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The physicochemical changes during the storage of high protein powders, such as skim milk powder (SMP), nonfat dry milk (NDM), and milk protein concentrates (MPC), can result in a variation in the functional properties of the powders. The objective of this study was to evaluate the effects of the storage of various milk powders (SMP, NDM, MPC40, and MPC70) on their functional properties. Three different lots of the powders were collected from US manufacturers and were analyzed for functional properties after 3, 9, and 15 months of storage at 25 °C. Additionally, this study also evaluated the effects of seasonal variation on the functionality of SMP and NDM. Functional properties, such as solubility, emulsification ability index (EAI), foaming, and surface hydrophobicity index (SHI), were evaluated at each storage time point. The solubility of MPC70 and the foam overrun of SMP, MPC40, and MPC70 decreased significantly (p < 0.05) with an increase in the storage time. The emulsification properties of MPC70 were significantly higher than other powders. Except for foam drainage, there was no effect of the season on the SMP and NDM functional properties. The storage of milk powders has an impact on some functional properties, and a proper selection of powders based on end-use is recommended.

ABSTRACT: Thermoduric bacteria are known to affect the quality of Cheddar cheese, with manifested defects including slits, weak body, and blowing. Thermoduric bacteria are likely to increase in numbers during cheese-making, as in-process conditions are conducive to proliferation. The present study was conducted to track thermoduric bacterial progression during an 18- to 20-h Cheddar cheese production run and during ripening when the pasteurizer was washed at midway through the production day. This study also correlated a broad range of chemical changes to the growth of thermoduric bacteria during ripening. Three independent cheese trials were performed at 3.5- ± 0.5-mo intervals. Samples were drawn in duplicates at 4 different times of the day: at the start of the run (vat 1), prior to a midday wash of the pasteurizer (vat 20), after the midday wash of the pasteurizer (vat 21), and at the end of the run (vat 42) for raw milk, pasteurized milk, and cheese. Cheeses were also tested during ripening for 6 mo. Results showed that raw milk total bacterial counts comprised 0.24% thermoduric mesophiles (TM) and 0.12% thermoduric thermophiles (TT). The thermoduric thermophilic bacterial counts increased by log10 1.23 during the pasteurizer run of 9 to 10 h, indicating a buildup of thermoduric thermophilic bacteria during the pasteurization process itself. Midday washing reduced thermophilic counts by log10 1.36, as evident by pre- and post-midday wash counts. However, a thermophilic buildup during post-midday wash was again noticed near the end of the 20-h run. We found that TT bacteria decreased in the first 60 d of ripening, whereas TM bacteria increased during the same period. However, TT bacteria increased later during 60 to 180 d of ripening. Bacillus licheniformis was the most frequently isolated bacteria in this study and was recovered at all production stages sampled during the cheese-making and ripening. We observed a significant increase in the level of orotic and uric acids in the vat made at the end of the day. No significant difference in the overall chemical composition, proteolysis, sugar, or other organic acids was observed in cheese made at the start versus the end of the production run.

Background: Cradle to Grave (C2G), a hospital-based violence prevention programme, brings inner-city youth into an urban Level I trauma centre to follow the path of an adolescent gunshot victim from trauma bay to morgue. We hypothesised that C2G alters student attitudes towards gun violence.Methods: Eighty-eight adolescents were prospectively enrolled. With parental and student consent, students completed the Attitudes Towards Guns and Violence Questionnaire (AGVQ), a previously validated and reliable social science assessment tool. Two weeks later, the students participated in C2G. The survey was re-administered four weeks after C2G participation. AGVQ results are reported both as a total score and as a breakdown of the four component subscales. Higher AGVQ scores indicate proclivity towards violence. ANOVA compared scores with respect to demographics and type of school (public vs. charter).Results: C2G altered student's attitudes towards guns and violence. Of 43 public school students, total scores decreased following C2G (p=0.02). The greatest attitudinal change occurred in subscale 1, "Aggressive Response to Shame" (p<0.01). C2G failed to produce significant changes AGVQ scores in the 45 students attending a city charter school. The two groups were found to have baseline differences, with public school students showing higher baseline tendencies towards violence.Conclusions: Our hospital-based programme is capable of positively impacting adolescents' attitudes towards guns and violence. This effect is most pronounced in subjects who already display increased tendencies towards violence. These results suggest that hospitals offer a unique opportunity to address the public health crisis posed by inner-city firearm violence. [ABSTRACT FROM AUTHOR]

Autoantibodies to the 75-kDa and 100-kDa subunits of the PM/Scl nucleolar protein complex are associated with an overlap syndrome, manifesting with clinical features of systemic sclerosis and idiopathic inflammatory myopathy. We describe the diverse clinical features in a series of 4 cases with anti-PM/Scl-75 and/or anti-PM/Scl-100 antibodies, including severe proximal muscle weakness, oesophageal dysfunction, respiratory weakness requiring mechanical ventilation, Raynaud's, calcinosis cutis, sclerodactyly and critical digital ischaemia. Despite the severity of striated and oesophageal muscle weakness, all patients responded very well to immune suppression, and calcinosis cutis in one case regressed substantially. We highlight the efficacy of Rituximab and intravenous immunoglobulin therapy (IVIg) in these cases, enabling return to normal muscle function within six months. Rituximab was preferentially chosen for cases with hyper-gammaglobulinemia and multiple autoantibodies in addition to anti-PM/Scl, and IVIg was utilised for cases where a rapid onset of effect was required, such as severe ventilator-dependent respiratory muscle weakness and oesophageal dysfunction., (© 2022. The Author(s).)

Most biopharmaceuticals produced today are generated using Chinese hamster ovary (CHO) cells, therefore significant attention is focused on methods to improve CHO cell productivity and product quality. The discovery of gene-editing tools, such as CRISPR/Cas9, offers new opportunities to improve CHO cell bioproduction through cell line engineering. Recently an additional CRISPR-associated protein, Cas12a (Cpf1), was shown to be effective for gene editing in eukaryotic cells, including CHO. In this study, we demonstrate the successful application of CRISPR/Cas12a for the generation of clonally derived CHO knockout (KO) cell lines with improved product quality attributes. While we found Cas12a efficiency to be highly dependent on the targeting RNA used, we were able to generate CHO KO cell lines using small screens of only 96-320 clonally derived cell lines. Additionally, we present a novel bulk culture analysis approach that can be used to quickly assess CRISPR RNA efficiency and determine ideal screen sizes for generating genetic KO cell lines. Most critically, we find that Cas12a can be directly integrated into the cell line generation process through cotransfection with no negative impact on titer or screen size. Overall, our results show CRISPR/Cas12a to be an efficient and effective CHO genome editing tool., (© 2021 Wiley-VCH GmbH.)

Ankle arthritis is a useful clinical signpost to differential diagnosis in rheumatic disease. Biomechanical features and differences in cartilage physiology compared with the knee may confer protection of the ankle joint from factors predisposing to certain arthritides. The prevalence of ankle OA is low, and usually secondary to trauma. Primary OA of the ankle should be investigated for underlying causes, especially haemochromatosis. New presentations of inflammatory mono/oligo arthritis involving the ankle are more likely due to undifferentiated arthritis or spondyloarthritis than RA, and gout over CPPD. The ankle is often involved in bacterial and viral causes of septic arthritis, especially bacterial, chikungunya and HIV infection, but rarely tuberculosis. Periarticular hind foot swelling can be confused with ankle arthritis, exemplified by Lofgren's syndrome and hypertrophic osteoarthropathy where swelling is due to subcutaneous oedema and osteitis respectively, and the ankle joint is rarely involved., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: To present a detailed exploratory data analysis for critically investigating the patterns in medical doctor (MD) to disposition time, pre and post 24/7/365 attending radiologist coverage, for patients presenting to an emergency department (ED)., Materials and Methods: The process involved presenting several modeling techniques. To share an understanding of concepts and techniques, we used proportions, medians, and means, Mann-Whitney U test, Kaplan-Meier's (KM) survival analysis, linear and log-linear regression, log-ranked test, Cox proportional hazards model, Weibull parametric survival models and tertile analysis. Retrospective chart review was conducted to obtain a data set which was used to determine the trends in MD to disposition time. Data comprised of patients who had visited the emergency department (ED) during two distinct time periods and whose imaging studies were read by an attending emergency and trauma radiologist., Results: Median provided more insight into the data as compared with the mean. The Mann-Whitney U test was appropriate to evaluate MD to disposition time, but provided limited information. The Kaplan-Meier (KM) was able to offer more insight into the data since it did not assume an underlying model and that is the reason why it was appropriate. However, KM had limited ability to handle measured confounders and was unable to describe the magnitude of difference between curves. The Cox proportional hazards semi-parametric model or some other parametric model such as the Weibull could handle multiple measured confounders and described the magnitude of difference between two (survival) groups in the data set. However, both methods assumed underlying models that may not apply to the data set such as the one used in this study. Linear regression was unlikely to be appropriate due to the shape of survival time distributions, but log transforming the outcome could address the distribution issue. Nearly all the results of the KM subgroup analyses were consistent with the results of the log-transformed linear regression subgroup analyses and the interpretation of the results was the same for both., Conclusion: Different statistical procedures may be applied to conduct exploratory subgroup analysis for a data set from a pre and post 24/7/365 attending coverage model. This could guide potential areas of further research to compare trends in MD to disposition time in ED. Pattern analysis provides evidence for various stakeholders to rethink the discourse about trends in MD to disposition time, pre and post 24/7/365 attending coverage. Graphical Illustration: The role of Emergency and Trauma Radiology in an Emergency Department.

The above article has an error in Figure 6 online (already correct in the PDF version) including the Graphical abstract figure. The original article has been corrected.

Remembering arbitrary associations, such as unrelated word pairs or object-background pairs, appears to depend on recollection. However, for cases in which the components of an association share pre-existing semantic relations, can familiarity support associative recognition? In two experiments with congruent object-background pairings, we found that participants were successful at direct and indirect associative recognition in both 1000 ms time restriction (speeded) and unlimited response time (non-speeded) test conditions. Because dual-process theory postulates that familiarity is less impacted by speeded responses, relative to recollection, these findings suggest that congruent object-background associations may not necessitate recollection when an arbitrary link is not constructed at encoding. Experiment 3 compared direct associative memory for congruent and incongruent object-background pairs in speeded and non-speeded test conditions. We found that participants in the non-speeded condition performed comparably with congruent and incongruent pairs, whereas those in the speeded condition performed significantly worse on the incongruent pairs than on the congruent pairs. Together, these findings suggest a differential role of familiarity and recollection depending on the types of associations. Implications for dual-process recognition memory models and levels of unitization framework are discussed.

The revelation effect is a robust phenomenon in episodic memory whereby stimuli that immediately follow a simple cognitive task are more likely to garner positive responses on a variety of memory tests, including autobiographical memory judgments. Six experiments investigated the revelation effect for judgments of past and future events as well as judgments made from others' perspectives. The purpose of this work was to determine whether these subjectively distinct judgments are subject to the same decision-making biases, as might be expected if they are governed by similar processes (e.g., Schacter, Addis, & Buckner 2007). College-aged participants were asked to rate a variety of life events according to whether the events had occurred during their childhoods or would occur during the next 10 years. Events that followed an anagram task were judged as more likely to have happened in the past and more likely to occur in the future. We also showed a revelation effect when participants were asked to adopt the perspective of others when making judgments about past and future events. When the task was reworded to be non-episodic (participants judged how common the events were during childhood and adulthood), no revelation effect was found for either past or future time frames, which suggests common boundary conditions for both types of judgments. The results are consistent with studies showing strong parallels between remembering and other forms of self-projection but not with semantic memory judgments.

Previous research on the effects of Divided Attention on recognition memory have shown consistent impairments during encoding but more variable effects at retrieval. The present study explored whether effects of Selective Attention at retrieval and subsequent testing were parallel to those of Divided Attention. Participants studied a list of pictures and then had a recognition memory test that included both full attention and selective attention (the to be responded to object was overlaid atop a blue outlined object) trials. All participants then completed a second recognition memory test. The results of 2 experiments suggest that subsequent tests consistently show impacts of the status of the ignored stimulus, and that having an initial test changes performance on a later test. The results are discussed in relation to effect of attention on memory more generally as well as spontaneous recognition memory research., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Regulation of protein abundance is crucial to virtually every cellular process. Protein abundance reflects the integration of the rates of protein synthesis and protein degradation. Many assays reporting on protein abundance (e.g., single-time point western blotting, flow cytometry, fluorescence microscopy, or growth-based reporter assays) do not allow discrimination of the relative effects of translation and proteolysis on protein levels. This article describes the use of cycloheximide chase followed by western blotting to specifically analyze protein degradation in the model unicellular eukaryote, Saccharomyces cerevisiae (budding yeast). In this procedure, yeast cells are incubated in the presence of the translational inhibitor cycloheximide. Aliquots of cells are collected immediately after and at specific time points following addition of cycloheximide. Cells are lysed, and the lysates are separated by polyacrylamide gel electrophoresis for western blot analysis of protein abundance at each time point. The cycloheximide chase procedure permits visualization of the degradation kinetics of the steady state population of a variety of cellular proteins. The procedure may be used to investigate the genetic requirements for and environmental influences on protein degradation.

Five experiments were conducted to test whether encoding manipulations thought to encourage unitization would affect fluency attribution in associative recognition memory. Experiments 1a and 1b, which utilized a speeded recognition memory test, demonstrated that definitional encoding increased reliance on familiarity during the recognition memory test. Experiments 2a, 2b, and 3, however, replicated previous research that had shown that fluency is unlikely to be attributed as evidence of previous occurrence in associative recognition (Westerman, Journal of Experimental Psychology: Learning, Memory, and Cognition 27:723-732, 2001). The results put limits on the degree to which fluency can influence recognition memory judgments, even in cases of enhanced familiarity, and are consistent with previous work suggesting that participants have preexperimental expectations about fluency that are difficult to change (e.g., Miller, Lloyd, & Westerman, Journal of Memory and Language 58:1080-1094, 2008), as well as with work suggesting that fluency has less of an influence on recognition memory decisions that are conceptual in nature (Parks, Journal of Experimental Psychology: Learning, Memory, and Cognition 39:1280-1286, 2013).

Four experiments were conducted to test whether conjunction errors were reduced after pictorial encoding and whether the semantic overlap between study and conjunction items would impact error rates. Across 4 experiments, compound words studied with a single-picture had lower conjunction error rates during a recognition test than those words studied with 2 pictures. This effect occurred even when participants were asked to respond quickly (Experiment 3) or to respond positively to any word that overlapped with the study phase (Experiment 2), as well as when the number of pictures shown at study was manipulated within-participants (Experiment 4). The effect of semantic overlap was ambiguous, with only Experiment 2 showing a difference between high and low overlap items. Overall, these results are inconsistent with a metacognitive interpretation of the role of pictures in reducing memory errors and are more consistent with impoverished familiarity after single-picture encoding., (PsycINFO Database Record (c) 2013 APA, all rights reserved.)

Four experiments were conducted to test the impact of having multiple heuristics (distinctiveness and fluency) available during a recognition test. Recent work by Gallo, Perlmutter, Moore, and Schacter (Memory & Cognition 36:461-466, 2008) suggested that fluency effects are reduced when the distinctiveness heuristic can be applied to a recognition decision. In Experiment 1, we used a response reversal paradigm (Van Zandt & Maldonado-Molina Journal of Experimental Psychology: Learning, Memory, and Cognition 30:1147-1166, 2004) to demonstrate that participants transitioned from an early response strategy that was largely reliant on fluency to a later strategy in which the influences of fluency and distinctiveness were both observable. Experiments 2a, 2b, and 3 showed no evidence for reduction of the fluency heuristic after picture study when the test required a delayed response (Exp. 2a), confidence ratings (Exp. 2b), or the application of conceptual fluency (Exp. 3). The results are consistent with models of memory that assume that familiarity and recollection influence individual memory decisions Wixted (Psychological Review, 114:152-176, 2007).

We hypothesized that T2DM vasculopathy can be revealed and quantified in the bulbar conjunctiva prior to its pathologic presentation in the retina. Using computer-assisted intravital microscopy (CAIM), an objective, non-invasive approach can provide a viable complement to retinal fundus photography to possibly screen patients for early signs of real-time, in vivo T2DM vasculopathy. Fundus photography was utilized to determine the retinopathy level (RL) in T2DM patients with non-proliferative diabetic retinopathy (NPDR) and control subjects. CAIM was used to quantify microangiopathy in the bulbar conjunctiva in the same patients, and reported on a severity index (SI). The average RL for the T2DM patients in this study is 19.68 ± 9.91, which differs from control subjects (RL = 10 ± 0.0; p < 0.05). A significant difference in vasculopathy was observed in the conjunctival microcirculation in the same patients (SI = 5.81 ± 1.30) when compared with control subjects (SI = 1.33 ± 1.58; p < 0.05). The results provide evidence that significant vasculopathy had developed in the microcirculation in the bulbar conjunctiva, though diabetic retinopathy had not developed significantly in the same patients - indicative of the presence of a time window for early intervention of T2DM before non-proliferative retinopathy develops, and the real-time availability of the conjunctival microvasculature as an in vivo platform to monitor disease progression.

Previous research has suggested that performance for items requiring memory-binding processes improves between ages 4 and 6 (J. Sluzenski, N. Newcombe, & S. L. Kovacs, 2006). The present study suggests that much of this improvement is due to retrieval, as opposed to encoding, deficits for 4-year-olds. Four- and 6-year-old children (N = 48 per age) were given objects, backgrounds, and object + background combinations to remember. Younger children performed equivalently to 6-year-olds during a working memory task for all types of memory questions but were impaired during a long-term memory task for the object + background combinations. Furthermore, this deficit was completely due to differences in false alarm rates, suggesting that separate analyses of hits and false alarms may be preferable to corrected recognition scores when studying memory development.

Two experiments are presented that explore the role of the distinctiveness heuristic (e.g., Schacter, Israel, & Racine, 1999) on rates of conjunction errors as a function of encoding condition. The results of Experiment 1 demonstrate a reliable reduction of conjunction errors when participants study pictures relative to both reading words aloud and silently. Experiment 2 demonstrates that the nature of the pictures presented during the study phase is important for reducing conjunction errors. Collectively, the experiments demonstrate that participants can use the distinctiveness heuristic in addition to recall-to-reject strategies to avoid conjunction errors. These findings add to a growing body of literature that suggests that participants are able to use expectations for memory to guide their recognition decisions.

Two experiments were conducted to investigate the effect of letter location information in recognition memory judgments. The experiments used the recognition without identification paradigm (Peynircioglu, 1990), in which participants first attempt to identify the test item and then make a recognition decision as to whether or not the item was studied. In these studies, items that are not identified but that correspond to items that were presented are typically still rated as more likely to have been studied than those that were not presented. The present experiments demonstrated this finding with a variant of the conjunction lure paradigm. In Experiments 1 and 2, participants were tested with word fragments that were made from the letters of two words. When the letters were from studied items, fragments were rated higher than when the test items were derived from two unstudied items, or one studied item and one unstudied item, suggesting that recognition without identification is prone to the same types of errors as recognition with identification. Results are discussed in terms of familiarity effects in recognition memory.

In five experiments, we investigated the primacy effect in memory for repetitions (DiGirolamo & Hintzman, 1997), the finding that when participants are shown a study list that contains two very similar versions of the same stimulus, memory is biased in the direction of the version that was presented first. In the experiments reported, the generality of the effect was examined by manipulating the orientation and features of the repeated stimuli. The results confirmed that the effect is reliable when stimulus changes affect the accidental properties of the stimulus (properties of the stimulus that give information about distance or angle but do little to aid in identification). However, the effect was not found when changes were made to other aspects of the stimulus. The results suggest that the primacy effect in memory for repetitions is not robust across all stimulus changes and converge with previous findings that have demonstrated that such properties of stimuli as orientation and size are represented differently in memory than are other stimulus characteristics.

Four experiments (total N=295) were conducted to determine whether within-modality changes in perceptual form between the study and the test phases of an experiment would moderate the role of the fluency heuristic in recognition memory. Experiment 1 showed that a change from pictures to words reduced the role of fluency in recognition memory. In Experiment 2, the same result was found using counterfeit study lists that supposedly consisted of pictures or words. Experiments 3 and 4 showed that changes in the font used to present the study and test words also attenuated the contribution of fluency to the recognition decision when font change was manipulated between subjects, but not within subjects. Results suggest that the fluency heuristic is subject to metacognitive control, since participants' attributions of perceptual fluency depend on the perceived usefulness of fluency as a cue to recognition.

Objective: For years it has been shown that more children die from moderate malnutrition (MM) than severe. Till yet few studies deal specifically with identifying these children. This study attempts to statistically determine the appropriate anthropometric measures and cut-off points for diagnosing moderate malnutrition in preschool children., Methods: Anthropometric measurements were obtained from 609 preschool children from the cities of Adigrat, Ethiopia; Janampet, India; San Paulo, Brazil. The values were used to determine the sensitivity, specificity, positive predictive value (PPV) and likelihood ratio (LR) of each index studied. The optimum cutoff point for each index was considered to be the cutoff point with the maximum Kappa coefficient for efficiency. The McNemar Test for the significance of changes was used to determine if these findings were in agreement when applied to this data., Results: Weight for height (WFH) at each site had the highest PPV and LR of 4 but was not signficant by the McNemar Test. Mid-upper arm circumference (MUAC) in India had the same PPV (77%) as WFH but a LR of 2. MUAC in India, Brazil and Ethiopia tested significantly for the McNemar Test. The cut-off point for MUAC in India and Brazil was determined to be <15.5 cm in India and Brazil but was <15 cm in Ethiopia. Waist circumference in India tested a significantly PPV of 64%, and a LR of 2., Conclusion: These results show that WFH and MUAC could be used with WFA to identify the MM child. The cut-off points for MUAC may vary per location. WC positive data suggests further study is warranted. The McNemar findings yielded significant evidence that statistically determined indicators can be established to identify MM. With further study these methods may prove to be an important component in the efforts to improve child survival.

A 52-year-old woman with rheumatoid arthritis treated with low-dose steroids developed bilateral distal tibia and fibula fractures over a 15-month period. Her bone density was within osteopenic levels. Such fractures are an unusual but increasingly recognised complication of rheumatoid disease and its treatment, although there is often diagnostic delay. Bilateral fractures are particularly rare. A high level of clinical suspicion is required for early diagnosis.

Purpose: To describe neuromuscular effects of rapacuronium in pediatric patients during N2O-halothane anesthesia and compare them with mivacurium in children., Methods: 103 pediatric patients, seven days -12 yr, received rapacuronium or mivacurium during N2O-halothane anesthesia. Onset and recovery of block were measured using EMG (Datex). Block was compared between groups based on drug treatment and age. Children < two years received 1 or 2 mg x kg(-1) rapacuronium: 2-12 yr received either 2 mg x kg(-1) or 3 mg x kg(-1) rapacuronium, or 0.2 mg x kg(-1) mivacurium., Results: There were no differences in onset (1.7+/-1.8 min) or maximum block (T1 2.4+/-8%) among neonates, infants, and toddlers after either dose of rapacuronium. There was no difference between 1 and 2 mg x kg(-1) of rapacuronium block at 60 sec. Train-of-four ratio (T4/T1) >0.7 occurred later after 2 mg x kg(-1) than 1 mg x kg(-1) in these patients (P<0.05). There was no difference in T25 among neonates, infants and toddlers for 1 mg x kg(-1) or 2 mg x kg(-1) doses. Rapacuronium, 3 mg x kg(-1), produced maximum block 1.5 min earlier than did mivacurium, 0.2 mg x kg(-1) (P<0.001). There was no difference in block at 60 sec, maximum block or time to maximum block between 2 and 3 mg x kg(-1) rapacuronium for children > two years of age. Maximum block occurred 1.0+/-0.5 min after 2 or 3 mg x kg(-1) when T1 was 0.2+/-1.1% of baseline. T25 and T4/T1 >0.7 occurred 10 to 11 min later after this dose of rapacuronium than after mivacurium., Conclusion: Rapacuronium produces block earlier than mivacurium. Recovery from rapacuronium block is dose related and slower than that following mivacurium during halothane anesthesia.

Study Objective: To distinguish among potential predictors of early, easy intubation in children, including apnea, neuromuscular block at two sites, and time, after administration of 0.3 mg/kg of mivacurium., Design: Prospective, randomized study., Setting: Operating rooms of Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania., Patients: 60 ASA physical status I and II children aged 2 through 7 years, scheduled for elective surgical procedures requiring endotracheal intubation., Interventions and Measurements: After premedication with midazolam, general anesthesia was induced with halothane and nitrous oxide, and patients were randomly assigned to one of four groups. Mivacurium 0.3 mg/kg was given and tracheal intubation was begun 45 seconds after its injection, or when apnea, block of the orbicularis oculi, (OO) or block of the adductor pollicis (AP) was noted. Intubation conditions were evaluated by an experienced endoscopist., Main Results: The first clinical event after administration of mivacurium 0.3 mg/kg was apnea at 43 seconds (median) (average 48 seconds, SEM 2 seconds) after injection. The difference in the time at which neuromuscular block occurred at the AP (median 75 seconds) (average 77 seconds, SEM 2 seconds) and the OO (median 63 seconds) (average 68 seconds, SEM 4 seconds) was statistically, but not clinically, significantly different. All nine intubations that were begun at least 90 seconds after administration of mivacurium resulted in good or excellent intubation conditions, as did 30 of the 51 intubations started earlier., Conclusions: In children, there is no advantage to monitoring neuromuscular function at the OO rather than the AP. After administration of 0.3 mg/kg of mivacurium, a 90-second interval before the start of intubation was a better predictor of good intubation conditions during halothane anesthesia (1% inspired) than were changes in evoked neuromuscular function.

Doxacurium was administered by titrated infusion to 14 pediatric patients for 4.7-12.3 days after laryngotracheal reconstruction to produce minimum spontaneous movement and less than five posttetanic movements of the first toe after stimulation of the posterior tibial nerve. Recovery was documented by stimulation of the ulnar nerve with 2 Hz for 2 s (train-of-four [TOF]) at intervals of 1 min and measurement of the ratio of the fourth to the first response (TOF ratio) at the adductor pollicis. During spontaneous recovery, the TOF ratio was between 0.4 and 0.7 for 0.6-3.3 h, mean (SEM) 2.2 (0.31) h. The TOF ratio equaled 1 between 4.7 and 23.0 h, mean (SEM) 11.0 (2.1) h after termination of doxacurium infusion. In six of the patients, weakness and decreased coordination were noted for a few days to weeks postoperatively. There were no complications related to impairment of upper airway function or ventilation in those patients who had recovery of neuromuscular transmission to the extent of TOF ratio equal to 1 prior to extubation or in those patients in whom weakness or lack of coordination was noted after tracheal extubation.

In this prospective study we tested the hypothesis that atropine administration, which is known to increase heart rate and cardiac output in infants, will result in a faster onset of neuromuscular block with atracurium. Thirty infants scheduled for elective surgery had anaesthesia induced with nitrous oxide and halothane. Fifteen patients were given atropine and 15 patients acted as controls. All the infants were given atracurium 0.5 mg.kg-1, and neuromuscular block was recorded with the Datex 221 neuromuscular transmission monitor. Although atropine caused an increase in heart rate compared to the control group (median 164 [range 151-182] vs 120 [98-160]min-1 P < 0.0001), there was not a statistically significant difference in the onset of neuromuscular block between the two groups. We conclude that onset of neuromuscular block after atracurium is determined mainly by noncirculatory factors and less by the circulation time to the muscle. The effect of atropine on the time course of neuromuscular block might be different with faster acting neuromuscular blockers.

Objective: To assess the association between serum insulin-like growth factor-I (IGF-1) concentrations and osteoarthritis, and bone mineral density, and fractures in a large group of middle aged women from the general population., Methods: 761 women aged 44-64 years from the Chingford study had serum IGF-I concentrations measured; hand, hip, spine, and anteroposterior weight bearing knee radiographs taken; and dual energy x ray absorptiometry (DEXA) scans of the hip and spine. X rays were scored using the Kellgren and Lawrence system. In addition knee x rays were scored using a standard atlas for individual features of osteophytes and joint space narrowing (both graded 0-3). IGF-I concentrations were adjusted for the effects of age., Results: In the osteoarthritis analysis results were compared to a constant group of 155 subjects with no evidence of osteoarthritis at any site. There was no significant difference in serum IGF-I between these subjects and 606 subjects with osteoarthritis at any site. When individual sites were analysed, serum IGF-I was higher in those cases with more severe bilateral knee osteoarthritis and in those with distal interphalangeal (DIP) joint disease. There was no significant association between serum IGF-I and other forms of osteoarthritis or milder forms of knee osteoarthritis. There was no correlation between IGF-I concentrations and bone mineral density at the spine or hip, nor any difference between IGF-I concentrations in subjects with and without a history of non-traumatic fracture [22.8 (SD 6.6) v 23.1 (SD 6.6) nmol litre-1, P = 0.6], Conclusions: There is a modest association between IGF-I concentrations and the development of DIP osteoarthritis and more severe or bilateral knee joint osteoarthritis in women from the normal population, but no association with other forms of osteoarthritis, bone density, or fractures.

Free protein S:Ag and protein S activity determined by clotting assay are often regarded as synonymous; however, in the study group of patients, abnormal protein S activity (PS:Act) results correlated poorly with abnormal free (PS:Ag(r2 = 0.164). Significantly none of the patients in whom lupus anticoagulant and low free protein S:Ag were detected were found to have low PS:Act. These results could not be explained by activated protein C resistance, suggesting that lupus anticoagulant may cause prolongation of the clotting time within the PS:Act assay and thus give falsely high results. As reduced levels of free protein S:Ag and/or protein S activity are considered risk factors of thrombosis in systemic lupus erythematosus, these findings question the suitability of the protein S activity assay for patients who may have phospholipid antibodies.

Despite its obvious benefits, many physicians are reluctant to prescribe HRT to patients with SLE. We have performed a retrospective study in 60 postmenopausal women with SLE including 30 HRT users and 30 never users. The patients were studied for 12 months after the initiation of HRT. The two groups were well matched for disease characteristics. The HRT users experienced significant improvements in general well being, libido and depression. There was no significant difference in any other parameter measured. There was no increase in the number of thrombo-embolic events in the user group despite 7 patients having a positive thrombophilia screen. In conclusion, in stable postmenopausal SLE HRT appears well tolerated and safe.

We report on a 24 year old woman with systemic lupus erythematosus (SLE) who presented with a cerebrovascular accident affecting her right side. Unusually, this was associated with an aortic root thrombus with absence of any commonly recognised thrombophilic features. Following removal of the thrombus and anticoagulation, she made a good recovery. The relationship between valvular problems and cerebral lesions in SLE is discussed.

This study investigated whether the gender of manuscript authors affected reviewers' editorial decisions. Female and male reviewers for five behavioral journals were asked to evaluate identical manuscripts according to their usual criteria. Half the manuscripts were supposedly written by men and half by women. Male reviewers did not evaluate male- and female-authored manuscripts differently. Female reviewers accepted significantly more female-authored (62%) than male-authored (10%) manuscripts. Female-authored manuscripts were accepted significantly more often by female (62%) than by male (21%) reviewers. Information unrelated to the quality of the manuscript appears to have influenced reviewers' decisions. Implications for the journal review process are discussed.

Daily electricity consumption of four families was recorded for 106 days. A reversal design, consisting of various experimental conditions interspersed between repeated baseline conditions, was used. During experimental conditions, daily prompts (written conservation slogans attached to front doors) and/or daily feedback (daily kilowatts consumed and daily cost information) were in effect. Maximum consumption occurred during the initial baseline; minimum consumption occurred during different experimental conditions for different families. The mean decrease from the maximum to the minimum for all families was 35%. Reversals in consumption were demonstrated in three families, although successive baselines tended to decrease. No clear differences in effectiveness between prompting and feedback conditions were apparent. The procedures used resulted in considerable dollar savings for the families.