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We have purified to near homogeneity from rat brain two Ca-calmodulin-dependent protein kinase I (CaM kinase I) activating kinases, termed here CaM kinase I kinase-α and CaM kinase I kinase-β (CaMKIKα and CaMKIKβ, respectively). Both CaMKIKα and CaMKIKβ are also capable of activating CaM kinase IV. Activation of CaM kinase I and CaM kinase IV occurs via phosphorylation of an equivalent Thr residue within the “activation loop” region of both kinases, Thr-177 and Thr-196, respectively. The activities of CaMKIKα and CaMKIKβ are themselves strongly stimulated by the presence of Ca-CaM, and both appear to be capable of Ca-CaM-dependent autophosphorylation. Automated microsequence analysis of the purified enzymes established that CaMKIKα and -β are the products of distinct genes. In addition to rat, homologous nucleic acids corresponding to these CaM kinase kinases are present in humans and the nematode, Caenorhabditis elegans. CaMKIKα and CaMKIKβ are thus representatives of a family of enzymes, which may function as key intermediaries in Ca-CaM-driven signal transduction cascades in a wide variety of eukaryotic organisms.

Primary health-care providers have been encouraged to counsel their patients about regular physical activity, but there are significant barriers to effective counseling. In this study a program of training and materials was tested for acceptability to providers, office staff, and patients. Primary care providers and office staff were trained to use the Physician-based Assessment and Counseling for Exercise (PACE) materials in four geographical sites in the United States. The program was tested in a variety of settings and with diverse patient populations. The acceptability of the program during a five-month study period was evaluated through structured interviews. The training was effective in preparing the providers to counsel, and the program was generally acceptable to providers, office staff, and patients. Counseling was provided in less than five minutes by 70% of providers, and most patients reported following the recommendations given. The PACE program assists providers in overcoming barriers to counseling patients about physical activity. The PACE program is potentially an important part of a national effort to enhance the adoption and maintenance of physical activity among adults.

This paper traces the evolution of the concept of clinical social work and looks at where we are and where we are headed as clinical social workers. It reaffirms the view that clinical social workers intervene with clients presenting the full range of problems in a variety of facilities and in private practice and must draw on a broad knowledge base within a person-situation perspective and address the special needs of culturally diverse and oppressed populations. The paper also considers the move toward legal regulation, the role of private practice, the need for clinical doctoral education, the importance of new models for clinical research, and the significance of advocacy for a broad range of services to clients.

This paper reviews issues that have arisen in the process of extending the Transtheoretical Model of behavior change (TTM) from smoking cessation to screening mammography. Conceptual and empirical considerations are discussed. Topics covered include defining the stages-ofadoption, writing items for the pros and cons, and identifying processes-of-change. Differences between smoking cessation and mammography as health-relate d behaviors are reviewed, as they have affected the adaptation of the model (e.g. prevention versus early detection; cessation versus initiation; periodicity; role of the provider). The fundamental appropriateness of mammography as a behavior to which the TTM should be extended is also addressed (i.e. clear behavioral guidelines, effective technology, a definitive target population). Several areas for further development of the TTM and mammography are presented.

Pharmacokinetics and toxicokinetics of IRI-695, a tripeptide, were investigated in the rat, rabbit, dog, and monkey. Tissue distribution and excretion of [ 14 C]IRI-695 were determined in the rat. Following a single intravenous (IV) injection, the elimination half-life (t 1/2 ) of IRI-695 in the rabbit, dog, and monkey was similar (about 65 min) and approximately four times that in the rat (15 min). This difference in t 1/2 can be attributed to about four times higher clearance of the drug in rats (11.2 mL min -1 kg -1 ). The volume of distribution (V ss ) in these four species, 132-234 mL kg -1 suggested negligible preferential distribution of IRI-695 to body tissue. After a 5 mg kg -1 oral dose, the absolute bioavailability of IRI-695 was 20% in rats and 3.1% in dogs. However, systemic drug exposure in the dog was about five to 10 times that in the rat, which is related to the slower clearance of the peptide in the dog. Toxicokinetic studies in the rat and dog indicated linear kinetics and systemic exposure of IRI-695 up to 300 mg kg -1 d -1 oral doses throughout the 28d toxicity study. Accumulation of the drug after the repeated oral dosing was negligible. After a single 0.10 mg kg -1 [ 14 C]IRI-695 IV injection in rats, almost all of the radioactivity administered was excreted in urine within 24 h postdose.

We review research on revenue models used by online firms who offer digital goods. Such goods are nonrival, have near zero marginal cost of production and distribution, low marginal cost of consumer search and low transaction costs. Additionally, firms can easily observe and measure consumer behavior. We start by asking what consumers can offer in exchange for digital goods. We suggest that consumers can offer their money, personal information, or time. Firms, in turn, can generate revenue by selling digital content, brokering consumer information, or showing advertising. We discuss the firm’s trade-off in choosing between the different revenue streams, such as offering paid content or free content while relying on advertising revenues. We then turn to specific challenges firms face when choosing a revenue model based on either content, information or advertising. Additionally, we discuss nascent revenue models that combine different revenue streams such as crowdfunding (content and information) or blogs (information and advertising). We conclude with a discussion of opportunities for future research including implications for firms’ revenues models from the increasing importance of the mobile internet.

Erectile dysfunction (ED) and cardiovascular disease (CVD) share risk factors and frequently coexist, with endothelial dysfunction believed to be the pathophysiologic link. ED is common, affecting more than 70% of men with known CVD. In addition, clinical studies have demonstrated that ED in men with no known CVD often precedes a CVD event by 2-5years. ED severity has been correlated with increasing plaque burden in patients with coronary artery disease. ED is an independent marker of increased CVD risk including all-cause and especially CVD mortality, particularly in men aged 30-60years. Thus, ED identifies a window of opportunity for CVD risk mitigation. We recommend that a thorough history, physical exam (including visceral adiposity), assessment of ED severity and duration and evaluation including fasting plasma glucose, lipids, resting electrocardiogram, family history, lifestyle factors, serum creatinine (estimated glomerular filtration rate) and albumin:creatinine ratio, and determination of the presence or absence of the metabolic syndrome be performed to characterise cardiovascular risk in all men with ED. Assessment of testosterone levels should also be considered and biomarkers may help to further quantify risk, even though their roles in development of CVD have not been firmly established. Finally, we recommend that a question about ED be included in assessment of CVD risk in all men and be added to CVD risk assessment guidelines.

Mid-life poses many stresses that are taxing even for those with relatively cohesive selves and good compensatory structures as well as those who show more severe pathology. This article will discuss mid-life issues, a self psychological perspective on mid-life, and will describe three individuals whose presenting problems were triggered by mid-life events that stimulated their underlying narcissistic vulnerability. The article will discuss and illustrate special emphases in the treatment of such patients drawing on self psychological theory generally.

Human Ca(2+)-calmodulin (CaM) dependent protein kinase I (CaMKI) encodes a 370 amino acid protein with a calculated M(r) of 41,337. The 1.5 kb CaMKI mRNA is expressed in many different human tissues and is the product of a single gene located on human chromosome 3. CaMKI 1-306, was unable to bind Ca(2+)-CaM and was completely inactive thereby defining an essential component of the CaM-binding domain to residues C-terminal to 306. CaMKI 1-294 did not bind CaM but was fully active in the absence of Ca(2+)-CaM, indicating that residues 295-306 are sufficient to maintain CaMKI in an auto-inhibited state. CaMKI was phosphorylated on Thr177 and its activity enhanced approximately 25-fold by CaMKI kinase in a Ca(2+)-CaM dependent manner. Replacement of Thr177 with Ala or Asp prevented both phosphorylation and activation by CaMKI kinase and the latter replacement also led to partial activation in the absence of CaMKI kinase. Whereas CaMKI 1-306 was unresponsive to CaMKI kinase, the 1-294 mutant was phosphorylated and activated by CaMKI kinase in both the presence and absence of Ca(2+)-CaM although at a faster rate in its presence. These results indicate that the auto-inhibitory domain in CaMKI gates, in a Ca(2+)-CaM dependent fashion, accessibility of both substrates to the substrate binding cleft and CaMKI kinase to Thr177. Additionally, CaMKI kinase responds directly to Ca(2+)-CaM with increased activity.

Purified pig brain Ca-calmodulin (CaM)-dependent protein kinase Ia kinase (Lee, J. C., and Edelman, A. M.(1994) J. Biol. Chem. 269, 2158-2164) enhances, by up to 24-fold, the activity of recombinant CaM kinase IV in a reaction also requiring Ca-CaM and MgATP. The addition of brain extract, although capable of activating CaM kinase IV by itself, provides no further activation beyond that induced by purified CaM kinase Ia kinase, consistent with the lack of a requirement of additional components for activation. Activation is accompanied by the development of significant (38%) Ca-CaM-independent CaM kinase IV activity. In parallel fashion to its activation, CaM kinase IV is phosphorylated in a CaM kinase Ia kinase-, Ca-CaM-, and MgATP-dependent manner. Phosphorylation occurs on multiple serine and threonine residues with a Ser-P:Thr-P ratio of 3:1. The identical requirements for phosphorylation and activation and a linear relationship between extent of phosphorylation of CaM kinase IV and its activation state indicate that CaM kinase IV activation is induced by its phosphorylation. Replacement of Thr-196 of CaM kinase IV with a nonphosphorylatable alanine by site-directed mutagenesis abolishes both the phosphorylation and activation of CaM kinase IV, demonstrating that Thr-196 phosphorylation is essential for activation.

In American Samoa (AS), nearly 22% of adults have type 2 diabetes. Diabetes is best managed by diet and lifestyle modifications and strict medication adherence. Cultural aspects might affect medication-taking beliefs, and thereby influence medication adherence. This study aims to explore diabetes medication-taking experiences and knowledge and related cultural beliefs in AS adults with diabetes and healthcare providers. Six focus groups were conducted with 39 AS adults with diabetes and individual interviews were performed with 13 diabetes healthcare providers. Data were transcribed and analyzed using NVivo 8 software. Themes pertaining to medication taking and adherence were identified. Patients and providers reported that barriers such as confusion about medications and concern about medication costs negatively influence medication taking, while cultural values and obligations both positively and negatively impact medication adherence. These findings help elucidate the relationship between medication-taking beliefs and culture in AS adults with diabetes and highlight the importance of continued research within this population.

In contrast to the traditional view that sees therapist self-disclosure as a form of countertransference acting-out that either makes the therapeutic process more difficult or subverts it completely, this paper will present a self psychological rationale for the selected use of therapist self-disclosure in treatment. It will discuss the nature of therapist self-disclosure, issues in its use, countertransference issues, and its evaluation.

Thymopoietin (TP) was originally isolated as a 5-kDa 49-aa protein from bovine thymus in studies of the effects of thymic extracts on neuromuscular transmission and was subsequently observed to affect T-cell differentiation and function. We now report the isolation of cDNA clones for three alternatively spliced mRNAs that encode three distinct human T-cell TPs. Proteins encoded by these mRNAs, which we have named TP alpha (75 kDa), TP beta (51 kDa), and TP gamma (39 kDa), contain identical N-terminal regions, including sequences nearly identical to that of the originally isolated 49-aa protein, but divergent C-terminal regions. TP mRNAs are expressed in many tissues, most abundantly in adult thymus and fetal liver of the tissues so far examined. Distinct structural domains and functional motifs in TPs alpha, beta, and gamma suggest that the proteins have unique functions and may be directed to distinct subcellular compartments.

High-performance liquid chromatography (HPLC) coupled to mass spectrometry (MS) using an electrospray ionization (ESI) interface provides a sensitive method for the quantitative analysis of peptide drugs in complex biological matrixes. ESI HPLC-MS was applied to the analysis of a pentapeptide drug (IRI-514) in rabbit and human plasma. Prior to analysis, the plasma samples were prepared using protein precipitation followed by solid-phase extraction. The lower limit of quantitation using selected ion monitoring was determined to be 2 ng/mL, when 8 mL of human plasma spiked with 1-40 ng/mL was extracted. Rabbit plasma (1 mL) samples spiked with 10-40,000 ng of authentic drug/mL gave a linear response when a deuterated peptide analog was employed as an internal standard. A commercial ESI interface was modified to permit higher flow rates (10-20 microL/min) to enter the mass spectrometer source. The revised interface provided a 10-fold increase in sensitivities and permitted the use of standard HPLC columns (2.0-mm i.d.) and HPLC instrumentation. ESI HPLC-MS analysis was automated to provide unattended, precise, and sensitive detection of small peptides in both human and rabbit plasma. Using this methodology, a toxicokinetic study of intravenously administered IRI-514 at three dose levels indicated that the area under the curve values were dose proportional.

We reported that difficult bladder emptying symptoms are prevalent in elderly men. Urodynamic tests were conducted among 94 volunteer male respondents identified from our Medical Epidemiologic and Social Aspects of Aging Study in Washtenaw County, Michigan. Urine flow rates were significantly slower among men with symptoms compared to those without symptoms; however, significant overlap exists. Voiding pressures were not significantly different between respondents with and without difficult bladder emptying symptoms. The results of voiding pressure flow studies on all respondents regardless of whether they have symptoms revealed 41% with an obstructive pattern (high pressure and poor flow), 28.2% with an underactive pattern (low pressure and low flow), 20.5% with a mixed pattern (high pressure and normal flow) and 10.3% with a normal pattern. Symptoms hesitancy was more reflective of weaker detrusor pressure and straining pattern. From these results we conclude that symptoms and flow rates should not be used as the sole criterion to diagnose obstruction but, rather, they should be included in the entire spectrum of clinical information needed to arrive at a clinical diagnosis.

The area around Worcester, Massachusetts, has been used to determine which deformational and metamorphic features are due to the Alleghanian (Permian) orogeny and which are pre-Alleghanian. Isolated, fault-bounded inliers of Carboniferous rocks display evidence of a single metamorphism and the formation of two prominent cleavages. The first cleavage formed synchronously with metamorphism. Pre-Carboniferous metasedimentary rocks have been affected by two metamorphisms and contain three prominent cleavages. The initial cleavage formed during the first metamorphism and the second cleavage formed during the second, retrogressive metamorphism. Thus the second two cleavages and the second metamorphism in pre-Carboniferous rocks are interpreted as Alleghanian. Normal displacements on two distinct faults are bracketed by the formation of the first and second Alleghanian cleavages. The initial faulting, along the newly defined Wachusett mylonite zone (WMZ), formed a wide zone of ductile mylonites which dips moderately to the northwest and contains elongation lineations which trend northwest. The second faulting, along the Clinton-Newbury fault (CNF) occurred along a steeply inclined plane which cuts the WMZ mylonites and contains a thin zone of phyllonites and mylonites which have elongation lineations which trend west. Alleghanian cleavages and metamorphism are confined to a mappable zone which is approximately 15 km wide where well defined. This zone is interpreted as a ductile shear zone which moved twice, forming the first and second Alleghanian cleavages. Early-formed, pre-Alleghanian metamorphic minerals are retrograded to hydrous phyllosilicates, and new hydrous minerals formed in the shear zone, indicating that it was a pathway for fluid flow. The initial motion was left-lateral with a thrust component. The second cleavage formed during top-to-the-northwest normal displacements. Thus the history of Alleghanian tectonism in this area began with sinistral faulting and then included three displacements along normal faults or shear zones. This suggests that the strain history included two distinct episodes, with the second experiencing slightly different strain orientations at different times, resulting in first WMZ normal motion, then CNF normal motion and finally normal displacements related to the second Alleghanian cleavages. This history agrees well with other work on the nature of the Alleghanian orogeny in the northeast United States.

This integrative study investigated the generalization of the transtheoretical model across 12 problem behaviors. The cross-sectional comparisons involved relationships between two key constructs of the model, the stages of change and decisional balance. The behaviors studied were smoking cessation, quitting cocaine, weight control, high-fat diets, adolescent delinquent behaviors, safer sex, condom use, sunscreen use, radon gas exposure, exercise acquisition, mammography screening, and physicians' preventive practices with smokers. Clear commonalities were observed across the 12 areas, including both the internal structure of the measures and the pattern of changes in decisional balance across stages.

This study examined whether distinct subgroups of women could be identified within stages of adoption for screening mammography. These subgroups may represent differential readiness to move to the next stage of the adoption continuum. Data were from a baseline survey of 1323 women between the ages of 50 and 74 years who were recruited through a staff- model HMO for an intervention study to increase rates of mammography. Multiple regression models were used to identify correlates of positive decisional balance within each of four stages of adoption, and an index of positive indicators was developed from the significant correlates for each stage. Analysis of variance showed that the number of positive indicators discriminated women within each stage. This information can be used to develop more effective tailored interventions to increase the percentage of women receiving mammograms on a regular schedule.

The risk of bleeding during dental procedures may be increased in patients with Gaucher disease. We aimed to evaluate potential coagulation and platelet function abnormalities and targeted therapy accordingly. Patients with type 1 Gaucher disease who were treated at the Oral and Maxilo-Facial surgery clinic at Sheba Medical Center between 2003 and 2010 comprised the study cohort. Data collected included disease history, enzyme treatment, platelet counts, dental therapy and outcome. Bleeding was defined as excessive bleeding during or immediately following procedure. Coagulation studies and platelet function tests including aggregometry were performed on all patients. Dental procedures (n = 14, including eight teeth extractions, two crown lengthening procedures, one cyst enucleation and three deep dental scaling) of seven patients were studied. Mean platelet count prior to procedure was 73 K ± 14.8 mm(3). Patients bleeding risk score was calculated according to previous history of bleeding tendency, degree of thrombocytopenia, presence of comorbid coagulopathy and the type of dental procedure. Two patients with highest risk score received prophylactic platelet transfusions, three patients (medium-risk) received DDAVP preprocedure and all received systemic tranexamic acid, which was the only systemic therapy for low-risk patients. Meticulous surgical local haemostasis was applied. No excessive intra-operative or postoperative bleeding occurred. Patients with Gaucher disease who have thrombocytopenia and abnormal platelet function tests may be safely treated if meticulous haemostasis is applied along with systemic therapy as required. Platelet transfusions are not mandatory and should be applied considering the procedure-related risk and the patient's calculated haematological risk for bleeding.

The efficacy of a home-based physical activity (PA) intervention for colorectal cancer patients versus contact control was evaluated in a randomized controlled trial.Forty-six patients (mean age = 57.3 years [SD = 9.7], 57% female, mean = 2.99 years post-diagnosis [SD = 1.64]) who had completed treatment for stages 1-3 colorectal cancer were randomized to telephone counseling to support PA (PA group, n = 20) or contact control (control group, n = 26). PA group participants received 3 months of PA counseling (based on the transtheoretical model and the social cognitive theory) delivered via telephone, as well as weekly PA tip sheets. Assessments of PA (Seven-day Physical Activity Recall [7-day PAR] and Community Healthy Activities Model Program for Seniors [CHAMPS]), submaximal aerobic fitness (Treadwalk test), motivational readiness for PA, and psychosocial outcomes were conducted at baseline, 3, 6, and 12 months post-baseline. Objective accelerometer data were collected at the same time points.The PA group reported significant increases in minutes of PA at 3 months (7-day PAR) and caloric expenditure (CHAMPS) compared with the control group, but the group differences were attenuated over time. The PA group showed significant improvements in fitness at 3, 6, and 12 months versus the control group. Improvements in motivational readiness for PA were reported in the PA group only at 3 months. No significant group differences were found for fatigue, self-reported physical functioning, and quality of life at 3, 6, and 12 months.A home-based intervention improved survivors' PA and motivational readiness at 3 months and increased submaximal aerobic fitness at 3, 6, and 12 months.

The recognition heuristic is a prime example of how, by exploiting a match between mind and environment, a simple mental strategy can lead to efficient decision making. The proposal of the heuristic initiated a debate about the processes underlying the use of recognition in decision making. We review research addressing four key aspects of the recognition heuristic: (a) that recognition is often an ecologically valid cue; (b) that people often follow recognition when making inferences; (c) that recognition supersedes further cue knowledge; (d) that its use can produce the less-is-more effect – the phenomenon that lesser states of recognition knowledge can lead to more accurate inferences than more complete states. After we contrast the recognition heuristic to other related concepts, including availability and fluency, we carve out, from the existing findings, some boundary conditions of the use of the recognition heuristic as well as key questions for future research. Moreover, we summarize developments concerning the connection of the recognition heuristic with memory models. We suggest that the recognition heuristic is used adaptively and that, compared to other cues, recognition seems to have a special status in decision making. Finally, we discuss how systematic ignorance is exploited in other cognitive mechanisms (e.g., estimation and preference).

Research exploring the relationship between psychological factors and the onset, exacerbation, and perpetuation of endocrine diseases has focused primarily on three diseases: diabetes mellitus (DM), Graves' disease, and Cushing's disease. There is insufficient evidence to support the position that psychological factors directly affect the onset of DM. Recent laboratory studies suggest that stress is associated with changes in glucose regulation in a subset of diabetic patients and that temperament and coping strategies influence glycemic control in diabetic children and adolescents. Relaxation training may improve blood glucose control in non-insulin-dependent DM patients. There is no good evidence that psychological characteristics affect the development and course of thyroid disorder or Cushing's disease. Recommendations are made for future research.

Patients who have completed Phase II cardiac rehabilitation have low rates of maintenance of exercise after program completion, despite the importance of sustaining regular exercise to prevent future cardiac events.The efficacy of a home-based intervention to support exercise maintenance among patients who had completed Phase II cardiac rehabilitation versus contact control was evaluated.An RCT was used to evaluate the intervention. Data were collected in 2005-2010 and analyzed in 2010.One hundred thirty patients (mean age=63.6 years [SD=9.7], 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n=64) or contact control (Contact Control group, n=66).Maintenance Counseling group participants received a 6-month program of exercise counseling (based on the transtheoretical model and social cognitive theory) delivered via telephone, as well as print materials and feedback reports.Assessments of physical activity (7-Day Physical Activity Recall), motivational readiness for exercise, lipids, and physical functioning were conducted at baseline, 6 months, and 12 months. Objective accelerometer data were collected at the same time points. Fitness was assessed via maximal exercise stress tests at baseline and 6 months.The Maintenance Counseling group reported significantly higher exercise participation than the Contact Control group at 12 months (difference of 80 minutes, 95% CI=22, 137). Group differences in exercise at 6 months were nonsignificant. The intervention significantly increased the probability of participants' exercising at or above physical activity guidelines and attenuated regression in motivational readiness versus the Contact Control Group at 6 and 12 months. Self-reported physical functioning was significantly higher in the Maintenance Counseling group at 12 months. No group differences were seen in fitness at 6 months or lipid measures at 6 and 12 months.A telephone-based intervention can help maintain exercise, prevent regression in motivational readiness for exercise, and improve physical functioning in this patient population.

Background Physician counseling can help patients make substantial changes in diet and physical activity behaviors that can result in weight loss and a reduction in metabolic risk factors. Unfortunately, time constraints and a lack of training often make it difficult for physicians to provide effective counseling. The objective in this study was to test the effect of a computerized support tool to enhance brief physician-delivered health lifestyle counseling to patients with increased metabolic risk factors during two usual care visits. Design/setting/participants This is a prospective controlled trial of a 12-month intervention conducted at two large community health centers serving mostly Hispanic patients. Participants (n=279) had a body mass index (calculated as kg/m 2 ) ≥25 and at least two components of the metabolic syndrome. Intervention In the intervention group, a computer program was used to help patients set tailored self-management goals for weight loss, nutrition, and physical activity. Goals were then reviewed and reinforced at clinic visits with participants' physicians at baseline and again at 6 months. The control group received care as usual. Data were collected between July 2007 and August 2008. Main outcome measures Change in body weight was the primary outcome. Secondary measures included changes in blood glucose, blood cholesterol, blood pressure, physical activity, and energy intake. Results Significantly more patients in the intervention group lost ≥5% of their body weight at 12 months than controls (26.3% vs 8.5%; odds ratio=3.86; P 5% of total body weight was associated with improvements in cardiovascular risk factors, including low-density lipoprotein cholesterol (−14.0 vs −4.1 mg/dL; P =0.04). Conclusions A brief computer-based intervention designed to increase the dialogue between patients and clinicians about behavioral goals can lead to increased 12-month weight loss.

Default options exert an influence in areas as varied as retirement program design, organ donation policy, and consumer choice. Past research has offered potential reasons why no-action defaults matter: (i) effort, (ii) implied endorsement, and (iii) reference dependence. The first two of these explanations have been experimentally demonstrated, but the latter has received far less attention. In three experiments we produce default effects and demonstrate that reference dependence can play a major role in their effectiveness. The experimental context involves two environmentally-consequential alternatives: cheap, inefficient incandescent lightbulbs, and expensive, efficient compact fluorescent bulbs. Within this context we also measure the impact of each potential rationale for a default effect. We find that the queries formulated by defaults can produce differences in constructed preferences and further that manipulating queries can also mitigate default effects.

We investigated in a rat myotube assay the combined effect of 26 myasthenic (MG) patient sera and a thymic peptide, thymopoietin (Tpo) which had previously been shown to bind Torpedo and human AChR and to compete with alpha-bungarotoxin (alpha-Bgt) binding. Cultures were first exposed to Tpo alone for 3 h (0.3, 7.5, 15 nM), then MG sera (5% final dilution) were added for an additional 18 h. Reduction in the amount of 125I-alpha-Bgt binding sites in the presence of various concentrations of Tpo were similar with control sera and in all the patients with low or undetectable anti-AChR Ab (11 cases). In cultures exposed to Tpo and sera with high anti-AChR Ab titre (15 cases), Tpo and anti-AChR Ab have an additive capacity to reduce the number of alpha-Bgt binding sites. The results are compatible with the hypothesis that anti-AChR Ab and Tpo could impair neuromuscular transmission by complementary mechanisms.

Carbon isotope composition, photosynthetic gas exchange, and nitrogen content were measured in leaves of three varieties of Metrosideros polymorpha growing in sites presenting a variety of precipitation, temperature and edaphic regimes. The eight populations studied could be divided into two groups on the basis of their mean foliar δ13C values, one group consisting of three populations with mean δ13C values ca.-26‰ and another group with δ13C values ca.-28‰. Less negative δ13C values appeared to be associated with reduced physiological availability of soil moisture resulting from hypoxic conditions at a poorly drained high elevation bog site and from low precipitation at a welldrained, low elevation leeward site. Gas exchange measurements indicated that foliar δ13C and intrinsic wateruse efficiency were positively correlated. Maximum photosynthetic rates were nearly constant while maximum stomatal conductance varied substantially in individuals with foliar δ13C ranging from-29 to-24‰. In contrast with the patterns of δ13C observed, leaf nitrogen content appeared to be genetically determined and independent of site characteristics. Photosynthetic nitrogenuse efficiency was nearly constant over the range of δ13C observed, suggesting that a compromise between intrinsic water- and N-use efficiency did not occur. In one population variations in foliar δ13C and gas exchange with leaf cohort age, caused the ratio of intercellular to atmospheric partial pressure of CO2 predicted from gas exchange and that calculated from δ13C to be in close agreement only in the two youngest cohorts of fully expanded leaves. The results indicated that with suitable precautions concerning measurement protocol, foliar δ13C and gas exchange measurements were reliable indicators of potential resource use efficiency by M. polymorpha along environmental gradients.

Objective. To assess the relative efficacy of methotrexate (MTX), azathioprine (AZA), and their combination in the treatment of rheumatoid arthritis (RA) in a double-blind, prospective, multicenter, controlled trial. Methods. Two hundred nine patients with active RA were treated with escalating doses of MTX (5–15 mg/week), AZA (50–150 mg/day), or combination (5 mg MTX/week plus 50 mg AZA/day–7.5 mg MTX/week plus 100 mg AZA/day), with opportunity to increase the dosage at 6-w eek intervals. The patients were evaluated for significant clinical and laboratory improvement and assessed for radiologic progression at 48 weeks. Results. One hundred ten patients remained on the initial, randomly assigned therapeutic regimen. The percentage of patients who were responders, defined as those who had 30% or greater improvement in at least 3 of 4 variables, was 38% for the combination treatment, 26% for AZA, and 45% for MTX (P = 0.06). A trend toward decreased radiologic progression was seen in the MTX-treated patients. Termination of treatment due to adverse experience occurred more frequently with combination and AZA treatments than with MTX treatment. Lack of effectiveness, adverse gastrointestinal effects, and liver enzyme elevation were the most frequent causes of treatment discontinuation. Conclusion. This study establishes that the combination of MTX and AZA in the dosages utilized is not associated with more toxicity than treatment with single agents; however, enhanced efficacy is also not seen. There is a trend toward decreased radiologic progression in patients treated with MTX.

A subcommittee of the American Psychiatric Association's Psychiatric Systems Interface Disorders Work Group was charged with examining the diagnostic category, Psychological Factors Affecting Physical Condition, for possible revision in the DSM-IV. As members of this subcommittee, we conducted a literature review to better characterize the current state of knowledge regarding the relationship between psychological factors and cardiovascular disease. This review, divided into two parts, focuses on three problems: coronary artery disease, sudden death, and hypertension. For each of these cardiovascular disorders, we describe models for understanding the relationship of psychological factors to the disorder, review the results of relevant research studies, and provide recommendations for further research.

Conventional approaches to reduce CO{sub 2} emissions, including fuel switching among fossil fuels, renewables, nuclear, end-use conservation, and increased efficiency, nearly all lead to reduction in coal use. Carbon removal technologies along have the potential to allow continued use of coal. All approaches must compete economically, technically, and environmentally for market share within the context of the total energy system. MARKAL, a dynamic energy systems model, was used to simulate this competition through 2025 for the US energy system. Three carbon removal technologies were evaluated: CO{sub 2} scrubbing from coal-fired power plant flue gas, CO{sub 2} separation during coal gasification, and carbon separation in the Hydrocarb process. CO{sub 2} was sequestered in depleted gas wells and the deep ocean, and solid carbon in depleted coal mines. All three technologies evaluated offer a more cost-effective path to CO{sub 2} emission reduction than the reference case. Moreover, the ability of pre-combustion methods of carbon removal can be combined with producing motor fuels as well as electric power fuels, a combination that provided greater opportunity for carbon removal.

Background . Medical illness has often been thought to provide smokers with motivation to quit smoking. However, the actual impact that illness and hospitalization has on smokers' interest in cessation is not clear. Further, little is known about the role that hospital staff play in encouraging cessation. Methods . This article is a descriptive study examining smoking prevalence and interest in cessation among 304 inpatients hospitalized in a specialized cardiovascular disease unit and a general medical unit. In addition, the efforts of hospital staff in promoting cessation were assessed. Results . The overall smoking prevalence among this older sample was 16%. Although the majority of smokers (79%) indicated a desire to quit smoking, there was little interest in using formal treatment options to quit. Quitting on one's own was the most preferred cessation strategy. Approximately one-third of the smokers expressed interest in receiving cessation counseling from their physicians. Patient reports indicated that both physicians and nurses on the general medical unit intervened on smoking less frequently than staff on the cardiovascular disease unit. Seventy-one percent of all smokers reported that the medical resident did not discuss smoking with them. Conclusion . Despite the small number of smokers in this sample, this study has implications for development of training programs for hospital staff on delivery of brief smoking interventions.

This entry describes the psychosocial framework and its resources. It is important to differentiate the psychosocial framework, which is a distinctive practice model, from the psychosocial or person-situation perspective that informs social work practice generally. The psychosocial framework originated in the early history of the social work profession and evolved greatly over time in response to new theoretical and practice developments. It exerted a major influence on social work practice, particularly from the 1940s to the 1960s, when it was the dominant social casework approach, particularly on the East Coast. Its goals were to restore, maintain, and enhance the personal and social functioning of individuals through mobilizing strengths; supporting coping capacities; building self-esteem; modifying dysfunctional patterns of thinking, feeling, and relating to others; linking people to necessary resources; and alleviating environmental stressors. Although it originally incorporated Freudian and ego psychological concepts, it has always drawn on both psychological and social theories. As new practice models developed in the 1960s, the psychosocial framework waned in importance, but it later underwent a resurgence. It continued to occupy an important place among an expanded repertoire of approaches and contributed to the generation of some of the newer practice models, such as crisis intervention. In recent years there have been numerous extensions to the psychosocial framework, which continues to be used widely by social work practitioners, particularly those who consider themselves to be clinical social workers. It may be more accurate today to describe the psychosocial framework as a perspective that guides practice rather than as a discrete practice model. Nevertheless, it does rely on a core of theoretical concepts and practice principles.

Treatment-related malignancies are widely reported in the medical literature. They are usually chemotherapy-related leukemias or radiation-induced solid tumors. Here we present a case of a 47-year-old woman treated with mantle radiation for Hodgkin's lymphoma who later developed a thymoma in the setting of a venous thrombosis. A review of the literature including surveillance recommendations for secondary malignancies will be discussed.

Simple statistical forecasting rules, which are usually simplifications of classical models, have been shown to make better predictions than more complex rules, especially when the future values of a criterion are highly uncertain. In this article, we provide evidence that some of the fast and frugal heuristics that people use intuitively are able to make forecasts that are as good as or better than those of knowledge-intensive procedures. We draw from research on the adaptive toolbox and ecological rationality to demonstrate the power of using intuitive heuristics for forecasting in various domains including sport, business, and crime. c 2009 International Institute of Forecasters. Published by Elsevier B.V. All rights reserved.

SUMMARY The process of smoking cessation involves progression through five stages of change: precontemplation, contemplation, preparation, action, and maintenance. Most patients are not prepared to take action on their smoking, yet most smoking cessation programs are designed for smokers who are so prepared. Small percentages of smokers register for action-oriented cessation programs. How much progress patients make after an intervention is directly related to what stage they are in prior to intervention. The stages of change can be quickly assessed with four questions. Physicians can then be more effective with a broader range of patients by matching their interventions to the patients’ stage of change. Helping patients progress just one stage can double their chances of not smoking 6 months later. Providing personalized information about the cons of smoking, asking affect-arousing questions, and encouraging patients to re-evaluate themselves as smokers are interventions physicians can use to help patients who are not prepared to quit smoking. Behavioral interventions, such as providing substitutes like nicotine gum and removing or altering cues for smoking, are most helpful for patients who are ready to take action. The use of a stage-matched, patient-centered counseling intervention can help physicians to feel less frustrated and more effective in their efforts to help a broad range of their patients.

Recent thinking about tobacco dependence has been influenced largely by a focus on the pharmacological effects of nicotine. We advocate a return to earlier views of dependence as comprising both pharmacological and non-pharmacological aspects. Moreover, we suggest that it may be profitable to reformulate research on dependence in terms of a bioinformational process model. The basic tenets of such a model are outlined, as are the challenges in exploring the nature of dependence simultaneously across the cognitive, physiological and behavioral domains of function.

Objective: To assess the effects of a communication skills training program for physicians and patients. Design: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). Main Outcome Measures: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians’ satisfaction and stress; and global ratings of the communication process. Results: The following significant (p .05) effects emerged: physician training improved patients’ satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians’ counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians’ sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians’ satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. Conclusion: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.

Gaining recognition in the United States in the late 1930s and 1940s, ego psychology focuses on a person's ego functions, defenses, sense of mastery, coping capacities, and life cycle stages. It also draws attention to the impact of interpersonal relationships, the environment, and the culture on human functioning. Biopsychosocial assessment, mobilizing client strengths, and the client-worker relationship are at the core of ego-oriented intervention, which utilizes psychological and environmental techniques. Ego-oriented intervention has been applied to diverse problems and populations and its proponents have attempted to integrate many of the ideas and principles of culturally sensitive, affirmative, and empowering interventive approaches. There is increasing evidence for the utility of ego psychological interventions and ego psychology is still popular today among social work practitioners. Keywords: ego psychology; ego-oriented intervention; clinical social work practice

Migration of epithelial cells is critical for normal homeostasis in gut and skin, but the factors regulating this process are not completely understood. The zinc finger transcription factor Klf5 (IKLF; BTEB2) is highly expressed in proliferating cells of esophagus, skin, and other organs. We hypothesized that Klf5 regulates keratinocyte migration via the integrin-linked kinase (ILK), which, like Klf5, is localized to basal keratinocytes. We stably transduced mouse primary esophageal keratinocytes to overexpress Klf5 or small interfering RNA against Klf5. Klf5 overexpression in keratinocytes increased migration and correlated directly with ILK expression and activation. ILK expression restored migratory capacity in keratinocytes with suppression of Klf5, whereas ILK small interfering RNA blocked the increased migration resulting from Klf5 overexpression. By chromatin immunoprecipitation, electromobility shift assay, and luciferase reporter assays, we confirmed that ILK was a direct target for Klf5. In addition, Klf5 induced the activation of the ILK targets Cdc42 and myosin light chain, which are critical for cell migration and motility but not Rac1, AKT, or GSK3β. Overall, these results demonstrate that Klf5 is a key regulator of cell migration via ILK and provide new insight into the regulation of epithelial cell migration.