The levels of gammaG, gammaA, and gammaM globulins were estimated in a group of patients with Down's anomaly and in groups of mentally retarded children and normal children, matched for age and sex, using an immunological method. Higher levels of gammaG globulin were observed in patients with Down's syndrome, in association with a small but significant lower concentration of gammaM globulin. The titres of anti-A and anti-B agglutinins and antibodies to Escherichia coli, estimated before and after treatment of serum with 2-mercaptoethanol, were found to be within normal levels. These data seem to suggest that patients with Down's syndrome do not produce ;faulty' immunoglobulins as has been previously postulated. It is suggested that the abnormal levels of immunoglobulins found in Down's anomaly are not peculiar to patients with Down's syndrome but occur in other disorders in which the reticuloendothelial system or the lymphocytes are involved.

Adolescent↗

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Traumatic stress disorder: diagnostic and clinical issues in former prisoners of war.

Examined are a variety of clinical issues in the diagnosis and treatment of Posttraumatic Stress Disorder (PTSD) of former prisoners of war (POWs). Difficulties and complexities in understanding and diagnosing PTSD in former POWs presenting symptomatic complaints associated with this disorder are explored. Data collected on former POWs complaining of PTSD and diagnosed by DSM-III-R criteria revealed Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI) clinical profiles appropriate for clinical application. Comparative data between German-held and Japanese-held POWs experiencing PTSD and adjustment-related stressors are discussed. Import on clinical strategies with diagnosed patients suggests both behavioral approaches to treatment and future directions in research.

Escape Reaction↗

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Introduction of a standardized "paternity index" for the statistical evaluation of blood group findings in paternity testing.

The introduction of a standardized paternity index (PI) for the statistical evaluation of blood group findings in cases of disputed paternity is proposed and explained. By using the PI X/Y as parameter, it is not necessary to give the information of the probability of paternity in percent. The PI includes the full information of the blood group findings. In addition to that, by using the suggested standardization based on the probabilities of error according to Schulte Mönting and Walter the test volume is also taken into account. The interpretation of the mathematical result is given by verbal predicates, the limitations of which are orientated by the verbal predicates for the probabilities of error according to Schulte Mönting and Walter, published by us elsewhere. Besides the essential fact that the test volume is taken into account, the most important advantage of this procedure is that the mathematical result is involved in the court decision only by the PI (which is free of any valuation) and its verbal predicate and not by sometimes relatively high percentages, which may be misunderstood by laymen.

Blood Group Antigens↗

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Pneumatic ankle tourniquets: physiological factors related to minimal arterial occlusion pressure.

This study investigates several physiological measurements for their correlation to the minimal arterial occlusion pressure using the pneumatic ankle tourniquet. Blood pressure (brachial), height, weight, body fat percentage, ankle circumference, and leg circumference measurements were collected from 50 normotensive healthy subjects. Ankle brachial index (ABI) was also compared. A pneumatic ankle tourniquet was applied to the right ankle and inflated until Doppler insonation confirmed that arterial occlusion had occurred. Mean arterial occlusion pressure was 161.7 mm Hg (N = 50, Nmales = 33, Nfemales = 17), and statistically less than 170 mm Hg (p < .05). The authors present a data model to predict the lowest necessary ankle tourniquet pressure for this study group. Forward stepwise linear regression (critical significance = .01) yields two variables, ankle brachial index and systolic blood pressure, which are used to predict occlusion pressure in this study group.

Adult↗

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The challenge of Pneumocystis carinii culture.

Published and unpublished data on the cultivation of P. carinii were reviewed by a panel of investigators convened by the National Institutes of Health. Although several cell culture systems allow propagation of P. carinii for a limited time with modest rates of replication, these have not proved adequate for isolation of P. carinii in sufficient quantity to explore important basic biological investigation. Attempts at cell-free culture have yielded only transient proliferation. Because much of the unsuccessful work on cultivation of the organism has been unpublished, the panel agreed that these data may be useful to other investigators in designing experimental strategies for cultivation. Therefore, the purpose of this report is to make available this information to researchers, lest others unknowingly repeat unsuccessful methods. It is hoped that by documenting the history and the complexities of Pneumocystis culture, renewed interest and efforts will be directed toward this fundamental scientific challenge.

Animals↗

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Functional conservation of calreticulin in Euglena gracilis.

Calreticulin is the major high capacity, low affinity Ca2+ binding protein localized within the endoplasmic reticulum. It functions as a reservoir for triggered release of Ca2+ by the endoplasmic reticulum and is thus integral to eukaryotic signal transduction pathways involving Ca2+ as a second messenger. The early branching photosynthetic protist Euglena gracilis is shown to possess calreticulin as its major high capacity Ca2+ binding protein. The protein was purified, microsequenced and cloned. Like its homologues from higher eukaryotes, calreticulin from Euglena possesses a short signal peptide for endoplasmic reticulum import and the C-terminal retention signal KDEL, indicating that these components of the eukaryotic protein routing apparatus were functional in their present form prior to divergence of the euglenozoan lineage. A gene phylogeny for calreticulin and calnexin sequences in the context of eukaryotic homologues indicates i) that these Ca2+ binding endoplasmic reticulum proteins descend from a gene duplication that occurred in the earliest stages of eukaryotic evolution and furthermore ii) that Euglenozoa express the calreticulin protein of the kinetoplastid (trypanosomes and their relatives) lineage, rather than that of the eukaryotic chlorophyte which gave rise to Euglena's plastids. Evidence for conservation of endoplasmic reticulum routing and Ca2+ binding function of calreticulin from Euglena traces the functional history of Ca2+ second messenger signal transduction pathways deep into eukaryotic evolution.

Amino Acid Sequence↗

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Rapid determination of HLA B*07 ligands from the West Nile virus NY99 genome.

Defined T cell epitopes for West Nile (WN) virus may be useful for developing subunit vaccines against WN virus infection and diagnostic reagents to detect WN virus-specific immune response. We applied a bioinformatics (EpiMatrix) approach to search the WN virus NY99 genome for HLA B*07 restricted cytotoxic T cell (CTL) epitopes. Ninety-five of 3,433 WN virus peptides scored above a predetermined cutoff, suggesting that these would be likely to bind to HLA B*07 and would also be likely candidate CTL epitopes. Compared with other methods for genome mapping, derivation of these ligands was rapid and inexpensive. Major histocompatibility complex ligands identified by this method may be used to screen T cells from WN virus-exposed persons for cell-mediated response to WN virus or to develop diagnostic reagents for immunopathogenesis studies and epidemiologic surveillance.

Costs and Cost Analysis↗

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The levers of influence.

Physicians often determine the demand for health care services, as well as control the clinical processes aimed at improving health outcomes at the individual and population level. Given their important role in enhancing health status and improving the health care delivery system, it is critical that physician executives master the tools necessary to positively influence physician behavior. But changing behavior is far more complex than "doing it or not doing it." The Nike slogan "just do it" is motivating, but over-simplified. The roots of human change include: consciousness-raising, emotional arousal, commitment, helping relationships, self-reevaluation, reward, and environmental control. A model to effectively influence behavior is presented and includes setting clear expectations, measuring and monitoring performance, providing feedback, and rewarding and recognizing improvement. If all else fails, try discipline. This five-step approach is based on the science of human behavior and working with physicians in diverse settings, ranging from academic medical centers to small practices.

Behavior↗