From Braxton Hicks to preterm labour: the constitution of risk in pregnancy.

With the recent introduction of preterm birth prevention programs there has been a shift in our understanding of what the presence of contractions during pregnancy means and a reconstituting of risk in ways that position increasing numbers of women at risk for preterm birth. This paper highlights the findings of a study exploring the influences of risk discourses on women's experiences of preterm labour. The primary goals of this institutional ethnographic study were to describe the effects of societal discourses, institutional structures, and nursing work processes on the everyday lives of childbearing women experiencing preterm labour. The findings suggest that risk discourses exert social control over pregnant women and result in fear, guilt, feelings of being judged or punished, and an overwhelming sense of personal responsibility for preventing preterm birth.The study also exposes ways in which biomedical constructions of risk and preterm labour affect the organization of health services, including nursing practice.     

Evidence for the presence of a non-catecholamine, clonidine-displacing substance in crude, methanolic extracts of bovine brain and lung

In the present study we have prepared crude, methanolic extracts of bovine lung and bovine brain and, using radioligand binding assays in conjunction with a number of simple chromatographic techniques, provided evidence for the presence of a non-catecholamine ’clonidine-displacing substance‘ (CDS). The level of CDS in lung extracts (9?units/g wet weight n=11) is approximately 3 times that in the brain extracts. Furthermore, the effect of the crude, methanolic extracts are selective for non-adrenoceptor, imidazoline (labelled by [ ³H]-idazoxan) and a ₂-adrenoceptor binding sites (labelled by [ ³H]-clonidine); both extracts are 5–10-fold more potent displacers of ligand binding to a ₂-adrenoceptors compared with binding to opiate receptors (labelled by [ ³H]-etorphine) and practically inactive against a ₁-adrenoceptor and muscarinic binding sites (labelled by [ ³H]- prazosin and [ ³H]-quinuclidinyl benzilate, respectively). With the exception of the non-adrenoceptor, imidazoline binding assay, which used rat kidney membranes labelled by [ ³H]-idazoxan in the presence of the a ₂-adrenoceptor antagonist RS-15385-197, all radioreceptor assays involved bovine cerebral cortex membranes. Although the extracts contain catecholamines (brain only), histamine (lung only) and monovalent cations (both), which have the potential to interfere with the radioligand binding assays, their concentrations were too low to account for the effects observed. Preliminary attempts at purification of the extracts revealed that CDS activities from the two tissues are similar, i.e., practically insoluble in organic solvents at room temperature, not affected by either Sep-Pak C ₁₈ column or anion exchange resins but retained (along with the monovalent cations) by cation exchange resin. However, following chromatographic separation on a Biogel P2 column, the CDS-containing eluates are cation-free and exhibit qualitatively similar elution profiles. Future experiments will involve further purification of ’clonidine-displacing substance‘ to characterize its interaction with a ₂-adrenoceptor binding sites in greater detail and establish whether it has biological activity consistent with the properties implied by its effects in radioligand binding assays.     

Advances in Statistical Methods for Substance Abuse Prevention Research

The paper describes advances in statistical methods for prevention research with a particular focus on substance abuse prevention. Standard analysis methods are extended to the typical research designs and characteristics of the data collected in prevention research. Prevention research often includes longitudinal measurement, clustering of data in units such as schools or clinics, missing data, and categorical as well as continuous outcome variables. Statistical methods to handle these features of prevention data are outlined. Developments in mediation, moderation, and implementation analysis allow for the extraction of more detailed information from a prevention study. Advancements in the interpretation of prevention research results include more widespread calculation of effect size and statistical power, the use of confidence intervals as well as hypothesis testing, detailed causal analysis of research findings, and meta-analysis. The increased availability of statistical software has contributed greatly to the use of new methods in prevention research. It is likely that the Internet will continue to stimulate the development and application of new methods.     

Attempted suicide in bipolar disorder pedigrees: evidence for linkage to 2p12.

BACKGROUND: We are interested in identifying susceptibility genes that predispose subjects to attempted suicide. METHODS: We conducted a secondary analysis of genome-wide linkage data from 162 bipolar pedigrees that incorporated attempted suicide as a clinical covariate. RESULTS: The strongest covariate-based linkage signal was seen on 2p12 at marker D2S1777. The logarithm of odds (LOD) score at marker D2S1777 rose from 1.56 to 3.82 after inclusion of the suicide covariate, resulting in significant chromosome-wide empirically derived p-values for the overall linkage finding (p = .01) and for the change in LOD score after the inclusion of the covariate (p = .02). CONCLUSIONS: The finding on chromosome 2 replicates results from two previous studies of attempted suicide in pedigrees with alcohol dependence and in pedigrees with recurrent early-onset depression. Combined, these three studies provide compelling evidence for a locus influencing attempted suicide on 2p12.     

A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism

BACKGROUND: Patients who have a first episode of venous thromboembolism in the absence of known risk factors for thrombosis (idiopathic thrombosis) are often treated with anticoagulant therapy for three months. Such patients may benefit from longer treatment, however, because they appear to have an increased risk of recurrence after anticoagulant therapy is stopped. METHODS: In this double-blind study, we randomly assigned patients who had completed 3 months of anticoagulant therapy for a first episode of idiopathic venous thromboembolism to continue receiving warfarin, with the dose adjusted to achieve an international normalized ratio of 2.0 to 3.0, or to receive placebo for a further 24 months. Our goal was to determine the effects of extended anticoagulant therapy on rates of recurrent symptomatic venous thromboembolism and bleeding. RESULTS: A prespecified interim analysis of efficacy led to the early termination of the trial after 162 patients had been enrolled and followed for an average of 10 months. Of 83 patients assigned to continue to receive placebo, 17 had a recurrent episode of venous thromboembolism (27.4 percent per patient-year), as compared with 1 of 79 patients assigned to receive warfarin (1.3 percent per patient-year, P<0.001). Warfarin resulted in a 95 percent reduction in the risk of recurrent venous thromboembolism (95 percent confidence interval, 63 to 99 percent). Three patients assigned to the warfarin group had nonfatal major bleeding (two had gastrointestinal bleeding and one genitourinary bleeding), as compared with none of those assigned to the placebo group (3.8 vs. 0 percent per patient-year, P=0.09). CONCLUSIONS: Patients with a first episode of idiopathic venous thromboembolism should be treated with anticoagulant agents for longer than three months.     

Effect of ouabain and metabolic inhibitors on the Na and K movements and nucleotide contents of L cells

1. The general characteristics and Na and K movements of L cells (derived from mouse epithelium) have been measured. Both cells grown in suspension (LS cells) and as a monolayer (L cells) were used.2. The volume of L cells was 1.2 x 10(-9) cm(3) and of LS cells 3.5 x 10(-9) cm(3); of this 82% was water.3. Electron micrographs showed the presence of numerous protrusions (filopodia) from both forms of the cell. These had the effect of increasing the surface area of the cell by 2-4 times over smooth cells of the same volume. On changing from the flattened to the spherical shape during trypsinization, the filopodia altered to maintain a constant V/A ratio.4. These cells contain K, about 170 m-mole/l. intracellular water and Na, 9 m-mole/l. intracellular water (L cells only) at 20 degrees C. The K fluxes are 1.9 p-mole/cm(2) sec for LS cells and 0.8 p-mole/cm(2) sec for L cells and the Na fluxes are 1.8 p-mole/cm(2) sec for L cells (expressed as per total cell surface (including filopodia)). If expressed as p-mole/cell per sec then L and LS cells have the same K flux.5. 10(-4)M ouabain reduces the K influx to half, indicating an insensitivity to the glycosides common to the species. In the prolonged presence of ouabain the cells come into a new steady state with a [K](1), of 140 and a [Na](1) of 20-30 m-mole/l. intracellular water, but a constant [Na + K](1).6. Both DNP (10(-3)M) and IAA (10(-4)M) are required for maximum inhibition of K uptake, as both aerobic and anaerobic metabolic pathways may be used to drive the pump.7. K removal decreases the Na efflux, and Na removal (eventually) decreases the K influx providing evidence for Na/K coupling.8. The cells contain 7.5 m-mole/litre intracellular water of ATP, a level some 15 times that of ADP.9. The Na pump in these cells is very similar to that found in other tissues in that (a) it requires K to work, (b) it is blocked by ouabain and metabolic inhibitors and (c) it transports three molecules of Na for each two molecules of K.     

The development of the ventral papillae ofNotocotylus triserialis (Digenea: Notocotylidae)

The development of the ventral papillae ofNotocotylus triserialis was studied by light and electron microscopy. The median row papillae first appeared on 2-day-old worms and the lateral rows on 4-day-old worms. The papillae grew in size and in number and size of constituent cells, with rapid development occurring between days 5 and 8. This rapid growth corresponded with the time of onset of egg production by the worm.Electron microscopy indicated that the papillae of 3- and 4-day-old worms contained numerous undifferentiated cells with little cytoplasm and extensive Golgi bodies. By days 5 and 6 most of these cells contained developing mitochondria; only a few undifferentiated cells were visible. Muscles and nervous tissue also became more prominent at this time. The ultrastructure of the papillae of 7-and 8-day-old worms was similar to that of papillae from adult worms. After day 9 or 10, the size and number of cells per papilla remained constant until the death of the worm.     

Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents

This article reviews major risk factors for cigarette smoking, alcohol, and other drug abuse and promising community-based approaches to primary prevention. In a longitudinal experimental study, 8 representative Kansas City communities were assigned randomly to program (school, parent, mass media, and community organization) and control (mass media and community organization only) conditions. Programs were delivered at either 6th or 7th grade, and panels were followed through Grade 9 or 10. The primary findings were (a) significant reductions at 3 years in tobacco and marijuana use and (b) equivalent reductions for youth at different levels of risk. This study provides evidence that a comprehensive community program-based approach can prevent the onset of substance abuse and that the benefits are experienced equally by youth at high and low risk.