SQUAMOUS CELL CARCINOMA IN KAUAI, HAWAII

Background. It is estimated that over 100,000 new cases of squamous cell carcinoma are diagnosed in the United States annually. This number is compounded by an increasing concern over the ozone layer depletion and the continued sunbathing behavior of many individuals. This could be particularly acute in Hawaii, which may have the highest rates of skin cancer in the country. We believe the updated information on skin cancer is essential to address the magnitude of the problem. Methods. A prospective 5-year population-based incidence study was conducted on Kauai, Hawaii, between 1983 and 1987 to investigate the frequency of squamous cell carcinomas in resident Caucasians. Results. A total of 58 residents, 37 men and 21 women, were identified with an initial episode of squamous cell carcinoma during the 5-year period. The average annual incidence rate per 100,000 Kauai Caucasian residents, standardized to the 1980 U.S. white population, was 153 for men and 92 for women with a combined rate of 118. The average patient age was 66.4 years. The head and neck was the most common anatomic site, with the extremities second. Subsequent new squamous cell carcinoma occurred in 13.8% of patients. Only one patient (2%) developed a recurrence after treatment. Twenty-five patients (43%) had basal cell carcinoma simultaneously or at other earlier times. Conclusions. In Kauai the incidence rate of squamous cell carcinoma is the highest yet documented in the United States. No consistent trend in incidence rates was appreciated during this 5-year period.     

Evaluation of the impact of recent changes in postgraduate continuing education for community pharmacists in England

Postgraduate continuing education for community pharmacists in England has undergone a radical change since the establishment of the Centre for Pharmacy Postgraduate Education (CPPE) in 1992. The present study was undertaken to assess the impact of the introduction of the CPPE on levels of participation and attitudes towards continuing education. Comparisons are drawn with an analysis made in 1991. Results showed that 76.8 per cent of respondents had participated in CPPE-based continuing education, as either workshops or distance learning. This level of participation is far higher than that previously recorded. Those pharmacists who attended the workshops also tended to request distance learning packages, while a significant proportion of users of distance learning declined to attend workshops. Owners of community pharmacies were significantly more likely than managers to use computer assisted learning material. Attitudes concerning restraints against participation in continuing education focused on the value pharmacists place on their spare time and the absence of a postgraduate education allowance for community pharmacists.     

Stability of the Defibrillation Probability Curve with the Development of Ventricular Dysfunction in the Canine Rapid Paced Model

Most patients with implantable defibrillators have diminished cardiac function. Progressive heart failure might impair defibrillation efficacy, leading to interpreted device, failure. This study sought to determine the effect of ventricular dysfunction on defibrillation energy using a biphasic endocardial system. Eleven dogs were ventricularly paced at 225 pulses/min for 2 weeks to induce ventricular dysfunction, and five control dogs remained unpaced. Dose response defibrillation probability curves were generated for each animal at baseline, after 2 weeks (at which time the pacemakers were turned off in the paced group), and then 1 week later. The defibrillation thresholds, ED₂₀, ED₅₀, and ED₈₀ (the 20%, 50%, and 80% effective defibrillation energies, respectively) were determined for each dog at each study. In the paced dogs, the mean ejection fraction fell from 55% to 25% after pacing (P < 0.0001), and rose to 46% after its discontinuation (P = 0.0002). The defibrillation threshold, ED20, ED₅₀, and ED80 remained unchanged in both the control and paced groups for all three studies, even after adjustment for dog weight or left ventricular mass. Rapid pacing produced no change in left ventricular mass. It induced ventricular cavity dilatation and wall thinning, which had opposing effects on defibrillation energy requirements, resulting in no net change of the ED₅₀ in heart failure. In conclusion, the defibrillation efficacy of a biphasic transvenous system is not changed by the development of heart failure using the rapid paced canine model.     

Allocation of attentional resources during habituation to food cues

Two experiments were designed to test the hypothesis that habituation to repeated food cues can be inhibited by allocating processing resources to nonfood cues. In two experiments, the salivary response to 10 presentations of lemon yogurt was assessed while subjects engaged in a controlled cognitive search task (demanding attentional resources), an automatic search task (needing fewer attentional resources), or no task. In Experiment 1, the controlled and automatic search tasks differed in the number of memory set items. In Experiment 2, the size of the memory sets was held constant, and individuals were provided practice to stabilize the different search strategies in the task. The automatic search and no task groups habituated to the repeated presentation of food cues in both experiments, but the controlled search group did not. These results support the hypothesis that allocation of attentional resources to external cues can influence the processing of food cues.     

Personality disorder in an outpatient offender population

Previous research with incarcerated and hospitalised offenders has produced a fourfold typology of personality types. These have been labelled primary psychopath, secondary psychopath, inhibited and controlled. The current study uses cluster analysis of the Millon Clinical Multiaxial Inventory (MCMI) scores to determine whether the same clusters emerge in a sample of non-incarcerated offenders. Results indicate the presence of the four types in this population. Consideration is given to how the clusters vary with respect to index offence and other variables.     

Incremental Value of Three-Dimensional Echocardiography Over Transesophageal Multiplane Two-Dimensional Echocardiography in Qualitative and Quantitative Assessment of Cardiac Masses and Defects

In the present study, we compared three-dimensionally (3-D) reconstructed images with multiplane two-dimensional (2-D) transesophageal echocardiographic (TEE) images in 17 patients with various cardiac masses and defects. To overcome the problem of making measurements from 3-D reconstructed images, we carefully "dissected" the 3-D dataset using paraplane and anyplane 2-D sections, which were then used to obtain the maximum sizes of the cardiac masses and defects. Of the 15 vegetations and 9 abscesses detected by 3-D TEE in 7 patients, only 8 (53%) vegetations and 4 (44%) abscesses were detected by multiplane 2-D TEE (P < 0.02). Also, the exact anatomical location, shape, geometry, and extent of various cardiac masses and defects were more clearly delineated by 3-D than 2-D TEE. The maximum dimensions of cardiac masses and defects were larger by 3-D than by 2-D TEE in 17 (89%) of the 19 lesions available for comparison (P < 0.002). In addition, 3-D TEE correlated more closely than 2-D TEE when compared to surgical measurements in three patients in whom they were available. Thus, it would appear that in several instances, the exact size of the cardiac lesion could only be assessed by analysis of the 3-D volumetric dataset. Out preliminary study has demonstrated the superiority of transesophageal 3-D reconstruction over multiplane 2-D TEE in both qualitative and quantitative assessment of various cardiac mass lesions and pathological defects.