Genetic polymorphisms in dopamine-related genes and smoking cessation in women: a prospective cohort study

Background  

Genes involved in dopaminergic neurotransmission have been suggested as candidates for involvement in smoking behavior. We hypothesized that alleles associated with reduced dopaminergic neurotransmission would be more common in continuing smokers than among women who quit smoking.     

Advanced primary breast cancer: assessment at mammography of response to induction chemotherapy

The response to induction chemotherapy is an important prognostic factor in patients with nonmetastatic, locally advanced breast carcinomas. Assessment at mammography of the response of 60 breast cancers in 59 women was performed between 1974 and 1986. Responses were excellent in 13 tumors, moderate in 34, and poor in 13 (excellent moderate = 78%). Assessment of response of discrete masses in a fatty breast was easiest; assessment of response of tumor areas that were poorly defined-such as a focal area of architectural distortion or mass in dense breast parenchyma-was more difficult. Of 17 patients with excellent pathologic responses-that is, minimal or no residual tumor-15 (88%) had complete responses (no residual tumor) as determined with mammography, physical examination, or both. Mammography provides information complementary to physical examination and is essential in the accurate assessment of the response to chemotherapy of locally advanced breast cancer.     

Artificial insemination and in-vitro fertilization using donor spermatozoa: a report on 15 years of experience

Donor insemination (DI) using cryopreserved semen commenced at The Royal Women's Hospital in 1976. Over the next 15 years we performed 5953 treatment cycles to achieve 816 pregnancies (13.7% per cycle) and 706 live births. In-vitro fertilization (IVF) using donor spermatozoa commenced in 1986. Over the next 5 years we performed 303 treatment cycles for 185 couples. Including subsequent transfer of cryopreserved embryos, a total of 33% of couples achieved a successful pregnancy by IVF. Statistical analysis indicated that, for DI pregnancies, the most important semen variable was the percentage post-thaw motility, whilst for normal fertilization in IVF it was the pre-freeze motility. These results may be explained by the compensatory effects of post-thaw processing of spermatozoa for IVF, but not for DI in our clinic.      

Reliability of Katz's Activities of Daily Living Scale when used in telephone interviews

The reliability of a five-item Katz's Activities of Daily Living (ADL) scale collected by self-report telephone interview is presented. A random sample of 6,472 South Carolina residents over 55 years of age selected from a statewide population is used. Factor structure, Guttman properties, internal consistency reliability, Mokken's index of test homogeneity, and Spearman's coefficient of rank-order correlation are used to show that ADL data gathered by telephone interview are reliable. Because telephone interviewing methods are faster, cheaper, and safer they are recommended as a viable way for researchers, policymakers, and practitioners to gather ADL information.     

Evaluation of South Carolina's HIV/AIDS community long-term care Medicaid waiver: cost comparison and patient satisfaction

South Carolina's HIV/AIDS community long-term care Medicaid (Section 2179) waiver is evaluated via cost comparison and patient satisfaction measures. The waiver offers personal care aids, adult day care, counseling, home meals, hospice, private-duty nursing, and foster care supervision in addition to regular Medicaid services. Services to 111 eligible individuals and 52 individuals pending eligibility are evaluated by five methods. A cost comparison is conducted by comparing the cost per patient eligible day of the waiver recipients with those of a comparable group of HIV/AIDS Medicaid patients who did not participate in the waiver. The waiver services are shown to cost less than services delivered to comparable recipients. Costs per patient eligible day were $35.68 and $68.56 for the waiver patients and non-waiver patients, respectively. Telephone surveys, focus groups, provider compliance reviews, and patient record reviews were used to assess patient satisfaction and quality of care. Waiver patients were satisfied with the program overall and with the service managers who are responsible for coordinating services. Problems are identified with personal care aid performance and TB testing for health care providers. A shortage of dentists willing to see waiver patients and delays in the eligibility process are also identified. In spite of small problems, the South Carolina's HIV/AIDS community long-term care Medicaid waiver program is considered a success.     

The role of the Medical Care Advisory Committee in the administration of state Medicaid programs. A twenty-year perspective

Every state Medicaid program has a Medical Care Advisory Committee (MCAC). MCACs are required by federal regulations to have representation from state human service agencies, health care providers, and Medicaid consumers. Survey data presented in this study show the make-up of MCACs by representative group. Other data presented show meeting frequencies, subcommittee structure, and information about MCAC activities. Comparisons are made from historical MCAC data showing long-term trends of their composition and structure. It is argued that MCACs can be useful to state Medicaid agencies in policy development but have not been structured to do so. Recommendations are given to make MCACs more useful.     

Early volatile depletion on planetesimals inferred from C–S systematics of iron meteorite parent bodies

During the formation of terrestrial planets, volatile loss may occur through nebular processing, planetesimal differentiation, and planetary accretion. We investigate iron meteorites as an archive of volatile loss during planetesimal processing. The carbon contents of the parent bodies of magmatic iron meteorites are reconstructed by thermodynamic modeling. Calculated solid/molten alloy partitioning of C increases greatly with liquid S concentration, and inferred parent body C concentrations range from 0.0004 to 0.11 wt%. Parent bodies fall into two compositional clusters characterized by cores with medium and low C/S. Both of these require significant planetesimal degassing, as metamorphic devolatilization on chondrite-like precursors is insufficient to account for their C depletions. Planetesimal core formation models, ranging from closed-system extraction to degassing of a wholly molten body, show that significant open-system silicate melting and volatile loss are required to match medium and low C/S parent body core compositions. Greater depletion in C relative to S is the hallmark of silicate degassing, indicating that parent body core compositions record processes that affect composite silicate/iron planetesimals. Degassing of bare cores stripped of their silicate mantles would deplete S with negligible C loss and could not account for inferred parent body core compositions. Devolatilization during small-body differentiation is thus a key process in shaping the volatile inventory of terrestrial planets derived from planetesimals and planetary embryos.

Major volatiles (H, C, N, and S) are inherently plentiful in the interstellar medium and abundant in primitive carbonaceous chondrites (CCs) (1, 2), but are scarce in terrestrial planets, which gained most of their mass from the inner parts of the solar nebula (3, 4). Formation of volatile-poor planets from a volatile-rich protoplanetary disk is a result of processes in the solar nebula, in accretion of precursor solids, and in interior differentiation. Addition of volatiles to nascent planets varies during accretion as protoplanetary systems become dynamically excited, contributing material originating from different heliocentric distances (3) and with different thermal histories. Much of this mass arrives in larger bodies (planetesimals or planetary embryos) that differentiated soon after formation (5). Key uncertainties include the nebular history of bulk materials that contributed volatiles to the rocky planets and how that affected their volatile cargos (6), and how planetesimal and planet formation influenced volatile distributions in accreted parent bodies.Processes responsible for volatile deficits in terrestrial planets (7, 8) can occur either in the nebular, planetesimal, or planetary environment. Nebular volatile depletion could result from chemical interactions between nebular gas and dust, chondrule formation, or the accretion of thermally processed solids (9–11), perhaps owing to the hotter conditions prevailing closer to the protosun (4). Li et al. (6) argue that the comparatively small C inventory of the bulk Earth requires that nebular materials experienced significant early (<1 Ma) heating, before the “soot line” moved inward of 1 AU. Planetesimal processes involve loss to space during differentiation or processing of intermediate-sized bodies of tens to hundreds of kilometers in diameter (e.g., refs. 12 and 13). Planetary loss processes occur on large (thousands of kilometers in diameter) bodies (14, 15) in which gravity plays an appreciable role—including loss from impacts (16). The sum of these is an important determinant for whether terrestrial planets form with volatiles sufficient for habitability but not so great as to become ocean worlds (17) or greenhouse hothouses (18).A key goal in the study of exoplanets and of young stellar systems is predicting environments and processes that could lead to habitable planets, including development of models that account for the distribution, acquisition, and loss of key volatile elements. Astronomical studies can reveal the architecture of other solar systems (19), the compositions of observable exoplanet atmospheres (ref. 20 and references therein), and the dust and volatile gas structure and composition of protoplanetary disks (ref. 21 and references therein), including interactions of the disk with gas- or ice-giant protoplanets. However, only limited astronomical observations can be made about conversion of disk materials (gas, dust, and pebbles) to planets in other solar systems. To understand this conversion, we must necessarily rely on planetesimals and their remnants (meteorites) as records of the processes that occurred. In this paper, we focus on volatile loss during planetesimal differentiation by examining evidence chiefly from iron meteorites. We note that ephemeral metal enrichments in white dwarf atmospheres confirm that differentiated planetesimals are common around other stars (22), and that our findings apply to how materials would have been processed during the assembly of other planetary systems.In classic oligarchic growth models of planetary origin, planets and embryos grow from accretion of planetesimals with characteristic radii of tens to a few hundreds of kilometers (3). In pebble accretion models of terrestrial planet formation, the fraction of planetesimals in accreting material varies with time and protoplanetary mass (23), but still remains significant. Thus, for understanding volatile delivery to growing planets, an important question is whether the volatile inventory of accreting planetesimals (or larger objects) remained similar to that of primitive materials, typically taken to be comparable to chondritic meteorites, or had diminished significantly from prior differentiation.^*Achondritic meteorites are fragments of differentiated planetesimals and provide direct evidence of processes on small bodies.^† Evidence for volatile loss on silicate achondritic parent bodies comes from elemental concentrations and from isotopes (24–27). However, the best-studied silicate achondritic suites, such as the eucrites and angrites, are igneous crustal rocks (28), and their compositions may not reflect average major volatile contents of their parent bodies. Volatile loss could have been locally enhanced by the igneous activity that produced the planetesimal crusts (29).Iron meteorites offer an additional record of volatile processing in planetesimals. Many, known as “magmatic” irons, originated as metallic cores of planetesimals (30) and potentially record volatile depletions in their parent planetesimals at the time of alloy–silicate separation. Iron meteorites contain measurable amounts both major (S, C, N) and moderately volatile (Ge, Ga) elements and represent the cores of at least 50 parent bodies (31). Thus, known parent body cores are likely survivors from a population of planetesimals that were mostly incorporated into larger bodies and planets. Additionally, isotopic evidence links iron meteorites with both carbonaceous (CC) and noncarbonaceous (NC) chondrites (32), thereby correlating the differentiated planetesimals to their primitive chondritic heritage.Here, we address the problem of planetesimal volatile loss by focusing on carbon and sulfur, two siderophile volatile elements that give important clues to the degassing history of metallic cores recorded iron meteorites and thereby their parent planetesimals.^‡ We begin by examination of C–S systematics in different classes of chondrites. Although chondritic parent bodies formed later than most parent bodies of iron meteorites (33), they provide the best available guide to undifferentiated materials in the early solar system. Their isotopic kinships to iron meteorites (32) suggest that they derive from similar, although not necessarily identical, reservoirs, and so they provide a basis for comparison to those estimated for parent body cores. They also reveal devolatilization processes associated with planetesimal metamorphism. We then examine iron meteorite groups and reconstruct the compositions of their respective parent cores. Finally, we consider a spectrum of simple planetesimal core-formation scenarios and model the resulting C and S distributions. Comparison of these to reconstructed parent core C and S places new constraints on the magnitude of degassing occurring from planetesimal interiors.     

Systemic inflammation after inspiratory loading in chronic obstructive pulmonary disease

Objective

Patients with chronic obstructive pulmonary disease (COPD) present systemic inflammation. Strenuous resistive breathing induces systemic inflammation in healthy subjects. We hypothesized that the increased respiratory load that characterizes COPD can contribute to systemic inflammation in these patients.

Patients and methods

To test this hypothesis, we compared leukocyte numbers and levels of circulating cytokines (tumor necrosis factor alpha [TNFα], interleukin-1β [IL-1β], IL-6, IL-8, and IL-10), before and 1 hour after maximal incremental inspiratory loading in 13 patients with stable COPD (forced expiratory volume in one second [FEV₁] 29 ± 2.5% ref) and in 8 healthy sedentary subjects (FEV₁ 98 ± 5% ref).

Results

We found that: (1) at baseline, patients with COPD showed higher leukocyte counts and IL-8 levels than controls (p < 0.01); and, (2) one hour after maximal inspiratory loading these values were unchanged, except for IL-10, which increased in controls (p < 0.05) but not in patients with COPD.

Conclusions

This study confirms the presence of systemic inflammation in COPD, shows that maximal inspiratory loading does not increase the levels of pro-inflammatory cytokines (IL-1β, IL-8) in COPD patients or controls, but suggests that the former may be unable to mount an appropriate systemic anti-inflammatory response to exercise.