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Torsion angle dynamics for NMR structure calculation with the new program DYANA.

The new program DYANA (DYnamics Algorithm for Nmr Applications) for efficient calculation of three-dimensional protein and nucleic acid structures from distance constraints and torsion angle constraints collected by nuclear magnetic resonance (NMR) experiments performs simulated annealing by molecular dynamics in torsion angle space and uses a fast recursive algorithm to integrate the equations of motions. Torsion angle dynamics can be more efficient than molecular dynamics in Cartesian coordinate space because of the reduced number of degrees of freedom and the concomitant absence of high-frequency bond and angle vibrations, which allows for the use of longer time-steps and/or higher temperatures in the structure calculation. It also represents a significant advance over the variable target function method in torsion angle space with the REDAC strategy used by the predecessor program DIANA. DYANA computation times per accepted conformer in the "bundle" used to represent the NMR structure compare favorably with those of other presently available structure calculation algorithms, and are of the order of 160 seconds for a protein of 165 amino acid residues when using a DEC Alpha 8400 5/300 computer. Test calculations starting from conformers with random torsion angle values further showed that DYANA is capable of efficient calculation of high-quality protein structures with up to 400 amino acid residues, and of nucleic acid structures.

Algorithms↗

The high production volume chemical challenge program: the relevance of the in vivo micronucleus assay.

The in vivo rodent bone marrow micronucleus assay (Mnt) has assumed a pivotal role in screening strategies for the identification of substances potentially carcinogenic to humans. The analysis of the results of the current international 5-year effort to provide toxicological data for high production volume chemicals will play a crucial role in developing future strategies for identifying health hazards. As part of that program, consideration is being given to accepting either in vitro genotoxicity data or results of the Mnt. The present analyses indicate that for hazard identification purposes that, in fact, in vitro genotoxicity test results, such as those derived from the Salmonella mutagenicity assay, may be an acceptable alternative.

Animal Testing Alternatives↗

What do the neighbors think now? Community residences on Long Island, New York.

Interviews with 75 neighbors of community residences for adults disabled by mental illness assessed perceptions of impact in five suburban communities. The Not in My Backyard (NIMBY) attitude articulated during program development changed to one of acceptance over time. After a few years experience, the overwhelming majority agreed that the community residences are good neighbors; they have had no problems; and the residences had no adverse effect on property values. The New York State Site Selection Law and comparative data on property value impact are discussed.

Community Mental Health Services↗

Pulse oximetry versus arterial blood gas specimens in long-term oxygen therapy.

Portable pulse oximeters are now widely available for the assessment of arterial oxygenation, and the U.S. Medicare program considers saturation readings to be acceptable substitutes for arterial PO2 in selecting patients for long-term oxygen therapy (LTOT). Current oximeters are reasonably accurate (plus or minus 4 or 5 percent of the co-oximetry value), but the clinician should be aware of several potential problems. Readings may be inaccurate in the presence of hemodynamic instability, carboxyhemoglobinemia, jaundice, or dark skin pigmentation, and also during exercise. Indicated saturation may substantially overestimate arterial PO2 if the patient is alkalemic. Pulse oximetry cannot detect hypercapnia or acidosis. For these and other reasons, pulse oximetry should not be used in initial selection of patients for LTOT, as a substitute for arterial blood gas analysis in the evaluation of patients with undiagnosed respiratory disease, during formal cardiopulmonary exercise testing, or in the presence of an acute exacerbation. Pulse oximetry is an important addition to the clinician's armamentarium, however, for titrating the oxygen dose in stable patients, in assessing patients for desaturation during exercise, for sleep studies, and for in-home monitoring.

Blood Gas Analysis↗

Evaluative and discriminative properties of the Portuguese MacNew Heart Disease Health-related Quality of Life Questionnaire.

The aim of this study was to validate the Portuguese version of the self-administered MacNew Heart Disease Health-related Quality of Life (MacNew) questionnaire in patients after diagnosis of acute coronary syndrome. The MacNew, with a Global score and physical, emotional and social subscales, the Short Form SF-36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS) were completed at baseline by 150 patients and again by 48 clinically stable patients 2-3 weeks later. A cohort of 50 different patients completed the same questionnaires before and after a cardiac rehabilitation program in order to examine responsiveness. Acceptance of the MacNew by the patients was good and the three factor model was substantiated and explained 52.2% of the variance. Internal consistency, intra-class-correlation, and test-retest reliability each exceeded 0.72. The predicted construct validity hypotheses were partially confirmed. The discriminative validity of the MacNew was confirmed with significantly higher MacNew scores for patients with normal left ventricular function, with improved health status, and who were not anxious or depressed. Even though MacNew scores improved significantly following cardiac rehabilitation, the evaluative validity of the MacNew was less robust with small responsiveness statistics. The Portuguese version of the MacNew HRQL questionnaire appears to be a reliable, valid, and moderately responsive instrument to evaluate health-related quality of life after diagnosis of acute coronary syndrome.

Adult↗

Teaching pelvic examination to second-year medical students using programmed patients.

A great deal of interest has been expressed in the use of the "programmed" patient during the past several years. This pilot study used programmed patients to teach medical students the techniques of pelvic examination. From the study, it was concluded that the experience with the programmed patient adds significantly to an undergraduate learning program, that this technique is well accepted by students and faculty, and that it adds realism to the study of obstetrics and gynecology early in a medical school curriculum.

Education, Medical, Undergraduate↗

Microcomputer control of behavior and the acquisition of digital and analog data.

Advances in technology and decreasing costs are enabling microcomputers to displace more traditional devices in the scientific laboratory. The availability of various approaches to software-system development for the use of microcomputers in the on-line control of experiments has contributed to the trend. This report describes a software system developed to control conditioned behavior during schedules of reinforcement while simultaneously accumulating behavioral data and physiological (analog) data using a hardware system base on the Radio Shack TRS-80 Model I microcomputer. The software utilizes a high-level interpretive language (Microsoft BASIC), assembly language and compiled BASIC to attain an acceptable execution speed and ease of programming.

Animals↗

MacSECPROT: two programs in BASIC to evaluate protein secondary structure.

Two interactive programs in BASIC are described, which provide useful tools to evaluate protein secondary structure. Output is given in two formats: (1) graphics are displayed on screen, which can be printed immediately, and (2) textfiles are saved to disk as permanent records and can be printed with a word-processing program. The programs are fast and easy to use and could be a valuable teaching aid in biochemical and molecular biology courses. Program lists are written in Microsoft BASIC for the Apple Macintosh, but can be adapted to other machines accepting graphic commands.

Microcomputers↗

Economics of practice and inpatient care.

The nature and structure of inpatient psychiatric services are rapidly evolving. This article identifies and explores how these changes are being influenced by four interrelated areas: rapid growth in general and private hospital psychiatric practice; increased connections of public, private, and voluntary sectors of care; the emergence and quick acceptance of capitated and managed care programs; and dramatic change and growth in the insurance industry. These four interrelated areas further the development of a two-tier system in psychiatry: one for those with insurance, and one of the poor and the severely disabled. The changes in these four areas have also led to greater demand for increased economic competition among services, and new alliances and innovations in the delivery of treatment. This article discusses how the four areas have combined to support a two-tier system and how they are likely to affect the future evolution of general and private hospital inpatient psychiatric practice.

Cost Control↗

Comparative analysis of the effectiveness of the diaphragm and birth control pill during the first year of use among suburban adolescents.

Little attention has been paid to the diaphragm as a contraceptive option for adolescents. To compare diaphragm and birth control pill use by adolescents, 124 females (aged 13-20 years) in a suburban-based adolescent health service were interviewed at least one year after receiving a contraceptive prescription. The 73 diaphragm choosers did not differ from the 51 pill choosers in age, race, or reason for their original visit to the health service. Diaphragm choosers, however, were better students, of higher socioeconomic status, and had had fewer prior pregnancies. In the year following prescription, continuous use for 12 months was reported by 43% of diaphragm choosers and 45% of pill choosers, with significantly more pill (26%) than diaphragm (8%) choosers reporting discontinued use for at least one month while remaining sexually active. Regular use (diaphragm every intercourse, missing less than or equal to 1 pill/month) was reported by 36% of diaphragm choosers compared to 88% of pill choosers; and at least one pregnancy during the year was reported by 15% of diaphragm choosers and 18% of pill choosers. At follow-up interviews, diaphragm subjects disliked the immediate annoyances of the diaphragm, and pill users expressed concern about the potential side effects of the pill. No single factor or set of factors correlated with continuous and regular use of either method. Because both methods present specific problems for certain patients, we suggest that in addition to the pill, the diaphragm should receive serious consideration as a contraceptive option for adolescents.

Adolescent↗

Donor selection limits use of living-related liver transplantation.

The purpose of this investigation was to assess the applicability of living-related liver transplantation in an established regional transplant program by determining the frequency of acceptable living donors from an unselected population of pediatric transplant candidates and identify specific factors limiting application of this technique. During the period May 1992 to May 1994, all children accepted as transplant candidates at the University of California-San Francisco were evaluated for potential living-related liver transplantation. Indications for transplantation and patient demographics represented the spectrum anticipated at a regional center. Donor evaluation was performed using a three-phase evaluation process we have previously reported. Retrospective analysis identified 75 potential donors for 38 pediatric candidates (age range, 17 days to 14.5 years; mean, 5.1 years). Twenty-three percent of potential donors declined evaluation. Of the 75 potential donors, only 10 (13%) were found to be acceptable for donation. The leading causes for donor declination were significant medical history (23%), ABO blood group incompatibility (23%), and psychosocial history (20%). Of the 38 recipient candidates, 9 (23%) were offered living-donor transplantation. Five patients have received living-donor transplantation, and 4 patients await the procedure when medical indications exist. Seventy-seven percent of recipient candidates received or are awaiting cadaveric transplantation. These results suggest that current donor criteria markedly limit the application of living-related liver transplantation.

Adolescent↗

Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients.

Fifty-four patients treated in a 3-week inpatient rehabilitation program were randomly assigned to and accepted treatment with electroacupuncture (n = 17), TENS (low intensity transcutaneous nerve stimulation, n = 18), and TENS dead-battery (placebo, n = 18). Outcome measures included estimates of pain (on a Visual Analogue Scale) and disability by both physician and patient, physical measures of trunk strength and spine range of motion, as well as the patient's perceptions of the relative contribution of the education, exercise training, and the electrical stimulation. Analyses of variance were utilized to determine effects of treatment (electroacupuncture, TENS, placebo) across time (admission, discharge, and return) for the outcome measures. There were no significant differences between treatment groups with respect to their overall rehabilitation. All 3 treatment groups ranked the contribution of the education as being greater than the electrical stimulation. However, the electroacupuncture group consistently demonstrated greater improvement on the outcome measures than the other treatment groups. For the visual analogue scale measure of average pain, there was a statistical trend at the return visit suggesting that the acupuncture group was experiencing less pain.

Acupuncture Therapy↗

Prenatal alcohol education for low-income women with interactive multimedia.

Prenatal alcohol use is a major cause of birth defects and other adverse outcomes of pregnancy. Educating expectant mothers concerning the need to limit alcohol consumption has been advocated as a method to decrease alcohol-related birth problems, however providing this service for low-income women is increasingly difficult due to ongoing changes in obstetrical practice patterns. The purpose of this work was to develop and test a computer-based multimedia prenatal alcohol education program which would be appropriate for use in a poor rural patient population. We first review the effect of alcohol consumption during pregnancy and previously employed intervention strategies. Then the design, development, and evaluation of the program is described. The content of the program reflects user beliefs and attitudes and takes advantage of a computer-based multimedia approach. This format provides numerous opportunities for user interaction, requires little reading ability and offers the potential to increase levels of health education efforts with no increase in staff. The program was found to be well accepted, to provide new information and to demonstrate potential for effecting change in behavioral intention. Possible uses of this technology for educating similar populations and the use of computers for health screening are discussed.

Alcohol Drinking↗

Marital predictors of symptom severity in panic disorder with agoraphobia.

Twenty-six to forty percent of individuals suffering from panic disorder with agoraphobia (PDA) do not benefit significantly from cognitive-behavior therapy. Marital problems are among risk factors that may explain this limited impact. Some studies suggest that PDA treatment outcome is related to the couple's ability to communicate and solve problems during and after treatment. It may be also useful to further clarify the interplay of marital interpersonal variables with PDA severity before any intervention. This study aims at specifying the links between PDA symptom severity on the one hand and, on the other hand, marital adjustment, attachment style and personal problem-solving skills in both spouses. Results obtained from a group of 67 PDA patients (44 women and 23 men) and their partners showed that some PDA symptoms or comorbid depressive symptoms were more severe when both spouses independently scored low on problem-solving skills or marital adjustment, and when attachment style of PDA patients was insecure. Marital adjustment and difficulties in problem-solving, more specifically, avoidance of problem-solving activities in PDA patients, were the best predictors of PDA symptom severity. In light of these findings, a more complete program of problem-solving and acceptance strategies could be developed as part of a cognitive-behavior treatment of PDA. Other theoretical and clinical implications are discussed.

Adult↗

Depression and mental health visits to physicians--a prospective records-based study.

Previous studies of access to care for depression have been based on cross-sectional surveys of self-reported use of mental health service use. As the recall of use may be differentially biased by mood states, inferences about how well persons with depression are accessing services in comparison to other groups may be misleading. Accordingly, we estimated the magnitude of the depression-use associations in relation to key covariates based on prospective records of mental health visits to physicians. The sample, N = 23,063, of persons 12 years and older, was drawn from the 1996/97 Ontario Health Survey and linked to their administrative mental health care records 24 months forward in time. We found that depression-use associations were in the expected direction but similar in magnitude to associations for gender and education unlike previous self-reported use surveys. Female gender was positively related to the use of a primary care physician but negatively related to seeing a psychiatrist as opposed to a primary care physician. Those who had attained higher levels of education were more likely to be seen by physicians than those with lower education levels. The meaning behind these findings bears further study as it may have implications for primary care reform and the design of future studies of access.

Adolescent↗

Simultaneous reversed-phase high-performance liquid chromatographic separation of mono-, di-and trichloroanilines through a gradient elution optimised by experimental design.

A new RP-HPLC method for the simultaneous determination of the 13 mono-, di- and trichloroanilines has been developed. In order to obtain the analyte resolution within an acceptable analysis time, a gradient elution program has been optimised through the use of an experimental design and a grid search algorithm. The optimized conditions provided the resolution of all the analytes in less than 80 min. The primary validation of the analytical method gave limit of detection values ranging between 0.02 and 0.06 mg/l and very good linearity of the calibration curves.

Aniline Compounds↗

Health and environmental benefits from air pollution reductions in Hungary.

The aim of this study was to assess the cost and benefit of the implementation of a specific energy saving program in Hungary. We have considered the possible reduced damage to public health, building materials and agricultural crops that may be obtained from reducing emissions of important air pollutants and also how the program contributes to reduced emissions of greenhouse gases. The measures are described in the National Energy Efficiency Improvement and Energy Conservation Programs (NEEIECP), elaborated by the Hungarian Ministry of Industry and Trade and accepted by the Government in 1994. The energy saving expected from the program is approximately 64 PJ/year. The benefits were estimated using monitoring data and population/recipient data from urban and rural areas in Hungary together with exposure-response functions and valuation estimates mainly from western studies. Our analysis indicates that the main benefit from reducing the concentrations of pollutants relates to public health and that reduced prevalence of chronic respiratory diseases is an important effect. Reduced premature mortality is also important and the estimated attributable risk of air pollution to excess mortality at present is approximately 6%. The estimated annual benefit of improved health conditions alone is likely to exceed the investments needed to implement the program. In addition there are significant benefits due to reduced replacement and maintenance costs for building materials (30-35 million US$ annually in Budapest only). The damage to crops due to ozone is large, but a significant improvement in Hungary depends upon concerted actions in several countries.

Agriculture↗

Molecular regulation of neuronal apoptosis.

Apoptosis is a fundamental biological process used by all muticellular organisms to eliminate unwanted or superfluous cells, and is a prominent feature of normal neural development. Developmentally occurring neuronal apoptosis serves to match the number of neurons to the requirements of their synaptic targets and to rid the nervous system of inappropriate connections. While it is generally accepted that apoptosis is a "suicide program" inherent in all cells, the molecular basis of this program is just beginning to be unraveled. Evidence from numerous recent studies indicate that a variety of proteins are involved in the transmission of external signals to the cell-death machinery within the cell. This review describes many of the recent findings of the regulatory pathways and genes that have been implicated in the induction or suppression of apoptosis in neurons.

Animals↗