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The results of a national panel survey of physician leaders are presented here. Although these perspectives are not drawn from a random national sample of all physician leaders, they do provide valuable insight from a group of key decision makers. Current technical and skill areas applicable to medical leadership, and projected future needs, are addressed. While medical leadership at present is focused on clinical medicine, perceptions of future directions for medical leadership suggests the increasing need for education related to specific technical skills as well as enhancement of personal characteristics. The results reported here help provide a platform for further elucidation of training needs for an audience of present and future physician leaders.

The cyclin-dependent kinase inhibitor p21WAF1/CIP1/SD11 (p21) plays a crucial role in DNA repair, cell differentiation, and apoptosis through regulation of the cell cycle. A2780 human ovarian carcinoma cells, which are sensitive to cisplatin and paclitaxel, express wild-type p53 and exhibit a p53-mediated increase in p21 in response to the chemotherapeutic agents. Here, we demonstrate that phosphatidylinositol 3-kinase (PI3K) and its downstream targets serine/threonine kinases AKT1 and AKT2 (AKT), are required for the full induction of p21 in A2780 cells treated with cisplatin or paclitaxel. Inactivation of the PI3K/AKT signal transduction pathway either by its specific inhibitor LY294002 or by expression of dominant negative AKT inhibited p21 expression but had no inhibitory effect on the expression of the proapoptotic protein BAX by cisplatin and paclitaxel treatment. In addition, overexpression of wild-type or constitutively active AKT in A2780 cells sustained the regulation of p21 induction or increased the level of p21 expression, respectively. Experiments with additional ovarian carcinoma cell lines revealed that PI3K is involved in the expression of p21 induced by cisplatin or paclitaxel in OVCAR-10 cells, which have wild-type p53, but not in OVCAR-5 cells, which lack functional p53. These data indicate that the PI3K/AKT signal transduction pathway mediates p21 expression and suggest that this pathway contributes to cell cycle regulation promoted by p53 in response to drug-induced stress. However, inactivation of PI3K/AKT signaling did not result in significant alteration of the drug sensitivity of A2780 cells, suggesting that the cell death induced by cisplatin or paclitaxel proceeds independently of cell protective effects of PI3K and AKT.

Of 364 patients undergoing insertion of a biliary endoprosthesis in 1989, six (1·6 per cent) developed gallbladder sepsis. Three patients had cholangiocarcinoma, two had carcinoma of the pancreas and one had a benign biliary stricture. Two of the five patients with malignancy had gallbladder stones, and the patient with a benign stricture developed stones after 3 years of stenting. Three patients developed gallbladder sepsis early after endoprosthesis insertion (< 6 days), while in the other three it occurred late (> 6 months). All six patients failed to respond to antibiotics and were successfully managed by percutaneous cholecystostomy; the patient with a benign biliary stricture also had cholecystolithotomy. The gallbladder drainage tubes were removed or became dislodged at intervals varying from 2 weeks to 6 months without complications. Percutaneous cholecystostomy is the treatment of choice for gallbladder sepsis unresponsive to antibiotics in patients with a biliary endoprosthesis in situ.

Bentonite may be used, in conjunction with cementitious materials, in repository designs for TRU wastes in Japan. Therefore, possible effects of the interaction of highly alkaline water with bentonite are of interest. In this study, the sorption of plutonium and uranium has been measured on a bentonite sample that had been altered by hydrothermal exposure to a high pH solution. Samples of Kunipia-F® bentonite were exposed to a pH 14 solution of sodium, potassium and calcium hydroxides for 20 days at 130°C, 160°C and 200°C under air. X-Ray analysis showed that alteration at 160°C was similar to alteration at 200°C. Batch sorption experiments were carried out at room temperature under nitrogen by contacting 200°C-altered bentonite with synthetic equilibrated water containing both uranium and plutonium in the presence of sodium dithionite as a reducing agent. The experiments were equilibrated for three months and then sampled after centrifugation, 0.45 gm filtration, and 10,000 nominal molecular weight cut-off (NMWCO) filtration. Uranium and plutonium remaining in solution were determined. The final redox potentials were between -500 to -51OmV vs SHE and the final pH values were 12.2. Sorption of both actinides showed some dependence on the solid:liquid separation method. The average RD value for uranium sorption after centrifugation was 2 × 103cm3g−1 which increased to 3 × 104 cm3g−1 after 0.45 ώm filtration. However, the effect of a further decrease in the pore size of the filter had little additional effect; 10,000 NMWCO filtration gave an average RD of 5 × 104 cm3g−1. The sorption of plutonium after solid:liquid separation by centrifugation was very similar to uranium with an average RD of 6 × 103 cm3g−1. After 0.45 ώm filtration the increase in RD to 2 × 105 cm3g−1 was more marked than for uranium. There was no significant increase in RD value after 10,000 NMWCO filtration compared to 0.45 μm filtration.

The results of a four year demonstration project of preventive services for Medicare managed care enrollees suggest that health promotion programs can impact health behaviors and outcomes. The study provided selected preventive services to 1,800 Medicare enrollees in a managed care environment. Participants were randomly assigned to control and experimental groups with the experimental group receiving an intervention service package and the control group usual care. The results included enhanced health behavior practices, lower depression, and higher immunization rates among those individuals in the experimental group. This study suggests that selected preventive services can be provided in a managed care environment to Medicare enrollees with likely positive health status and utilization outcomes.

1. Electrical field stimulation (EFS) (1-10 Hz, 30 V, 2 ms) of frog oesophageal body strips resulted in frequency-dependent non-adrenergic, non-cholinergic (NANC) relaxations. 2. Tetrodotoxin (TTX) (10(-6)-10(-5) M) had no effect on EFS evoked relaxations with a 2 ms pulse width. At a pulse width of 0.5 ms only the responses to the highest frequency (10 Hz) were significantly inhibited by TTX at 10(-5) M. Relaxation at 2 ms pulse width were unaffected by omega-conotoxin (10(-6) M), nifedipine (10(-6) M) or cobalt (5 x 10(-4) M). 3. NG-nitro-L-arginine (L-NOARG) (10(-6)-10(-4) M), a nitric oxide synthase (NOS) inhibitor, caused a concentration-dependent inhibition of the EFS-induced NANC relaxant responses. The inhibitory effect of L-NOARG was both prevented and reversed by L-arginine but not D-arginine (5 x 10(-3) M). 4. The phosphodiester type V inhibitor (PDE V), SKF 96231 (10(-7)-10(-4) M), caused a concentration-dependent potentiation of both the percentage relaxation and the duration of the relaxant responses to EFS. 5. ODQ (10(-7)-10(-5) M), a guanylate cyclase inhibitor, produced a concentration-dependent inhibition of EFS-evoked NANC relaxations. 6. Oxyhaemoglobin (10(-6) M), which binds nitric oxide (NO), inhibited NANC relaxations to EFS. 7. The NO donor sodium nitroprusside (SNP) (10(-8)-10(-4) M) produced a concentration-dependent inhibition of evoked tone. L-NOARG (10(-4) M) had no effect on the SNP evoked relaxations. Preincubation with oxyhaemoglobin (10(-6) M) caused a reduction in the SNP (10(-6)-10(-5) M) induced relaxations. 8. These results suggest NO is the relaxant transmitter of the frog oesophageal body and the source of NO may be non-neuronal.

The role of medical leadership in hospitals and health systems is under constant scrutiny and change. The nature of the Vice President for Medical Affairs (VPMA) position and its relationship to leadership in the health care system is explored through a national panel survey conducted recently. The effective VPMA will: be an aggressive manager able to implement change, address strategic planning and quality of care issues; have a high level of integrity; and be a good communicator and problem solver. The results of the research are presented in three sections. The first section describes the background characteristics and compensation of the VPMAs who participated in the survey. The second section focuses on the current role of the VPMA, including duties and responsibilities, job performance barriers and required skills. The final section addresses respondents' perceptions regarding areas for improvement in the role of the VPMA, as well as projections for future changes in this position.

A new program of K-isomer research has been initiated with the 8π spectrometer sited at the ISAC facility of TRIUMF. We discuss in this paper the identification of a new 2.3 s isomer in 174Tm and its implications.

Background: Preterm babies are the most vulnerable group to get adjusted to the new environment. Following birth, the first few months acts as a transitory period during which the baby adjusts from the aquatic to the aerial environment. As a result, the way in which baby is positioned throughout this time is very important and his posture dictates the level of his wellbeing. Promoting good positioning and encouraging opportunities for flexion can prevent the problems like motor coordination, balance and posture difficulties. The correct positioning will help the baby to develop good posture and improve muscle control. Method: In this study, a quasi-experimental control group pretest- posttest design was used and non probability convenience sampling technique was adopted to select 60 preterm babies, both in experimental and control group. Pilot study was conducted, the tool and study design were found to be feasible. Data were collected using structured observation checklist for posture and movement. An intervention, nesting was provided for the experimental group. The data were collected and analyzed using descriptive and inferential statistics. Results: The result of the study revealed that the significance of difference between the mean pretest and post test posture score which was statistically tested using paired 't' test and was found to be highly significant at 0.05 level of significance.(t(29) = 5.42 in post test 1, 46.14 in post test 2 and 56.82 in post test 3 ; (p < 0.05) and the significance of difference between the mean post test posture score between experimental and control group which was statistically tested using independent 't' test was found to be highly significant at 0.05 level of significance t(58) = 7.41, 7.89 and 8.49; (p < 0.05 ). The significance of difference between the mean pretest and mean post test movement score which was statistically tested using paired 't' test was found to be highly significant at 0.05 level of significance.(t(29) = 36.94 in post test 1, 15.59 in post test 2 and 22.80 in post test 3 ; p< 0.05 ) and the significance of difference between the mean post test movement score between experimental and control group which was statistically tested using independent t test was found to be highly significant at 0.05 level of significance. (t(58) = 8.12, 5.26 and 4.88 ; p < 0.05 ). The result shows that the posture and movement score had no significant association with their selected personal variables. Conclusion: Therefore, the study concluded that the nesting was an effective method to maintain the normal posture and movement of preterm babies.

Presence of an estrogen receptor is crucial for cells to respond to estrogen; thus, estrogen-responsive neurons should be identifiable by immunohistochemically staining for the estrogen receptor (ER). Even though spinal neurons are involved in sexual behaviors and innervation of genital organs, little information is available about ER-containing neurons in the spinal cord. Consequently, we have undertaken a study of ER-containing neurons in the female rat lumbosacral cord, an area involved in reproductive functions and predicted to contain estrogen-responsive neurons. In addition, since parasympathetic preganglionic neurons in the lumbosacral cord produce nitric oxide (NO), we also sought to determine if ER-immunoreactive (-IR) neurons contain the enzymes for NO production. Finally, we compared the distribution of ER-IR neurons to the presence of uterine cervix-related neurons. Uterine cervix-related neurons were identified by expression of FOS-immunoreactivity after vaginocervical mechanostimulation (VCS). The lumbosacral spinal cords were removed from intact, ovariectomized, and VCS-treated rats and sections stained by immunohistochemistry. ER-IR was present in the nuclei of neurons located predominately in the dorsal one-half of the spinal cord. Specific sites include the dorsal horn, lamina V, the sacral parasympathetic nucleus (SPN) (which contains preganglionic parasympathetic neurons) and extending into the lateral funiculus, and lamina X. Some ER-IR neurons were NADPH-d-positive and were localized in laminae V and VII. FOS-IR neurons had a distribution pattern similar to the distribution of neurons containing ER. The presence of ER neurons in these regions suggest that they are responsive to circulating estrogen.

The influence of alkaline degradation or radiolytic degradation of asphalt on plutonium solubility has been investigated. Asphalt has been contacted with water, sodium hydroxide solution or concrete leachate at 80°C for periods of up to approximately 2 years. Sodium nitrate was also present in some of the experiments. Plutonium solubilities were measured at pH 12 in the leachates and found to be less than 10-8 mol dm-3 for most degradations. Relatively low levels of Total Organic Carbon were measured in the leachates. Alpha radiolysis of asphalt in the presence of concrete and water has also been studied. Samples of asphalt were encapsulated in concrete after coating with the 238PuO2, crushed and leached at room temperature. The solubility of plutonium was measured in samples of the leachates after approximately 90 days and 180 days had elapsed. The results showed that the solubility of plutonium in the α-radiolysis leachates remained low and was in the range 2 × 10-11 to 8 × 10-9 mol dm-3. A consideration of these results, and data published elsewhere, suggests that chemical and radiolytic attack on asphalt or bitumen under anaerobic, alkaline conditions typical of a deep cementitious repository is unlikely to generate complexants for plutonium which are effective at high pH. Any enhancement of plutonium solubility is likely to be less significant than that arising from the degradation of some other organic materials.

Increasing attention has been devoted to the urgent need for identifying depressive symptomatology at the primary care point of contact for older individuals to prevent more serious disease and potential negative behavioral outcomes. Delivering medical care services in a system that is sensitive to the symptoms of depression may lead to greater cost-effectiveness and improved quality of life. This paper examines the correlates of depression in a random sample of 1800 Medicare beneficiaries enrolled in a risk-sharing HMO. Ten percent of the total sample reported a high degree of depressive symptoms, as measured by the CES-D score. The prevalence of depressive symptoms was significantly higher for those who were not married, reported less well-developed social support networks, had low perceived ability to control future health, or had poorer health status. Depressive symptoms were also associated with a greater number of physician office visits and higher ambulatory charges, although no significant relationship was found for inpatient use or total charges. Practical approaches to monitoring depressive symptomatology at the primary care level in an HMO are suggested.

This study examines the longitudinal (48 months) effects of a preventive services intervention trial with Medicare beneficiaries. The health promotion intervention incorporated a series of workshops and targeted individualized counseling dealing primarily with nutrition and exercise. All subjects completed a health risk appraisal (HRA) questionnaire, which served as a dependent measure. Results show significant, positive changes in intervention subjects in two activity outcomes, aerobic activity and stretching exercises. Although previous research on this cohort found significant positive changes in nutrition behaviors at 12-month follow-up, these differences were not sustained over the three-year follow-up period. The results offer encouragement that continued research on health promotion will eventually produce protocols for select activities that will improve the status of seniors' health.

The region of the rat sacral parasympathetic nucleus (SPN) contains distinct subpopulations of neurons that project supraspinally or are preganglionic neurons. Some preganglionic neurons in the SPN serve as the motor outflow for urinary bladder contraction; other neurons in the SPN project to regions of the rostral pons that subserve micturition reflexes. Previous studies utilizing immunohistochemistry or staining for nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) have demonstrated that numerous neurons in the SPN contain nitric oxide synthase (NOS), the enzyme for nitric oxide synthesis. Thus, the objectives of this study were to determine 1) the distribution of neurons in the region of the SPN that project to the laterodorsal tegmentum (LDT) of the pons, 2) whether spinal neurons projecting to a peripheral autonomic ganglion also project to the LDT, and 3) whether NOS or NADPH-d is present in LDT projection neurons. Preganglionic neurons were identified by injecting the retrograde tracer fluorogold (FG) into the major pelvic ganglion (MPG). Supraspinally projecting neurons were identified by injecting the retrograde tracer fast blue (FB) into the LDT. Numerous FB-labeled neurons were present in the ipsi- and contralateral SPN and were immediately dorsal to FG-labeled preganglionic neurons. Neurons containing both tracers were not observed. Approximately 20% of preganglionic neurons, but no LDT projection neurons, were reactive for NOS and NADPH-d. These data suggest that the region of the SPN is a site for distinct subpopulations of neurons that project to the LDT and to the MPG and that NOS is contained in some preganglionic neurons, but is not a marker for LDT projection neurons.

To evaluate the response to treatment with interferon alfa and the long term outcome of patients with chronic active hepatitis B.Sixty-two patients with chronic active hepatitis B (43 males, 19 females; age range, 10-67 years) who were treated with interferon alfa at Westmead Hospital between 1984 and 1992 were followed up (mean period of follow-up, 44 months). Thirty-nine patients were treated with interferon alfa-2a and 23 with interferon alfa-2b for a mean of 22.5 weeks. Interferon was given three times a week with a dose range of 3-21 million U. We evaluated pretreatment predictors of response (patient's age, sex, ethnic origin, presence of cirrhosis, serum levels of alanine aminotransferase [ALT] and hepatitis B virus DNA [HBV-DNA]) and the effect of dose and type of interferon.Nine patients had a complete response to treatment with interferon alfa (loss of hepatitis B surface antigen), 26 had a partial response (permanently HBV-DNA negative, hepatitis B e antigen to anti-hepatitis Be seroconversion), eight had a transient response and 19 had no response. All patients with a complete response had normal ALT levels at last follow-up. Histological evidence of hepatic inflammation was significantly reduced in responders. A high pretreatment ALT level and a low HBV-DNA titre were both positive predictors of a favourable response. We found no significant difference in the response to different types of interferon or to high or low dose regimens, or in the responses of patients with cirrhosis.Treatment with interferon alfa was associated with prolonged suppression of HBV replication in over half these patients and 14% appear to have been cured of the infection. Suppression of HBV replication is associated with sustained abatement of liver disease.

Nirex is seeking to develop a deep underground repository for the disposal of solid intermediate-level and low-level radioactive wastes (ILW and LLW) in the UK. One possible influence on the behaviour of radionuclides is the formation of water-soluble complexants by the degradation of the solid organic polymers that will be present in the wastes. The degradation products of cellulose have been shown to increase the solubility of plutonium and other radionuclides and to reduce sorption onto near-field and far-field materials. Degradation of cellulose under anaerobic alkaline conditions produces a range of organic acids. In this paper 2-C-(hydroxymethyl)-3-deoxy-D-pentonic acid (isosaccharinic acid, ISA) is identified by High Performance Liquid Chromatography as a significant component of cellulose leachates. A combination of fractionation of cellulose leachates and plutonium solubility determinations shows that ISA is responsible for the majority of the enhancement of plutonium solubility observed in such leachates. Further degradation of ISA by chemical or microbial action may lessen the effect of degraded cellulose leachates. Experimental studies on the chemical degradation of this compound under alkaline conditions suggest that the presence of oxygen is required. Microbial degradation studies show that the plutonium solubility in solutions of ISA is reduced by their exposure to microbial action.

An integrated programme of batch sorption experiments and mathematical modelling has been carried out to study the sorption of plutonium and americium on a series of repository, backfill and geological materials relevant to the JNFL low-level radioactive waste repository at Rokkasho-Mura.The sorption of plutonium and americium on samples of concrete, mortar, sand/bentonite, tuff, sandstone and cover soil has been investigated. In addition, specimens of bitumen, cation and anion exchange resins, and polyester were chemically degraded. The resulting degradation product solutions, alongside solutions of humic and iso-saccharinic acids were used to study the effects on plutonium sorption onto concrete, sand/bentonite and sandstone.The sorption behaviour of plutonium and americium has been modelled using the geochemical speciation program HARPHRQ in conjunction with the HATCHES database.

The Di-pentagonal Array for Nuclear Timing Experiments (DANTE) is an array of ten BaF2 detectors used in conjunction with the 8π gamma-ray spectrometer at the TRIUMF-ISAC radioactive-ion beam facility. DANTE is used to conduct direct lifetime measurements of nuclear excited states in the picosecond - nanosecond range. This, in turn, will aid in probing the collective structures of deformed nuclei. The capability of DANTE to measure nanosecond-scale lifetimes is demonstrated by using a 152Eu source. The half-life of the Iπ = 21+ state of 152Sm is measured to be 1.426 ± 0.018 ns.

582 Background: Resistance to HER2 antagonism in HER2-positive breast cancer has been associated with activation of the PI3K signaling pathway. PIK3CA mutations in exon 9 and exon 20 have been show...

A comprehensive marketing effort--using direct mail, telemarketing, and orientation seminars--to enroll elderly participants in a Medicare preventive health services demonstration project was undertaken in 1989. Out of the more than 11,000 eligible members in a large Medicare HMO plan in San Diego County, 1,800 (16.2%) agreed to participate. The authors describe the recruiting effort in detail and postulates reasons why the elderly resisted enrolling in the study. These results have important policy implications for the nation's Medicare program and are relevant to promoting other useful health care services in this population.

UK Nirex Ltd is seeking to develop a deep underground repository for the disposal of solid low- and intermediate-level radioactive wastes in the UK. The Nirex Safety Assessment Research Programme (NSARP) comprises scientific research to support the post-closure performance assessment of the repository. One of the investigations carried out by AEA Technology under the NSARP is the investigation of the formation of water-soluble complexants from the degradation of the solid organic polymers and cellulosic materials present in such wastes. The influence of these complexants on the solubility and sorption of a number of radionuclides is also being investigated by a combination of experimental measurements and thermodynamic modelling. Under the alkaline, anaerobic conditions representative of the near field of the repository, cellulose has previously been shown to degrade to yield soluble products which enhance the solubilities and reduce the sorption of several radionuclides. As part of this investigation, cellulose was chemically degraded under conditions similar to those expected in the near field and the leachate analysed. Separation of the products by HPLC gave direct identification of 2-C-(hydroxymethyl)-3-deoxy-D-erythro-pentonic (isosaccharinic) acid as one of the degradation products. More tentative assignments were made for glycolic, formic, lactic and acetic acids. A comparison was made with the degradation products suggested in the literature. The possible mechanisms and extent of cellulose degradation are discussed, as well as the factors affecting its degradation in the near field. The sorption of plutonium on to cement from a leachate produced under alkaline, anaerobic conditions is reported.

A service which can promote both marketing and public education is especially useful in these highly competitive times, writes Bridget Larsen Wright, M.P.H., et al. HealthLine, an information service for the general public, was developed to promote these areas, and Wright explains how a Southern California clinic implemented the service, and provides some preliminary results.

UK Nirex Ltd are seeking to develop a deep underground repository for the disposal of solid ILW and LLW in the UK. The formation of water-soluble complexants from the degradation of the solid organic polymers and cellulosic materials present in such wastes may influence the solubility and sorption properties of a number of radioelements. A number of materials have been chemically degraded under alkaline, anaerobic conditions representative of the near field of the repository. Measurements of plutonium solubility in the leachates obtained show that the degradation of cellulose is of particular concern; the effects on the solubility can be several orders of magnitude greater than those of other organic materials. Products formed from the degradation of ion-exchange resins were found to have little effect. Solubilities of a number of other radioelements in aerobically degraded cellulose leachates are also given. The effect of reducing the ratio of celluloseto cement in the degradation experiments results in a decrease in plutonium solubility in the corresponding leachate. Several of the likely degradation products of cellulose have been individually synthesised including isosaccharinic acid, a key degradation product of cellulose. Enhanced plutonium solubilities have been measured in 10-3M solutions of these compounds. Sorption of plutonium onto cement from leachates obtained by the degradation of 10% cellulose in cement is reduced by about two orders of magnitude. Interaction with cement removes significant concentrations of complexants from solution. Thermodynamic modelling studies show that hydroxyl groups present in the compounds which result from the alkaline degradation of cellulose can strongly complex with plutonium.

SUMMARY Ten patients with metastatic pancreatic endocrine tumours were treated with the long-acting somatostatin analogue octreotide (SMS 201–995). Three patients showed no response, clinically or biochemically, and treatment was therefore withdrawn. The seven remaining patients continued treatment for a median period of 28 months (range 13–54 months). Treatment was initially effective, symptoms improved and the concentrations of tumour-related hormones were reduced. Worsening of symptoms and rising levels of tumour-related hormone concentrations occurred a median of 5 months (range 1–6 months) after the start of therapy and were initially reversed by increasing the dose of octreotide over a median of 10 months (range 6–16 months). However, after a median of 13 months (range 5–34 months) at the maximum dosage, symptoms recurred and were no longer responsive to a further increase in dosage of octreotide or other therapeutic measures. All patients died within a period of 5 months once this resistant phase of their illness had been reached.

7B2 is a protein originally isolated from pituitary, which has been shown to be present in the central nervous system and in certain peripheral tissues, with very high concentrations in pancreatic islets. Endocrine and nonendocrine tumors from 185 patients were investigated by RIA for the presence of immunoreactive pituitary protein 7B2. The highest mean concentration of 7B2 immunoreactivity was found in insulinomas [452 +/- 174 (+/- SEM) pmol/g wet wt tissue; n = 16], which was significantly higher than the concentration in normal adult pancreatic tissue (28.3 +/- 4.4 pmol/g; n = 7). High concentrations of 7B2 immunoreactivity also were found in other endocrine tumors. The cellular localization of 7B2 was studied in normal pancreas, pancreas with hyperplastic islets, and endocrine tumors. 7B2 immunoreactivity was localized to B-cells in the normal pancreas and to variable proportions of cells in islet cell hyperplasias, B-cell tumors, and pheochromocytomas. Plasma concentrations of 7B2 immunoreactivity also were determined in 255 patients with established diagnoses of endocrine or nonendocrine tumors. The proportion of patients with elevated plasma concentrations (arbitrarily set at more than 4 SD above the mean) were 42 of 72 with pancreatic islet cell tumors, 7 of 11 with midgut carcinoid tumors, and 5 of 13 with medullary carcinomas of the thyroid. Especially high values were found in patients with glucagonomas (14 of 20), vipomas (12 of 13), and pancreatic polypeptide-producing tumors (5 of 6). Thus, 7B2 immunoreactivity is produced by a variety of different tumors and may serve as a tumor marker, especially in patients with certain pancreatic islet tumors.

In tetraplegia there is often paradoxical inward motion of the rib cage during inspiration. The volume of this negative contribution is difficult to estimate but can be obtained by optical mapping. The partitioning of ventilation between the rib cage and abdomen in six normal subjects, 10 stable tetraplegic patients, and one tetraplegic patient at intervals during rehabilitation has been studied by this technique. In normal subjects the tidal volume and the vital capacity were the sum of positive contributions from the rib cage and abdomen. In stable tetraplegic subjects with similar neurological levels, the rib cage contribution varied widely but the total chest wall displacement could not be predicted from the vital capacity. In the patient studied sequentially rib cage paradox reversed with time after injury, and this was associated with an absolute increase in vital capacity and an improvement in the action of the diaphragm.

1. Arterial and venous whole blood and plasma histamine concentrations and eosinophil and basophil counts were determined in five patients with acute severe asthma who had not previously received steroid therapy, in five who had been maintained on steroid therapy and in a control group of nine patients with acute non-respiratory illnesses. 2. No significant arteriovenous differences were observed for any of these measurements in any of the groups of patients. Significant net loss of arterial histamine does not therefore occur peripherally in acute asthma. 3. When compared with the values for the controls, statistically significant increases were observed, in the group not receiving steroids, for arterial and venous whole blood histamine concentrations, eosinophil counts and basophil counts, and, in those receiving steroids, for the venous basophil counts. 4. When compared with the venous plasma histamine concentration of normal subjects, that of the asthmatic subjects not receiving steroids was significantly raised. 5. The venous plasma histamine concentration of the control group was also significantly higher than that of normal subjects, but less so than in the asthmatic subjects, suggesting that acute illness per se produces an increased plasma histamine concentration. 6. Both groups of asthmatic patients were treated similarly with hydrocortisone and bronchodilators. There was a striking fall in whole blood histamine concentration and in eosinophil and basophil counts, but plasma histamine fell more slowly, especially in those who had not previously received steroids. 7. The mean histamine content of the basophil cell is 0·01 pmol and significant differences in this value did not occur within the various groups or as a result of treatment. The approximate number of molecules of histamine per basophil cell is 6·0 × 109.

The structure of glassy boron trioxide B 2 O 3 is a subject of debate since it is not yet established which of two possibilities, either -BO 3 triangles or -B 3 O 6 ‘boroxol’ rings, forms the structural unit of a continuous random network describing the structure. We describe the construction of the first hand-built ‘ball-and-stick’ structural model to simulate the structure of glassy B 2 O 3 . It is composed solely of -BO 3 triangles with no boroxol rings whatsoever; the calculated scattering properties of the model agree very well with experimental X-ray and neutron data, although the density of the model is some 17 % higher than the experimental value. This might be reduced either by relaxing the constraint placed during construction that the model be made as dense as possible, or by incorporating a small proportion of boroxol units.

The s-wave neutron fraction of the 0 + levels in 12Be has been investigated for the first time through the 11Be( d , p ) transfer reaction using a 5 A MeV 11Be beam at TRIUMF, Canada. The reaction populated all the known bound states of 12Be. The ground state s-wave spectroscopic factor was determined to be 0.28 − 0.07 + 0.03 while that for the long-lived 0 2 + excited state was 0.73 − 0.40 + 0.27 . This observation, together with the smaller effective separation energy indicates enhanced probability for an extended density tail beyond the 10Be core for the 0 2 + excited state compared to the ground state.

We habe obtained part of the laser-induced fluorescence spectrum of chromyl fluoride in a free jet expansion at an instrumental resolution of better than 0.001 cm −1 . This spectrum (together with that of the dispersed fluorescence) allows the identification of the (0,0) band or the absorption spectrum and of several progressions in the lowest bending frequency.

We examined the demand for doctorally prepared public health personnel in academia. We developed an unduplicated list of positions advertised during 1983 in several of the nation's public health journals. Based on this, we identified a total of 217 available positions. We surveyed the persons who placed the advertisements regarding their perceptions of the applicant pool, their experiences in filling the positions, and their perceptions of the future supply of doctorally prepared public health personnel. Of the respondents, 93% were in institutions of higher education. Based on their response, it appears that the current supply of doctorally prepared public health personnel is short and is likely to continue to be limited. Respondents had difficulty filling the advertised positions, based on the amount of time necessary to fill the position, and a number of positions had to be modified in order to be filled. Thirty-two percent of the respondents replied that the pool of applicants was low or poor. Thirty-four percent felt there was a shortage of such personnel, and a similar percentage felt there would be a future shortage. Based on our data, we believe that there is now a shortage of doctorally educated public health personnel for academic positions and that this shortage is likely to continue.

Faced with increasing pressures to become more competitive, many hospitals are rethinking their ambulatory care services. This article suggests considerations that should be addressed in the organization and design of ambulatory care services and outlines a plan of action for boards and administrations wishing to expand their involvement in ambulatory care.

We report a well tolerated endoscopic technique of administering intraluminal radiotherapy to 14 patients with inoperable cholangiocarcinoma, in which the iridium-192 wire source was inserted down a nasobiliary catheter placed within a previously inserted endoscopic biliary prosthesis, thus allowing bile flow to continue during treatment. Radiotherapy was commenced 2 weeks after biliary decompression, when the median serum bilirubin level had fallen from 213 to 34 μmol/l. A total radiation dose of 6000 cGy at 0·5 cm from the source was administered over a median of 85 h (range 77·116 h). In four patients there was a transient increase in serum bilirubin during iridium treatment and, in two cases (14 per cent), this was associated with mild cholangitis. Both cases resolved rapidly once the iridium wire and nasobiliary catheter were removed. The median hospital stay after treatment was 2·5 days (range 0·28 days). The late complications associated with stent blockage were minimized by routinely changing stents at 4–6-monthly intervals; ten of the patients have so far undergone from one to five (median three) stent changes. Five patients have died at 3·6–8·2 months (median 4·8 months) following iridium treatment; four had extensive type III hilar lesions at diagnosis. Nine patients are still alive at 5·4–31·0 months (median 16·4 months). The overall median survival after iridium therapy is 10·5 months. This technique of endoscopic biliary decompression before internal iridium administration minimizes complications by allowing biliary drainage during treatment. The role of this treatment in patients with inoperable cholangiocarcinoma awaits the results of randomized, controlled trials.

A variety of laboratory procedures can be used to define the chemistry and pharmacokinetics of myocardial cationic imaging agents. These methods are utilized to define the in vivo chemistry of cationic heart agents, in order to understand the kinetics and mechanisms of: tissue and cellular transport, subcellular distribution, and intracellular localization. Transport across cell membranes can be active, passive or facilitated. Studies performed in erythrocytes, heart cells, slices and isolated perfused hearts using methods for separation of metabolites have shown a high degree of myocardial specificity for [99mTc]hexakis alkyl isonitrile by an uptake mechanism different from 201Tl. These studies demonstrate the importance of in vivo chemistry and pharmacokinetics in the development of new radiopharmaceuticals.

We provide 1985 estimates of the work force of epidemiologists in the United States, the number of graduates from training programs in epidemiology, and a projection of the future need for these health professionals. Our methods included a search of mailing lists from professional organizations, mail contact with graduate training programs, telephone interviews with experts, and a review of job announcements in professional journals. The study indicates that the current work force of epidemiologists in the United States is estimated to include 4,600 persons, more than half of whom are physicians; most epidemiologists are located in either a state with a major federal public health agency or one with a large population; and programs in epidemiology graduate an average of 475 persons with one or two years of master's level education and approximately 80 with doctoral-level education each year. After considering the factors that influence the supply of epidemiologists, we project a substantial need for more epidemiologists in the future than current sources will provide.