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PubMed1991

Radiological survey of Goiânia by a mobile monitoring unit.

In September 1987, a 137Cs teletherapy source was ruptured in Goiânia and environmental consequences ensued. After the initial response to this accident, a radiological survey throughout the city was performed using a mobile unit. This unit was equipped with two Geiger-Müller detectors outside the vehicle and one 102 X 102 mm NaI(Tl) detector connected to a dual recorder. All three detectors were placed 1 m above ground. The survey system covered a wide range of exposure rates, from environmental levels [typically 3.9 X 10(-10) C kg-1 h-1 (15 X 10(-6) R h-1) in Goiânia] up to 2.6 X 10(-3) C kg-1 h-1 (10 R h-1). Eighty percent of the Goiânia urban area was covered by this survey, and except for some specific locations, the contamination was restricted to the main foci surroundings occurring in a nonhomogeneous pattern. The highest value observed in the city after the main foci decontamination was 1.8 X 10(-7) C kg-1 h-1 (0.7 mR h-1) in the 57th Street area where the source was originally opened. The system, designed to perform the survey in the city, played a fundamental role during the decontamination process.

Accidents↗
PubMed2006

Neurocognitive functioning in dually diagnosed middle aged and elderly patients with alcoholism and schizophrenia.

BACKGROUND: Alcohol abuse and dependence have important clinical implications for managing patients with schizophrenia. Alcoholism in schizophrenia patients can interfere with the course and prognosis of the schizophrenic illness. OBJECTIVE: The purpose of the present study was to compare the cognitive status, symptom profile and quality of life of middle aged and older patients (>44 years old) with schizophrenia and alcohol abuse/dependence vs those without alcohol abuse/dependence. We initially hypothesized that more males in this age group with schizophrenia would exhibit alcoholism. We also examined the characteristics of the 45-54 year age group with those of the > or = 55 year old group and hypothesized that comorbidity with alcohol would be associated with worse cognition and quality of life in later life. METHODS: Data were obtained from a database from the Center for Services and Interventions research at the University of California, San Diego. Patients had diagnoses of schizophrenia or schizoaffective disorder. Data collected included demographic characteristics, cognitive status (tested with the Mattis Dementia Rating Scale learning, the Figural and Story Memory Test of the Wechsler Memory Scale-Revised and the California Verbal Learning Test [CVLT]). In addition, patients had undergone psychopathologic assessment and were screened for quality of life using the Quality of Well Being scale. RESULTS: We demonstrated that the older aged patients with alcoholism had worse scores assessing cognition relative to the same aged group without alcoholism. In addition, they had worse cognitive scores relative to the younger group (45-54 year old) with alcoholism. There was no significant difference with regards to quality of life. In addition, more males than females exhibited alcoholism. CONCLUSION: The results are consistent with the premise that the higher cognitive function in the younger schizophrenia patients with alcoholism appear to mask the effects of alcohol use on cognition at that age. However, for the older group of schizophrenia patients, the effects of alcohol use on neuropsychological functioning appear to be deleterious.

Alcoholism↗
PubMed1992

Evidence for a dual source of relaxin in the pregnant rat: immunolocalization in the corpora lutea and endometrium.

Uterine tissue was collected from intact pregnant rats on days 4, 10-15, 18, and 22 of pregnancy and day 2 postpartum and from rats on day 22 of pregnancy after ovariectomy (day 9) and progesterone-estrogen treatment. Placental, cervical, mammary, and pituitary tissues were collected from intact pregnant rats on day 22. Ovarian tissue was collected from intact pregnant rats on days 15, 20, and 22. These tissues were evaluated for relaxin immunostaining at the light microscope level using an antiserum to purified rat relaxin and the avidin biotin immunostaining technique. Since the corpus luteum is the major source of relaxin in the rat, this tissue was used as a positive control. Relaxin immunostaining in the corpus luteum was observed in a discrete region of the cytoplasm. This pattern of staining corresponded with the discrete clustering of relaxin-containing secretory granules found in the rat luteal cells. Relaxin was not observed in the day 22 placenta, cervix, mammary gland, pituitary gland, or day 4-13 pregnant uterus. Relaxin immunostaining was detected in endometrial epithelial cells on days 14-22 of pregnancy and day 2 postpartum. Relaxin immunostaining was more evident at implantation sites than between implantation sites. Antimesometrial epithelial cells at implantation sites contained relaxin immunostaining. The mesometrial surface, which consists of the placenta and decidualized endometrium, did not contain relaxin immunostaining. Relaxin immunostaining was also present in the endometrial epithelial cells of the day 22 pregnant rats that had been ovariectomized on day 9 and given subsequent replacement therapy with ovarian steroids. The presence of relaxin immunostaining in the ovariectomized rat indicates the endometrium is not sequestering relaxin secreted from the corpus luteum. These data provide evidence that the pregnant rat endometrium is a source of relaxin in addition to the corpus luteum. The appearance of relaxin in endometrial epithelial cells after implantation and its prominence at implantation sites may indicate that locally secreted conceptus factors stimulate endometrial relaxin synthesis.

Animals↗
PubMed2005

Risk management strategies in the postmarketing period : safety experience with the US and European bosentan surveillance programmes.

In view of the shortcomings of the current system for postmarketing drug surveillance that is based on voluntary spontaneous adverse drug reaction (ADR) reporting, new approaches are needed. We describe an approach involving a combination of limited distribution, patient and physician education, as well as a novel pharmaco-vigilance system that is capable of promoting the safe and adequate use of a new drug. Importantly, it provides the possibility of calculating true ADR occurrence rates, as the exposed population (denominator) and the number of patients with events (numerator) are known. These measures were taken for the oral dual endothelin ET(A)/ET(B) antagonist bosentan (Tracleer). In recent guidelines issued by the European Society of Cardiology, American College of Chest Physicians and the WHO, this drug is considered as first-line oral treatment for the treatment of pulmonary arterial hypertension, a devastating orphan disease associated with a poor prognosis. Bosentan was approved in 2001/2 on the basis of two pivotal studies that showed improved exercise capacity and haemodynamic parameters while delaying time to clinical worsening. Elevations in serum liver aminotransferase levels of >3 times the upper limit of normal were noted in 10.2% of patients (placebo-subtracted incidence). Therefore, liver function tests have to be performed on a regular basis. In addition, bosentan has potential as a teratogen. In the US, a controlled distribution network for bosentan (Tracleer) Access Program [T.A.P.]) and the development of a patient database to follow patients was set up. Accompanied by comprehensive physician and patient education programmes, T.A.P. was developed to provide a mechanism to assist with the primary risk management goals for bosentan therapy, namely pregnancy prevention and liver enzyme monitoring and prevention of hepatic injury. In Europe, the Tracleer) Excellence (TRAX PMS) database is a novel European non-interventional, prospective, internet-based surveillance system initiated by the manufacturer in cooperation with the European Medicines Agency. It collected potential safety signals associated with bosentan use including adverse events, elevations of liver aminotransferase levels, other abnormal laboratory values, death and hospitalisation. TRAX PMS has accrued 79% of all known patients in the EU and the data provide supportive 'real-life' evidence on the long-term safety of bosentan. The two different systems had similar goals and outcomes. The data received concerning thousands of patient-years of use have confirmed the clinical trial results regarding product safety and the favourable benefit/risk ratio of bosentan, especially with regard to known type A adverse events. The clinical monitoring algorithm has also been confirmed. In addition, no rare type B events were uncovered despite the increased reporting rate. These systems might serve as templates for future pharmaco-vigilance efforts regarding drugs that require particular safety attention.

Abnormalities, Drug-Induced↗
PubMed2004

Alcoholic subtypes: are two sufficient?

AIMS: Guided by the literature on alcohol subtypes, cluster analytical solutions ranging from two to five were evaluated for a large (n = 802), ethnically diverse sample of alcoholic in-patients. DESIGN: Personal interview data were collected from in-patients regarding their substance abuse and psychiatric disorder status, risk factors for psychopathology and health outcomes. SETTING: The data were collected at five alcohol in-patient treatment settings in New York; three settings were in New York City, one in Rochester and one in Buffalo. PARTICIPANTS: The sample included 802 participants (481 males and 321 females) with racial/ethnic group diversity (418 blacks, 180 whites, 187 Hispanics, 17 of other ethnic origin). MEASUREMENTS: Subjects were assessed with standardized measures of substance abuse and psychiatric disorders, family history of alcoholism, psychopathy, temperament, alcohol expectancies and clinical health variables. FINDINGS: Based on internal and external criteria and compatibility with the existing literature, four subtypes were identified: mild course, polydrug, negative affect and chronic/antisocial. On external criteria, the polydrug subtype had the highest rate of family criminality, high-risk sexual behavior and intravenous drug use; the negative affect subtype had the highest rate of childhood sexual abuse, attempted suicide and childhood homelessness; the chronic/antisocial personality (ASP) subtype had the most severe pattern of drinking and antisocial behavior. CONCLUSIONS: Findings are discussed with regard to the etiological and clinical utility of the four-subtype formulation, and consistency with recent studies in molecular genetics and pharmacology.

Adult↗
PubMed2003

Early clinical investigation of Viozan (sibenadet HCl), a novel D2 dopamine receptor, beta2-adrenoceptor agonist for the treatment of chronic obstructive pulmonary disease symptoms.

Viozan, (Sibenadet HCl, AR-C68397AA) is a dual D2 dopamine receptor, beta2-adrenoceptor agonist that combines bronchodilator activity with the sensory afferent modulating effects associated with D2-receptor agonism. Investigation in animal models of key chronic obstructive pulmonary disease (COPD) symptoms has demonstrated that sibenadet effectively inhibits sensory nerve activity, thereby reducing reflex cough, mucus production and tachypnoea. The results of the early clinical evaluation of this novel agent are reported. An initial proof of concept study (Study 1) aimed to determine the clinical potential of this novel agent by assessing the effects of three doses of sibenadet therapy relative to placebo, with two commonly used bronchodilators, intended to provide a benchmark against which sibenadet activity could be judged. In all, 701 patients were randomized to one of three sibenadet dose groups (400, 600 or 1000 microg ex valve), salbutamol 200 microg, ipratropium bromide (IB) 40 microg or placebo, all three times daily via pressurized metered dose inhaler (pMDI) for 4 weeks. Once the results of Study 1 had been evaluated, a dose-ranging, study (Study 2) involving 872 patients randomized to receive sibenadet (45, 270, or 495 microg ex actuator), or placebo all three times daily via pMDI, for 6 weeks commenced. Both studies were preceded by a 2-week baseline phase and followed by a 2-week follow up period.The primary efficacy variable identified changes in key COPD symptoms over the treatment period (compared with baseline data) as determined by the novel Breathlessness, Cough and Sputum Scale (BCSS). In addition, data on lung function, health-related quality of life and adverse events were collected. Patients receiving sibenadet therapy three times daily exhibited statistically significantly greater improvements in BCSS total score than those receiving placebo or bronchodilator therapy alone. A clear dose-response was evident in Study 2. Symptom improvement in this study was also accompanied by improved lung function and health-related quality of life. Sibenadet therapy was well tolerated with an adverse events profile comparable to current bronchodilator therapy. These data were viewed as extremely encouraging, warranting further, large-scale clinical investigation.

Administration, Inhalation↗
PubMed2003

Spirituality and attempted suicide among American Indians.

American Indians exhibit suicide-related behaviors at rates much higher than the general population. This study examines the relation of spirituality to the lifetime prevalence of attempted suicide in a probability sample of American Indians. Data were derived from a cross-sectional sample of 1456 American Indian tribal members (age range 15-57yr) who were living on or near their Northern Plains reservations between 1997 and 1999. Data were collected by personal interviews. Commitment to Christianity was assessed using a measure of beliefs. Commitment to tribal cultural spirituality (or forms of spirituality deriving from traditions that predate European contact) was assessed using separate measures for beliefs and spiritual orientations. Results indicated that neither commitment to Christianity nor to cultural spirituality, as measured by beliefs, was significantly associated with suicide attempts (p(trend) for Christianity=0.22 and p(trend) for cultural spirituality=0.85). Conversely, commitment to cultural spirituality, as measured by an index of spiritual orientations, was significantly associated with a reduction in attempted suicide (p(trend)=0.01). Those with a high level of cultural spiritual orientation had a reduced prevalence of suicide compared with those with low level of cultural spiritual orientation. (OR=0.5, 95% CI=0.3, 0.9). This result persisted after simultaneous adjustment for age, gender, education, heavy alcohol use, substance abuse and psychological distress. These results are consistent with anecdotal reports suggesting the effectiveness of American Indian suicide-prevention programs emphasizing orientations related to cultural spirituality.

Adolescent↗
PubMed2000

HTLV-I/HTLV-II coinfection in an AIDS patient from São Paulo, Brazil.

A serological survey for HTLV infection identified an AIDS patient with HTLV-I/HTLV-II dual seroreactivity. Two further sequential blood samples were collected (samples A and B) for PCR, restriction fragment length polymorphism (RFLP), and sequence analyses of HTLV-I and HTLV-II strains. PCR analyses confirmed dual infection in both samples. Restriction digests of the env region amplified from sample A showed the presence of an HTLV-IIa subtype; the HTLV-II provirus was found to be defective in the pol and env regions in the second sample from this patient. RFLP analysis of the HTLV-II LTR region of both samples confirmed this finding and identified an a5/bzl restriction type. Nucleotide sequence analyses revealed full homology in the HTLV-I env and LTR regions and in the HTLV-II LTR region between the two samples. These findings document the first case of an HTLV-I/HTLV-II coinfection that was fully confirmed and characterized by means of molecular analyses.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Distribution of learning styles and preferences for learning environment characteristics among Emergency Medical Care Assistants (EMCAs) in Ontario, Canada.

INTRODUCTION: In Ontario, Canada, Emergency Medical Care Assistants (EMCAs) have many opportunities for continuing education. However, little is known about how EMCAs learn. OBJECTIVES: The intent of this study was to explore the distribution of learning styles, preferences for major learning environment characteristics, and the associations between these two factors among the EMCA population in Ontario, Canada. METHODS: Following review of the literature, a 32-item survey of learning environment characteristics was constructed to measure the respondents' preferences. Using a random number generator, 386 EMCAs were selected for participation. Each received: a) an explanatory cover letter; b) a copy of the Kolb Learning Style Inventory (LSI) questionnaire; c) a second questionnaire consisting of learning environment characteristics; and d) a stamped, return addressed envelope. Completed surveys were scored to determine the respondent's Learning Style. The LSI and Learning Environment survey results were entered into a data base and subjected to Dual Scaling analysis in order to 1) Identify the distribution of learning styles; and 2) Explore associations between styles and environmental characteristics. RESULTS: A total of 75 completed surveys were returned, each of the four styles of learning (Converger; Diverger; Assimilator; and Accommodator) were identified in the sample. Dual Scaling analysis indicated a noteworthy association (R(jt) correlation > 0.300) between learning style and 10 of the 32 environmental characteristics. The data describe the usefulness of each of the learning styles. Accommodators believed courses with a strong emphasis on practical applications and working in groups to be very useful, but were less interested in courses with a strong emphasis on theory. Assimilators felt lectures and courses with a strong emphasis on theory very useful, but were less interested in providing input into course objectives. Divergers found that a lot of verbal explanation is useful, but were less interested in working with teachers who act as coaches. Convergers believed that working with teachers who act as coaches is useful. They also preferred courses with a strong emphasis on practical applications, but were less interested in courses with a strong emphasis on theory. CONCLUSIONS: The findings in this study, provide some additional insight into the connections between learning style and elements of the learning environment, and their application may contribute to operationalizing learning theory.

Data Collection↗
PubMed1999

Risk-adjusted outcome models for public mental health outpatient programs.

OBJECTIVE: To develop and test risk-adjustment outcome models in publicly funded mental health outpatient settings. We developed prospective risk models that used demographic and diagnostic variables; client-reported functioning, satisfaction, and quality of life; and case manager clinical ratings to predict subsequent client functional status, health-related quality of life, and satisfaction with services. DATA SOURCES/STUDY SETTING: Data collected from 289 adult clients at five- and ten-month intervals, from six community mental health agencies in Washington state located primarily in suburban and rural areas. Data sources included client self-report, case manager ratings, and management information system data. STUDY DESIGN: Model specifications were tested using prospective linear regression analyses. Models were validated in a separate sample and comparative agency performance examined. PRINCIPAL FINDINGS: Presence of severe diagnoses, substance abuse, client age, and baseline functional status and quality of life were predictive of mental health outcomes. Unadjusted versus risk-adjusted scores resulted in differently ranked agency performance. CONCLUSIONS: Risk-adjusted functional status and patient satisfaction outcome models can be developed for public mental health outpatient programs. Research is needed to improve the predictive accuracy of the outcome models developed in this study, and to develop techniques for use in applied settings. The finding that risk adjustment changes comparative agency performance has important consequences for quality monitoring and improvement. Issues in public mental health risk adjustment are discussed, including static versus dynamic risk models, utilization versus outcome models, choice and timing of measures, and access and quality improvement incentives.

Activities of Daily Living↗
PubMed2004

Probing the transition-state structure of dual-specificity protein phosphatases using a physiological substrate mimic.

Dual-specificity phosphatases (DSPs) belong to the large family of protein tyrosine phosphatases that contain the active-site motif (H/V)CxxGxxR(S/T), but unlike the tyrosine-specific enzymes, DSPs are able to catalyze the efficient hydrolysis of both phosphotyrosine and phosphoserine/threonine found on signaling proteins, as well as a variety of small-molecule aryl and alkyl phosphates. It is unclear how DSPs accomplish similar reaction rates for phosphoesters, whose reactivity (i.e., pK(a) of the leaving group) can vary by more than 10(8). Here, we utilize the alkyl phosphate m-nitrobenzyl phosphate (mNBP), leaving-group pK(a) = 14.9, as a physiological substrate mimic to probe the mechanism and transition state of the DSP, Vaccinia H1-related (VHR). Detailed pH and kinetic isotope effects of the V/K value for mNBP indicates that VHR reacts with the phosphate dianion of mNBP and that the nonbridge phosphate oxygen atoms are unprotonated in the transition state. (18)O and solvent isotope effects indicate differences in the respective timing of the proton transfer to the leaving group and P-O fission; with the alkyl ester substrate, protonation is ahead of P-O fission, while with the aryl substrate, the two processes are more synchronous. Kinetic analysis of the general-acid mutant D92N with mNBP was consistent with the requirement of Asp-92 in protonating the ester oxygen, either in a step prior to significant P-O bond cleavage or in a concerted but asynchronous mechanism in which protonation is ahead of P-O bond fission. Collectively, the data indicate that VHR and likely all DSPs can match leaving-group potential with the timing of the proton transfer to the ester oxygen, such that diverse aryl and alkyl phosphoesters are turned over with similar catalytic efficiency.

Aniline Compounds↗
PubMed1993

Caring for neighbors: an examination of nonresident use of New York City hospitals.

In 1989, almost 10 percent of all patients--or nearly 100,000 patients--hospitalized at facilities located in New York City were not city residents. Nonresidents are attracted to the city by the prestige and expertise of the city's hospitals; they are more likely than residents to require the hospitals' most sophisticated and specialized services, ranging from transplantation and coronary bypass surgery to treatment of malignant conditions. The largest numbers of nonresident patients, however, receive care for conditions that are relatively routine, care which would seem to be generally available at suburban hospitals. Although New York City hospitals continued to serve a substantial number of patients residing outside the city, the flow of nonresident patients seems to be slowly diminishing, particularly at the city's academic medical centers. (The specialty hospitals, on the other hand, seem to be attracting an increasing share of nonresident patients.) This decline occurred despite the one-third increase in population since 1960 in the New York State counties surrounding the city. To complicate matters, many New Yorkers are leaving the city for care. Almost 40,000 New York City residents were admitted to hospitals elsewhere in New York State, and perhaps another 20,000 to 40,000 may be receiving hospital care in other states. These trends have obvious implications for the city's hospital in their dual role as leaders in advanced and sophisticated medical care and as providers of vital patient care services to the city's population. The most highly specialized services can maintain clinical expertise and remain financially viable only if a sufficient number of patients can be attracted from throughout the metropolitan area and beyond. Likewise, the city's hospitals can be confident of fulfilling basic patient care needs only as long as New Yorkers do not look elsewhere for care. With the myriad pressures on our hospitals, the challenge of keeping them inviting and responsive will be formidable, but the construction of modern facilities, emphasis on patient-centered care, cultivation of strong relationships with communities and practitioners, and careful monitoring of patient flows and patient satisfaction should help the city's hospitals continue to attract patients, both from within the city and beyond the city limits.

Adolescent↗
PubMed2006

Longitudinal population analysis of dual infection with recombination in two strains of HIV type 1 subtype B in an individual from a Phase 3 HIV vaccine efficacy trial.

This study documents a case of coinfection (simultaneous infection of an individual with two or more strains) of two HIV-1 subtype B strains in an individual from a Phase 3 HIV-1 vaccine efficacy trial, conducted in North American and the Netherlands. We examined 86 full-length gp120 (env) gene sequences from this individual collected from nine different time points over a 20-month period. We estimated evolutionary relationships using maximum likelihood and Bayesian methods and inferred recombination breakpoints and recombinant sequences using phylogenetic and substitutional methods. These analyses identified two strongly supported monophyletic clades (clades A and B) of 14 and 69 sequences each and a small paraphyletic recombinant clade of three sequences. We then studied the genetic characteristics of these lineages by comparing estimates of genetic diversity generated by mutation and recombination and adaptive selection within a coalescent and maximum likelihood framework. Our results suggest significant differences on the evolutionary dynamics of these strains. We then discuss the implications of these results for vaccine development.

AIDS Vaccines↗
PubMed1988

Intraseason changes in the body composition of collegiate female gymnasts.

Body composition measures were collected pre-, mid- and post-season on a team of eight national-calibre collegiate women gymnasts to examine intraseason changes. Also analysed were interseason changes using pre- and post-season data on five of the eight subjects during the current and previous year, according to a 2 x 2 (years x tests) analysis of variance repeated-measures design. Skinfold, circumference and diameter measures were collected with percentage body fat, lean body mass and body density determined by regression equations developed specifically for collegiate female gymnasts. Intraseason body weight decreased significantly from pre- to mid-season (means = 55.0 and 53.6 kg respectively); but the difference between mid- and post-season (53.9 kg) values was not significant (P greater than 0.05). The majority of the 1.4 kg weight loss occurred during intense pre-season conditioning and not during the actual season. Percentage body fat, on the other hand, decreased significantly from pre- to mid-season and mid- to post-season (means = 21.4%, 17.4% and 13.45% respectively; P less than 0.0005). Body density increased significantly from pre- to mid-season and mid- to post-season (means = 1.0476, 1.0584 and 1.0681 respectively; P greater than 0.0005). Of the circumference and skinfold values used in calculating percentage body fat and body density, only the skinfold values displayed significant decreases throughout the season. Interseason analyses revealed no significant changes in any of the dependent measures between seasons, despite consistent trends. There were no significant years x tests interactions and all intraseason changes for two seasons (n = 5) were the same as those found in more detailed analysis of a single season (n = 8) except in the case of weight loss, which was marginally significant (P less than 0.046) in the single-season and not in the dual-season analysis (P greater than 0.05). Body composition of these gymnasts changed in many ways within competitive seasons. The most pronounced changes observed were decreases in subcutaneous fat and increases in body density. This study reinforces the need for administrators, coaches and athletes to be concerned with percentage body fat and skinfold measures rather than weight alone when determining if a person is 'fat'.

Adipose Tissue↗
PubMed2000

Service use and cost by mentally ill chemical abusers: differences by retention in a therapeutic community.

PURPOSE: Earlier research estimated the incremental costs and outcomes of a modified therapeutic community (modified TC) for mentally ill chemical abusers (MICAs) relative to a treatment-as-usual (TAU) control group. The present study extended the cost analysis by disaggregating the modified TC group into clients who completed the program (completers) and clients who dropped out (separaters). METHODS: Bivariate and multivariate analyses were conducted to estimate differences in treatment and other service costs among completers, separaters, and TAU. Subjects were sequentially assigned to the modified TC (n = 171) or TAU (n = 47), and the analysis period covered 12 months post-baseline. Using a standardized instrument to collect resource use and cost data, the estimated weekly cost per client in the modified TC was $554, with completers showing a larger average cost of treatment ($27,595) than separaters ($9,986). RESULTS: The average TAU subject had a much higher cost for other (non-modified TC) services ($29,795) relative to separaters ($22,048) or completers ($1,986). These findings suggest that, from baseline to the 12-month follow-up, the total cost of modified TC treatment and other services for completers may be slightly lower than the total cost for separaters or TAU subjects. Since the modified TC group had better outcomes than the TAU group, and the completers had better outcomes than the separaters, the modified TC program could be an effective mechanism to reduce the costs of service utilization as well as improve clinical outcomes. IMPLICATIONS: This detailed investigation into service utilization and cost provides policy-makers and program directors with valuable information regarding potentially cost-effective interventions and further underscores the importance of retention in treatment for this vulnerable population.

Adult↗
PubMed2003

Five-year outcomes of a brief alcohol intervention for adult in-patients with psychiatric disorders.

AIMS: To compare 5 year outcomes (general hospital and mental health morbidity and mortality) among general hospital psychiatric in-patients randomized to receive either an alcohol reduction motivational interview (MI) or information pack (IP), and compare these to matched controls. DESIGN: We recruited 120 patients aged 18-64 years who scored >/=8 on the Alcohol Use Disorders Identification Test (AUDIT). We selected matched controls from in-patients not recruited but who reached the same AUDIT threshold. At 5 years, follow-up data were collected via a state-wide hospital record system. FINDINGS: There were no significant differences between the MI and IP groups in terms of 'survival' to their first alcohol-related, other general hospital or mental health admission over 5 years. Matched controls had significantly more mental health in-patient episodes (F[1,226] 4.4, P < 0.05) and greater length of hospital stay (F[1,226] 4.8, P < 0.05) than the combined MI-IP group. Furthermore, the MI-IP group had longer 'survival' times to both first general hospital (mean 583 versus 392 days) and mental health in-patient (mean 788 versus 580 days) events. Collapsed across groups, dependent and harmful consumers had shorter 'survival' times than hazardous consumers (AUDIT classifications). CONCLUSIONS: Alcohol interventions have medium-term health benefits for those with mental health and alcohol use problems. Importantly, there were no differences in outcome between the intervention groups. The low cost of providing an IP makes it attractive as an alcohol intervention. The AUDIT provided an effective means of identifying those who are at risk of subsequent alcohol-related admissions and may benefit from intervention.

Adolescent↗
PubMed2001

Fluorescence-based directed termination PCR: direct mutation characterization without sequencing.

We describe a fluorescence-based directed termination PCR (fluorescent DT-PCR) that allows accurate determination of actual sequence changes without dideoxy DNA sequencing. This is achieved using near infrared dye-labeled primers and performing two PCR reactions under low and unbalanced dNTP concentrations. Visualization of resulting termination fragments is accomplished with a dual dye Li-cor DNA sequencer. As each DT-PCR reaction generates two sets of terminating fragments, a pair of complementary reactions with limiting dATP and dCTP collectively provide information on the entire sequence of a target DNA, allowing an accurate determination of any base change. Blind analysis of 78 mutants of the supF reporter gene using fluorescent DT-PCR not only correctly determined the nature and position of all types of substitution mutations in the supF gene, but also allowed rapid scanning of the signature sequences among identical mutations. The method provides simplicity in the generation of terminating fragments and 100% accuracy in mutation characterization. Fluorescent DT-PCR was successfully used to generate a UV-induced spectrum of mutations in the supF gene following replication on a single plate of human DNA repair-deficient cells. We anticipate that the automated DT-PCR method will serve as a cost-effective alternative to dideoxy sequencing in studies involving large-scale analysis for nucleotide sequence changes.

Automation↗
PubMed2005

Dual symbiosis in a Bathymodiolus sp. mussel from a methane seep on the Gabon continental margin (Southeast Atlantic): 16S rRNA phylogeny and distribution of the symbionts in gills.

Deep-sea mussels of the genus Bathymodiolus (Bivalvia: Mytilidae) harbor symbiotic bacteria in their gills and are among the dominant invertebrate species at cold seeps and hydrothermal vents. An undescribed Bathymodiolus species was collected at a depth of 3,150 m in a newly discovered cold seep area on the southeast Atlantic margin, close to the Zaire channel. Transmission electron microscopy, comparative 16S rRNA analysis, and fluorescence in situ hybridization indicated that this Bathymodiolus sp. lives in a dual symbiosis with sulfide- and methane-oxidizing bacteria. A distinct distribution pattern of the symbiotic bacteria in the gill epithelium was observed, with the thiotrophic symbiont dominating the apical region and the methanotrophic symbiont more abundant in the basal region of the bacteriocytes. No variations in this distribution pattern or in the relative abundances of the two symbionts were observed in mussels collected from three different mussel beds with methane concentrations ranging from 0.7 to 33.7 microM. The 16S rRNA sequence of the methanotrophic symbiont is most closely related to those of known methanotrophic symbionts from other bathymodiolid mussels. Surprisingly, the thiotrophic Bathymodiolus sp. 16S rRNA sequence does not fall into the monophyletic group of sequences from thiotrophic symbionts of all other Bathymodiolus hosts. While these mussel species all come from vents, this study describes the first thiotrophic sequence from a seep mussel and shows that it is most closely related (99% sequence identity) to an environmental clone sequence obtained from a hydrothermal plume near Japan.

Animals↗