The outcome of diabetic pregnancies: a prospective study. In a large prospective study of pregnancy the perinatal mortality rate was 141/1000 births for diabetic gestations in which the onset of labour was spontaneous, 33/1000 for diabetic gestations in which labour was induced or the infant delivered by Caesarean section and 34/1000 for the non-diabetics. Forty per cent of the perinatal mortality excess in the diabetics was due to the consequences of maternal vascular lesions, i.e. large placental infarcts and marked retardation of placental growth. Seventeen per cent of the perinatal mortality excess was related to maternal acidosis or to insulin shock, 12% to severe congenital anomalies, 12% to the complications of Caesarean sections and the remainder to other disorders. Mothers with diabetes mellitus had more than twice the frequency of atheromata, fibrinoid change and thrombi in decidual arteries as non-diabetic mothers. Histological grading revealed that overweight newborns of diabetic mothers had immature lungs by comparison with the lungs of normally grown infants of diabetic mothers and infants of non-diabetic mothers. Low IQ values and an excess of neurological abnormalities in children of diabetic mothers who were ketotic during pregnancy were found to be due to amniotic fluid bacterial infections and their complications rather than to the maternal ketosis.


Congenital malformations: the possible role of diabetes care outside pregnancy. A consecutive and prospective series comprising 949 newborn infants of diabetic mothers treated during pregnancy and delivery in the period 1966--1977 has been analysed. The malformation rate was 8.2%. As compared to infants of mothers (White classes B-F alone) controlled outside pregnancy elsewhere, the rate of malformations was significantly reduced (from 14.1 to 7.4%) in fants whose mothers attended two hospitals specializing in the treatment and ambulatory control of diabetics. For diabetics not controlled at a diabetic centre outside pregnancy the malformation rate was 9% in classes B + C and 19.4% in classes D + F, compared to 6.2 and 8.5%, respectively, for those who were controlled. The rates of malformation (total as well as severe alone) were significantly reduced in infants of White's classes D + F, and insignificantly reduced in classes B + C (in class A no comparison could be made). The findings indicate that poor diabetic control outside pregnancy is teratogenic, although the 'disastrous malformation factor' of diabetes appears not to be totally dependent on the degree of compensation of the disbetic metabolism, as measured by the variables usually applied.


Principal substrates of fetal metabolism: fuel and growth requirements of the ovine fetus. In those fetuses studied, the glucose uptake by the fetus has been a major source of calories, although in all instances it has been insufficient to account for the total fuel requirements of the fetus. The glucose/oxygen quotients in different mammalian fetuses vary from about 0.5 to 0.8. Glucose transport across the placenta has been altered by fetal hyperinsulinaemia and by maternal fasting. Fetal hypoglycaemia is common to both conditions. However, umbilical glucose uptake increases with fetal hyperinsulinaemia and decreases with maternal fasting. During fasting, concomitant with a decrease in fetal glucose supply, there is an increase in amino acid catabolism. A high rate of placental production of both ammonia and lactate has been demonstrated in several mammalian species. Umbilical lactate uptake is sufficient to account for about 25% of the oxygen consumption in the ovine fetus. Ammonia production by the sheep placenta is reflected in increased ammonia concentrations in both the maternal and fetal circulations. In the ovine fetus, transport of umbilical amino acid has exceeded that required for new tissue growth, supporting the observations of a high urea production rate during fetal life. Neutral and basic amino acids represent the bulk of the amino acids transported across the placenta. In contrast there is a net uptake of glutamate from the fetal circulation into the placenta and very little umbilical uptake of aspartic acid. The umbilical uptake of free fatty acids varies markedly among species. In some species, such as the sheep and the cow, no umbilical veno-arterial differences for free fatty acids can be demonstrated.


Methionyl-tRNA-Met-f deacylase. Purification, characterization, and effects on translational initiation complexes. A methionyl-tRNA-Met-f deacylase was found in ribosomal salt wash from cultured human cells of the HeLa line. This enzyme was purified by the use of DEAE-cellulose, ammonium sulfate precipitation, gel filtration and isoelectric focusing, and appears to be a protein with a native molecular weight of 80,000, which consists of two 40,000-Mr subunits. The mechanism of the Met-tRNA-Met-f deacylase is shown to involve end-product inhibition by the deacylated form of Met-tRNA-Met-f. The methionyl-tRNA-Met-f deacylase is rather specific for Met-tRNA-Met-f as opposed to Met-tRNA-Met-m, has a KCl optimum of 85 mM, is inhibited by MgCl2 and is inhibited by GTP and NAD+ at physiological concentration. 40-S and 60-S subunits inhibit the enzyme, possibly by binding to it. The stability of translational initiation complexes, containing methionyl-tRNA-Met-f, was investigated in the presence of the enzyme. Purified ternary complex was slowly broken down by the enzyme, while the 40-S-subunit . Met-tRNA-Met-f complex was stable in the presence of enzyme. The 80-S complex formed with A-U-G trinucleotide as the message molecule was broken down, whereas the 80-S complex formed with globin mRNA was stable in the presence of the enzyme. The physiological role of this enzyme is unclear, but it might act to regulate initiation by deacylating Met-tRNA-Met-f.


Synthesis of chloroplast ribonucleic acid in Chlamydomonas  reinhardtii toluene-treated cells. Chlamydomonas reinhardtii cells treated with toluene at 0 degrees C and 25 degrees C incorporate ribonucleoside triphosphates (NTPs) into chloroplast RNA at 25 degrees C and also at 35 degrees C. The incorporation requires all four NTPs and Mg2+, and is completely inhibited by DNase, RNase, actinomycin D (40 microgram/ml) and rifampicin (350 microgram/ml).  However, the incorporation is almost totally insensitive to both alpha-amanitin and streptolydigin at 200 microgram/ml.


Evidence for fatty acid transfer across the human placenta. Lipid analysis of blood from umbilical artery and vein, experiments on artificially perfused human placentas, measurements of fetal blood triglyceride concentrations and the relative percentage of essential fatty acids in fetal adipose tissue are all consistent with the view that fatty acids cross the human placenta and that the flow to the fetus is influenced by maternal blood concentrations of free fatty acids and triglycerides.


Eucaryotic elongation factors Ts is an integral component of rabbit reticulocyte elongation factor 1. Elongation factor 1 (EF-1) was purified from rabbit reticulocytes and found to contain at least two distinct polypeptides: one of Mr 53 000 and one of Mr 30 000. The 30 000-Mr polypeptide was purified from EF-1 by treatment of the factor with 5.4 M guanidine . HCl and subsequent chromatography on DEAE-BioGel A in the presence of 5 M urea. By a number of functional criteria, the 30 000-Mr polypeptide was found to be the eucaryotic elongation factor Ts (eEF-Ts). These criteria include the ability of the polypeptide to stimulate Artemia salina eEF-Tu-dependent binding of aminoacyl-tRNA to 80-S ribosomes as well as eEF-Tu + EF-2-dependent polyphenylalanine synthesis. The reticulocyte factor also markedly increased the rate of exchange of eEF-Tu . gdp complexes with free GTP. Furthermore, rabbit antibodies to EF-1 from A. salina which was previously shown to contain eEF-Ts [Slobin, L. I. and Möller, W. (1978) Eur. J. Biochem. 84, 69--77] were found to cross-react with reticulocyte eEF-Ts, suggesting extensive structural homology between brine shrimp and rabbit eEF-Ts. The demonstration that eEF-Ts is and integral component of EF-1 from such diverse sources as brine shrimp and rabbit reticulocytes supports the conclusion that the factor is universally present in eucaryotic EF-1.


Metabolism during normal and diabetic pregnancy and its effect on neonatal outcome. Diurnal profile studies have been used to define the fetal carbohydrate and lipid substrate environment in normal and diabetic women during late pregnancy. In women with normal glucose tolerance the diurnal plasma glucose concentration was maintained within close limits (mean +/- S.D., 4.70 +/- 0.38 mmol/l) but in chemical and insulin-dependent diabetics there was a marked increase in both the mean diurnal glucose value and in the variability of the plasma glucose levels observed through the day (mean +/- S.D., 5.61 +/- 5.61 +/- 1.03 and 6.02 +/- 1.26 mmol/l respectively, P less than 0.01). No difference was observed between the peripheral insulin activity of the normal and chemical diabetic women, and the impaired glucose tolerance of the latter group was due to a deficient insulin response to goucose. The diurnal glucose variability, expressed as the standard deviation of the mean, was found to be inversely correlated with the residual C-peptide response in insulin-requiring diabetics. The mean diurnal plasma free fatty acid (FFA) concentration was slightly raised in chemical diabetic subjects compared to normal women (mean +/- S.D., 0.77 +/- 0.34 and 0.68 +/- 0.20 mmol/l respectively) but this difference was not significant. Insulin treatment produced a marked reduction in circulating FFA concentration, with a mean value in the insulin-dependent diabetic group of 0.45 +/- 0.11 mmol/l (P less than 0.001). Neonatal glucose assimilation during the first two hours of life correlated strongly with several functions of maternal carbohydrate tolerance. This was associated with higher plasma insulin concentrations at birth, and a marked tendency to hypoglycaemia in the infants of untreated chemical diabetic women. Impaired mobilization of triglyceride stores was also observed during the two hours after birth in the infants of diabetic women. This, however, appears to be due not to impaired lipolysis but to rapid re-esterification of FFA. These findings all indicate a state of functional hyperinsulinism in the infant of the diabetic women secondary to maternal hyperglycaemia.


[The importance of computer tomography in the diagnosis of epilepsy (author's transl)]. 208 patients with epilepsy were investigated by computertomography (Emi Scanner CT 1010 and CT 5005). In 173 patients with generalised epilepsy 87 had a normal scan, 51 revealed a definitive diagnosis and 37 showed generalised atrophy. Of the 35 patients with partial seizures a definitive diagnosis was possible in 22; representing a higher proportion than the group with generalised seizures. A definitive diagnosis from the CT Scan was significantly more common in both patients with generalised and partial seizures when pathological neurological findings were also present. Symptomatic epilepsy was only significantly commoner in Dementia patients with generalised seizures. A significantly higher proportion of patients over 30 years old demonstrated a symptomatic epilepsy than those under 30 years of age.


Relationship between histidyl-tRNA level and protein synthesis rate in wild-type and mutant Chinese hamster ovary cells. A preliminary investigation was carried out to determine how conditional lethal mutants affected in particular aminoacyl-tRNA synthetases may be used to study the role of tRNA charging levels in protein synthesis. The relationship between rate of protein synthesis and level of histidyl-tRNA in wild-type cultured Chinese hamster ovary cells was determined using the analogue histidinol to inhibit histidyl-tRNA synthetase activity. This response was compared with that obtained using a mutant strain with a defective histidyl-tRNA synthetase that phenotypically shows decreased rates of protein synthesis at reduced concentrations of histidine in the growth medium. The approach used was based on measuring the histidyl-tRNA levels in live cells. The percentage charging was estimated by comparing [14C]histidine incorporated into alkali-labile material in paired samples, one of which was treated with cycloheximide, five minutes before terminating during the incubation, to produce maximal aminoacylation. Wild-type cells under histidinol inhibition exhibited a sensitive, sigmoidal relationship between the level of histidyl-tRNA and the rate of protein synthesis. A decrease in the relative percentage of acylated tRNA (His) from 46% to 35% elicited a large reduction in the rate of protein synthesis from 90% to 30% relative to untreated cells. An unpredicted result was that the relationship between protein synthesis and histidyl-tRNA in the mutant was essentially linear. High acylation values for tRNA (His) were associated with rates of protein synthesis that were not nearly as high as in wild-type cells. These findings suggest that the charging charging levels of tRNA (His) isoacceptors could play a regulatory role in determining the rate of protein synthesis under conditions of histidine starvation in normal cells. The mutant appears to be a potentially useful system for studying the pivotal role of tRNA charging in protein synthesis, assuming that the altered response in the mutant is caused by its altered synthetase.


Regulation of protein synthesis in mitotic HeLa cells. Mitotic HeLa cells (M cells) synthesize protein at about 25% of the rate of S phase cells. This decrease in protein synthesis is due to a reduction in the rate of initiation. However, extracts prepared from M cells are almost as active in protein synthesis as S cell extracts. Both cell extracts are quite active in in vitro initiation of protein synthesis. Moreover, two steps in initiation, binding of Met-tRNAf to 40S ribosomal subunits and binding of mRNA to ribosomes, show similar activity in both extracts. The difference in protein synthesizing activity observed in vivo is largely eliminated in the preparation of cell-free systems. The ribosomes of M cells contain small mol wt RNA, which inhibits protein synthesis in vitro. This RNA, which has possibly a nuclear origin, may be a cause of the reduction in the rate of protein synthesis in M cells.


Who cares? Nursing and sociology: the development of a symbiotic relationship. The paper has three aims: to illustrate ways in which sociology may help nurses to achieve their primary objective: good patient care; to show how nursing can contribute to sociology; and to indicate some conditions for a healthy relationship between the two activities. After a brief discussion of the nature of sociology, intended for non-sociologists, four examples of ways in which sociology may be relevant to nursing are discussed: (i) Implications for nursing of changing patterns of disease, dependency and death; (ii) Social and cultural variations in perceptions of, and responses to, pain and disease; (iii) Organizational analyses, with particular reference to the importance of nurse-patient communication; (iv) Sociological studies of inter-personal relationships, illustrated by a study of student nurse training. Nursing is described as the major caring profession; as such it has inherent interest for sociologists interested in health care. However, its sociological interest is enhanced by the fact that it is permeated by paradoxes. Reference is also made to current debate on the most appropriate model for health care: the traditional medical model places relatively greater emphasis on cure than does nursing, with its relatively greater involvement with care. It is suggested that current patterns of disease and dependency increase the importance of the care model, and that nursing could play a crucial role in such a shift of emphasis. Having shown that sociology can make positive contributions to nursing, attention is drawn to certain dangers. Nursing should thus make sure that the sociology which it welcomes into its domain is academically sound, and not ideology in disguise. It is also suggested that nursing education should encourage more critical thinking, to enliven nurses' appreciation of what sociology has to offer, and to improve their ability to evaluate the quality of health care.


Breast feeding in Cambridge, England: factors affecting the mother's milk supply. Mothers breast feeding 2 weeks after delivery were studied. One group (106 mothers) were advised to 'eat for two' during lactation to sustain their milk supply. They were compared at 3 months with a control group of 152 mothers. At 3 months only half as many advised group mothers had weaned their babies due to insufficient milk as control mothers. The numbers weaning for other reasons were similar in both groups. More breast feeding mothers reported an increased appetite during lactation than did mothers who had changed to artificial feeding. Smokers were more likely to have given up breast feeding between 2 weeks and 3 months than non-smokers but smoking was not associated with any particular weaning reason. Women taking a contraceptive pill during lactation more often experienced a diminution of milk supply than non-pill-takers. Sustained lactation benefits the mother since those who were still breast feeding were less likely to suffer from depression or fatigue at 3 months, and were more likely to  have lost weight. The early introduction of solids was less frequent among infants being breast fed at 3 months.


The role of the nurse in support of breast feeding. The nurse can provide information about, and support of, breast feeding. The prenatal nurse can inform the mother of the advantages of breast feeding to herself and her baby. The labour and delivery nurse can aid the mother in her first contact with the baby and reassure the mother who has a Caesarean birth, or a premature or sick infant, that she too can nurse. The postpartum nurse can help breast feeding to continue by providing frequent maternal-infant contact during the mother's hospital stay. The nursery nurse supports breast feeding by refraining from giving the baby other fluids. The paediatric nurse continues the helping pattern by reinforcing the statements and actions of others which will further impress the mother with the appropriateness of her infant feeding method. Mothers need to be informed about infant feeding options in order to make a knowledgeable choice based on awareness of alternatives. The nurse's role in support of breast feeding varies with the time and place where patient care is provided. In each setting, however, the nurse plays a significant role in helping the mother to begin breast feeding and to enjoy it, at the same time providing her infant with optimum nutrition for his early growth and development.


Nursing in a changing society.

Nursing in a changing society. In this paper the technological, demographic, social and disease-pattern changes in British society are considered and their implications for the nursing and health services discussed. The influences of major nursing reports as well as the consequences of the growth of professionalism in nursing and the potential outcome of the spread of political consciousness among nurses are also highlighted. Nurses are admonished to come to terms with the 'real' diseases of today; those resulting from affluence and senescence. Although conceding that nurses have unique and professional roles, a plea is made for the importance of good team work in health care. The paper ends with the recognition that by building up the body of knowledge of nursing, not only will the planning of nursing care be enhanced but also the ability to change as the needs of society change.


The relationship between the level of nurse staffing and the patterns of patient care and staff activity. Data relating to patterns of nursing activity and all the interactions occurring between patients and nursing staff were obtained during observation periods of 1 week's duration on a total of 20 wards in three hospitals. When analysed these data reveal that in all wards there is a strong relationship between the nursing hours available and the various components of the nursing care provided. Indeed the linear relationship is so strong in some cases that it appears that these wards are a long way short of the staffing levels which produced the 'saturation' effect described by several American authors. The analysis of the interactions reveals, as one would suspect, that a disproportionate number of patients account for a large proportion of the interactions, but two further analyses will, it is hoped, shed a little more light on this aspect of the ward situation. The data are being subject to further examination to ascertain whether extra nursing staff leads to more or longer interactions and a longer term investigation is under way which is focused on patients with comparable diagnoses in different hospitals.


Is the nursing profession really research-based? Modern nursing has its origins in the pioneering research of Florence Nightingale but a research approach to nursing problems was never transmitted as part of the traditions of the Nightingale pattern of nurse training. Although nurses in North America established nursing education programmes in centres of higher education as long ago as 1899, British nurses did not utilize these facilities until the 1950s. This militated against the proper preparation of British nurses for research and the innovation of nursing research activities was therefore drastically delayed in the United Kingdom. Such research as there was tended to focus on nurses rather than nursing. The Royal College of Nursing of the United Kingdom, together with the Department of Health and Social Security, London, sponsored a number of nursing care research projects in the late 1960s. This was followed, in the 1970s, by an upsurge of research interest and research activity among British nurses. But it is still very difficult to demonstrate any direct benefits from nursing research interest or activity on patient care. There are also problems associated with the lack of experimental and replicated studies, the death or research-minded nurses and the apparent lack of interest in implementing nursing research findings. This places a great responsibility on the teachers of nurses. Hope is on the horizon. This is fostered by recent syllabuses and guides produced by British statutory bodies responsible for basic and postbasic nursing research. In conclusion, the author argues that nursing research activity should not be permitted to become an end in itself. The search for a research base for nursing should be motivated primarily by a desire to achieve better nursing practice.


A discharge planning tool for use with families of high-risk infants. The transition from hospital care to home care for high risk infants can be facilitated by the process of discharge planning. A tool designed specifically to coordinate discharge counseling and instruction for parents of high-risk infants has been developed and implemented in a perinatal center. Preliminary results indicate that the tool enables the health team to make an objective, rather than subjective, decision in respect to discharge of infants. Use of the tool also standardizes and documents the nurse's role in discharge planning.


The high-risk mother viewed in relation to a holistic model of the childbearing experience. The high-risk antepartal mother is, first, a woman facing the experience of childbearing and, second, a woman for whom this experience is defined as high risk. Too often, health professionals concentrate on the latter almost to the exclusion of the former. In this article a holistic model of the experience of childbearing, common to all women, is proposed. It takes into account relevant social, cultural, and psychological as well as physiological factors. The model is then related to specific problems that may threaten the successful outcome of pregnancy. Appropriate implications for nursing are also discussed.


A breastfeeding protocol.

A breastfeeding protocol. Specific guidelines for assisting patients in breastfeeding their infants are outlined, beginning in the prenatal period and continuing through initiation of nursing and established lactation. Prevention of possible problems is emphasized, but included are methods for relieving difficulites encountered during breastfeeding, such as flat nipples, sleepy babies, sore nipples, oversupply, engorgement, multiple births, forceful expulsion of milk, and breast infections.


Counseling the parents of a critically ill newborn. Nurses caring for critically ill infants should be reminded of their responsibilities to the parents of these children. The parents' needs often go either unrecognized or unmet. Nurses in a neonatal intensive care unit should have a working knowledge of their additional responsibility of serving in the role of counselor. Knowing sufficiently what emotional factors should be considered, one can effectively implement this counseling.


An education program for nurses from referring hospitals in a perinatal regionalization system. Administering high-quality perinatal care at a regional center involves more than providing in-center service. An outreach education program was developed for nurses in referring hospitals. The authors believe that through the carefully phased development of an outreach education program, quality perinatal care on all levels can be realized.


Child abuse prevention--implementation within the curriculum. The number of reported cases of child abuse and neglect is increasing. Most educators are aware of the problem; however, awareness alone has minimal impact on prevention. Specific planning is needed, and this article explores various avenues for including child abuse education as a part of the regular school curriculum. The ultimate goal is to develop educational strategies as one means of preventing abuse when school children grow to adulthood and become parents.


Instructional emphasis in family life and sex education: viewpoints of students, parents, teachers and principals at four grade levels. This study was conducted to assess and compare the opinions of four population groups -- students, parents, teachers and principals -- concerning the amount of teaching emphasis that should be given to family life and sex education at school grades three, six, nine and twelve. The population was derived from a large, county school corporation in north central Indiana. A large proportion of each population at each grade supported at least some instructional emphasis about the topic, with nearly a majority or more of the subjects of most of the 16 populations favoring major teaching emphasis. Some differences in endorsement among the populations and sub-populations (male vs. female students) at each grade and among the four grades were found.


Health education for the preadolescent: basic first aid. Accidents are the leading cause of death and disability in the preadolescent age group. For this population, the State of California now recommends specific accident and emergency health education. This article discusses the American Red Cross' self-paced Basic First Aid course which can meet the needs of the student as suggested and integrate the student-teacher-nurse in a health education experience profitable for all.


Are basic assumptions we hold about health education defensible? Underlying numerous programs designed to promote healthfulness are several implicit and/or overlooked assumptions. These suppositions are considered to be "understood." However, more often they lack validation in an empirical sense. The article is intended to prompt a systematic appraisal of certain presumptions about health, health education and health educators.


Regulation of protein synthesis during postnatal maturation of mouse brain. On a DNA basis, there is higher concentration of polysomes in the brain of newborn than in the brain of adult mice, but there is no maturation-dependent decrease in tRNA content during postnatal development. The amino acid incorporating activity of cell-free systems with polysomes or mitochondria from newborn brain exceeds that of adult controls significantly in contrast to a smaller incorporating rate of labelled amino acids into synaptosomal protein. Addition of polysomes isolated from newborn brain increases the amino acid incorporation by cell-free systems with adult brain tRNA and enzymes, whereas the polysomes from adult brain decrease the incorporating activity of newborn brain systems. The loading capacity of newborn brain tRNA exceeds that of the adult controls and the velocities of its aminoacylation are four times faster. Uncharged as well as precharged newborn brain tRNA increases the amino acid incorporating activity of tRNA-dependent cell-free systems with adult brain polysomes and enzymes. In contrast to polysomes and tRNA, the newborn brain enzymes involved in protein synthesis seem to be less active in cell-free amino acid incorporation than the enzyme fractions from adult brain. These data indicate that the different protein synthesizing activity in developing and adult mouse brain is the result not only of higher amino acid incorporating activities of the newborn polysomes, but also of a stimulated acceptance and transfer function of the newborn brain tRNA.


Immunization and health advice for international travelers. Physicians are increasingly being called upon to advise travelers regarding health matters. Travel to virtually all parts of the world can be medically safe, given a modest investment of effort to provide appropriate immunizations and education of travelers regarding precautionary steps regarding food, drink and other matters. Instruction regarding the self administration of a few simple drugs is reasonalbe for most patients anticipating prolonged travel in tropical areas.


Use of antibiotics in the outpatient setting. Antibiotics with small but definable mortality, such as chloramphenicol, should not be used when safer drugs will suffice. Antibiotics with a low (1 to 5 per cent) morbidity should not be used when safer drugs are available. Therefore, cleocin, minocycline, or oral erythromycin estolate should rarely be used and regular erythromycin base is almost always preferable. Fever should not be treated with antibiotics since they are not antipyretics. "Colds" should not be treated with antibiotics, but antibiotics should be administered to patients with a history of chronic bronchitis, sinusitis, and recurrent otitis as soon as any symptoms begin. Intramuscular antibiotics should not be given except for benzathine penicillin. Use placebos instead of antibiotics when the patient's psyche demands an intramuscular injection. Make certain that the needle, syringe, and solution are sterile. Agents other than penicillin or cephalosporins should be used in patients with a definite history of penicillin allergy. Combination antibiotics or broad spectrum antibiotics like cephelosporins or tetracyclines should not be used when narrow spectrum antibiotics of known efficacy are available for specific syndromes such as streptococcal pharyngitis.


Parasympathetic degeneration secretion of saliva in rats. In rats under chloralose anaethesia saliva was found to flow from the submandibular and parotid glands previously subjected to (partial) postganglionic parasympathetic denervation. Secretion started in the submandibular glands 8.8-11.8 hours, and in the parotid glands 14.0-12.6 hours after the denervation and lasted about 7 hours in both glands. It was not abolished by sympatholytic drugs but by atropine. It is regarded as an example of the "degeneration activity" described in many organs and species and provides a method for prolonged stimulation of salivary glands in rats.


Daily changes in the curved crown-rump length of individual sheep fetuses during the last 60 days of pregnancy and effects of different levels of maternal nutrition. A method is described by which daily changes in the curved crown-rump length (CRL) of individual sheep fetuses were observed during the last 50 to 60 days of pregnancy. The mean discrepancy between the derived value for CRL and the CRL measured directly in eight fetuses aged between 100 and 135 days and in 12 lambs born at 143 to 150 days was 1.5 +/- 0.2 per cent (mean +/- s.e.). In adequately nourished ewes between 100 and 115 days of gestation growth rate showed a between-fetus range of 4.2 to 7.5 mm.day-1 (n=16), remained constant within each fetus until about 132 days and then decreased by about 27 per cent (n=4). Decreases in growth rate of about 30 to 44 per cent occurred within three days of the introduction of maternal undernutrition at 115 or 120 days of gestation (n=6) and in two other fetuses maternal undernutrition effected an almost complete cessation of growth. The relationship between fetal CRL and weight is described and some physiological implications of the results are discussed.


The relation between structure and function of bile ducts in man, some laboratory animals and the Adelie penguin. The biliary trees of man, dog, cat, rabbit, rat, guinea pig and penguin were examined in histological sections and by latex casts. The trees of man, dog, and cat were similar with only minor differences. Tubulo-alveolar glands were present in all three species around large intrahepatic ducts and in large portal tracts there were zones of ductules (areas with many small bile ducts), surrounded by small vessels with no apparent relation to hepatocytes. Both these features were present in the guinea pig and tubulo-alveolar glands were present in the penguin liver. The biliary epithelium of the rat was comparatively simple but that of the rabbit appeared to be highly specialized. An estimation of the complexity of the biliary tree was obtained in the mammals by comparing the circumference of small portal venous branches with the circumference of the accompanying bile ducts, and obtaining a ratio. Man, dog, and cat had fewer and smaller bile ducts than the other species. The literature on the rate of formation and composition of bile in the species studied here was reviewed and it appears that the physiology of bile secretion can be related to the morphology of the biliary tree.


Oxygen consumptions and potassium contents of slices of rat renal cortex. An oxygen electrode respirometer for determining the oxygen consumption of slices of mammalian renal cortex is described and assessed. Though rat renal cortical slices incubated in potassium-free medium for one hour lost 102 +/- 14 mmol of potassium/kg dry weight, there was only a small, nonsignificant fall in oxygen consumption. In contrast the oxygen consumption of slices incubated in potassium-free medium with 10 mmol.1-1 ouabain was markedly reduced (by 32 +/- 6%), while such slices lost 180 +/- 15 mmol of potassium/kg dry weight. These disproportionate effects on potassium loss and inhibition of oxygen consumption suggest that in renal cortical slices the loss of potassium in low potassium medium is not primarily due to inhibition of the conventional sodium pump.


Water and electrolyte excretion during the oestrous cycle in sheep. Electrolyte excretion was observed during 24 oestrous cycles in housed sheep, together with mixed salivary Na/K ratio during 10 additional cycles. 1. The sharp fall in food and fluid intake at oestrus accompanied a peak of sodium excretion which changed to peak retention 3 days later, both in faeces and urine. 2. Potassium excretion declined with food intake at oestrus but subsequently failed to recover to pre-oestrous levels dispite full recovery of dietary intake. 3. Curiously, water intake also recovered completely whereas urinary and faecal water retention continued; faecal loss actually exceeded renal excretion on these liberal water intakes. 4. Changes in salivary, urinary and faecal Na/K indicated an aldosterone peak neither during the luteal phase nor at oestrus but three days later. The data raise questions concerning the regulation of water and electrolyte balance within the normal cycle. They also provide a baseline for the investigation of renal effects of gonadal steroids. Possible roles for aldosterone, ADH and progesterone in maintaining fluid and electrolyte balance are discussed, emphasising problems confronting species which have evolved with heavy obligatory potassium excretion but undependable supplies of sodium and water.


Parotid salivary flow and composition during infusion of acetylcholine and atropine into the carotid artery of conscious sodium-replete sheep. The rate of salivary flow and the concentrations of the major electrolytes in parotid saliva and arterial plasma of conscious sodium-replete sheep were measured during resting salivary secretion and when salivary flow was either increased by intracarotid infusion of acetylcholine at 10-30 nmol. min-1 for 20 min or reduced by intracarotid infusion of atropine at 14 nmol. min-1 for 50 min. During both treatments salivary phosphate concentration was always negatively correlated with salivary flow and salivary bicarbonate concentration was always positively correlated with flow. The chloride concentration of the saliva during the acetylcholine infusion experiments was positively correlated with salivary flow whereas when atropine was infused the chloride concentration was negatively correlated with flow. Acetylcholine infusion caused the potassium concentration of the saliva to increase significantly resulting in a marked increase in the total rate of loss of potassium in the saliva. The salivary potassium concentration fell significantly at the onset of the atropine infusion and then rose progressively so that the potassium concentration was elevated by the end of the infusion. In both treatments the concentrations of sodium and hydrion were negatively correlated with salivary flow rate. The maximum sodium concentration which occurred in the low-flow saliva of the atropine infusion was substantially higher than the concentration that would be achieved by equilibrium with the aqueous phase of arterial plasma. It was concluded that the negative correlation between salivary flow and sodium concentration occurred because the reabsorption of sodium from the saliva by the excurrent duct system was minimal in sodium-replete sheep which would have low levels of mineralocorticoids in the circulation. The inconsistency between this  study and previous reports presumably reflects differences in the criteria used to define the sodium status of the animals.


[Effect of fasting on aminoacylation of tRNA from rabbit muscles]. The aminoacylation of tRNA from muscles was studied in the fasting rabbits. It is shown that under equal conditions of incubation the intensity of the process is higher in the fasting animals. It may be a result of an increase in the content or activity of leucil-tRNA-synthetase in muscles of the fasting rabbits, that is testified by the evidence on the level of aminoacylation in heterologous systems.


The response of Staphylococcus aureus to benzylpenicillin. The response to benzylpenicillin of 2 strains of Staphylococcus aureus was investigated in vitro using 3 techniques in parallel: continuous turbidimetric monitoring, continuous microscopic monitoring, and thin-section electron microscopy. Cultures of staphylococci were exposed to several concentrations of penicillin for various intervals of time before terminating the antibiotic activity with penicillinase. Bacterial lysis by penicillin was concentration-dependent and showed an optimal dosage effect which was very marked for one of the strains. The growth and division of cells continued for up to 1 h in the presence of penicillin. A variety of morphological responses was observed at each penicillin concentration. These changes ranged from complete bacterial lysis to apparently normal cells, and included several different types of aberrant morphological forms. On addition of penicillinase to cultures exposed to penicillin, there was a time interval before survivors began to divide. This period was increased by raising the concentration of penicillin or by increasing the period of exposure to penicillin. Bacteria resuming growth after surviving penicillin action exhibited markedly aberrant septation. Most of the survivors were found to originate from clumps of cocci rather than from individual cells or small groups.


Animal models for human sexuality.

Animal models for human sexuality. The value of animal models in biomedical research is firmly established, and many basic principles of human psychology have been explicated as the result of comparative studies. There is pressing need for non-human models in the behavioural sciences as represented by psychiatry, psychology and ethology; and such models should be constructed, provided their validity can be assured. Valid models cannot be based exclusively on similarity in the formal properties of behaviour. Commonality of descriptive terms as applied to different species does not guarantee identity of the concepts to which the terms apply. Model builders must evaluate interspecific similarities and differences in the causes, mediating mechanisms and functional outcomes of behaviour. The validity of interspecific generalization can never exceed the reliability of intraspecific analysis; and the latter is an indispensable antecedent of the former. Existing and potential models for homosexuality and other psychosexual characteristics of human beings are evaluated within the perspective provided by the foregoing generalizations.


Male homosexuality: perversion, deviation or variant? Male homosexuality has complex determinants: biological, psychological, social, cultural and situational factors may be relevant, either inhibiting hetereosexuality or leading towards homosexuality. Environmental factors seem paramount, particularly significant early relationships, usually within the family. Especially implicated are the personalities and interaction of the parents, recent interest being especially in the father's role. Also relevant is the family as a complex social system and the modes of communication within it, both verbal and non-verbal. Social research and sociopolitical pressures have helped to liberalize attitudes to homosexually 'deviant' behaviour but have not added significantly to its understanding. Many factors are involved in determining whether homosexual men seek therapy and reach a particular therapist. These factors relate to the patient's and therapist's personalities; to different therapeutic philosophies and therapeutic goals; and to the formal and informal referral networks in society.


Transsexuality: some remarks based on clinical experience. People with severe gender identity problems have always existed. Some hope to find a solution to their deep intrapersonal conflicts in a so-called sex transformation. The term 'transsexual' was coined by Cauldwell in 1949 and since then an unknown number of people all over the world, probably more biological men than women, have undergone a hormonal and surgical sex-transformation procedure. In this chapter we discuss the impossibility of real sex change from man to woman and vice versa. We briefly touch on two classical cases of sex transformation with some connection with Denmark: the Lili Elbe case of 1930 and the famous Chris Jorgensen case from the early fifties. We discuss the incidence of transsexuality and follow-up studies of patients, and give preliminary results from a Danish study of 110 people (81 men and 29 women) who during the past 25 years have applied for a sex-change operation. Of these, 56 individuals (42 men and 14 women) have had such operations. These are minimum figures since some transsexuals are known to have had operations in other countries but have not contacted Danish hospitals or health personnel.


The endocrine function of the human testis in regard to sexuality. It is well known that the testes play a determining role in male sexuality. However, the exact interrelations between endocrine testicular function and sexual behaviour are not well understood. If these interrelations are to be investigated a number of factors influencing testicular function have to be considered: circadian and seasonal variations, age-related changes, body constitution, physical activity and drug interactions, as well as the influence of endocrine and non-endocrine diseases. The paper emphasizes the complexity of the field and warns against seeing correlations between single random plasma sex hormone determinations and sexual behaviour.


Psychosexual development: an examination of the role of prenatal hormones. Naturally occurring endocrine syndromes and the offspring from steroid-treated pregnancies are the major sources of evidence for a role of prenatal hormones in psychosexual development in man. Effects of prenatal androgens have been established for the sex-dimorphic behaviour clusters of energy expenditure (increased), parenting rehearsal (decreased), peer associations (shifted to male), and grooming-related behaviour (decreased); most of the information was obtained on the syndrome of congenital adrenal hyperplasia and in progestin-induced female hermaphroditism. Studies of children and adults exposed prenatally to exogenous oestrogens and/or progestagens suggest slight demasculinizing effects but cannot yet be considered conclusive. Gender identity is largely dependent on the sex of rearing; a direct role of prenatal hormones in its formation has not been shown. The evidence for the role of prenatal hormones in the development of sexual orientation is inconclusive.


Basic sexual trends in the development of vertebrates. The chain of events occurring during sexual development involves successive steps: genetic sex, gonadal sex and body sex. The latter comprises the genital tract, secondary sex characters and neural structures mediating sexual interest and appetite. Body sex obeys a hormonal control. In the absence of any hormone it develops in conformity with the homozygous sex type--feminine in mammals, masculine in birds, newts and one lizard studied so far. Similar differences have been observed for sex behaviour in some mammals and birds. It has been suggested that the sex of the gonads is determined by the presence (or absence) of the histocompatibility antigen produced by the sex chromosome of the heterozygous sex (Y or W). However, in newt or Xenopus graft chimaeras as well as in bovine freemartins, testicular dominance over presumptive ovaries is obvious whatever the mode of chromosomal control of sex. A unifying concept for sex differentiation in all vertebrates, accounting for the long series of recognized data, is still difficult to delineate.


Androgens and human sexual behaviour.

Androgens and human sexual behaviour. Androgens are generally believed to be necessary for normal sexual responsiveness in the human male and female. The evidence for this is limited and sometimes conflicting. This paper considers evidence from experiments in which exogenous androgens are given to people with impaired sexual response. Results from a study in which testosterone was given to unresponsive women are reported, together with the preliminary results of giving androstenedione to sexually unresponsive women taking oral contraceptives and giving testosterone undecanoate to hypogonadal males. In the first study, when testosterone was combined with counselling, significant effects were produced by the addition of testosterone. In the androstenedione study, where no counselling was given, beneficial effects of the androgen have been unusual. Examples of the evaluation of androgen replacement in hypogonodal males are also presented. Finally, some methodological problems of evaluating the effects of exogenous hormone in human sexual behaviour are briefly discussed.


Sex-dimorphic behaviour development in the human: prenatal hormone administration and postnatal socialization. An interdisciplinary integrative approach must be utilized in the study of psychosexual differentiation. The approach must capitalize on data derived from non-human models, from experiments of nature, and from experiments of nurture. Studies from non-human primates strongly suggest the influence of prenatal sex hormone levels on postnatal sexually dimorphic behaviours. Starting from this basis we have studied sixty young adult men whose mothers received, during pregnancy, diethylstilboestrol, diethylstilboestrol and natural progesterone, natural progesterone, or synthetic progesterone. They have been compared with matched controls not exposed in utero to exogenous hormones. Studies of socialization patterns must document the differential developmental experiences, if any, of children with atypical and typical sex-typed behaviours. To this end, we are studying 60 boys whose behaviour before puberty was decidedly feminine, and their parents, and contrasting them with masculine boys and their parents. We are also studying 50 girls whose behaviour before puberty was 'masculine', and contrasting them with 'feminine' girls. Additionally, we are studying the sexually dimorphic behaviour of children of sexually atypical parents. The parents have either undergone sex-change surgery (male-to-female or female-to-male) or are homosexual. Data from the three studies are presented. A call is made to researchers working with non-human primates to test and extend these findings.


Hormones and sexual differentiation of the brain. Male rats castrated on the first day of life exhibited predominantly heterotypical (homosexual) behaviour after androgen substitution in adulthood. In addition, an increased evocability of a positive feedback effect of oestrogen was observed in such genetic males. In homosexual men, an increased evocability of a positive oestrogen feedback on luteinizing hormone (LH) secretion was also found as compared to heterosexual men. These findings suggest that male homosexuality may be based, at least in part, on andogen deficiency during a critical period of brain differentiation. In addition, we have found significantly increased plasma follicle-stimulating hormone (FSH) and LH levels associated with decreased plasma free testosterone levels in homosexual men, but only in effeminate homosexuals. In view of these data, sexual deviations in the human may be based, at least in part, on discrepancies between the genetic sex and a sex-specific sex-hormone level during brain differentiation in prenatal life. Methods were therefore developed for determining genetic sex and sex-specific sex-hormone level during brain differentiation in prenatal life. Methods were therefore developed for determining genetic sex and sex-specific sex-hormone levels in amniotic fluid, in order to detect and possibly correct such discrepancies. Sex hormone-dependent brain differentiation may be mediated, at least in part, by neurotransmitters, which may be regarded as local hormones of the brain. Interestingly enough, we have found permanent abnormalities of mating and other non-mating behaviour associated with permanent structural and chemical alterations in discrete brain regions of rats after neonatal treatment with psychotropic drugs known to affect neurotransmitter metabolism in the brain. Therefore, changes in  neurotransmitter concentrations and/or turnover rates induced by psychosocial influences as well as by systemic hormones (particularly by sex hormones), when occurring during differentiation and maturation of the brain, may permanently affect sexual behaviour, sexual orientation and gender role behaviour throughout life.


[The initial symptoms of cerebral atrophy (author's transl)]. The paper reports about the initial symptoms of cerebral atrophy. A general view of the special literature about the aetiology, diagnosis and clinical forms of cerebral atrophy will be given. The initial symptoms of cerebral atrophy will be given. The initial symptoms of cerebral atrophy, their structure, the connections between them and their social consequences will be discussed. The difficulties of the use of a standard psychopathometrical trial including all the symptoms will be described. We think that the description of symptoms in each individual case is more precise than a collective description under a vague syndrom-labelling.


[The carpal tunnel syndrome--clinical symptomatology and electrophysiological findings (author's transl)]. In the first part of this study 17 patients with a clinically clear-cut carpal tunnel syndrome but with normal electrophysiological findings have been controlled after 1 to 3 years. In 12 of these patients an other cause of the complaints could be found. In 2 patients no definite diagnosis could be made and in 3 the previous diagnosis was considered to be corrected. Control electromyography was pathological in 2 of them and 1 patient was symptom-free after the operation. In the second part 133 hands with clinical symptoms of a carpal tunnel syndrome were examined clinically and electrophysiologically. In the group of patients with pathological electrophysiological findings there were significantly more objective signs than in those with normal EMG findings. In 13 of these patients which could be followed an other diagnosis could be made. It was not possible to establish a clinical index for the carpal tunnel syndorme. For a definite diagnosis, positive clinical and electrophysiological findings are required.


[On the temperature sensitivity of multiple sclerosis patients (author's transl)]. Aggravation of neurological symptoms in MS patients in heating is well known. This phenomenon is explained by the change of conduction in demyelinated nerve fibers. In raised temperature conduction block occurs. The threshold of conduction block dependent on temperature, is probably proportional to the degree of demyelination. It is possible to inhibit this effect by tyrosin. This model may present a view to a part of neurophysiological mechanisms of MS, on which we possibly can take therapeutical influence. By way of a questionnaire 125 MS patients were asked about changes of their symptoms in heating or cooling. 93% had marked sensitivity to heating. In 90% worsening of neurological symptoms or of general feeling occured in a hot bath. On the other hand about half the patients reported improvement in a cold bath. Therefore we suggest, that a noticeable part of neurological deficit is reversible, if we were able to raise the threshold of conduction block, which depends on temperature, ph, electrolytes and neurotransmitters.


[Quantitative measurement of muscle tone in patients with Parkinsonism before and during therapy with madopar (author's transl)]. Muscle tone at rest and during passive movement was measured in 13 patients with Parkinsonism before and during Madopar therapy. We used the method of kommutative therapy with additional therapy. Data were obtained by myointegration using surface electrodes on the musc. biceps brachii. As already communicated earlier for measurements during passive movements, we could now also state a significant decrease of rigidity at rest during therapy with Madopar. The rigidity improved by 77,5% after an average duration of treatment of 6,25 months and by 84,8% after 25,7 months. There was a proportional dependence between the degree of rigidity at rest and rigidity during passive movements before therapy. Beyond that the decrease for both types of rigidity was approximately similar during therapy. Furthermore possible pathophysiological sources and correlations of alterations of muscle tone in man are discussed.


[On relapsing paraneoplastic cerebral embolism. Case report and survey of literature (author's transl)]. The disease of a 34-year-old patient with relapsing cerebral embolisms, endocarditis, thrombophlebitis and hypercoagulopathy had the characteristics of paraneoplastic syndromes described and discussed in literature. Autopsy yielded a clinically unrecognised, dedifferentiated adenocarcinoma of the bronchial system. At an early stage of the disease cerebral embolisms had produced severe cerebral neurological signs with varying manifestations. This influenced not only the clinical picture and course of the disease to a considerable extent, but also focussed diagnostic attention on these signs to such a degree that the possibility of a masked carcinoma did not seem to suggest itself. The assumption of paraneoplastic linkups is supported by experimental and postmortem examinations on metabolic and immunological remote action of tumours on cardiac valves and on the vascular and coagulation system. However, the exact pathogenetic details are still largely unknown.


The use of [14C]eukaryotic initiation factor 2 to measure the endogenous pool size of eukaryotic initiation factor 2 in rabbit reticulocyte lysate. [14C]Eukaryotic initiation factor 2 (eIF-2), obtained by reductive methylation of the purified initiation factor, was shown to be active in the unfractionated reticulocyte lysate. This allowed a direct measurement of the endogenous pool size of eIF-2 in rabbit reticulocyte lysate according to the principle of isotope dilution. A value of 20 to 30 pmol/ml of lysate was obtained. Although translational inhibition resulting from hemin deficiency appears to be characterized by a change from catalytic to stoichiometric utilization of eIF-2, the pool size of eIF-2 is too small to account for the normal period of protein synthesis before the onset of translation inhibition. This suggests, therefore, that additional events to eIF-2 alpha phosphorylation may be required for translational inhibition.


Personality correlates in a sample of male nurses in the British Royal Air Force. This descriptive study provides data relevant to two currently popular views of the male nursing image. Firstly, that male nurses tend to prefer the more technological or administrative aspects of nursing and secondly, that they exhibit to an unusually high degree what are commonly thought of as being amongst the more feminine personality traits. The sample consisted of 91 male RAF nurses working in RAF hospitals, and was of predominantly English nationality. Of the 39 SRNs in the sample 65.8% preferred general nursing to the more technical areas such as intensive care, operating theatre, orthopaedic and renal. The preference for general nursing was even greater, 76.1%, amongst the 30 SENs surveyed. The Eysenck Personality Questionnaire (EPQ) and a Level of Aspiration Test (LOA) were used to obtain measures of the personality traits of the sample. The scores obtained showed that the male RAF nurses were significantly less psychotic than male civilian nurses, male civilians or serviceman of similar age. They were also significantly less extraverted than servicemen as a whole and significantly more stable than the male civilian norm. A comparison of SRNs with SENs revealed only two significant differences. The SRNs were significantly less extraverted and had a significantly higher level of adpiration than the SENs.


Theory of nursing: creating effective care. Aspects are identified which are to be considered when attempting to identify those activities we wish to call nursing. Using conceptual analysis by means borderline and model cases, an exposition of the nature of nursing is reached, The process of theory building, the function of theories and their application to what has been identified as the sphere of nursing are explained. The relationship of 'micro theory' and 'paradigmatic theory' are described. The application of theory to nursing education are linked by the use of Peters' (1966) criteria for education. A model attempts to demonstrate the relationships pointed out in the text.


Perspectives and problems on quality of nursing care: an overview of contributions from North America and recent developments in Europe. The author focuses on the quality of nursing care and discusses the major problems inherent in control of the quality of nursing care. The concept of quality is analysed and the approaches of health care professionals to the concept are discussed. An overview of the American contribution to the relevant research is presented together with ongoing deveopments in Europe.


Nursing: the European Economic Community dimension. The author traces the history and discusses the implications of the EEC Nursing Directives, put into the perspective of the nursing histories of the nine countries within the European Economic Community. She focuses, in particular, on the strengths of the nursing profession in the United Kingdom and argues that the Nursing Directives can lead to enhancement of nursing services and nursing education, better cooperation between health care professions and a stronger voice for the nursing profession, throughout the EEC.


Nurses' perception of their psychological role in treating rehabilitation patients: a study employing the critical incident technique. This study presents the theoretical literature on the psychological role of nurses. The nurses' perception of their psychological role is empirically obtained, employing the critical incident technique. General aims and objectives of pschological care of physically ill patients are formulated and are found to generally support the theoretical literature. Nurses were clearly found to perceive their psychological role as covering a very broad spectrum, the ultimate of which was the ability to anticipate and meet the emotional needs of the patient. The importance of implementing the application of social science concepts and methods to nursing is discussed.


The relevance of a philosophical perspective on education. The relevance of philosophy to education is discussed from three aspects. The first concerns the nature of philosophy; the second concerns the nature of education; and the third concerns the nature of the curriculum. These aspects are then followed by an example from the practice of education. The paper ends by outlining some criticisms and conclusions about the relevance of philosophy to education.


The functions of the nurse in an integrated national health service. The British National Health Service was reorganized in 1974 when the hospital services and the community health services, previously administered separately, were brought together into one organization: the Area Health Authority. The reorganization was a culmination of developments triggered off as long ago as 1589 when the first Poor Law Act was passed, but more particularly, the reorganization was the natural outcome of a number of important government and professional nursing reports published during the past 30 years. From 1974 the community and hospital nursing services have, therefore, been amalgamated under the direction of one head of the nursing services: a district (or area) nursing officer, who, together with medical, administrative and financial colleagues, manages the health services on a day-to-day basis in a team managing by consensus. The nurse's role in the management teams is both executive and professional: the nurse's unique contribution is that he/she brings a nursing perspective to management. The new nursing service organization has provided new opportunities for reorientating middle nurse managers to a clinical role. It has also provided opportunities for innovating integrated teams of community and hospital nurses and for developing specialist nursing roles. Nurses are also now able to make other additional contributions to health care by their involvement in health care planning team activities and by their membership of the statutory area and regional nursing and midwifery advisory committees. But, on the whole, changes and influence on health care have been brought about chiefly by changes in the managerial structure of British nursing, which is a perspective of the British nursing profession that seems to have been all pervasive since Florence Nightingale's reforms and which is perpetuated by the powerfully socializing agent of British nurse training. As health care and nursing service organizations should be means towards the end of good patient care, it may be timely to focus on the suggestion of autonomous nurse practitioners supported by a separately organized administrative structure.


An EM radiation safety controller.

An EM radiation safety controller. A safety control system has been developed for use in high power RF/microwave radiation exposure facilities. The system features Fail-Safe RF detectors, visible "RF ON" indicators, door-status sensors and digital logic to maintain safe operating conditions in spite of human errors or unsafe equipment malfunctions.


Research in resource allocation in a prepaid group practice. Much that has been written about the concept, operation, and performance of HMOs--their use of resources compared with other health service systems--masks the real differences among HMOs themselves. Investigation of autonomous units within a unified HMO program shows a surprising diversity. Analytic formulations drawn from long-term and large-scale research fail to account for variations in staffing, budgeting, rate setting, and expansion when applied to institutional research. Judgment of intangibles remains a key aspect of most major decisions.


Comparison of primiparas' perceptions of vaginal and cesarean births. Twenty primiparous mothers who had cesarean births were compared with 30 primiparous mothers who had vaginal deliveries to determine differences in their perceptions of the birth experience. The effect of general versus regional anesthesia on the satisfaction level of the cesarean mothers was also investigated. All subjects were between 20 and 32 years of age, were interviewed within 48 hours postpartum, and completed a 29-item questionnaire that measures maternal perceptions about the labor and delivery experience. Satisfaction with the birth experience was significantly lower among cesarean mothers and among those who had general anesthesia. The cesarean group displayed greater hesitancy in naming their infants and tended to view their deliveries as abnormal and having social stigma. The presence of a support person in the operating room for a cesarean birth seemed to lessen anxiety among these mothers. These findings suggest that a cesarean birth has a negative impact on the mother's perceptions of her labor and delivery experience. There is a need for further study of factors that can enhance this experience for families.


Attitudes of psychiatric nurses toward same sex orientations. This descriptive survey attempted to discern attitudes of a sample of 67 psychiatric nurses toward lesbianism. The sample included nurses employed at two midwestern psychiatric facilities and students beginning the masters program in psychiatric nursing at a midwestern university. Two questionnaires were administered: MacDonald's Attitude toward Homosexuality Scale--Female (ATHS--F) and the TAW Attitude toward Lesbianism Scenario. Scores on the ATHS--F range from 28 to 252, reflecting increasingly negative attitudes toward lesbianism; scores for this sample ranged from 28 to 232. Demographic variables which showed relationships to ATHS--F scores were type of education (p = .058), religious preference (p = .002), and level of religious devotion (p = .001). The TAW scenario proved more efficacious in determining affective components of attitudes than behavioral aspects.


Prenatal nipple conditioning for breastfeeding. Twenty-two primigravida women who planned to breastfeed began conditioning their nipples six weeks before their expected delivery date by nipple rolling twice a day for two minutes each time; providing gentle friction against the nipple with a terry cloth towel for 15 seconds once a day; and nipple airing for two hours a day, allowing outer clothing to rub against the nipple. Each woman served as her own control, conditioning one nipple but not the other. No nipple ointments or soap were used on either nipple during the course of the study. Each woman was given instructions on breastfeeding techniques to be used after delivery. The women completed two checklists: One revealed how consistently they followed the nipple-conditioning regime; with the other, they rated nipple pain on each breast, for every nursing, during the first five days postdelivery. Ratings were: 1--negligible pain or no pain, 2--definite pain, 3--extreme pain. Seventeen women successfully completed the study. Effect of skin color on the amount of nipple pain was also investigated. The prenatal nipple-conditioning regime significantly reduced the amount of total nipple pain experienced during the first few days of breastfeeding. The amount of extreme pain experienced on the conditioned nipple was significantly (p less than .01) reduced compared to the control nipple. Fair-skinned women reported more nipple soreness on unconditioned nipples, and olive-complected women reported significantly (p less than .01) less nipple soreness on unconditioned nipples.


Rape: the process of recovery.

Rape: the process of recovery. Based on tape-recorded interviews with 11 rape victims, the victims' reports of rape, rape sequelae, and disruptions of the social system were analyzed. Victims who articulated their feelings were able to cope with fears, interact with others, and return to normal routines faster than those who did not discuss their feelings.


Nursing staff attitudes toward the geriatric nurse practitioner student. This study investigated nursing staff attitudes toward the geriatric nurse practitioner as an agent of change in a long-term care facility, based on two University of Miami GNP students' practicum in a county nursing home. Nursing personnel were surveyed before and after the practicum to measure their acceptance of the GNP. While nursing staff initially held a wait-and-see attitude, posttest ratings were favorable. Recommendations for improving quality of care in the setting were made by student participants, and a six-month follow-up revealed that a number of changes had been implemented.


Measures of transactional analysis ego states for nurses. Factor analysis of 432 registered nurses' responses to three measures of the transactional analysis ego states of parent, adult, and child were run in order to develop shorter scales tailored to nurses. The analysis resulted in four 10-item scales labeled parent, adult, adapted child, and natural child. Reliability coefficients ranged from .79 to .85. Interscale correlations ranged from -.20 to .18. Means, standard deviations, and percentile scores were presented for each scale. Implications for nursing research are discussed.


Concerns of final semester baccalaureate nursing students. At 10 taped group meetings data pertaining to concerns of 19 final semester baccalaureate nursing students were collected. When data were categorized according to task-, self-, or client-related concerns, an important finding was the low frequency of client-related concerns. Recommendations and suggestions for further research were made.


Blocked- and integrated-content baccalaureate nursing programs: a comparative study. This study evaluated the differences between blocked- and integrated-content baccalaureate nursing programs related to faculty satisfaction, senior students' critical thinking ability, and students' state board examination performance. Faculty satisfaction had 10 factor scores--7 directly teacher-related factors and 3 indirectly teacher-related factors. Analysis of 85 faculty members by a one-dimensional, nested multivariate analysis of variance design revealed that faculty satisfaction was not a function of the type of content program. Analysis of 104 senior students by a one-dimensional, nested univariate analysis of variance design revealed no significant difference in critical-thinking ability between the two types of content programs. When 230 students' SBE scores were subjected to a one-dimensional, nested multivariate analysis of variance, blocked-content program students scored significantly higher than integrated-content program students. Recommendations for further study are made.


Insider-out: the health worker as researcher. This article discusses two dimensions related to the insider-outsider dilemma in conducting anthropological research in the health setting. One dimension concerns advantages of the insider's special knowledge in selecting and conducting successful research in a health institution. The other dimension deals with the ambiguity and confusion of roles attributed by staff to the investigator who may be seen as practitioner as well as social scientist. The patient may also see the researcher as performing dual, and possibly conflicting, roles. The advantage gained in the first dimension may be negated, to some extent, by the disadvantages associated with the second.


Significance of methicillin tolerance in experimental staphylococcal endocarditis. Methicillin-tolerant staphylococci are organisms that are inhibited by low concentrations of the drug but are resistant to its bactericidal effects. The clinical significance of this in vitro phenomenon is unknown. An experimental model of staphylococcal endocarditis in rabbits was used to determine whether methicillin-tolerant staphylococci are particularly difficult to eradicate from infected heart valves. In vitro sensitivity testing was used to identify a tolerant and a nontolerant strain of Staphylococcus aureus. Rabbits prepared by the insertion of a polyethylene catheter into the left ventricle and injected with a tolerant strain survived significantly longer than those injected with a nontolerant strain. No significant differences were demonstrated in the prevention of endocarditis with a single prophylactic dose of methicillin, or in the treatment of established endocardial infection with multiple doses of methicillin. In this study, methicillin had the same activity against experimental endocarditis caused by a tolerant and a nontolerant strain of S. aureus.


Comparative susceptibility of Haemophilus species to cefaclor, cefamandole, and five other cephalosporins and ampicillin, chloramphenicol, and tetracycline. The minimal inhibitory concentration of cefaclor, cephalexin, cephradine, cefamandole, cephalothin, cephapirin, cefazolin, ampicillin, chloramphenicol, and tetracycline for inhibition of 198 freshly isolated clinical strains of Haemophilus species (23 H. influenzae type b, 157 H. influenzae non-type b, 14 H. parainfluenzae, and 4 H. aphrophilus) was determined simultaneously by a slightly modified WHO-ICS agar dilution method. Nine strains were resistant to ampicillin. There was no correlation between ampicillin resistance and minimal inhibitory concentration of other antibiotics. All strains were susceptible to chloramphenicol, and all except five were susceptible to tetracycline. Cefaclor was the most active oral cephalosporin, and cefamandole was the most active parenteral cephalosporin. Among the seven cephalosporins tested, cefamandole was the most effective compound. All but two strains were inhibited by cefamandole at 2 mug or less per ml.


Energy cost of proofreading to increase fidelity of transfer ribonucleic acid aminoacylation. The paradox of relatively error free function in biological systems composed of relatively error prone components has recently come under intensive investigation. In the case of tRNA aminoacylation, aminoacyl-tRNA synthetases were discovered to have a separate function that allows misacylated molecules to be hydrolyzed more rapidly than correctly acylated molecules. This additional function of the synthetases provides a proofreading or verification mechanism that is believed to improve significantly the overall accuracy of tRNA aminoacylation. In this paper we provide an explicit relationship between the accuracy achieved by proofreading and the energy cost. Experimental data available in the literature are examined in light of this relationship. The following are the principal conclusions from our study: (1) high-accuracy proofreading of tRNA aminoacylation has a high energy cost, as much as 100 times greater than indications from early experimental work; (2) the minimum net error derived in previous theoretical studies is never actually reached; (3) mechanisms in which misacylation and subsequent proofreading occur on the surface of the same synthetase molecule achieve a much higher accuracy than mechanisms in which these functions occur on the surface of different synthetase molecules.


Mechanisms of protection against the damage produced in biological systems by oxygen-derived radicals. This paper will concentrate on the damage to liver endoplasmic reticulum and plasma membrane fractions that results from exposure to O2- derived radicals and lipid peroxidation. Lipid peroxidation in rat liver endoplasmic reticulum can be produced in various ways involving electron flow out of the NADPH-cytochrome P450 electron-transport chain; analogous reactions occur also in liver plasma membrane suspensions. The subsequent damaging reactions of oxygen-derived radicals and of lipid peroxidation on biological components can be attenuated by various free-radical scavengers and a survey of more than 50 such scavengers in four different systems involving lipid peroxidation has been made. The conditions required for such scavenging reactions to be effective will be outlined, and the difficulties inherent in using such scavengers in vivo will be discussed.


Lipid peroxidation: detection in vivo and in vitro through the formation of saturated hydrocarbon gases. Saturated, short-chain hydrocarbon gases (ethane, propane, etc.--but not methane) are evolved during the spontaneous lipid peroxidation of mouse tissue slices or homogenates. A relatively-selective increase in either ethane or pentane was observed when either linolenic acid or linoleic acid, respectively, was added to tissue homogenates. When mice were challenged by injection of carbon tetrachloride or cumene hydroperoxide (two agents that induce a lipid peroxidative attack on liver), they exhaled ethane. The gas chromatographic detection and monitoring of hydrocarbon gases can serve as an index of lipid peroxidation in vivo.


Hydroxyl radicals and biological damage in vitro: what relevance in vivo? Hydroxyl radicals have been implicated in various forms of tissue injury ranging from radiation-induced cell death to alloxan-induced diabetes in animals. Although hydroxyl radicals can be readily generated in vitro, for example by the action of radiation or from the reaction of ferrous (FeII) ions with peroxides, they have not been observed directly in vivo. Their involvement in tissue damage has generally only been inferred from studies with so-called selective radical scavengers. In this paper the validity of such inferences will be briefly discussed in the light of current knowledge about the mechanisms and rates of reactions of hydroxyl radicals with biological compounds.


Specific induction of pulmonary indoleamine 2,3-dioxygenase by bacterial lipopolysaccharide. Indoleamine 2,3-dioxygenase (molecular weight about 42,000) has been purified from rabbit intestines and contains one mole of protohaem IX as the sole prosthetic group. It catalyses the oxidative cleavage of the pyrrole ring of various indoleamines with a much broader specificity of substrate than tryptophan 2,3-dioxygenase. The enzyme has an absolute requirement for superoxide anion for catalytic activity. The enzyme was induced specifically in the lungs of mice for 24 h after administration of the lipopolysaccharide fraction of E. coli. This  increase is due to synthesis of enzyme protein and is specific for the lipopolysaccharide fraction. These results are interpreted to mean that indoleamine dioxygenase is induced in pulmonary inflammatory processes in response to an increase in production of superoxide anion, 5-hydroxytryptamine or other indoleamines in the lung as a consequence of inflammation. The dioxygenase reaction is a more innocuous way of disposing of superoxide than dismutation.


The pulmonary and extrapulmonary effects of ozone. The toxicity of ozone is solely due to its action as an oxidant. It is an extremely reactive gas which rapidly forms intermediate oxidizing derivatives after inhalation. High concentrations cause death from pulmonary oedema. Both pulmonary and extrapulmonary toxicity have been observed at lower concentrations of ozone, including those currently present in urban air. Pulmonary cellular and subcellular membranes appear to be particularly susceptible. A primary mechanism of this effect is the oxidative decomposition of polyunsaturated fatty acids, which has been demonstrated in rodent lungs after inhalation of ozone. Supporting evidence includes the potentiation of ozone toxicity by vitamin E deficiency and an increased use of this antioxidant vitamin during repetitive exposure to ozone. Other membrane effects include oxidation of thiol groups and, perhaps, of tryptophan. Microsomal alterations include a loss of lung cytochrome P450 which may also be related to lipid peroxidation. Extrapulmonary toxicity is not directly due to ozone but may represent in effect due to lipid peroxide decomposition products, particularly malonaldehyde. This three-carbon dialdehyde has been shown to alter cell membrane fluidity and to have mutagenic properties; the latter perhaps due to cross-linkage of DNA to histone.


Interactions between iron metabolism and oxygen activation. On account of its easy access in aqueous solution to the two states ferrous (FeII) and ferric (FeIII), iron is ideally suited for the activation of molecular oxygen. It is, therefore, logical to seek links between the normal and pathological metabolism of iron and oxygen activation. The pathways of intracellular iron metabolism require changes in the oxidation state of iron both in its deposition in the storage form, ferritin, and in its mobilization from the storage form and use in the cell. Evidence is presented which shows that iron oxidation and deposition in ferritin involves activation of molecular oxygen with formation of a stable peroxo-complex as an intermediate in which the oxygen is bound between two iron atoms attached to adjacent polypeptide chains. The release of iron from ferritin is thought to involve reduction by a flavin, which is associated with the protein, and serves as a cofactor being alternately reduced by NADH or NADPH and oxidized by iron(III). The nature of the low-molecular-weight iron complex which serves to transfer storage iron to transferrin and to supply iron for intracellular use remains to be established. The consequence of excessive iron overload can be rationalized on the basis of oxidative free-radical reactions which provoke lesions typical of deregulated oxygen activation. In some cases these pathological defects can be reversed by iron chelators. Progress in the development of chelation therapy for iron overload are reviewed.


Human haemoglobin genetics.

Human haemoglobin genetics. The genes which direct the structure of human fetal and adult haemoglobin consist of a linked pair of alpha-chain loci on chromosome 16 and the G gamma-A gamma-delta-beta loci complex on chromosome 11. The delta-and beta-chain genes contain inserts similar to those of the mouse and rabbit globin genes. The structure of the various messenger RNAs transcribed from these loci is now worked out although the function of the non-coding regions is not known. The abnormal haemoglobin disorders and thalassaemias result from a variety of lesions at these loci which include single base substitutions, deletions of one or more bases or entire loci, insertions, frame-shifts, fusion genes caused by abnormal crossing over, chain termination mutations and ill-defined defects which lead to a reduced rate of transcription or abnormal structure of messenger RNA. Some progress has been made towards an understanding of the cellular mechanisms whereby the haemoglobin polymorphisms have been maintained. Very little is known about the regulatory mechanisms involved in the switch from fetal to adult haemoglobin production, although it is likely that certain specific areas of the gamma-delta-beta gene complex are involved in its control.


The genetics of the complement system.

The genetics of the complement system. It is suggested that the classical and alternative pathways of C3 activation and the terminal complement reaction pathway represent three replicates formed by gene duplication. It seems likely that the precursor system was what is now the alternative pathway and that its original function was a positive feedback loop for amplifying inflammatory reactions. These views are supported by physicochemical data on the complement components; by genetic data; and by similarities in the reaction patterns. Study of subjects with isolated complement component deficiencies provides information on the function of complement in vivo. It has been found that complement component deficiency is associated with bacterial infection, particularly with Neisseria; and even more so with immune complex disease. This second, rather surprising, association is likely to be the result of a requirement for complement in the catabolism of immune complexes on the one hand, and the need for an intact complement system to eliminate low virulence infectious organisms on the other.


Monoclonal antibodies and cell surface antigens. Antibody chains are encoded in three gene clusters containing genes for the variable and constant regions. V and C genes are separated in germ line and during differentiation a rearrangement takes place. But even after this rearrangement the V and C coding sequences are not contiguous. A final splicing must take place in committed cells between the transcription of a discontinuous V-and C-region DNA and the expression of a continuous mRNA coding for an antibody chain. Analysis by cell fusion indicates that the splicing is cis. When two antibody-producing cell lines are fused, the resulting hybrids express the two antibodies that characterize the parental lines. Permanent cell lines producing antibody of predefined specificity have now been derived in this way. Spleen cells from hyperimmunized donors are fused with myeloma cells and a proportion of the hybrids that are established synthesize and secrete antibodies directed against the immunogen. The heterogeneous cell population can be cloned and propagated. This is a potent way of producing monospecific antibodies to complex antigens such as cell membranes and transplantation antigens. Monoclonal xenogeneic antibodies to rat cell-surface membranes have proved very valuable for characterizing and separating rat lymphocyte subpopulations. In more recent experiments, monoclonal xenogeneic antibodies to mouse and human cell-surface antigens have also been produced which permit the characterization of the hitherto undescribed differentiation antigens.


Human gene mapping and cancer biology.

Human gene mapping and cancer biology. The topics covered in this paper include: (i) a somatic cell genetics approach for measuring the individual variability in the susceptibility to DNA damage/repair at the level of specific chromosomal sites; (ii) a rationale for a selective chemotherapy and/or immunotherapy of chromosomally unbalanced tumours; and (iii) studies on complementation for sister chromatid exchange (SCE) in roden-human hybrids. Preliminary studies indicate that the 'radiation co-transfer method' for gene mapping can be simplified and used in screening for differences in individual susceptibility to radiation induced chromosomal damage. The second topic is dealt with only speculatively, with the explicit aim of emphasizing a practical application in clinical medicine which may potentially derive from the admittedly esoteric activity of gene mappers. The third topic summarizes a somatic cell genetic approach to the study of SCE in mammalian cells. The high rate of SCE observed in an established rodent cell line can be fully suppressed after hybridization with SCE-normal human cells. However, this suppression can be fully removed after extensive loss of the human chromosome complement. Correspondingly, the high SCE rate of Bloom syndrome cells is fully corrected after hybridization with a Chinese hamster line, though the chromosomes of the latter parental cells continue to exhibit in the hybrid cells the moderately high rate of SCE which is typical of this animal line. These complementation experiments indicate that more than one lesion can upset the normal chromatid replication of mammalian cells and lead to high SCE. The experimental studies described promise to be of significant help for studies on the biology of SCE in general and offer a suitable way of screening for possible genetical heterogeneity among different Bloom syndrome patients.


Multilocus enzymes in man.

Multilocus enzymes in man. Two or more separate loci may be concerned in coding for enzyme proteins with the same or very similar catalytic properties. The phenomenon appears to be remarkably common and rough estimates suggest that perhaps 50% or more of structural loci coding for enzyme proteins are concerned with these so-called multilocus enzymes. The separate enzymes in such a multilocus set ressemble each other not only in their enzyme properties, but also in subunit structures and in molecular sizes. However there are often remarkable differences in expression of the several loci of a set from tissue to tissue. Such sets of loci probably arose in evolution by gene duplications with subsequent divergence by point mutations. Tissue differentiation in expression suggests that, pari passu with the divergence of the structural genes, there was an evolution of genetic regulating systems controlling their tissue expression.


Genes and non-coding DNA sequences.

Genes and non-coding DNA sequences. Many new categories of DNA sequence organization in higher organisms have been discovered in the last 20 years. Most of these are not found in bacterial and each in turn is hailed as a likely candidate for those regulatory elements which are assumed to distinguish higher from lower organisms. This article stresses the similarities between their sequence organizations and the continuing lack of convincing function for any of them. It suggests that these sequences often appear after chance recombinational events and their presence then facilitates further change. Within the constraints of proper function the genome is clearly able to find many organizational solutions of apparently equal advantage to the organism. Finally, an example of rapid genome reorganization resulting from selection for resistance to the drug methotrexate is considered.


Surfactant substitution.

Surfactant substitution. A mixture of synthetic phospholipids containing 90% Dipalmitoylphosphatidylcholine and 10% Dipalmitoylphosphatidylglycerol was tested for its suitability as surfactant substitute. Different methods of preparation were employed. The substance was studied by chromatography, Wilhelmy balance, and in rabbits after tracheal instillation during mechanical ventilation. When prepared as suspension of multilamellar liposomes in NaCl, the phospholipid samples displayed the essential surfactant features of adsorption from the subphase, spreading to a monolayer and lowering the surface tension to 3.7 dyn/cm at compression. For a dose of 2.55 microgram/cm2, the stability index was 1.83 +/- 0.29. Samples prepared with ultrasound were not surface-active. Sonication also destroyed the surface-tension-lowering ability of previously active samples. No signs of local toxicity were found in the treated animals. When radioactive DPPC/DPPG was instillated into the trachea of the ventilated rabbit, autohistoradiography demonstrated radioactive material in the alveoli covering the alveolar wall with a thin layer. Provided that proper techniques of preparation and administration are employed, the phospholipids tested are a promising surfactant substitute worthy of clinical study.


[Neuromuscular manifestation of sarcoidosis (author's transl)]. Three of our own observations of neuromuscular manifestation of sarcoidosis are presented. In two cases, a slowly progredient myopathic syndrome was evident. This syndrome developed in mid-life and showed asymmetrical distribution. In another case, a polyneuropathic syndrome was seen, which mainly affected motor function of the lower extremities. None of these patients had typical findings on chest x-rays. Histological proof of granulomatous alterations of skeletal muscle was the first indication of sarcoidosis. With reference to a further observation, the diagnostical value of muscle biopsy in sarcoidosis without neuromuscular manifestation is discussed.


[Cortical somatosensory evoked potentials in patients with thalamic lesions (author's transl)]. The influence of thalamic lesions on the configuration of the somatosensory evoked cortical potential is studied on the basis of two own observations and of the literature. An increased latency of the initial component N1 and a reduced voltage in the beginning of the potential recorded on the side of the thalamic lesion are the most frequent findings in patients with thalamic syndromes. Most dramatic changes of the evoked response occur in cases with lesions of the VPL nucleus and with proprioceptive sensory disturbances. Considering the morphological basis of the normally configurated potential possible developmental mechanisms of the pathological evoked response are discussed.


Some recent progress in the analysis of malignancy by cell fusion. Malignancy, as measured by the ability of cells to grow progressively in vivo, is intimately linked to the presence of a structural abnormality in the polysaccharide moiety of one particular membrane glycoprotein. This abnormality is present in a wide range of different tumours; it co-segregates with malignancy in all crosses between malignant and non-malignant cells that have so far been tested; and it remains linked to malignancy in a stringent new test in which non-malignant variants are selected from tumour cell populations by the use of a lectin. Current work indicates that the abnormal membrane glycoprotein is, in all probability, one of the glucose transport proteins.


The genetics of learning disabilities.

The genetics of learning disabilities. Rapid progress in the study of learning disabilities requires a common context within which investigators and professionals with very diverse backgrounds can work towards common goals. Much evidence points to the heterogeneity of origin and clinical expression of learning disabilities as well as to many other ways in which they resemble such multifactorial conditions as mental retardation, gout and hypertension. In these conditions, genetic and epidemiological methods have been used to sort out the constitutional and environmental factors which precipitate disease in susceptible persons. Such an approach to learning disabilities can be expected to be rewarding.


DNA repair defects and chromosome instability disorders. Xeroderma pigmentosum (XP), Fanconi anaemia (FA), ataxia telangiectasia (AT) and Bloom disease (BS) are four rare autosomal recessive disorders in which there is defective DNA repair and/or chromosome instability and proneness to malignancy. Between 80 and 90% of patients with XP have a defect, demonstrable at cell level, of excision of DNA lesions induced by ultraviolet rays, while the remainder have a cellular error of post-replication repair. XP cells are also deficient in repairing DNA damage caused by a variety of chemical mutagens. There are at least five different complementation groups of the first, or classical, type of XP (A to D, etc.) Apparently group C patients, as well as those with defective post-replication repair, do not show the progressive neurological illness found in a proportion of the other patients. AT is heterogeneous clinically and genetically. Clinically it presents with a progressive neurological illness, progressive telangiectases and a developmental disorder of the thymus. AT is characterized by sensitivity to X-rays and AT cells are unable to repair gamma-ray-induced damage to bases in the DNA. It appears that in many cases of the disorder a chromosomally marked cellular clone is found. In BS the main defect, which results in growth retardation, sun-induced lesions of the face and susceptibility to infection, appears to be a slow DNA chain maturation during DNA synthesis. An increase of sister chromatid exchanges is characteristically seen in the chromosomes of cultured BS cells. In FA, in which there is progressive pancytopenia with eventual bone marrow exhaustion and a tendency to haemorrhage and infection, the cellular defect seems to consist of faulty removal of repair of cross-links in the DNA. In this condition, as in BS and AT, various structural chromosome changes are detected in cultured cells. Patients with XP develop skin cancers in early life and often maligant melanomas. In the other three disorders, in which an immune deficiency is often present, leukaemia and related proliferative disorders are a frequent cause of death while other malignancies also occur. There is some evidence that points to an increased risk of malignancy in heterozygotes who carry the FA and AT genes.


[Four decades of clinical psychiatry--from a personal angle (author's transl)]. The article confronts the issues in clinical psychiatry during the past four decades which contributed to both scientific progress and the current crisis. The author's own experience as German medical student and American psychiatrist serves as basis for the formation of a conceptual perspective.


On being an individual, or: the man in the red hat. If health is a state of equilibrium between intrinsic (genetic) functions and extrinsic (environmental) factors, then disease can be defined as a state of disequilibrium. Medicine has traditionally emphasized extrinsic factors in the origin of human diseases; medical genetics is concerned with the intrinsic factors (mutations) that either yield disease in the universal environment or constitute states of risk for individuals in particular (or universal) enviroments. Genetic screening is a process that defines specific risks for particular individuals. Screening is an ineffective activity if there is no participation by clients. Newborn (and homozygote) screening, on the basis of an experience involving 35 million infants, is usually considered as a 'successful' enterprise. But adult screening, usually for heterozygosity, is quantitatively a much more important activity in its execution, judging from current experience. Comprehension of risk and perceived importance of biological individuality by potential participants and advocates are part of the problem. A major revision in the education of medical personnel and citizens is indicated if medical genetics is to achieve its goals.