Texas Medication Algorithm Project: definitions, rationale, and methods to develop medication algorithms

BACKGROUND: The Texas Medication Algorithm Project (TMAP), a public-academic collaborative effort, is a 3-phase project to develop, implement, and evaluate medication treatment algorithms for public sector patients with schizophrenia, major depressive disorders, or bipolar disorders. DISCUSSION: This paper, the first in a series describing the activities of the TMAP, focuses on the various definitions and reasons why guidelines have gained popularity. Also discussed are their strengths, the limitations of the various methods used to develop them, and potential barriers to their implementation.     

Behavioral markers and recognizability of the smile of enjoyment

Several age-dependent modifications of inner mitochondrial membrane and synaptosomal plasma membrane proteins from different brain regions of 4-, 12-, 18- and 24-month-old male Wistar rats, were observed. Some proteins, identified by immunoblotting assay as various subunits of mitochondrial respiratory chain complexes and calmodulin, were particularly impaired. Chronic treatment with CDP-choline at a dose of 20 mg/kg body weight per day for 28 days caused significant changes in the amounts of several of the above mentioned proteins. Most of the proteins, which decreased during aging, showed a significant increase after CDP-choline treatment compared with the corresponding control values at the same age. The effect of CDP-choline might be due to: the increased availability of cytidylic nucleotides, which in the brain are present in limited amounts compared to the other nucleotides; the increased content of total adenine nucleotides; the improvement of brain energy metabolism.     

How should we organize to do informatics? Report of the ACMI Debate at the 1997 AMIA Fall Symposium

The dielectric properties of the human skin stratum corneum (SC) in the frequency range higher than 107 Hz are not well understood because of the difficulty in selective scanning of the SC area in vivo. The present study was carried out to make clear factors responsible for the dielectric properties using a measuring system specially developed for the study of SC [S. Naito, M. Hoshi, S. Mashimo, Anal. Biochem. 251 (1997) 163-172]. We found that the dielectric properties of SC can be expressed by the linear combination of two relaxation processes and d.c. conduction. The faster relaxation is that of free water. The slower relaxation and d. c. conduction were analyzed using a model assuming interfacial polarization between dissimilar materials. We concluded that the polarization is the origin of the slower relaxation process because the experimental data could be well interpreted according to the above mechanism. We also concluded that the polarization of swelled SC locates at the interface between SC cells and the intercellular lipid layer, or at the interface between the lipophilic and the hydrophilic part of the lamellar structured intercellular lipid layer.     

Heifer sterility associated with single-birth freemartinism

Thirty-four heifers not conceiving to three or more inseminations or natural service were bled and karyotyped by leucocyte culture. Twelve were found to be sex-chromosome chimeras of which five were single-born. Three out of the five singleton sex-chromosome chimeric heifers were slaughtered and at post mortem examination abnormalities of the reproductive tract were observed. Two the the slaughtered animals were Friesian heifers that had shown normal oestrous cycles and had reproductive organs apparently normal on clinical examination; however, one of them with 5 per cent male cells had a nonpatent cervix, while the other with 12 per cent male cells had non-patent uterine horns. Both heifers possessed functional ovaries, the former had an active corpus luteum and the latter had a developing follicle. The third heifer with 45 per cent male cells had a normal vagina, enlarged clitoris, seminal vesicles and gonads resembling fetal testes with both primitive ovarian and testicular structures. The Old Gloucester and Friesian heifers with 2-5 per cent and 12-0 per cent male cells are alive and have normal external genitalia but rudimentary uterine horns with no palpable gonads. Cytogenetic examination has demonstrated for the first time the existence of single-born freemartins resulting from the death of their male co-twins after fetal vascular anastomosis has been established.     

Normal single coronary artery and myocardial infarction

A single left coronary artery was found in an asymptomatic 21-year-old man who initially had electrocardiographic and vectorcardiographic evidence of anterolateral myocardial infarction. The single left coronary artery, which supplied the distribution of both the left and right coronary arteries, was free of disease at catheterization. There has been no previous association of a normal single left coronary artery and anterior myocardial infarction. Patients with the finding of a single coronary artery should be watched closely, as this may represent a potentially fatal condition.