Das Problem der a-priori-Wahrscheinlichkeit bei Verwendung der Essen-Möller-Formel zur Berechnung der Vaterschaftswahrscheinlichkeit

Zusammenfassung Die Annahme der a-priori-Wahrscheinlichkeit, daß Nichtväter und wahre Väter gleichhäufig zur Begutachtung gelangen, wird an Hand von 408 Aktenfällen bestätigt.Die Berechnung der Vaterschaftswahrscheinlichkeit bietet, insbesondere bei Mehrverkehrsfällen, wertvolle Hinweise für die Vaterschaft oder Nichtvaterschaft eines Probanden, Hinweise, die durch die Angabe der Vaterschaftsausschlußchance aufgrund der Mutter-Kind-Konstellation nicht erbracht werden können. Auf Beziehungen zwischen der Vaterschaftsausschlußchance und der Vaterschaftswahrscheinlichkeit wird hingewiesen.

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The assumption of prior probability computing the plausibility of paternity by the Essen-Möller equation and its problem

Summary Among objectivists the assumption of firsthand probability, that non-fathers and true-fathers are being given an opinion on with equal frequency, yields to a rejection in calculating the probability of fatherhood according to Essen-Möller. By means of 408 cases it is shown, that this assumption does meet the actual situation. Non-fathers and true-fathers are observed equally frequent. Calculation of fatherhood probability renders a valuable reference to paternity or nonpaternity of a subject in cases of multiple intercourses. These references cannot be brought on by the statement of the exclusion chance of fatherhood based on the mother-child-constellation. The relationship between the exclusion chance and the probability of fatherhood is pointed out.

     

The “dural tail” adjacent to meningiomas studied by dynamic contrast-enhanced MRI: a comparison with histopathology

We examined 32 patients with intracranial tumors (17 meningiomas, 8 neuromas, 7 pituitary adenomas) by conventional and dynamic contrast-enhanced MRI. Our aim was to clarify whether the pathological dural contrast enhancement adjacent to meningiomas (the dural tail) is specific to meningiomas and, more important, whether it represents neoplastic dural infiltration or hypervascularization as a tumor accompanying reaction. A dural tail was found in 9 of 17 meningiomas. None of the other extra-axial tumours (neuromas, pituitary adenomas) showed comparable dural enhancement. Dynamic examinations with an ultrafast single slice imaging technique (snapshot-FLASH) after a bolus injection of contrast medium showed a dural tail in seven out of these nine meningiomas, while in two cases the dural tail turned out to be a cortical vein with a characteristic dynamic contrast enhancement pattern. In the dynamic study all seven dural tails were found to have earlier, steeper contrast enhancement than the corresponding tumours. All the tumours and part of the adjacent dura mater in four of the seven meningiomas with dural enhancement were examined histopathologically. In none of these four cases was neoplastic tissue found more than 2 mm away from the main tumour. The results strongly support the suggestion that the dural tail adjacent to meningiomas represents a hypervascular, non-neoplastic dural reaction.     

The immunohistochemical localization of alpha1-antichymotrypsin and fibronectin and its meaning for the determination of the vitality of human skin wounds

Summary A total of 39 vital human skin wounds (20 cases with short survival times ranging from a few seconds to approximately 30 min and 19 cases with wound ages between 50 min and 13 days) were investigated. Alpha,-antichymotrypsin (A₁-ACT) was visualized by immunohistochemistry. Additionally, fibronectin was localized in 13 of these wounds (8 cases with short and 5 cases with longer survival times). Furthermore, 13 postmortem lesions (stab wounds) were removed from corpses approximately 4h after infliction and analyzed for A₁-ACT and fibronectin. The vital reaction previously described for A₁-ACT in form of a band-shaped staining pattern at the wound edges was observed in both vital wounds and in most postmortem lesions. A similar reaction was also obtained for fibronectin in wounds inflicted after death, but could be unambiguously distinguished from vital fibronectin staining by morphological criteria. Therefore, it seems questionable that the vitality of skin wounds can be determined by the immunohistochemical detection of A₁-ACT and probably other proteinase inhibitors. The meaning of the localization of fibronectin for the determination of the vitality of human skin wounds with a survival time of at least a few minutes could be confirmed.This study was supported by a grant from the Deutsche Forschungsgemeinschaft (grant No. Ei 209/3-1) and by a grant from the Friedrich-Baur-Stiftung, University of Munich, Germany     

Die besonderen konstruktionsmerkmale des japanischen „Tan-to“-(Messers) als Kriterien für dessen Gefährlichkeit

Zusammenfassung Es wird auf die besondere Klingenform japanischer Blankwaffen und auf die Neuentwicklung eines Verwandlungs-Tan-to verwiesen. Bei letzterem läßt sich die Klinge in der Handgriffmitte um 90° drehen und arretieren, eine ideale Fixierung dieses Messers durch Faustschluß am Quergriff. Durch diese Bedingungen ist eine hohe Verletzungsgefährdung mit tödlichem Ausgang gegeben. Diese seit kurzer Zeit im Handel erhältlichen Messer sollten nach § 37 Waff G umgehend als verbotene Gegenstände definiert werden.     

MRI of porencephalic cyst associated with cerebral hemiatrophy

Whereport seven cases of porencephalic cyst associated with cerebral hemiatrophy. One case was due to an unknown prenatal factor. One case had maternal injury and shock, which presumably caused temporary fetal asphyxia. One case had perinatal asphyxia. The other four cases had infantile head injury; of these, two cases had serial follow-up computed tomography (CT) and magnetic resonance imaging (MRI) that verified the evidence of post-traumatic infarction of the brain, and then caused porencephaly with cerebral hemiatrophy. In the other two cases, MRI clearly showed ulegyria on the side of the lesion, which is evidence of remote hypoxic ischemic damage. These cases lead us to believe that hypoxic ischemic damage of the brain is the etiology of porencephalic cyst when associated with cerebral hemiatrophy or when adjacent ulegyria is present. Correspondence to: W.-C. Shen     

Vergleich der nach Essen-Möller berechneten Vaterschaftswahrscheinlichkeit einschließlich „Zuordnung“ mit anthropologischen Resultaten bei Einmannfällen

Zusammenfassung Nach der Formel von Essen-Möller berechnete Vaterschaftswahrscheinlichkeiten von 909 Vätern und 909 Nichtvätern, ausgedrückt als lg Y/X, verteilen sich in einer aus 2 Normalverteilungen zusammengesetzten Kurve. Der überlagernde Anteil von 5% der Fälle wird auf eine Beimengung echter bzw. falscher Terzetten mit einem populationsfremden Mann zurückgeführt. Der Mittelwert von Nichtvätern liegt bei einem höheren lg Y/X-Wert als der von Vätern. Die Zuordnungswahrscheinlichkeiten von Vätern, ausgedrückt als lg(1–Z)/Z, sind ebenfalls normal verteilt, während Nichtväter und — in geringerem Maß — serologisch nichtausgeschlossene Männer aus Ein- und Mehrmannsachen (n=910) eine nach niederen Z-Werten hin schiefe Verteilung zeigten. Serostatistische und anthropologische Urteile gehen, wie an 331 Einmannfällen gezeigt werden konnte, weitgehend parallel. In 7 Fällen kam es zum Widerspruch zwischen der serostatistischen Vaterschaftswahrscheinlichkeit (W90%) und dem anthropologischen Ergebnis (Vaterschaft sehr unwahrscheinlich bis praktisch ausgeschlossen). Bei 5 von diesen handelte es sich jedoch im eigentlichen Sinn um Mehrmannfälle.Unter Anwendung der Grundsätze des Feststellungsparagraphen des neuen Unehelichengesetzes der BRD wären 254 von 331 bei Einmannfällen beteiligte Männer aufgrund des serostatistischen Resultats (W80%) und weitere 61 aufgrund des anthropologischen als Erzeuger zu verurteilen. In 16 Fällen müßte die Klage abgewiesen werden, weil aufgrund des anthropologischen Befundes an der Vaterschaft des beteiligten Mannes ernsthaft zu zweifeln ist.

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Evaluation of probability of paternity as determined by the essen-möller formula in a given mother-child constellation

Summary Using the formula of Essen-Möller, the probability of paternity was evaluated in 909 fathers and in 909 non-fathers. The lg Y/X of these groups yield two identical curves of gaussian distribution. 5% of the total number of cases is believed to result from an admixure of true or false trios with a man outside of the normal population. Non-fathers show a higher mean value of lg Y/X than fathers. The classification possibility of fathers, expressed as lg(1–Z)/Z shows a normal distribution curve; non-fathers, however, and to a smaller extent also serologically non-excluded individuals involved in single or multiple-men cases (n=910), show an oblique curve. Evaluation of the serological and anthropological data in 331 single-man cases indicates a significant correlation. In 7 cases there was a discrepancy between the serological evaluation of paternity (W90%) and the anthropological results (paternity very unlikely or practically excluded). Five of these were multiple-men cases, however. According to the new illegitimacy law of the German Federal Republic, 254 men out of 331 single-man paternity cases should be found guilty on the grounds of serostatistical data (W80%) and an additional 61 should be found guilty of paternity on the basis of anthropological findings. 16 cases should be dismissed on the basis of serious doubt cast by the anthropological data.

     

A new approach to computer-aided comparison of skull and photograph

A computer-based method developed for the purpose of checking the results of identification performed with the traditional method of video-superprojection (developed by Helmer and Grüner) is demonstrated; it does not require any special programs in addition to those necessary for digitising the video pictures. The method is suitable for filtering out false-positive cases. A great advantage is that the phase of computer evaluation can be separated from the job performed in the video studio, both in time and space. The process can be reconstructed, which means it can be checked. The results can be easily documented and interpreted for lay people.     

Local Administration of NF-κ B Decoy Oligonucleotides to Prevent Restenosis after Balloon Angioplasty: An Experimental Study in New Zealand White Rabbits

Purpose To evaluate the efficacy of NF- B oligonucleotides (ODN) administered by local administration with the channeled balloon catheter to prevent restenosis after balloon angioplasty in restenotic iliac arteries of New Zealand white rabbits.Materials and Methods In vitro, 8000 rabbit vascular smooth muscle cells (rVSMC) where transfected with a liposomal carrier (TfX50) with 100 ng of decoy and scrambled ODN. Inhibition of proliferation was measured using a MTT assay after 24 hours in comparison to control. In vivo, 22 male New Zealand White rabbits were fed a 1% cholesterol diet and received denudation of both common iliac arteries with a 3 mm balloon catheter to induce an arterial stenosis. Four weeks after stenosis induction, local application of NF- B in two different concentrations (1 g: n=14; 10 g: n=8) was performed randomly on one common iliac artery. Scrambled oligonucleotides without specific binding capacities were injected into the contralateral side. The channeled balloon catheter allows simultaneous balloon dilation (8 atm) of the stenosis and local application of a drug solution (2 atm). Four weeks after local drug delivery the animals were killed and the vessels were excised and computerized morphometric measurements were performed.Results NF- B decoy ODN but not scrambled ODN inhibited proliferation of rVSMC in vitro. Following local ODN application in the animals, no acute vascular complications were seen. NF- B ODN resulted in a statistically non significant reduction of neointimal area compared to the control group. The neointimal area was 0.97 mm² using 1 g NF- B ODN compared to 0.98 mm² in the control group. The higher dose resulted in a neointimal area of 0.97 mm² compared to 1.07mm² at the control side.Conclusions Local drug delivery of NF- B ODN using the channeled balloon catheter could not reduce neointimal hyperplasia in stenostic rabbit iliac arteries. Application modalities have to be improved to enhance the effect of the local application to prevent restenosis after balloon angioplasty.     

A report on autopsy cases involving amitriptyline and nortriptyline

Summary The concentration and distribution of amitriptyline and nortriptyline in different parts of the body of 55 autopsy cases are reported. The cases are grouped into three categories: i) cases in which poisoning by ami- or nortriptyline seemed to have been the only cause of death, (ii) cases of mixed poisoning by these two drugs and other compounds and/or ethanol, and finally (iii) deaths by physical means where ami- or nortriptyline was found but did not play a direct role in the lethal outcome.The severity of the intoxication by ami- or nortriptyline is best judged by the concentration of the drug (and its metabolites) in the liver, in a similar fashion as for the phenothiazine drugs discussed in an earlier paper.The autopsies reported in this paper have been performed by Drs. K. Boström, B. Falconer, P. Geertinger, H. Glaumann, S. Jacobsson, H. Knutson, B. Larsson, S. O. Lidholm, J. Lindberg, A. Lindgren, I. Lingmark, L. Rammer, T. Saldeen, Hj. Sjövall, G. Voigt, B. Zetterlund, and one of us (G.S.).     

Mixed-sclerosing-bone-dystrophy: Report of a case and review of the literature

We present clinical, laboratory, radiologic, genetic, and pathologic findings in a 49-year-old man with mixed-sclerosing-bone-dystrophy (MSBD), review the six cases previously reported as MSBD, and examine the nosology of this rare bone dysplasia. Our asymptomatic patient showed radiographic changes consistent with osteopoikilosis, osteopathia striata, and melorheostosis and had widespread osteosclerosis of the axial skeleton. Several previous reports of combined osteosclerotic disorders suggest the latter finding represents osteopetrosis, however, histologic examination of our patient's iliac crest excluded that diagnosis. Limited radiographic surveys of his eight children were unremarkable except for isolated bone islands in two sons. Literature review revealed that MSBD has actually been used generically to describe the association of a variety of osteosclerotic bone dysplasias when they occur together in a single patient.     

Comparison of iodine-123 labelled 2β-carbomethoxy-3β-(4-iodophenyl)tropane and 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)nortropane for imaging of the dopamine transporter in the living human brain

Several cocaine congeners are of potential for imaging the dopamine transporter (DAT). Previous studies have shown that iodine-123 labelled 2-carbomethoxy-3-(4-iodophenyl)tropane ([¹²³I]-CIT) is a promising radiotracer for imaging the serotonin (5-HT) and dopamine (DA) transporters in the living human brain with single-photon emission tomography (SPET). [¹²³I]-CIT was found to be not very practical for 1-day DAT imaging protocols since peak DAT uptake occurs later than 8 h. Here we report a pilot comparison of [¹²³I]-CIT and 2-carbomethoxy-3-(4-iodophenyl)-N-(3-fluoropropyl)nortropane ([¹²³I]-CIT FP), using SPET imaging in four healthy male subjects. Peak uptake of [¹²³I]-CIT-FP into the basal ganglia occurred earlier (3–4 h after injection of tracer) than that of [¹²³I]-CIT (>8 h). However, the specific DAT binding of [¹²³I]-CIT-FP in the basal ganglia was somewhat less (0.813±0.047) than that of [¹²³I]-CIT (0.922±0.004). Imaging quality is excellent with both tracers and they are potentially of value for brain imaging in various neuropsychiatric disorders.     

Sodium bicarbonate-augmented stress thallium myocardial scintigraphy

It is well known that sodium bicarbonate in pharmacological doses induces transient alkalosis, causing intracellular transport of serum potassium. The aims of this study were (a) to investigate whether, in humans, myocardial thallium-201 uptake can be augmented by pretreatment with a single bolus of sodium bicarbonate at a pharmacological dose, (b) to verify general safety aspects of the intervention and (c) to evaluate the clinical implications of augmentation of ²⁰¹Tl uptake, if any. Routine exercise myocardial scintigraphy was performed twice in eight adult volunteers (five normal and three abnormal), once without intervention and the second time (within a week) following intravenous administration of sodium bicarbonate (88 mEq in 50 ml) as a slow bolus 1 h prior to the injection of ²⁰¹Tl. Conventional myocardial thallium study was compared with sodium bicarbonate interventional myocardial scintigraphy with respect to myocardial uptake (counts per minute per mCi injected dose), washout patterns in normal and abnormal myocardial segments, and overall clinical interpretation based on planar and single-photon emission tomographic (SPET) images. All patients remained asymptomatic after the intervention. A mean increase of 53% in myocardial uptake of thallium was noted in post-exercise acquisitions after the intervention, confirming uptake of the tracer via the potassium-hydrogen pump and its augmentation by transient alkalosis. The washout pattern remained unchanged. The visual quality of planar and SPET images improved significantly after the intervention. Out of the five abnormal myocardial segments identified in three cases, four showed significant filling-in after the intervention, causing the diagnosis to be upgraded from partial scar to ischaemia, or from ischaemia to normal. The overall scan impression changed in two out of three such cases. Sodium bicarbonate augmentation may have significant implications for stress-thallium scintigraphy and may be a new parameter for defining myocardial viability.     

Usefulness of different myocardial sampling zones for the postmortem diagnosis of myocardial infarction

Summary The diagnosis of myocardial infarction requires the use of a group of tests that are very efficient, quick and inexpensive. Another important consideration is the choice of myocardial sampling zones, especially in cases of differential diagnosis between a cardiac injury secondary to a trauma or violent asphyxia and others, secondary to myocardial infarction. The aim of this work was to choose, through discriminant analysis, the most useful zones of cardiac tissue for the quantification of free fatty acids and free carnitine and for the performance of the K/Na quotient, as biochemical parameters for the postmortem diagnosis of myocardial infarction. According to the discriminant analysis performed, seven zones of cardiac tissue are necessary to achieve a differential diagnosis among myocardial infarction, other natural deaths, and violent deaths with a 71.9% efficacy. Greater diagnostic efficacy was found (78.1%) for differentiating between natural deaths and violent deaths. Offprint requests to: E. Lachica     

Results on forensic application of the C3 system

Summary The results of the application of the C3 system to 155 cases of disputed paternity are presented. In this preselected material (none of the 234 accused men could be excluded by any of the usual markers of red blood cells and serum) 23 men were excluded. Of these 23 exclusions, 17 could be examined in the HLA-system and were confirmed by this system. In 211 mother-child pairs no theoretically impossible combinations were observed.Vortrag auf dem III. Workshop on the Genetics of the Complement System in Köln, Mai 1979     

Three-dimensional display of myocardial perfusion detection of ischemic lesions using a new image subtraction method

A recent, commercially available computer program for the three-dimensional (3D) display of single-photon emission tomography (SPET) data was used to study myocardial perfusion in patients with coronary artery disease (CAD). To enable the detection of small ischemic lesions, the authors proposed a new distance-subtraction method: after suitable centering of the axial slices, 3D distance-shaded images of the stress study were subtracted from the corresponding views of the rest study. With this technique, small changes in surface-to-observer distance were highlighted, thus enabling us to detect nontransmural ischemic areas of the myocardium. General characteristics and possibilities of the subtraction technique were tested on a simple myocardial phantom. Some clinical results of the application of this method on CAD patients are presented and discussed. In CAD patients in whom only nontransmural ischemic lesions are present, the subtraction of distance-shaded images is decisive for a correct diagnosis.     

Computed-tomography of bilateral isodense chronic subdural hematomas

Summary While unilateral chronic isodense subdural hematomas as a result of indirect signs of a space-occupying lesion are easily recognizable on computed tomography (CT) and clearly diagnosed on the angiogram, bilateral chronic isodense subdural hematomas may cause considerable difficulty. In two cases with CT false negative findings we observed, retrospectively, significant small cellae mediae and also the main part of the anterior horns sharply pointed and approaching one another. Three further cases showed the same ventricular configuration, which we called hare's ears sign. This sign together with clinical data is always suspicious of chronic bilateral isodense subdural hematomas and carotid angiography is indicated. Other possible signs are: subtle midline shift if the size of the hematoma varies, changed formation of density of brain tissue, non-appearance of cerebral sulci especially in elderly patients, and eventually the visualization of a membrane after intrevenous injection of contrast material.     

Time-dependent pericellular expression of collagen type IV,laminin, and heparan sulfate proteoglycan in myofibroblasts

Summary Human skin wounds (n = 62) with a wound age between 5 h and 6 weeks were investigated. The appearance of cell-associated pericellular basement membrane components collagen type IV, laminin and heparan sulfate proteoglycan (HSPG) in myofibroblasts was evaluated by immunohistochemistry. Laminin and HSPG were first detectable around myofibroblasts approximately 1.5 days after wounding. Collagen type IV did not appear before the 4th day after wound infliction. In wounds more than 7 days old, 94% of the cases showed fibroblastic cells positively staining for laminin, 70% of the wounds contained fibroblastic cells positive for HSPG and in 63% a positive reaction for collagen type IV was obtained around these cells. The numbers of the cases as well as of the cells positively stained for laminin exceeded the corresponding values for HSPG and especially for collagen type IV. The pericellular appearance of laminin or HSPG around myofibroblasts, therefore, indicates a wound age of at least approximately 1.5 days. The pericellular localization of collagen type IV indicates a survival time of approximately 4 days or more. Since these proteins are still detectable in the pericellular region of myofibroblasts in skin wounds with advanced wound age (6 weeks) further information for the time-estimation of older human skin lesions cannot be obtained. A semiquantitative analysis revealed no significant correlation between the number of positively stained cells and the wound age, rendering this parameter unsuitable for a practicable time-estimation of human wounds.This study was supported by grants from the Deutsche Forschungs-gemeinschaft (grant Ei 209/3-1) and from the Friedrich-BaurStiftung, University of Munich, Germany     

125I-β-iodo-D-alanine-synthesis,biodistribution and antimicrobial activity

Methyl N-carbobenzoxy--iodo-D-alaninate (1) served as an intermediate to synthesize methyl -iodo-D-alaninate (2) and -iodo-D-alanine (3). The ¹²⁵I-labeled compound 1 was synthesized by the melt method and used to synthesize ¹²⁵I-labeled compounds 2 and 3. Compound 3 was shown to be substrate for D-amino acid oxidase. It was also shown that compounds 2 and 3 were rapidly eliminated from normal mammalian tissues and that compound 3 inhibited the Escherichia coli growth in a dose-dependent manner at 100–500 g/ml while compound 2 showed no effect at 500 g/ml level. Therefore, it was suggested that compound 3 may serve as an abscess localizing agent.Research carried out at Brookhaven National Laboratory under contract with the U.S. Department of Energy (No. DE-AC-02-76CH00016) and supported by its Office of Health and Environmental Research     

Sclerotic changes of the manubrium sterni

Six females with nearly identical sclerotic and hyperostotic changes of the manubrium sterni are reported. Malignancies, bacterial inflammatory processes, and Paget disease, which were first suspected, could be excluded. The youngest patients also had sclerotic changes of other bones, including the lumbar spine, the pubic bone, and the clavicle, and may be classified as having chronic recurrent multifocal osteomyelitis (CRMO). The two oldest patients had ossification of the costoclavicular ligament(s) and may be classified as having inter-sterno-costo-clavicular ossification (ISCCO). One had only hyperostotic and sclerotic changes as seen in sterno-costo-clavicular hyperostosis (SCCH). The pathogenesis of these uncommon diseases is unknown, but they are all frequently associated with pustulosis palmoplantaris and have similar clinical courses and laboratory abnormalities. None of the present patients had HLA-B₂₇. The similarity of the radiological abnormalities of the manubrium sterni suggests that the diseases themselves may be similar, but with different courses depending on age, CRMO being present in children and young adults and ISCCO or SCCH in older adults.     

Falx “calcification” — Does this exist?

Summary In discussing mineralization of the falx cerebri many radiology textbooks use the term calcification and make no mention of ossification. A retrospective study of 18 consecutive autopsy cases, in which skull radiographs had revealed mineralization of the falx, was undertaken. These areas of mineralization were excised and submitted for histological evaluation. The density seen on the skull radiograph consisted of membranous bone complete with bone marrow elements in all cases. Two cases had metastatic deposits in the ossified falx and one case showed leukemic infiltration. Some aspects of the pathogenetic mechanisms involved in calcification of the falx are discussed.

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Falxverkalkungen — existieren sie überhaupt?

Zusammenfassung Oftmals wird in radiologischen Lehrbüchern der Ausdruck Falxverkalkung gebraucht und von einer Verknöcherung keine Notiz genommen. Die Verfasser führten bei 18 Autopsie-Fällen mit Falxverkalkung histologische Untersuchungen durch. Dabei zeigte es sich, daß es sich um Verknöcherungen der Falx handelt. Die Gesichtspunkte der Pathogenese dieser Falxverknöcherung werden diskutiert.

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La calcification de la faux existe-t-elle?

Résumé Lorsqu'ils parlent des dépôts opaques dans la faux du cerveau, beaucoup d'auteurs utilisaient le terme de calcification et ne font pas mention d'ossification. L'étude de 18 cas autopsiés de sujets présentatant un dépôt radio-opaque au niveau de la faux et leur examen histologique a montré qu'il s'agit d'ossification membraneuse. Dans deux cas les auteurs ont trouvé une métastase au niveau de l'ossification de la faux et dans un cas une infiltration leucémique.

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This work was supported in part by a Special Fellowship Award # 2F11 NS 2576-02, NSRB, from the National Institute of Neurological Diseases and Stroke, U.S. Public Health Service.