substance exposure through state legislation and work-place policies

Little research attention has focused on ways to encourage physician response to prenatal substance exposure. We report initial results from a study examining the impact of state laws and work-place policies on physician response by combining legal analyses and data from a national physician survey. Our findings indicate that the message that laws and policies exist usually does not reach physicians. However, when the message does come through, some physician behaviors are influenced. In particular, physicians in states with clearer policies and behavioral expectations are significantly more likely to know and understand the law than physicians in other states. Further, believing that a work-place protocol on prenatal substance exposure exists is associated with significantly increased likelihood of an active response in case vignettes portraying prenatal substance exposure. The findings suggest that state legislative behaviors may increase physician response to prenatal substance exposure, but that response depends on the nature of the policy and on efforts to disseminate it.     

Interinnominate motion and symmetry: comparison between gymnasts and nongymnasts

Some clinical approaches to the treatment of low back pain evaluate and treat observed asymmetries of pelvic posture and motion. Scientific evidence suggests the motion available between the innominate bones is small and variable in nature. The purposes of this investigation were 1) to determine if interinnominate motion of subjects without low back pain was symmetrical in reciprocal test posture combinations, 2) to assess innominate bone symmetry in standing, and 3) to determine if a difference in the magnitude of interinnominate motion was present between a subject group which performs more frequent flexibility activities compared with a subject group representing the general population. Thirty-four subjects (eight male gymnasts, nine female gymnasts, eight male nongymnasts, and nine female nongymnasts) were evaluated in standing and three other reciprocal postures (modified standing, modified sitting, and half-kneeling). In each posture, the Metrecom Skeletal Analysis System was used to obtain coordinates for the anterior and posterior iliac spines. Projection angles were used to determine the relative positions of the right and left innominate bones. Results suggest that stand to right modified standing and stand to left modified standing oblique sagittal interinnominate composite motions were symmetrical, stand to right modified sitting and stand to left modified sitting oblique sagittal interinnominate composite motions were asymmetrical, and stand to right half-kneel and stand to left half-kneel oblique sagittal interinnominate composite motions' symmetrical properties were mixed depending on the group. Gymnasts as a group were found to have asymmetrically positioned innominate bones while nongymnasts as a group had symmetrically positioned innominate bones.     

A virtual environment for multimedia intelligence data analysis

The article describes an experimental, exploratory information visualization system under development at the Pacific Northwest National Laboratory. The system aims to integrate multimedia data and help users visualize the contents of multimedia databases. The prototype, named Starlight, interactively generates information-dense 3D graphical representations of multimedia data interrelationships. Despite the richness and complexity of the information displays, they remain easy to understand. The prototype incorporates an experimental immersive interface intended to foster improved understanding of, and interactions with, 3D information visualizations. The interface is intended to be of practical use in a production-oriented information analysis environment. Although the existing prototype intentionally addresses a specific class of problems faced by intelligence analysts, the authors feel the general approach has broad applicability outside the intelligence community     

Sardinian alcohol-preferring rats prefer chocolate and sucrose over ethanol

The purpose of this study was to evaluate the effect of sequential external counterpulsation (SECP) on cerebral and renal blood flow. The effect of SECP on carotid and renal artery blood flow was studied in 35 and 18 patients, respectively. With a portable unit, cuffs were applied to the calves and thighs, sequentially inflated with air at the onset of diastole, and deflated at the onset of systole. Carotid and renal artery Duplex studies were performed during intermittent SECP. Flow velocity and flow velocity integral were measured at baseline and during SECP. Diastolic augmentation of carotid and renal artery flow velocity was observed in all patients. The mean carotid flow velocity integral increased by 22% from 27.7 +/- 1.8 cm to 33.1 +/- 2.3 cm (P = 0.001). The mean renal artery flow velocity integral increased by 19% from 21 +/- 1 cm to 25 +/- 1 cm (P = 0.0001). With SECP, a new diastolic Doppler flow velocity wave was observed, with an average peak carotid diastolic flow velocity of 56 +/- 4 cm/sec and an average peak renal artery diastolic flow velocity of 40 +/- 2.5 cm/sec. This diastolic wave was 75% (carotid) and 68% (renal) as high as the systolic wave during SECP. In addition, with SECP the systolic wave increased by 6% and 8% in the carotid and renal artery, respectively (P = 0.02 and 0.006, respectively). In conclusion, SECP significantly increases carotid and renal blood flow. This noninvasive, harmless treatment may be useful to support patients with decreased cerebral and renal perfusion.     

A project to reduce the burden of diabetes in the African-American Community: Project DIRECT

Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together) is the first comprehensive community diabetes demonstration project in the United States in an African-American community. This article describes its intervention components and evaluation design. The development and implementation of Project DIRECT has included the community since the project's beginning. Interventions are targeted in three areas: health promotion (improving diet and physical activity levels), outreach (improving diabetes awareness, detection of undiagnosed diabetes, and ensuring that persons with diabetes who are not receiving continuing diabetes care are integrated into the health-care system), and diabetes care (improving self-care, increasing access, and improving the quality of diabetes preventive care received within the health-care system). Evaluation will be internal (conducted by Project DIRECT staff to assess process outcomes in persons directly exposed to each specific intervention) and external (review of outcomes to assess the impact of the multi-intervention program at the level of the entire community). Because diabetes exacts a disproportionate toll among African Americans, the findings from this project should aid in developing strategies to lessen the burden of this disorder, particularly among minority populations.     

Polarization states of a single-mode (microchip)Nd3+:YAG laser. Part II: comparison of theory and experiment

We present a comparison between experimental results for a quasi-isotropic single-frequency YAG laser and the polarization behavior predicted by the theory outlined in Part I [see ibid., p.1485, 1998]. The calculations are carried out without the use of freely adjustable parameters. Substantive agreement is found between theory and experiment     

Metabotropic glutamate receptors contribute to the induction of long-term depression in the CA1 region of the hippocampus

Long-term depression of synaptic transmission was induced following the prior induction of long-term potentiation in the CA1 region of rat hippocampal slices. We show that the induction of this form of synaptic depression can be prevented by (+)-alpha-methyl-4-carboxyphenylglycine, a selective antagonist of metabotropic glutamate receptors.     

Treatment of cancer chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome by protein A immunoadsorption of plasma

BACKGROUND: Chemotherapy-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (C-TTP/HUS) is a condition involving thrombocytopenia, microangiopathic hemolytic anemia, and progressive renal dysfunction that develops in 2-10% of patients with a history of malignant neoplasms treated with certain chemotherapeutic agents. Pathogenesis of the disease may depend on the following: (1) generation of endothelial lesions in the kidney microvasculature, resulting from drug toxic effects and/or generation of small soluble circulating immune complexes (CIC), and (2) generation of autoantibodies and/or CIC that trigger aggregation and deposition of platelets around the lesions. METHODS: Extracorporeal immunoadsorption treatment of plasma (PROSORBA columns, IMRE Corporation, Seattle, WA) to remove immunoglobulin G and CIC was evaluated in 55 patients for the potential to induce significant clinical benefits (increase in platelet count, decrease in hemolysis, stabilization of renal function) and longer survival. RESULTS: Response to therapy was achieved in 25 of 55 patients examined. Response was associated with an estimated 1-year survival rate of 61%, as compared with an estimated survival rate of only 22% in those who did not respond (P = 0.0001). Patients whose malignant neoplasms were in complete or partial remission at the time of development of C-TTP/HUS had a significantly higher estimated 1-year survival rate (74%) as compared with a historic control group of patients receiving other treatments (22%, P = 0.0161). Clinical responses were correlated with normalization of serum levels of CIC and complement components C3c and C4. There were no side effects associated with 75% of treatments. Immunoadsorption therapy was associated with generally mild to moderate manageable side effects, such as fever, chills, nausea/vomiting, respiratory symptoms, pain, hypertension, and hypotension, which were reported in 25% of procedures. CONCLUSIONS: This multicenter study establishes protein A immunoadsorption as an effective and safe treatment for cancer chemotherapy-associated TTP/HUS, an otherwise fatal disease.