Search

The River Dee, in North East Scotland, is a mountainous river strongly influenced by patterns of snow accumulation and melt from the Cairngorm Mountains. Analysis of this river's flow record from 1929-2004, the longest in Scotland, supports anecdotal evidence that river extreme flows are increasing. There was no detectable change in the overall annual flow patterns. However, an analysis of seasonal data suggested a shift towards increased flows in spring (March-May) and decreased flows in summer (June-August) over the 75 years of the record. Flows in spring exceeded 29 m(3) s(-1) for 50% of the time over the earliest part of the record (1930 to 1954), whereas in the last 25 years of the record (1979 to 2004) 50% of the flows exceeded 35 m(3) s(-1). Precipitation is increasing in the spring and decreasing in July and August. If these trends continue they have important implications for water management in the Dee, with a potential increase in flood risk in spring and the increased possibility of drought in summer. Combined with this increase in flows the river appears to be more responsive to precipitation events in the catchment. In large heterogeneous catchments with a marginal alpine/high latitude climate it is difficult to assess the amount of precipitation falling as snow and its relative accumulation and ablation dynamics on daily to seasonal time scales. Changes in the temporal pattern of coherence between flow and precipitation are thought to be linked to changing snow patterns in the upland part of the catchment. A decreased amount of precipitation occurring as snow has led to higher coherence. We also show that in responsive systems it is important to record river flows at an hourly rather than daily time step in order to characterise peak flow events.

As part of a wider investigation of the biogeochemistry and fate of Pb deposited from the atmosphere at Glensaugh, a rural upland catchment in N.E. Scotland, the concentration and isotopic composition of Pb were determined in four thinly sectioned monolith cores (25 cm) of peat collected at altitudes of 426--434 m from different faces of Thorter Hill and in a series of 21 10-cm unsectioned cores of peat and organic-rich soil along a transect from near the top (434 m) to the bottom (224 m) of the catchment. Depth profiles of Pb concentration and (206)Pb/(207)Pb ratio were similar for the longer cores. Subsurface Pb maxima (238--489 mg kg(-1)) typically occurred below (206)Pb/(207)Pb minima (1.123-1.134). One core was (210)Pb-dated and had a fairly constant (206)Pb/(207)Pb value of 1.170 from mid-19th century to ca. 1930, followed by a decline (attributable to the increasing influence of Australian Pb of much lower (206)Pb/(207)Pb ratio) to 1.134 by the early 1990s, and then a rapid increase to 1.160 by 2002, after the phased withdrawal of leaded petrol. The fluxes of Pb increased from 15 mg m(-2) year(-1) in the late 19th century to a peak of 60 mg m(-2) year(-1) ca. 1960, before declining steadily to 3.6 mg m(-2) year(-1) by the beginning of the 21st century. Some 40% of the anthropogenic Pb in the core had been deposited prior to 1900. The mean anthropogenic Pb inventory of the four longer cores was 7.4+/-1.5 g m(-2), of which approximately 70% occurred in the top 10 cm, in good agreement with the inventories of the shorter cores collected above 400 m. These inventories are higher than those of the industrial central belt of Scotland, probably because of enhanced deposition at altitude. This is consistent with the derived average (210)Pb flux of 198+/-11 Bq m(-2) year(-1), which is twice that of typical UK (210)Pb deposition and the rainfall for the site. The past deposition of Pb at Glensaugh, including that from sources (e.g., smelting, coal combustion) other than leaded petrol, has clearly been considerable. Even since the introduction of leaded petrol ca. 1930, car-exhaust emissions may have accounted for no more than 35% of the Pb deposited.

Background: Current recommendations on how to break bad news are primarily based on expert opinion. Little is known about the association between communication practices and patients' psychological response., Patients and Methods: One-hundred and thirty-one patients with newly diagnosed melanoma were surveyed 4 months after the initial consultation at the Sydney Melanoma Unit regarding their communication experiences and their satisfaction with these experiences. They completed the Hospital Anxiety and Depression Scale (HADS) at this time, and 4 and 13 months later., Results: Both patients' satisfaction with communication and their psychological morbidity were found to be associated with particular communication practices. Practices linked to lower anxiety included preparing the patient for a possible diagnosis of cancer; having the people wanted by the patient present to hear the diagnosis; giving the patient as much information about the diagnosis as desired; providing written information; presenting the information clearly; discussing the patient's questions the same day; talking about the patient's feelings; and being reassuring. Practices linked with lower levels of depression included using the word 'cancer'; discussing the severity of the situation, life expectancy and how the cancer might affect other aspects of life; and encouraging the patient to be involved in treatment decisions., Conclusions: This study provided preliminary evidence that communication strategies recommended in the literature produce positive patient outcomes. Further studies are needed which document actual communication.

Background: In the past, recommendations on how to break the bad news of a cancer diagnosis have been based on expert opinion. Recently, consensus-based guidelines for medical practitioners have been developed. The objective of this work is to investigate patient preferences for communication practices and to identify any disparities between these guidelines, patient preferences and patient recollections of hearing their diagnosis., Patients and Methods: A consecutive sample of 131 newly diagnosed melanoma patients were surveyed approximately 4 months after initial diagnosis to document their preferences and recollections of their communication experiences., Results: Of the 'breaking bad news' recommendations investigated, patients did not strongly endorse the doctor helping tell others of the diagnosis or telling the patient about cancer support services. Very few patients expressed a preference for having another health professional present. One communication feature, the patient feeling confident about getting the best treatment, was endorsed as 'very important' but does not feature in published guidelines. The most notable disparities between guidelines and the reported experiences of patients related to perceived delays in receiving the diagnosis, and having adequate opportunity to ask their clinician questions., Conclusion: Current Australian recommendations on how to communicate a diagnosis of cancer were generally supported by the patients' expressed preferences, but several modifications are proposed., Implications: Suggestions are offered to help overcome the disparities identified between recommendations and patients' preferences when a diagnosis of cancer is being communicated.

Study Objective: To compare the ease of insertion of a warmed standard tracheal tube to that of a wire reinforced tracheal tube when placed over a flexible fiberoptic bronchoscope., Design: Randomized controlled trial., Setting: Tertiary care hospital., Patients: 50 patients undergoing elective general anesthesia., Interventions: Patients' tracheas were intubated with a flexible fiberoptic bronchoscope and had either a standard or wire-reinforced tracheal tube inserted. If resistance was met, the tube was withdrawn, rotated, and readvanced. This was repeated two times. If unsuccessful, the flexible fiberoptic bronchoscope was removed, and intubation was attempted with the other type of tracheal tube., Measurements: The ability to advance the tracheal tube was determined., Main Results: There were no demographic differences between the two groups. There was a similar ease of advancement of the two tracheal tubes., Conclusions: When performing elective flexible fiberoptic bronchoscopy for intubation, we recommend using the less expensive warmed standard tracheal tube.

The nitrate concentration in discharge from the Balmalcolm borehole in Fife, Scotland, has steadily increased from 4.5 mg l(-1) NO3-N in the early 1970s to 11.0 mg l(-1) NO3-N in 1998. Consequently the catchment of the borehole, covering an area of 400 ha has recently been designated a Nitrate Vulnerable Zone under the EC Nitrate Directive [Commission of European Communities L375, (1991) 1]. The sandstone aquifer that supplies the borehole is recharged by water draining from land that is intensively cropped to green vegetables. There is, therefore, a need to identify appropriate land management techniques that will help to abate the nitrate losses from the land and to estimate the length of time that it is likely to take before the abatement is observed as a decrease in well-water concentrations. Estimates of nitrate leaching for the range of crops that have been grown in the catchment over the last 30 years have been made using a balance sheet approach, modified to allow for estimates of denitrification and in-field composting of vegetable crop residues. Integration over the whole catchment using a GIS approach, indicates a steady-state well water [NO3--N] of 23 mg l(-1)--a situation that has not yet been reached. Prediction of the time course of change in well water quality from 1970 (when intensification began) has been made by calculating the travel time from different parts of the catchment both in the saturated and unsaturated zones. The results show good agreement between the measurements and simulation. Well water [NO3-N] under potential future management scenarios have also been investigated using the same approach. The greatest reduction in steady-state concentration, to 9 mg l(-1), is achieved for the scenario of extensification to spring cereals with moderately fertilised grassland. However, the temporal simulations suggest that it would take approximately 100 years before 80% of this change is observed in the well-water, starting from a concentration of 23 mg l(-1) .

In regions such as northern Scotland, where winter temperatures are such that the occurrence of snow is borderline under the present climate, potential changes affecting precipitation and temperature regimes may have a disproportionately large impact on snow processes and hydrological behaviour. The physical characteristics of mountainous areas in Scotland mean that the spatial variability of snowpack accumulation is high, as well as the temporal variability caused by the climate. There have been few modelling studies aimed at assessing the significance of snow resources in these areas and none that have adopted a spatially distributed approach. This paper describes the approach taken in applying a new distributed model to a headwater catchment in the Cairngorm Mountains. The results demonstrate the importance of wind on re-distributing snow to create deep accumulations in small sheltered pockets. These accumulations are shown to be important in sustaining baseflows in the rivers, long after snow has melted from the rest of the catchment. The model has also produced a first set of maps showing how predicted snow depths vary across the catchment through the winter.

Under equilibrium conditions, the nicotinic acetylcholine receptor from Torpedo electroplax carries two high affinity-binding sites for agonists. It is generally assumed that these are the only agonist sites on the receptor and that their occupancy results in rapid channel activation followed by slower conformational transitions that lead to the high affinity equilibrium state. These slow transitions are thought to reflect the physiological process of desensitization. Here we show that preequilibration of the high affinity sites with saturating concentrations of carbamylcholine does not diminish the ion flux response to subsequent exposure to higher (activating) concentrations of this agonist. This finding has profound implications with respect to receptor function: (1) occupancy of the high affinity sites per se does not desensitize the receptor and (2) these sites cannot be directly involved in receptor activation. It is thus necessary to invoke the presence of additional binding sites in channel opening., (Copyright 2000 Academic Press.)

Background: Research interest in psychosocial predictors of the onset and course of cancer has been active since the 1950s. Recently we reported associations between psychological factors and survival in patients with metastatic melanoma. We now report a replication of this study in a sample of women with metastatic breast cancer., Patients and Methods: Ninety-nine patients with metastatic breast cancer completed questionnaires measuring cognitive appraisal of threat, coping, psychological adjustment, perceived aim of treatment, social support and quality of life, approximately four months after diagnosis. Survival was measured from date of study entry to date of death or censored at the date of last follow-up for surviving patients., Results: In a multivariate analysis, four factors independently predicted outcome. Patients with metastases in the liver, lung or pleura survived for a shorter duration (P < 0.001); older patients (P < 0.001) and those with a better appetite (P < 0.05) also lived for a shorter time. Patients who minimised the impact of cancer survived longer (a median of 29.1 vs. 23.9 months after study entry, P < 0.01)., Conclusions: Minimisation was also significantly associated with outcome in patients with metastatic melanoma who participated in an identically designed study, reported elsewhere. This suggests that minimisation may have a general impact on cancer progression and deserves closer scrutiny in other cancers.

Digital subtraction of (plane film) radiographs of an area of interest taken over time is a powerful diagnostic tool. In dentistry for example, this is used to detect and treat periodontal disease (i.e. the sequence of diseases that leads to the loss of bone supporting the teeth). A precondition of subtraction radiography is correct three-dimensional registration of the film and X-ray source, without which the subtraction images are meaningless. A small misalignment can be compensated for by post-processing of the digitized films (by correspondence and rectification) to remove artifacts due to positioning errors. This paper presents a novel approach to subtraction radiography which replaces customary mechanical alignment methods (such as a stent or cephalostat) with a robot. A mechanical stent is a short rod attached at one end to the X-ray source and at the other to a mechanical appliance protruding from the patient's mouth. An experimental system was constructed which creates a 'sensorized stent' by integrating a plastic mouth appliance (with the impression of the patient's teeth), a robot carrying an X-ray source and a host computer. Results showed that the robotic system was superior to the mechanical alignment approach, due to its excellent accuracy and repeatability. This resulted in much less variation in the non-registered X-ray images, and in a smaller standard deviation in the intensities of subtracted images overall. The results suggest that in the future, diagnostic studies including subtraction radiography will not need either mechanical alignment (which is imprecise) or post-processing registration (which is time consuming).

A cross-sectional survey of all medical and radiation oncologists in Australia was undertaken, plus surgeons listed as participants of the ANZ Breast Cancer Trials Group, to examine whether doctors' participation in randomized trials of adjuvant systemic therapy for breast cancer, is associated with their recommendations for adjuvant therapy in two clinical scenarios. Two-hundred and sixty-nine questionnaires were returned (response rate 71%). Fifty-six per cent of respondents, were participating in current adjuvant systemic therapy trials. Radiation oncologists were significantly more likely than surgeons or medical oncologists to recommend radiotherapy, while medical oncologists and surgeons were significantly more likely than radiation oncologists to recommend chemotherapy, in both clinical scenarios. In a multivariate analysis adjusting for the differences between specialist groups, respondents recommending chemotherapy were more likely to be high accruers to clinical trials (OR 3.6, 95% CI 0.93 to 13.9, P=0.08) in scenario 1, or participants of a breast cancer trials organization (OR 3.1, 95% CI 1.6 to 5.9, P=0.001) in scenario 2. Some of the variation in adjuvant systemic therapy recommendations is associated with participation in adjuvant systemic therapy trials. However, this study is unable to determine if trial participation influences opinions about adjuvant therapy, or opinions influence trial participation.

Aim: We aimed to document the prevalence of misunderstanding in cancer patients and investigate whether patient denial is related to misunderstanding., Patients and Methods: Two hundred forty-four adult cancer outpatients receiving treatment completed a survey assessing levels of understanding and denial. Doctors provided the facts against which patient responses were compared. Multiple logistic regression analyses determined the predictors of misunderstanding., Results: Most patients understood the extent of their disease (71%, 95% CI: 65%-77%) and goal of treatment (60%, 95% CI: 54%-67%). Few correctly estimated the likelihood of treatment achieving cure (18%, 95% CI: 13%-23%), prolongation of life (13%, 95% CI: 8%-17%) and palliation (18%, 95% CI: 10%-27%). Patient denial predicted misunderstanding of the probability that treatment would cure disease when controlling for other patient and disease variables (OR = 2.20, 95% CI: 0.99-4.88, P = 0.05). Patient ratings of the clarity of information received were also predictive of patient understanding., Conclusions: Patient denial appears to produce misunderstanding, however, doctors' ability to communicate effectively is also implicated. The challenge that oncologists face is how to communicate information in a manner which is both responsive to patients' emotional status and sufficiently informative to allow informed decision-making to take place.

The Notch signalling pathway is an important mediator of cell fate selection whose involvement in epidermal appendage formation is now becoming recognised. Hair follicle development and hair formation involve the co-ordinated differentiation of several different cell types in which Notch appears to have a role. We report intricate expression patterns for the Notch-1 receptor and three ligands, Delta-1, Jagged-1 and Jagged-2 in the hair follicle. Notch-1 is expressed in ectodermal-derived cells of the follicle, in the inner cells of the embryonic placode and the follicle bulb, and in the suprabasal cells of the mature outer root sheath. Delta-1 is only expressed during embryonic follicle development and is exclusive to the mesenchymal cells of the pre-papilla located beneath the follicle placode. Expression of Jagged-1 or Jagged-2 overlaps Notch-1 expression at all stages. In mature follicles, Jagged-1 and Jagged-2 are expressed in complementary patterns in the follicle bulb and outer root sheath, Jagged-1 in suprabasal cells and Jagged-2 predominantly in basal cells. In the follicle bulb, Jagged-2 is localised to the inner (basal) bulb cells next to the dermal papilla which do not express Notch-1, whereas Jagged-1 expression in the upper follicle bulb overlaps Notch-1 expression and correlates with bulb cell differentiation into hair shaft cortical and cuticle keratinocytes., (Copyright 1998 Elsevier Science Ireland Ltd. All Rights Reserved)

We have used photoaffinity labelling and protein cleavage techniques to identify the site of photoincorporation of [3H]Ro15-4513 into the alpha subunit of the bovine gamma-aminobutyric acid type A (GABAA) receptor. Bovine brain membranes were photoaffinity labelled with [3H]Ro15-4513 and after solubilization and denaturation, proteins were specifically cleaved at either cysteine or tryptophan residues. Peptides were resolved by sodium dodecyl sulphate polyacrylamide gel electrophoresis. Cleavage at cysteine residues generated a labelled peptide of Mr 6.5K, while cleavage at tryptophan residues generated a labelled peptide with an Mr of 5K. Cleavage products of this size indicate that the site of [3H]Ro15-4513 incorporation occurs between the end of the first transmembrane domain and the first four amino acids of the third transmembrane domain (residues 247-289). This region of the GABAA receptor has not previously been implicated in the formation of the benzodiazepine binding site and may be part of a unique recognition domain for inverse agonists.

Background: While the importance of providing individualised communication to cancer patients is now well recognised, little is known about the stability and validity of patients' expressed preferences for information and involvement in decision-making. This study explored the stability and possible predictors of such preferences over time., Patients and Methods: Cancer patients seeing two Medical Oncologists in an out-patient clinic at an Australian teaching hospital completed a questionnaire battery before and directly after one consultation, and before their next consultation. Eighty consecutive patients with heterogeneous cancers participated in the study. Preferences for general and specific information, involvement and support were elicited at each assessment. Locus of control and patient familiarity with the clinic were measured before the first consultation. Patient satisfaction with the consultation was assessed directly after the consultation. Demographic and disease data were recorded for each patient., Results: General preferences for information and involvement were relatively stable, at least in the short term; however there was considerable variability in preferences for specific topics of information. Patients whose condition had recently worsened were more likely to want progressively less involvement in decision-making. Gender, the doctor seen and religion were also predictive of patient preferences., Conclusions: Situational factors, such as change in disease status, may alter a patient's preferences for information and involvement. If we wish to match the provision of information and support to the expressed needs of patients, we must ask patients at each consultation what those needs are.

People receiving a diabetes diagnosis must absorb information, change habits and adopt new behaviours almost immediately. Guidelines thoroughly cover the medical aspects of initial management however the information and psychological needs of patients are not addressed. This study aimed to identify diabetes patient needs for information and emotional support at the time of diagnosis. A sample of 1159 patients completed a questionnaire which assessed their concerns and information preferences at the time of diagnosis (response rate 64.4%). A sample of 100 general practitioners (GPs) were interviewed about their perceptions of these issues using a subset of items from the patient questionnaire. The diagnosis of diabetes was distressing for 60% of responders and 23% wanted more emotional support. Immediate issues such as injections were major concerns for patients and GPs correctly identified these. However GPs significantly overestimated complications as a concern for patients at diagnosis. Patients preferred diabetes educators and courses as sources of information. Satisfaction with information at diagnosis was high (80%), however younger patients were dissatisfied with their discussions concerning diabetes therapy. The findings suggest that clinicians giving a diagnosis of diabetes should: (1) be aware of patient variability in needs for emotional support and information preferences, (2) ask patients for their preferences and offer choices if available and (3) provide more information about treatment and increase patient involvement in discussions about therapy.

Background: A study conducted in 1983 to identify and rank the symptoms experienced by patients receiving cancer chemotherapy reported that vomiting and nausea were the most important symptoms experienced. With the advent of new antiemetic regimens and changes in cancer chemotherapy, it was anticipated that changes may have occurred in patient perception of symptoms. The study was therefore repeated in 1993., Patients and Methods: One hundred and fifty-five cancer patients receiving chemotherapy at a large urban teaching hospital participated in the study. Patients selected from cards listing symptoms all those experienced and the five most troublesome., Results: Patients reported experiencing an average of 20 symptoms (13 physical and 7 psychosocial). Nausea was reported as the most severe symptom followed by tiredness and loss of hair. Vomiting which was the most severe symptom in 1983, now ranked 5th. Differences were detected in the symptoms experienced and reported as most severe, between chemotherapy regimens, between older and younger patients and between males and females., Conclusions: The results suggest a reduction in the severity of some symptoms experienced while receiving chemotherapy and a shift from concerns about physical to psychosocial issues.

Patient education and chronic illness are linked inextricably in the training of health care providers as we move to the year 2000. However, professional training remains organised around the traditional clinical interview with its focus on acute illness. Research into aspects of the health care consultation is well advanced, but we are only just beginning to understand the implications of the long-term interaction between patient and provider in the management of illnesses which cannot be cured. The challenges for health care providers are: to relinquish control of the consultation when it is appropriate; to be aware of the human biases affecting clinical judgment; to develop a professional approach to the human aspects of their relationships with patients and other professionals as part of a management team; and to focus on the longer term relationship and long-term benefit to the patient.

Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic growth factor produced by mesenchymal and myeloid cells following activation by inflammatory stimuli. It has previously been shown that a region of the G-CSF promoter, (-200 to -165) containing the decanucleotide CK-1 element and two repeated sequences that resemble nuclear factor (NF)-interleukin-6 (IL-6) binding sites, is required for activation of the G-CSF gene by tumor necrosis factor-alpha (TNF-alpha) and IL-1 beta. We now show that the NF-kappa B p65 protein can bind to and activate this TNF response region. There are several unusual features of this p65 interaction with the TNF response region. First, NF-kappa B p65 but not the related NF-kappa B p50 binds to the CK-1 element and a p50/65 hybrid protein that relies on the p50 rel homology domain for DNA binding does not transactivate the TNF response region. Second, p65 transactivation of this region is cell specific and requires not only its own binding site but also the NF-IL6 consensus sites. NF-IL6 also binds to the TNF response region of the G-CSF promoter. Electrophoretic mobility shift studies show that p65 and NF-IL6 can bind cooperatively to the TNF response region. The ability of this region to respond to TNF-alpha or p65 is correlated with the ability to form the p65/NF-IL6 ternary complex.

Background: Active participation and asking questions are important ways in which patients can ensure they understand what the doctor has said. This study evaluated a question prompt sheet designed to encourage patients to ask questions in the cancer consultation., Patients and Methods: Patients (n = 142) were randomised to receive (i) a question prompt sheet or (ii) a general sheet informing patients of services available through the regional Cancer Council. Recall of information was assessed in a structured interview 4-20 days after the consultation. Questionnaires to assess patient satisfaction and adjustment to cancer were sent by mail., Results: The question prompt sheet had a significant effect in one content area: prognosis. Thirty-five percent of patients who received the question handout asked questions about prognosis compared to 16% of those receiving the information handout. The prompt sheet did not increase the mean number of questions asked overall. Age, in/out-patient status, gender and involvement preference were predictive of both number and duration of patient questions., Conclusions: A question prompt sheet has a limited but important effect on patient question asking behaviour in the cancer consultation.

This study investigates the effect of emotional behavior on the masseteric muscle EMG response patterns. Two experimental protocols are utilized: (1) does not elicit emotional behavior (stick chewing) and (2) elicits emotional behavior (hypothalamic stimulation). The Karhunen-Loève transform is used to compute features which exactly represent the correlated patterns of mean-zero observations, with data compression and noise immunity. Using nonparametric tests, it is found that the populations of biting and hissing features are significantly different (p < 0.05), with increased statistical significance as the size of the training set is increased. No statistically significant difference is seen in a test of the two biting populations.

Dental digital radiology is a rapidly changing field. The advantages and disadvantages are presented with an understanding that attention to fundamentals is paramount. The message for the near future is cautious optimism.

In assessing the effectiveness of management strategies for patients with asthma, it is important to measure outcomes which are relevant to the concerns of patients. Quality of life is one such outcome which may not be adequately reflected in lung function measurements. We have developed an asthma quality of life questionnaire (the AQLQ) for this purpose. The aim of this study was to test the validity and responsiveness of the AQLQ as a measure of change. Forty four adults with asthma were assessed on two occasions 4 months apart. On each occasion subjects completed the AQLQ and the Sickness Impact Profile (SIP). Lung function and the degree of bronchial hyperresponsiveness (BHR) were measured and diary cards were used to derive a symptom score and mean daily peak flow variability. The relation of change in AQLQ scores to change in the other outcomes was assessed. Questionnaire responsiveness was assessed by comparing the change in AQLQ scores between 19 improved and 20 stable subjects. Improvement was assessed on lung function and BHR criteria. As expected, change in AQLQ score was correlated with change in symptom score (r = 0.37, 95% CI -0.04 to 0.64) and change in BHR (r = 0.38, 95% CI 0.06 to 0.64). The associations with change in peak flow variability (r = 0.12, 95% CI -0.26 to 0.47) and change in SIP score (r = 0.18, 95% CI -0.12 to 0.45) were in the expected direction but weaker than expected. The AQLQ was capable of detecting differences between improved and stable subjects (p = 0.007).(ABSTRACT TRUNCATED AT 250 WORDS)

A 20-item self-administered questionnaire with Likert scale responses was developed to measure quality of life in adult subjects with asthma. A total scale score together with subscale scores for breathlessness, mood disturbance, social disruption and concerns for health were calculated by addition of item scores. Items for the scale were selected by principal components analysis of the responses of 283 subjects to a preliminary pool of 69 items. In 58 subjects with stable asthma, good short term test-retest reliability was demonstrated with the intraclass correlation coefficient for the total scale being 0.80. The questionnaire was internally consistent in a sample of outpatients (Cronbach's alpha 0.92 in 77 subjects) and in a community sample with asthma (Cronbach's alpha 0.94 in 87 subjects). Weak correlations in the expected direction were seen with three medical markers of asthma severity. This supports the construct validity of the questionnaire and emphasizes that quality of life represents a separate dimension of asthma.

The GABAA/benzodiazepine receptor has been solubilized from bovine brain membranes and purified by benzodiazepine affinity chromatography. Polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate revealed two major protein species of 53 and 56 kDa. The purified protein has been reconstituted, in a functionally active form, into phospholipid vesicles. Chloride flux responses of the reconstituted preparations were investigated in stopped-flow experiments by monitoring fluorescence changes of a chloride-sensitive dye trapped within the vesicles. Flux was rapidly stimulated by muscimol and this response was potentiated by diazepam and blocked by desensitization of the receptor and by preincubation with the channel blocker, picrotoxin.

Diabetes patient education has emerged as an integral component of comprehensive diabetes care during the past 50 years. The medical model of information transfer is now inadequate to support the variety of effective techniques which have been shown to influence patients' knowledge and health behavior. To cope with rapidly changing patterns of diabetes care, diabetes education must develop new models and modes. This article presents a re-evaluation of the traditional concepts of diabetes education and identifies new challenges and new directions for the 1990s.

Evaluation of diabetes education programs (DEPs) has provided minimal empirical support for a relationship between improved knowledge and better metabolic control. We hypothesized that improved knowledge in specific areas is predictive of changes in specific measures of diabetes control. Patients (n = 558) attending one of five DEPs completed a diabetes knowledge questionnaire at baseline and post-DEP. Glycosylated hemoglobin (GHb) was measured at baseline and at 3 months follow-up. Total diabetes knowledge (DKN) scores increased significantly by 18%, but improvement was uncorrelated with changes in GHb (r = 0.03). Improvement in nine specific content areas failed to predict changes in GHb (all P greater than 0.05) and improvement in knowledge of the causes of hypoglycemia did not predict changes in frequency of hypoglycemia (chi 2 = 1.54; P greater than 0.05). We conclude that neither global nor specific knowledge improvement predicts metabolic control in diabetes and suggest that evaluation of diabetes education should focus more intensively on behavioral and attitudinal outcomes.

The intercellular adhesion molecule (ICAM-1) is a cell-surface molecule which binds to leukocyte function antigen-1 (LFA-1) and regulates both leukocyte adhesion to endothelial cells and immune functions requiring cell-cell contact. Membrane expression of ICAM-1 is highly regulated on all hematopoietic lineages. Cell membrane antigen is significantly expressed on a small subset of bone marrow (BM) progenitors but is weak or absent on all cell lineages once they enter the circulation. However, strong expression on tissue macrophages and germinal center B cells suggested that activated cells may show upregulated expression. When B cells, T cells, macrophages, or granulocytes were activated in vitro by suitable mitogens, ICAM-1 expression was induced in all cases. Parallel studies of hematopoietic tumors demonstrated a heterogeneity of expression which correlated with expression on their normal cellular counterparts. In particular, a striking correlation between expression on B-cell tumors and corresponding stages of B-cell differentiation was noted. The widely varying expression of ICAM-1 contrasts with LFA-1 which, while variable, is nevertheless significantly positive at all stages of differentiation. This suggests that the major regulation of homotypic adhesion mediated by the LFA-1/ICAM-1 linkage occurs through control of ICAM-1 expression. In keeping with this notion, ICAM-1 expression was also correlated with the "adhesiveness" of B-lymphoid tumors. Large solitary lymphoma masses showed intense expression of ICAM-1. Conversely, chronic lymphocytic leukemia (CLL) cells and lymphoma cells from tumors exhibiting diffuse, widespread lymph node disease showed weak expression. These observations are discussed in relation to the role of ICAM-1 in regulation of lymphoid recirculation and the biology of lymphoid tumors.

During October and November, 1978, gastroenteritis developed in 17 of 24 young children aged between eight months and two years from an R.A.F. station in the U.K. The illness, in which diarrhoea was always the predominant symptom, had an incubation period of eight to ten days and lasted about a week. It seemed to be transmitted from child to child, and in all but one instance parents and older siblings remained well. Stool specimens from 14 of the affected children were examined bacteriologically and virologically, and a highly significant association was found between the presence of adenovirus particles in stools, identified by electron microscopy, and the acute stage of the illness. This evidence suggests that an adenovirus was the cause of this outbreak of gastroenteritis.

Torpedo acetylcholine receptor (AcChR) exists predominantly as dimers, formed by two monomers held together by a disulfide bridge(s). The dimers are easily cleaved to monomers by reducing agents. 2-mercaptoethanesulfonic acid is shown to be a membrane-impermeant reducing agent which cleaves receptor dimers when it is present only on the outside of intact membrane vesicles. There is no increase in the extent of cleavage when 2-mercaptoethanesulfonic acid is also loaded inside the vesicles. Therefore the disulfide bond(s) involved in the dimerization of the Torpedo acetylcholine receptor is (are) formed by cysteine residues which are exposed on the extracellular side of the membrane.