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In a study conducted to determine if the existence of a joint labor-management health and safety committee (HSC) was correlated with either the number of Occupational Safety and Health Administration (OSHA) complaints or hazardousness, as measured by OSHA serious citations, virtually no effect could be detected in a sample of 127 Massachusetts manufacturing firms. At a sample of 13 firms, interviews of HSC members were conducted. Committee attributes and perceptions about committee effectiveness were compared with the number of OSHA complaints and serious citations. There were fewer complaints and fewer serious citations at firms with HSCs that were perceived as effective. Results of the study suggest that the objective attributes of the committee may be less important to its success than the commitment of management and labor to solving workplace safety problems.

We reviewed 530 patients treated with anatrophic nephrolithotomy during a 14.5-year period. Significant postoperative renal bleeding occurred in 34 cases (6.4 per cent). The average postoperative blood transfusion requirement in this group was 5,279 cc. Bleeding patients were significantly older and they had worse renal function compared to the nonbleeding group. If bleeding did not begin immediately it usually started 5 to 8 days postoperatively. Bleeding dyscrasias were identified in 6 patients and correction allowed nonoperative management in 4. Epsilon aminocaproic acid was helpful only in the treatment of patients with slow, lower volume bleeding. Eight patients required 9 open renal explorations to control bleeding. Two arteriovenous fistulas and 1 false aneurysm were identified. An attempt at angiographic embolization of an arteriovenous fistula was unsuccessful. Only 1 patient required a nephrectomy (1 of 34 or 2.9 per cent) and there was no mortality. A treatment plan for this complication is described.

Hyperammonemia was documented in a 10-week-old male Lhasa Apso referred for urethral obstruction and rupture. Results of liver function tests were normal. Staphylococcus sp was isolated from urine. Anomalies of the portal vascular system and hepatic insufficiency are the most common causes of hyperammonemia in the dog. Hyperammonemia, however, in the absence of recognizable concurrent hepatic disease, also may result from urinary stasis and infection with urea-splitting organisms.

The relationship between active Na transport (estimated by the short-circuit (SCC)) and active inorganic phosphate (Pi) transport was studied in the toad bladder. When SCC was inhibited by amiloride, ouabain, or removal of K from the serosal bathing solution, active Pi transport was totally inhibited. When Na was replaced isotonically by choline in either the mucosal bathing solution or both the mucosal and serosal bathing solutions, there was no measurable SCC or active Pi transport. These experiments are compatible with the hypothesis that active Pi transport occurs only in the presence of active Na transport.

The effect of changing the pH of the mucosal and serosal bathing solutions on active Na transport (estimated by the short-circuit current) and active inorganic phosphate (Pi) transport was studied in the toad bladder. The short-circuit current was unaffected by lowering the pH from 7.6 to 7.1 but was inhibited (29-45%) at pH 6.6, 8.1, 8.6, 9.1, or 9.6. The Pi transport was not changed when the pH was increased from 7.6 to 8.1, but was totally inhibited at pH 6.6, 7.1, 8.6, 9.1 or 9.6. Thus, active transport of Pi occurs only when most of the Pi is HPO4(-2), but the effect of varying pH on active Pi transport in the toad bladder is more complicated than a simple titration of Pi.

Changes in contractile protein expression during myogenesis are usually categorized as developmentally programmed or neuronally dependent. Studies on aneurogenic chick embryos indicated that the neuronally dependent phase begins at about Embryonic Day 15, immediately prior to the fetal transition in myosin and C-protein expression. The prime candidate for the neuronal event that induces the fetal transition is the conversion to the adult form of singly innervated neuromuscular junctions (NMJs), which occurs contemporaneously with the fetal transition. Using curare to inhibit the conversion to focal innervation, we find that the fetal transition proceeds unimpaired, demonstrating that there is no causal link between the fetal transition and the conversion to focal innervation. Furthermore, because the doses of curare used inhibit motor activity by more than 80%, the fetal transition can occur in the absence of normal levels of motor activity. These observations show that the fetal transition in ovo is not induced by either a specific change in innervation or use. Rather, the dependence on innervation seems to be a consequence of the need for muscle activity to prevent atrophy, and the fetal transition appears to have characteristics more like the preprogrammed contractile protein transitions that precede it.

The modified nucleoside 5'-triphosphates O6-MedGTP ad O4-MedTTP have been synthesised and their acceptability as DNA-precursors investigated using DNA polymerases I and alpha in an in vitro assay. O6-MedGMP is only incorporated into newly-synthesized DNA-like material in the presence of templates containing thymine bases. Similarly O4-MedTMP is only incorporated in the presence of templates containing guanine bases. The results confirm the promutagenic nature and base-pairing properties of O6-MeG ad O4-MeT.

A meta-analysis of studies on consumer satisfaction with medical care yielded 221 studies that reported relations between satisfaction and other variables, of which 107 reported satisfaction levels for two or more aspects of medical care. A method was developed to derive the relative levels of patient satisfaction with 11 aspects of care across these 107 studies. Humaneness and technical quality of medical care were ranked near the top, while the bottom five ranks were occupied by aspects of care that reflected the provider's attention to other patient needs and the patient's relation to the system as a whole. In addition, it was demonstrated that different aspects of medical care are measured with extremely uneven frequencies in satisfaction instruments.

Kinetic parameters for the action of bovine Factor Xa (EC 3.4.21.22) on 25 commercially available peptide p-nitroanilides have been determined. The selectivity constant, kc/Km, ranges from 1.5 X 10(1) to 2 X 10(6) M-1 X s-1 for the poorest and the best substates, respectively. The best substrates for Factor Xa were identified as those with arginine in the P1 position, and glycine in the P2 position. Quantitative distinction between lysine and arginine in the P1 position and other amino acids in the P2-P4 positions of the substrate is reported from the changes in the kinetic parameters for substrates differing in only a single amino acid in these positions. Effect of NaCl and CaCl2 concentrations and temperature on the action of Factor Xa on selected substrates have been assessed. Km values for Factor Xa hydrolysis of most substrates are greater than 100 microM. Solubility of the substrates consequently restricts measurements of reaction velocities to concentrations lower than desirable for optimally determining kc. Comparison of these kinetic parameters for Factor Xa with those of thrombin (Lottenberg, R., Hall, J.A., Blinder, M., Binder, E. and Jackson, C.M. (1983) Biochim. Biophys. Acta 742,539-557) for these same substrates indicates that the greater hydrolytic efficiency of thrombin is due primarily to lower Km values.

Verbal and nonverbal communication of affect was examined in schizophrenic and control families, using audio tapes and transcripts of family interactions. In Study 1, data were available for parents interacting with their schizophrenic child (index session) or with a well child (well-sibling session), and for two parent-child sessions in normal families. In Study 2, data consisted of index sessions only with schizophrenic, non-schizophrenic psychiatric, and normal families. Audio tapes were electronically filtered, and ratings were obtained on nonverbal (filtered speech) and verbal (transcript) samples. The double-bind hypotheses of different nonverbal expression of affect and greater verbal-nonverbal discrepancy in schizophrenic as compared to normal families were not supported. In both studies no overall differences were found between diagnostic groups in terms of nonverbal ratings, indicating that clinical perceptions of inappropriate and conflicted affect in schizophrenic families are not based on spontaneously produced simultaneous discrepancy between verbal and nonverbal channels of spoken communication.

Understanding the precise nature of the links among styles of behavior, emotional expression, and the development of heart disease is a major challenge in psychology and health. In the present research, 60 men at high risk for coronary heart disease were examined in terms of their expressive style, their specific nonverbal cues, their personality, and their health. As assessed by the self-report Jenkins Activity Survey (JAS; Jenkins, Zyzanski, & Rosenman, 1979), half the men were Type A and half were Type B. To provide a more refined grouping, the men were further classified on the basis of scores on the Affective Communication Test (ACT; H. S. Friedman, Prince, Riggio, & DiMatteo, 1980), a self-report measure of nonverbal expressiveness. In the framework of theory and research on nonverbal expressive style, videotapes of the men were extensively rated and coded in terms of their judged appearance, the actual audio and video nonverbal cues emitted, and the words said (transcript). Two groups of Type A individuals were found--one that was repressed, tense, and illness-prone, but another that was healthy, talkative, in control, and charismatic. Furthermore, in addition to the expected healthy Type B men, a subgroup of Type B men was found who were submissive, repressed, tense, have an external locus of control, and may be illness-prone. A refined conception of the Type A behavior pattern is deemed necessary in light of these findings. Implications for improving the validity of the Type A construct and understanding the link between psychosocial factors and disease are discussed.

Parathyroid hormone (PTH) inhibited active transport of inorganic phosphate and stimulated an increase in cyclic AMP concentration in the urinary bladder of the toad, Bufo marinus. Active transport of phosphate in the toad bladder was also inhibited by an analog of cyclic AMP (dibutyryl cyclic AMP) and by other drugs (pitressin and theophylline) which increase toad bladder intracellular cyclic AMP concentration. These data support the concept that cyclic AMP may be the mediator of PTH-induced phosphate transport inhibition in the toad bladder.

In four experiments the effects of form and orientation pecking preferences of 1- and 3-day old Vantress X Arbor Acre chicks on successive discrimination learning were determined, using heat reinforcement. Major findings were as follows: (a) The young chick has both circle and verticle orientation pecking preferences that are present during at least the first 3 days after hatching; (b) when either of these preferred cues is the nonreinforced cue, the young chick has difficulty in learning not to respond to it but learns quickly not to respond to an unpreferred cue (e.g., triangle and horizontal oriented dots or bar); and (c) these pecking preferences can be modified by heat reinforcement, and the effects of this conditioning is evidenct in subsequent extinction and retention tests. The main conclusion from these experiments is that form and orientation preferences, like brightness and color preferences, are important developmental constraints on conditioning of the young chick.

Kinetic parameters for the action of bovine alpha-thrombin on 24 commercially available peptide p-nitroanilides have been determined. The selectivity constant, kcat/Km, ranges from 3.3 X 10(1) to 1.1 X 10(8) M-1 X S-1 for the poorest and the best substrates, respectively. The best substrates for thrombin were identified as those with arginine in the P1 position, proline or a proline homolog in the P2 position, and an apolar amino acid in the P3 position. Quantitative distinction between lysine and arginine in the P1 position and other amino acids in the P2-P4 positions of the substrate is reported from the changes in the kinetic parameters for substrates differing in only a single amino acid in these positions. Effects of NaCl, CaCl2 and poly(ethylene glycol) concentrations, pH and temperature on the action of thrombin on selected substrates have been assessed. A source of large systematic error in thrombin concentration estimates was identified as resulting from adsorption losses. These losses were eliminated by inclusion of poly(ethylene glycol) in dilution and reaction buffers.

Roles of histamine and prostaglandins in the induction of ovarian cysts after unilateral ovarian manipulation (MAN) and in the process of ovulation were evaluated in prepubertal gilts treated with pregnant mare's serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG). Administration of pyrilamine maleate, an H1 receptor antagonist, before MAN or hCG injection reduced the number of cysts formed but did not alter ovulation rate. Administration of cimetidine, an H2 receptor antagonist, failed to alter the incidence, number, or diameters of cysts formed in response to MAN or the ovulation rate on non-MAN ovaries. Administration of indomethacin, an inhibitor of prostaglandin synthesis, before MAN or hCG injection did not alter the incidence, number, or diameters of cysts formed on MAN ovaries but reduced the number of corpora lutea on non-MAN ovaries. Excessive accumulation of fluid in ovarian cysts apparently was mediated by histamine interacting with the H1-type receptor. Enhanced secretion of prostaglandins produced by the cyclooxygenase pathway did not contribute to development of ovarian cysts but, unlike histamine, was required for formation of corpora lutea in prepubertal gilts treated with PMSG and hCG.

This article summarizes the results of 41 independent studies containing correlates of objectively measured provider behaviors in medical encounters. Provider behaviors were grouped a priori into the process categories of information giving, questions, competence, partnership building, and socioemotional behavior. Total amount of communication was also included. All correlations between variables within these categories and external variables (patient outcome variables or patient and provider background variables) were extracted. The most frequently occurring outcome variables were satisfaction, recall, and compliance, and the most frequently occurring background variables were the patient's gender, age, and social class. Average correlations and combined significance levels were calculated for each combination of process category and external variable. Results showed significant relations of small to moderate average magnitude between these external variables and almost all of the provider behavior categories. A theory of provider-patient reciprocation is proposed to account for the pattern of results.

This paper investigates associations between physicians' task-oriented and socioemotional behaviors, on the one hand, and analogue patients' satisfaction, recall of information, and global impressions. The study is based on role-playing subjects' responses to interactions between physicians and simulated patients. Audiotapes of two standardized patient cases presented by trained patient simulators to 43 primary care physicians were rated by role-playing patients (N = 258), and electronically filtered excerpts from the encounters were rated for vocal affect by 37 independent judges. Content analysis was made of the visits' transcripts to assess interaction process and to identify all medical information communicated. Finally, speech error rate was calculated from a combination of audiotape and transcript. Findings revealed that role-playing patients clearly distinguished task from socioemotional behaviors of the physicians, and a consistent pattern of association emerged between physicians' task behaviors and role-playing patients' satisfaction, recall, and impressions. Within the task domain, patient-centered skills (i.e., giving information and counseling) were consistently related to patient effects in a positive direction, but physician-centered behaviors (i.e., giving directions and asking questions) demonstrated the opposite relationship. A negative pattern of association was also evident between physicians' socioemotional behaviors and patient effects.

The clinicopathologic findings of 13 patients having extramammary Paget's disease of the vulva are discussed with emphasis on its histogenesis and biological behavior. For the purpose of study and assessment of prognosis, these cases were divided into two groups, those with an underlying invasive cutaneous adnexal adenocarcinoma, and those lacking an underlying invasive lesion. Four cases contained invasive cutaneous adnexal adenocarcinoma; in one of these the invasion was superficial. Three of the cases with an invasive lesion and three other cases showed in situ adenocarcinoma of sweat glands. Surgical treatment is mandatory for both groups of patients. The prognosis was excellent for the patients having Paget's disease without an underlying invasive carcinoma. From the literature, the prognosis of those with an underlying invasive carcinoma of the vulva appears to be less favorable. Multiple surgical excisions may be required to control the recurrences and metastases. A frequent association with other internal malignancy was observed. In four cases, second malignancies were found. Of special interest was the demonstration in one case of columns of neoplastic cells extending from involved sweat glands to the surface epithelium via the intradermal sweat duct. Our study leads us to support the concept that the Paget's cells, in a number of cases, are derived from an underlying carcinoma in situ of sweat gland origin.

A review of 25 patients with more than 1 rubella titer by hemagglutination-inhibition testing revealed 3 patients with high positive titers that were reported to be negative in subsequent pregnancies. None of the patients had received the rubella vaccine. Because the sensitivity and reliability of hemagglutination-inhibition testing is markedly influenced by multiple variables, it is important for both the clinician and the pathologist to be aware of both the limitations of the testing method and the meaning of an antibody titer on a single isolated specimen.

The stimulant effects of adrenaline and noradrenaline on contractile force and adenylate cyclase, mediated through beta 1 and beta 2-adrenoceptors, are analysed in isolated atrial and ventricular myocardium of man. The tissues were obtained from patients without advanced heart failure undergoing heart surgery. Usually, both adrenaline and noradrenaline stimulated adenylate cyclase predominantly through ventricular and atrial beta 2-adrenoceptors. Because the relative density of beta 2-adrenoceptors is usually smaller than that of beta 1-adrenoceptors, stimulation of one beta 2-adrenoceptor leads to the production of up to 10 times more cyclic AMP molecules than does stimulation of one beta 1-adrenoceptor. Adrenaline and noradrenaline maximally enhance contractile force through both atrial and ventricular beta 1-adrenoceptors. Adrenaline can also maximally enhance contractile force through atrial beta 2-adrenoceptors. In the ventricle, adrenaline increases force via beta 2-adrenoceptors by up to 60% of its maximal beta 1 response. Noradrenaline can increase atrial and ventricular contractile force through beta 2-adrenoceptors but only at high concentrations. Unexpectedly, in atria from patients treated with the beta 1-selective antagonist atenolol, contractile responses to adrenaline are markedly and selectively augmented through activation of beta 2-adrenoceptors. In atria from atenolol-treated patients equi-inotropic concentrations of adrenaline and noradrenaline acting through beta 2 and beta 1-adrenoceptors, respectively, cause similar increases of cyclic AMP and of cyclic AMP-dependent protein kinase activity.

My purpose has been to call attention to the special meanings of religious images in dreams. It is neither possible nor desirable to make rigid rules as to their interpretation; some basic guidelines, however, may be helpful. For religious images that are active and meaningful in the conscious mind of the dreamer, interpretation may be unnecessary, since they may appear in such a way as to modify other contents of the psyche. If the consciously active religious image appears in a surprising way, this may indicate that the boundaries of value in the personal levels of the mind are under pressure for revision from deeper structures. Religious images that come from outside the conscious tradition of the dreamer may require little more than personal amplification if they are known in the conscious associations of the dreamer. If they are outside the personal associations, however, they may be difficult to amplify, although they frequently seem to be appropriately used by the dream-making function of the mind, the Self. Such unconscious but appropriate uses of verifiable archetypal images raise profound questions about the nature of the psyche, but do not greatly modify analytical practice, since images are frequently meaningful in their context alone. Contextual religious images indicate a high value in symbols that may have been consciously overlooked, like the "orphaned" philosopher's stone. Contextual religious images often indicate the need to consider revision of the conscious hierarchy of values.

We have described a patient with metastatic small cell carcinoma of the lung in whom cranial CT and contrast-enhanced CT failed to show metastases. When the patient died four days later, two sizable intracerebral metastatic foci were found at autopsy. Reviewing previously reported causes of nonvisualization of lesions, we have speculated on reasons for the lack of CT findings in this case.

Infrared sensitive television-camera tubes have responsivities orders of magnitude higher than scanner cells, yet the latter give better images of terrestrial scenes by their own thermal radiation. It is shown that although the camera tube electron beam reading mechanism saturates to limit maximum signal-to-noise ratio (SNR) to about 100, the large ir photon flux permits SNR up to 10(5) for typical nonsaturating cells that respond from the visible to 12 microm, despite their lower responsivity. Since ir images have very low contrast, ir sensitive camera tubes would be preferred only for wavelengths shorter than about 2.5 microm where photon flux is small and high responsivity is required.

Hexokinases of Drosophila melanogaster were investigated by starchgel electrophoresis. A hexokinase is present in both sexes during earlier stages of development, but it persists only in male adults. In addition, in this species there is a testis-specific hexokinase which is first observed during the pupal period.