Critical skills assessment for the treatment of geriatric patients: Geriatric Dentistry

This paper reports the results of a needs assessment survey conducted to identify education objectives for the dentist geriatric fellowship program initiated by the Veterans Administration in 1982. A cascading sample design was used to identify 82 persons recognized as experts in geriatric dentistry. Each was asked to list five knowledge, skill, and attitudinal objectives considered most crucial for comptence of the geriatric dentist. The 30 major critical competencies cited and their relative frequencies are presented as a kind of definition of the competent geriatric dentist and a guide to planning and evaluation of geriatric dentistry programs     

Continuous ambulatory peritoneal dialysis in the United States: a three-year study

This report of the NIH-supported National Continuous Ambulatory Peritoneal Dialysis (CAPD) Registry summarizes data on 7,404 patients treated with CAPD during the three-year period 1981 through 1983, or nearly one-half of patients treated in the USA who were treated with CAPD during this time. While age and diabetes mellitus impact on mortality, they appear to have a limited influence on transfer or infection rate. There were 1.7 episodes of peritonitis, 0.7 exit site/tunnel infections, and 0.3 catheter replacements reported per patient year of observation. Patients averaged 10.2 hospital days per year for CAPD complications and 22.3 hospital days per year for all causes. Comparisons of these data with similar data reported for other therapies are subject to variations in the distribution of population and disease characteristics, as well as the length of the observation period.     

Heterogeneous expression of erbB-2 messenger RNA in human breast cancer

Amplification and mRNA expression of the erbB-2 gene was analyzed in 61 samples of primary human breast carcinoma. In the 57 samples where RNA could be isolated four different expression level groups were identified. Comparison of hybridization signal with that for beta-actin revealed that erbB-2 mRNA could not be detected in 6 of 57 samples (11%), was detected at normal levels in 32 of 57 samples (56%), showed 4- to 8-fold overexpression in 8 of 57 samples (14%), and showed 16- to 128-fold overexpression in 11 of 57 samples (19%). Examination of the DNA of the same set of samples revealed 6 of 61 samples (10%) with distinct gene amplification and 6 of 61 samples (10%) with possible gene amplification. The highest levels of erbB-2 overexpression were associated with gene amplification. Samples with 4- to 16-fold overexpression of the erbB-2 mRNA occurred without evident gene abnormalities. There was no association of erbB-2 expression or gene amplification with clinical stage of breast carcinoma or axillary lymph node involvement. The clear amplification of the erbB-2 gene may be associated with a significantly shorter time to treatment failure.     

Blood Pressure and Body Size in Precocious Puberty

ABSTRACT. Blood pressure increases with age in normal children. This increase appears to be related to body size. To assess the role of body size as a determinant of blood pressure in precocious puberty, we compared the Mood pressure of 81 children with precocious puberty with the blood pressure standards for normal children from the NHLBI Task Force on Blood Pressure Control in Children. Children with precocious puberty had significantly increased blood pressure for chronologic age ( p <0.05) but generally appropriate Mood pressure for height age or weight age. These data are consistent with the hypothesis that increased body size causes the increased blood pressure for chronologic age in children with precocious puberty. Physicians who evaluate such children should assess whether blood pressure is appropriate for height age rather than chronologic age.     

Hemoglobin Indianapolis (beta 112[G14] arginine). An unstable beta-chain variant producing the phenotype of severe beta-thalassemia.

Hemoglobin (Hb) Indianapolis is an extremely labile beta-chain variant, present in such small amounts that it was undetectable by usual techniques. Clinically, it produces the phenotype of severe beta-thalassemia. Biosynthetic studies showed a beta:alpha ratio of 0.5 in reticulocytes and about 1.0 in marrow after a 1-h incubation. These results, similar to those seen in typical heterozygous beta-thalassemia, suggested that betaIndianapolis was destroyed so rapidly that its net synthesis was essentially zero. To examine the kinetics of globin synthesis, reticulocyte incubations of 1.25--20 min were performed with [3H]leucine. The betaIndianapolis:beta A ratio at 1.25 min was 0.80 suggesting that beta Indianapolis was synthesized at a near normal rate. At 20 min, this ratio was 0.46 reflecting rapid turnover of beta Indianapolis. The erythrocyte ghosts from these incubations contained only betaIndianapolis and alpha-chains, and the proportion of betaIndianapolis decreased with time, indicating loss of betaIndianapolis. Pulse-chase studies showed little change in beta A:alpha ratio and decreasing betaIndianapolis:alpha and betaIndianapolis:beta A with time. The half-life of betaIndianapolis in the soluble hemoglobin was approximately equal to 7 min. There was also rapid loss of beta Indianapolis from the erythrocyte membrane. From these results, it may be inferred that betaIndianapolis is rapidly precipitated from the soluble cell phase to the membrane, where it is catabolized. Heterozygotes for beta 0-thalassemia usually have minimal hematologic abnormalities, whereas heterozygotes with betaIndianapolis, having a similar net content of beta-chain, have severe disease. The extremely rapid precipitation and catabolism of betaIndianapolis and the resulting excess of alpha-chains, both causing membrane damage, may be responsible for the severe clinical manifestations associated with this variant. It seems likely that other, similar disturbances in the primary sequence of globin polypeptide chains may produce clinical findings similar to those seen with hemoglobin Indianapolis and thus produce the phenotype of severe beta-thalassemia.     

Regular or decaffeinated coffee and subsequent human aggressive behavior

A new methodology was used to study the effects of coffee on human aggressive behavior in a laboratory situation. Aggressive responding was elicited by subtracting money from the research subjects, an action which was attributed to a fictitious person. Regular coffee compared to decaffeinated coffee produced decreases in aggressive responses, but increased nonaggressive monetary reinforced responding. Thus, the suppressing effect of regular coffee on aggressive responding was not due to a nonspecific depressant action.