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OBJECTIVE: Persons with mental illness and/or substance abuse are frequently perceived by the public to be dangerous. This has resulted in an increase in state legislation restricting their ability to purchase, possess, register, obtain licensure, retain, and/or carry a firearm of any sort. The purpose of this article is to educate clinicians about the impact of firearms statutes and restrictions for their patients. Many state statutes mandate that treating psychiatrists report such gun possession to state justice or police departments. Psychiatrists may also have a statutory role in an appeals process. METHOD: The firearms statutes of the 50 states, the District of Columbia, and Puerto Rico and the Federal National Firearms Act were surveyed, with particular attention paid to the ability of persons with mental illness and/or alcohol or substance abuse to obtain firearms. The results were tabulated. RESULTS: These statutes are not uniform. They vary in their definition of mental illness, the type and duration of gun restriction, reporting practices, the confidentiality of medical information, and the immunity of clinician reporters and appeals processes. CONCLUSION: Clinicians would be wise to familiarize themselves with the provisions of the relevant statutes in their particular states. This will allow them to identify the consequences to their firearm-possessing patients, understand their own roles and obligations--if any--and better consider potential clinical and ethical issues for particular patients. [ABSTRACT FROM AUTHOR]

Imogene King is universally recognized as a pioneer of nursing theory development. Her interacting conceptual system for nursing and her theory of goal attainment have been included in every major nursing theory text, are taught to thousands of nursing students, form the basis of nursing education programs, and are implemented in a variety of service settings. [ABSTRACT FROM AUTHOR]

A dynamic approach to parenting in a neonatal intensive care unit provides a framework to test King's nursing theory. The framework is based on selected concepts from King's theory of goal attainment and current literature on parenting. The framework stresses the valuational components of human interaction. This article describes an attempt to move neonatal care from medicalization of parenting toward transaction between parents and nurses. [ABSTRACT FROM AUTHOR]

The integrity of the plasma membrane is critical to cell function and survival. Cells have developed multiple mechanisms to repair damaged plasma membranes. A key process during plasma membrane repair is to limit the size of the damage, which is facilitated by the presence of tetraspanin-enriched rings surrounding damage sites. Here, we identify phosphatidylserine-enriched rings surrounding damaged sites of the plasma membrane, resembling tetraspanin-enriched rings. Importantly, the formation of both the phosphatidylserine- and tetraspanin-enriched rings requires phosphatidylserine and its transfer proteins ORP5 and ORP9. Interestingly, ORP9, but not ORP5, is recruited to the damage sites, suggesting cells acquire phosphatidylserine from multiple sources upon plasma membrane damage. We further demonstrate that ORP9 contributes to efficient plasma membrane repair. Our results thus unveil a role for phosphatidylserine and its transfer proteins in facilitating the formation of tetraspanin-enriched macrodomains and plasma membrane repair., (© 2024 Li et al.)

The in vitro oxygen microenvironment profoundly affects the capacity of cell cultures to model physiological and pathophysiological states. Cell culture is often considered to be hyperoxic, but pericellular oxygen levels, which are affected by oxygen diffusivity and consumption, are rarely reported. Here, we provide evidence that several cell types in culture actually experience local hypoxia, with important implications for cell metabolism and function. We focused initially on adipocytes, as adipose tissue hypoxia is frequently observed in obesity and precedes diminished adipocyte function. Under standard conditions, cultured adipocytes are highly glycolytic and exhibit a transcriptional profile indicative of physiological hypoxia. Increasing pericellular oxygen diverted glucose flux toward mitochondria, lowered HIF1α activity, and resulted in widespread transcriptional rewiring. Functionally, adipocytes increased adipokine secretion and sensitivity to insulin and lipolytic stimuli, recapitulating a healthier adipocyte model. The functional benefits of increasing pericellular oxygen were also observed in macrophages, hPSC-derived hepatocytes and cardiac organoids. Our findings demonstrate that oxygen is limiting in many terminally-differentiated cell types, and that considering pericellular oxygen improves the quality, reproducibility and translatability of culture models., (© 2024. The Author(s).)

This column discusses burnout and moral injury among Black psychiatrists and other Black mental health professionals and highlights the contribution of racism to these outcomes. In the United States, the COVID-19 pandemic and racial turmoil have revealed stark inequities in health care and social justice, and demand for mental health services has increased. To meet the mental health needs of communities, racism must be recognized as a factor in burnout and moral injury. The authors offer preventive strategies to support the mental health, well-being, and longevity of Black mental health professionals., Competing Interests: The authors report no financial relationships with commercial interests.

Distinct tissue-specific mechanisms mediate insulin action in fasting and postprandial states. Previous genetic studies have largely focused on insulin resistance in the fasting state, where hepatic insulin action dominates. Here we studied genetic variants influencing insulin levels measured 2 h after a glucose challenge in >55,000 participants from three ancestry groups. We identified ten new loci (P < 5 × 10 -8 ) not previously associated with postchallenge insulin resistance, eight of which were shown to share their genetic architecture with type 2 diabetes in colocalization analyses. We investigated candidate genes at a subset of associated loci in cultured cells and identified nine candidate genes newly implicated in the expression or trafficking of GLUT4, the key glucose transporter in postprandial glucose uptake in muscle and fat. By focusing on postprandial insulin resistance, we highlighted the mechanisms of action at type 2 diabetes loci that are not adequately captured by studies of fasting glycemic traits., (© 2023. The Author(s), under exclusive licence to Springer Nature America, Inc.)

The failure of metabolic tissues to appropriately respond to insulin ("insulin resistance") is an early marker in the pathogenesis of type 2 diabetes. Protein phosphorylation is central to the adipocyte insulin response, but how adipocyte signaling networks are dysregulated upon insulin resistance is unknown. Here we employ phosphoproteomics to delineate insulin signal transduction in adipocyte cells and adipose tissue. Across a range of insults causing insulin resistance, we observe a marked rewiring of the insulin signaling network. This includes both attenuated insulin-responsive phosphorylation, and the emergence of phosphorylation uniquely insulin-regulated in insulin resistance. Identifying dysregulated phosphosites common to multiple insults reveals subnetworks containing non-canonical regulators of insulin action, such as MARK2/3, and causal drivers of insulin resistance. The presence of several bona fide GSK3 substrates among these phosphosites led us to establish a pipeline for identifying context-specific kinase substrates, revealing widespread dysregulation of GSK3 signaling. Pharmacological inhibition of GSK3 partially reverses insulin resistance in cells and tissue explants. These data highlight that insulin resistance is a multi-nodal signaling defect that includes dysregulated MARK2/3 and GSK3 activity., (© 2023. The Author(s).)

The biogenesis of lipid droplets (LDs), key organelles for cellular lipid storage and homeostasis, remains poorly understood. Seipin is essential to normal LD biogenesis but exactly how it regulates LD initiation remains to be elucidated. Our previous results suggested that seipin may bind anionic phospholipids such as PI(3)P. Here, we investigate whether PI(3)P is functionally linked to seipin and whether PI(3)P can also impact LD biogenesis. In seipin-deficient cells, there were enlarged PI(3)P puncta where its effector, DFCP1, also appeared to congregate. Reducing cellular PI(3)P partially rescued the defective LD initiation caused by seipin deficiency. Increasing PI(3)P impeded the lipidation of nascent LDs. We further demonstrated that DFCP1 localized to LDs and facilitated the efficient lipidation of nascent LDs. However, the normal function and localization of DFCP1 were disrupted when cellular PI(3)P homeostasis was perturbed. Our results thus identify PI(3)P as a novel regulator of LD initiation and suggest that PI(3)P may impact the biogenesis of LDs through DFCP1.

Insulin-induced GLUT4 translocation to the plasma membrane in muscle and adipocytes is crucial for whole-body glucose homeostasis. Currently, GLUT4 trafficking assays rely on overexpression of tagged GLUT4. Here we describe a high-content imaging platform for studying endogenous GLUT4 translocation in intact adipocytes. This method enables high fidelity analysis of GLUT4 responses to specific perturbations, multiplexing of other trafficking proteins and other features including lipid droplet morphology. Using this multiplexed approach we showed that Vps45 and Rab14 are selective regulators of GLUT4, but Trarg1 , Stx6 , Stx16 , Tbc1d4 and Rab10 knockdown affected both GLUT4 and TfR translocation. Thus, GLUT4 and TfR translocation machinery likely have some overlap upon insulin-stimulation. In addition, we identified Kif13A, a Rab10 binding molecular motor, as a novel regulator of GLUT4 traffic. Finally, comparison of endogenous to overexpressed GLUT4 highlights that the endogenous GLUT4 methodology has an enhanced sensitivity to genetic perturbations and emphasises the advantage of studying endogenous protein trafficking for drug discovery and genetic analysis of insulin action in relevant cell types., (© 2022 Diaz-Vegas et al.)

Trafficking regulator of GLUT4-1, TRARG1, positively regulates insulin-stimulated GLUT4 trafficking and insulin sensitivity. However, the mechanism(s) by which this occurs remain(s) unclear. Using biochemical and mass spectrometry analyses we found that TRARG1 is dephosphorylated in response to insulin in a PI3K/Akt-dependent manner and is a novel substrate for GSK3. Priming phosphorylation of murine TRARG1 at serine 84 allows for GSK3-directed phosphorylation at serines 72, 76 and 80. A similar pattern of phosphorylation was observed in human TRARG1, suggesting that our findings are translatable to human TRARG1. Pharmacological inhibition of GSK3 increased cell surface GLUT4 in cells stimulated with a submaximal insulin dose, and this was impaired following Trarg1 knockdown, suggesting that TRARG1 acts as a GSK3-mediated regulator in GLUT4 trafficking. These data place TRARG1 within the insulin signaling network and provide insights into how GSK3 regulates GLUT4 trafficking in adipocytes., (© 2022 The Author(s).)

Environmental management often requires making decisions despite system uncertainty. One such example is mudflat mediation in flood control reservoirs. Reservoir mudflats limit development of diverse fish assemblages due to the lack of structural habitat provided by plants. Seeding mudflats with agricultural plants may mimic floodplain wetlands once inundated and provide fish habitat and achieve habitat management objectives. However, planting success is uncertain because of unpredictable water level fluctuations that affect plant survival and growth. Decision support tools can account for uncertainty that influences decision outcomes and reduce the risk in reservoir mudflat planting decisions. We used Bayesian decision networks and sensitivity analyses to quantify uncertainty surrounding mudflat plantings as supplemental fish habitat in four northwest Mississippi reservoirs. When averaged across all uncertainty, planting was the optimal decision only in Enid Lake. Response profiles indicated planting decisions depended on elevation contours within Enid, Sardis, and Grenada reservoirs. No planting was optimal at all elevations for Arkabutla Lake. These results provide a quantified basis for establishing best management practices and identify key system states that influence decision outcomes. The process used in this study to evaluate planting decisions can be applied to any reservoir by modifying reservoir dependent inputs to evaluate planting decisions to provide supplemental fish habitat., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The phosphoinositide 3-kinase (PI3K)-Akt network is tightly controlled by feedback mechanisms that regulate signal flow and ensure signal fidelity. A rapid overshoot in insulin-stimulated recruitment of Akt to the plasma membrane has previously been reported, which is indicative of negative feedback operating on acute timescales. Here, we show that Akt itself engages this negative feedback by phosphorylating insulin receptor substrate (IRS) 1 and 2 on a number of residues. Phosphorylation results in the depletion of plasma membrane-localised IRS1/2, reducing the pool available for interaction with the insulin receptor. Together these events limit plasma membrane-associated PI3K and phosphatidylinositol (3,4,5)-trisphosphate (PIP3) synthesis. We identified two Akt-dependent phosphorylation sites in IRS2 at S306 (S303 in mouse) and S577 (S573 in mouse) that are key drivers of this negative feedback. These findings establish a novel mechanism by which the kinase Akt acutely controls PIP3 abundance, through post-translational modification of the IRS scaffold., Competing Interests: AK, DN, MG, MK, SH, LC, GY, KC, PY, TG, SS, DF, LN, JB No competing interests declared, DJ Reviewing editor, eLife, (© 2021, Kearney et al.)

Exercise stimulates cellular and physiological adaptations that are associated with widespread health benefits. To uncover conserved protein phosphorylation events underlying this adaptive response, we performed mass spectrometry-based phosphoproteomic analyses of skeletal muscle from two widely used rodent models: treadmill running in mice and in situ muscle contraction in rats. We overlaid these phosphoproteomic signatures with cycling in humans to identify common cross-species phosphosite responses, as well as unique model-specific regulation. We identified > 22,000 phosphosites, revealing orthologous protein phosphorylation and overlapping signaling pathways regulated by exercise. This included two conserved phosphosites on stromal interaction molecule 1 (STIM1), which we validate as AMPK substrates. Furthermore, we demonstrate that AMPK-mediated phosphorylation of STIM1 negatively regulates store-operated calcium entry, and this is beneficial for exercise in Drosophila. This integrated cross-species resource of exercise-regulated signaling in human, mouse, and rat skeletal muscle has uncovered conserved networks and unraveled crosstalk between AMPK and intracellular calcium flux., (© 2019 The Authors.)

Protein oxidation sits at the intersection of multiple signalling pathways, yet the magnitude and extent of crosstalk between oxidation and other post-translational modifications remains unclear. Here, we delineate global changes in adipocyte signalling networks following acute oxidative stress and reveal considerable crosstalk between cysteine oxidation and phosphorylation-based signalling. Oxidation of key regulatory kinases, including Akt, mTOR and AMPK influences the fidelity rather than their absolute activation state, highlighting an unappreciated interplay between these modifications. Mechanistic analysis of the redox regulation of Akt identified two cysteine residues in the pleckstrin homology domain (C60 and C77) to be reversibly oxidized. Oxidation at these sites affected Akt recruitment to the plasma membrane by stabilizing the PIP 3 binding pocket. Our data provide insights into the interplay between oxidative stress-derived redox signalling and protein phosphorylation networks and serve as a resource for understanding the contribution of cellular oxidation to a range of diseases.

The Ser/Thr protein kinase Akt regulates essential biological processes such as cell survival, growth, and metabolism. Upon growth factor stimulation, Akt is phosphorylated at Ser 474 ; however, how this phosphorylation contributes to Akt activation remains controversial. Previous studies, which induced loss of Ser 474 phosphorylation by ablating its upstream kinase mTORC2, have implicated Ser 474 phosphorylation as a driver of Akt substrate specificity. Here we directly studied the role of Akt2 Ser 474 phosphorylation in 3T3-L1 adipocytes by preventing Ser 474 phosphorylation without perturbing mTORC2 activity. This was achieved by utilizing a chemical genetics approach, where ectopically expressed S474A Akt2 was engineered with a W80A mutation to confer resistance to the Akt inhibitor MK2206, and thus allow its activation independent of endogenous Akt. We found that insulin-stimulated phosphorylation of four bona fide Akt substrates (TSC2, PRAS40, FOXO1/3a, and AS160) was reduced by ∼50% in the absence of Ser 474 phosphorylation. Accordingly, insulin-stimulated mTORC1 activation, protein synthesis, FOXO nuclear exclusion, GLUT4 translocation, and glucose uptake were attenuated upon loss of Ser 474 phosphorylation. We propose a model where Ser 474 phosphorylation is required for maximal Akt2 kinase activity in adipocytes., (© 2019 Kearney et al.)

In this chapter we detail methods for the systematic dissection of GLUT4 trafficking. The methods described have been optimized for cultured 3T3-L1 adipocytes, but can be readily adapted to other cell types.

Akt is a key node in a range of signal transduction cascades and play a critical role in diseases such as cancer and diabetes. Fluorescently-tagged Akt reporters have been used to discern Akt localisation, yet it has not been clear how well these tools recapitulate the behaviour of endogenous Akt proteins. Here, we observed that fusion of eGFP to Akt2 impaired both its insulin-stimulated plasma membrane recruitment and its phosphorylation. Endogenous-like responses were restored by replacing eGFP with TagRFP-T. The improved response magnitude and sensitivity afforded by TagRFP-T-Akt2 over eGFP-Akt2 enabled monitoring of signalling outcomes in single cells at physiological doses of insulin with subcellular resolution and revealed two previously unreported features of Akt biology. In 3T3-L1 adipocytes, stimulation with insulin resulted in recruitment of Akt2 to the plasma membrane in a polarised fashion. Additionally, we observed oscillations in plasma membrane localised Akt2 in the presence of insulin with a consistent periodicity of 2 min. Our studies highlight the importance of fluorophore choice when generating reporter constructs and shed light on new Akt signalling responses that may encode complex signalling information.This article has an associated First Person interview with the first author of the paper., Competing Interests: Competing interestsThe authors declare no competing or financial interests., (© 2017. Published by The Company of Biologists Ltd.)

Periprocedural myocardial infarction (PMI) is a common complication associated with percutaneous coronary intervention (PCI), occurring in approximately 15% to 20% of patients undergoing the procedure. The established diagnostic criteria for PMI is an increase in cardiac biomarkers, specifically creatine kinase-MB levels > 3 times the upper limit of normal. As PMI has been associated with an increased risk of mortality after PCI, investigative efforts have been directed at therapies that can potentially decrease PMI. One such therapy is the use of hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) administered as a loading dose before PCI. Multiple small, randomized, controlled trials have demonstrated significant reductions in the incidence of PMI with statin loading before PCI. The risk reduction was seen in patients with stable and unstable coronary artery disease, as well in statin-naive patients or those on chronic statin therapy. Potential mechanisms for the rapid benefits of statin loading include: anti-inflammatory effects, reversal of endothelial dysfunction, decrease in oxidative stress, and inhibition of the thrombotic system. None of the current studies were of sufficient power or duration to detect benefits on mortality, though a recent meta-analysis did demonstrate a reduction in major adverse cardiovascular events. In addition to long-term effects, several additional questions remain with regard to statin loading, such as statin type, dose, and optimal timing of administration. However, given the current evidence of benefit and the low risk of adverse events, it can be recommended that all patients undergoing PCI be considered for statin loading before the procedure.

Persons with mental illness or substance abuse have been perceived by the public to pose an increased risk of violence to themselves and others. As a result, federal and state laws have restricted the right of certain categories of persons with mental illness or substance abuse to possess, register, license, retain, or carry a firearm. Clinicians should be familiar with the specific firearm statutes of their own states, which describe the disqualifying mental health/substance abuse history and the role and responsibility of the psychiatrist in the process. State statutes vary widely in terms of the definitions of, and reporting requirements relating to, prohibited persons with mental illness or substance abuse. States also vary in the duration of the prohibition and in the timing of the appeals process. Some of the statutes have specific provisions for the removal of a firearm when a prohibited person is identified. States may maintain a mental health database that is used to determine firearm eligibility and may forward information to the National Instant Criminal Background Check System. The National Instant Criminal Background Check System Improvement Amendments Act of 2007 will likely increase the number of persons identified as belonging to the prohibited class.

Native American children in the United States have been adopted by non-Indian families at rates that threaten the preservation of their Indian history, traditions, and culture. The Indian Child Welfare Act (ICWA), which established restrictive parameters that govern the placement of Native American children into foster care and adoptive homes, was ratified in an effort to keep American Indian families intact. This article addresses matters of importance to psychiatrists who conduct custody evaluations of Native American children and families. A summary of events that preceded enactment of the ICWA is given, along with guidelines for forensic psychiatrists who conduct foster and adoptive care evaluations of Native American children. We use clinical vignettes to illustrate how the ICWA informs the custody evaluation process as well as approaches to cultural concerns, including biases that forensic evaluators may encounter during these evaluations.

In this era of increased interest in white-collar crime, forensic psychiatrists are in a key position to study the individual characteristics of offenders. While a comprehensive theory of high-level white-collar crime should consider societal and organizational contributions, there is value in understanding the personal traits that place an individual at high risk for offending. As the impact of the criminal acts of this group has been increasingly felt by larger groups from all socioeconomic strata, there is less willingness by the public to view these crimes as victimless and harmless.

Little is known about nursing students' perceptions of barriers to addressing patient sexuality concerns. The twofold purpose of this study was to identify and describe attitudes and beliefs that might act as barriers to addressing patient sexuality concerns and to determine the extent to which these attitudes and beliefs are influenced by personal factors such as age, gender, and education. The Sexuality Attitudes and Beliefs Survey was used to assess students (N = 341) enrolled in either a traditional or accelerated second-degree baccalaureate program. Important barriers to addressing patient sexuality concerns reported by the majority of the students included not making time to address the concerns (67.9%) and believing that patients do not expect nurses to address the concerns (66.4%). Findings also revealed that accelerated second-degree students were more restrictive in their attitudes toward addressing patient sexuality concerns, compared with traditional students. Results of this study have implications for BSN program development and evaluation.

The National Instant Criminal Background Check Improvement Act has serious implications for persons with mental illness with regard to the ability to purchase firearms. Federally prohibited persons include those who have been adjudicated as mentally defective, or have been committed to a mental institution, or are unlawful users of or are addicted to a controlled substance. The legislation was intended to expand the reporting practices of states by providing significant financial incentives and disincentives for releasing all relevant records, including those contained within mental health databases, to the National Instant Criminal Background Check System (NICS). As of April 2007, only 22 states were voluntarily submitting records from mental health databases to the NICS. The legislation was introduced following the Virginia Tech tragedy, when public opinion favored tightening control over access to firearms of persons with mental illness.

A 16-question post-treatment survey was sent to 874 patients after extracorporeal shockwave treatment for chronic plantar fasciitis. Of the 377 surveys returned, 353 were used for analysis. These patients were treated by 169 physicians in 19 states using either electrohydraulic or electromagnetic extracorporeal shockwave equipment. Seventy-six percent of the patients underwent treatment after having had continued pain for a year or longer. Seventy percent of patients who rated their pretreatment pain level as severe (score >or= 8 on a scale from 1 to 10) experienced sharp declines in pain, with a sharp decline considered to be a difference in pain level before and after treatment of 3 or more. In addition, 66% of patients who rated their pretreatment immobility as severe (score >or= 8 on a scale from 1 to 10) experienced sharp declines in immobility. Of the patients who underwent extracorporeal shockwave treatment, 69% indicated that they would recommend this procedure to someone in a similar situation. If extracorporeal shockwave treatment were not available, 62% of patients indicated that they would have undergone open or invasive surgery, and 41% indicated that they would have continued with additional physician office visits.

Drawing on their own consultative experience illustrated by case vignettes and with support from the professional literature, the authors discuss the perennial problematic issue of boundary violations and sexual misconduct, aiming at an audience of both experienced and novice clinicians. The authors review the difference between boundary crossings and boundary violations and stress the therapist's responsibility to maintain boundaries. Therapist risk factors for violations include the therapist's own life crises, a tendency to idealize a "special" patient or an inability to set limits, and denial about the possibility of boundary problems. Factors exacerbating patient vulnerability, such as overdependence on the therapist, seeking therapy to find an intense relationship or even "true love," and the acceptance by childhood abuse victims of an abusive therapy relationship, are discussed. Consultation and education-for students and for clinicians at all levels of experience-and effective supervision are reviewed as approaches to boundary problems.

Imogene King is universally recognized as a pioneer of nursing theory development. Her interacting conceptual system for nursing and her theory of goal attainment have been included in every major nursing theory text, are taught to thousands of nursing students, form the basis of nursing education programs, and are implemented in a variety of service settings.

Green ash is one of the few tree species rejected as food by larvae of the generalist gypsy moth,Lymantria dispar L. (Lepidoptera: Lymantriidae). Such rejection is based especially on chemicals present in green ash foliage. The gypsy moth larval feeding-inhibitory activity is contained in the ethyl acetate extractables of green ash foliage. Three representative columnchromatographed fractions of the extractables contained antifeedant activity. Individual fractions showed weaker antifeedant activity compared to the total ethyl acetate extractables. Acid hydrolysis of the extractables destroyed antifeedant activity and yielded feeding stimulant activity at higher concentrations. The aqueous extractables were not feeding-inhibitory. Compounds in the green ash extractables were separated by TLC, HPLC, CC, and GC.

Objective: Evaluate antibiotic-associated diarrhea and toxigenic Clostridium difficile in stool specimens obtained from children before and after 10 days of amoxicillin/clavulanate for otitis media., Design: Children, 12 to 47 months of age, treated with amoxicillin/clavulanate for otitis media in an outpatient setting were enrolled. Stool specimens were obtained at enrollment, when diarrhea occurred and at the end of therapy. All stool specimens were tested for C. difficile toxins A and B by enzyme immunoassay., Results: Seventy-six children who had stool specimens collected at enrollment and after therapy were included in the analysis. None had C. difficile toxin in stool specimens at enrollment. Six (27%) of 22 children with diarrhea, and 4 (7%) of 54 children without diarrhea had C. difficile toxin present at completion of therapy (P = 0.03)., Conclusion: Toxigenic C. difficile was identified in 13% of children at the conclusion of amoxicillin/clavulanate therapy with a significantly higher frequency in children with diarrhea.

Radiologists in hospital practice often encounter radiographs that either bear no patient identification or are incorrectly labeled as those of a different patient. To avoid repeating these improperly labeled radiographs, and to establish correct patient identity, most radiologists compare these radiographs with previous radiographs of several patients. This happens most often with portable chest radiographs. To study the reliability of various surgical, pathologic, and anatomic features and to help establish a fast and accurate method of establishing the correct patient identity, we performed a retrospective study of 50 patients in the intensive care unit. The characteristic location and configuration of surgical material, fractures, and dense parenchymal/pleural scars with or without calcifications are extremely helpful in establishing patient identity. In the vast majority of patients who lack such characteristic surgical and pathologic features, the anatomic structures that are most reliable for identification purposes are, in order of decreasing reliability, the transverse processes of the first thoracic vertebrae and the adjoining tubercles of the first ribs, the spinous processes, and the scapular wings. We believe that this information will help radiologists to identify the right patient when radiographs are incorrectly labeled.

Treatment of Davis soybeans (Glycine max (L.) Merrill) with a proven stress elicitor, iodoacetic acid, which binds specifically with sulfhydryl groups, induced a defensive phytochemistry, which included increased concentrations of aromatic compounds. High-performance liquid chromatography resolved groups of peaks, including one that contains the major allelochemical daidzein and several that contained relatively nonpolar compounds. Some peak groups were increased quantitatively, while others were decreased by iodoacetic acid elicitation. The more significant differences in methanol-extractable HPLC-resolved aromatic metabolites between elicited and nonelicitedG. max apical leaves occurred at 24, 48, and 72 hr after elicitation.

Visual laser ablation of the prostate was performed on 108 patients (ages 44 to 84 years) as an outpatient procedure from May 1992 to October 1992. Preoperatively, the patients underwent digital rectal examinations, determination of prostate specific antigen levels and transrectal ultrasound guided biopsies when necessary to rule out the presence of prostate cancer. The Urolase laser fiber delivery system was used to transmit laser energy from a neodymium: YAG generator. For the 97 patients with preoperative and postoperative American Urological Association symptom index testing, scores decreased by an average of 12.59 (p < 0.001). For the 75 patients with preoperative and postoperative uroflow rates an average increase of 4.92 ml. per second (p < 0.001) was noted following the procedure. Only 3 patients required hospitalization for an average of 1.33 days. No patient required a blood transfusion. There have been no fluid or electrolyte abnormalities following visual laser ablation of the prostate. There have been no recognizable urethral strictures, deaths or postoperative sepsis. Only 3 patients experienced retrograde ejaculation. We found visual laser ablation of the prostate to be a cost-effective and less morbid alternative to traditional transurethral resection of the prostate.

The antioxidant α-tocopherol (vitamin E), applied in a basal trunk band to the green ash tree,Fraxinus pennsylvanica var.subintergerrinia, elicited an alteration of foliar feeding byMalacosoma disstria larvae (Lepidoptera: Lasiocampidae). The bioassayed effects were dependent on the dosage of elicitor, the time after elicitation, and the position in the tree. Leaves for chemical analysis were collected from trees receiving two dosages and at two intervals after elicitation. Compounds in the ethyl acetate extractables from the ash tree leaves were separated by TLC and HPLC. TLC separations showed differences in the nonhydrolyzed extractables attributable to elicitor dosage and time after elicitation. TLC-resolved differences were also evident among acid-hydrolyzed samples. HPLC-resolved profiles revealed eight peaks in the nonhydrolyzed extractables that were quantitatively negatively correlated with larval feeding preference between elicited versus control foliage on at least one of the two sampling dates. Results from this study and other investigations reported in the literature indicate that the antioxidantα-tocopherol (vitamin E) can function as an environmental-stress elicitor of alterable defensive chemistry in green ash and other plants.

The hypocotyl of different soybean genotypes was tested for its inducible phytoalexin (i.e. glyceollin or coumestrol) accumulation and its inducible soybean looper resistance in response to chemical elicitation. A very highly insect-resistant soybean genotype (PI 227687) produced significantly more phytoalexins than a relatively insect-susceptible one (Davis) in response to the same chemical elicitation. The resultant standardized hypocotyl assay allowed quick categorization of unknown soybean genotypes regarding the level of insect resistance in the fully developed plants. Glyceollin was a better indicator of inducible resistance than coumestrol. Elicitor concentration influenced the amount of glyceollin and coumestrol accumulated. Younger seedlings (4-5 d old) responded stronger to chemical elicitation than did older ones (7-10 d old). The elicited accumulation of glyceollin showed a temporal pattern that peaked at 72 h. Accumulation of coumestrol showed a gradual increase. Elicitation of phytoalexins in juvenile soybean plants by sulfhydryl-binding reagents was found to be useful for the prediction of genotypic differences in the level of insect resistance in the fully developed plants.