Subgroups of smokers with different success rates after use of transdermal nicotine

To identify subgroups of smokers with different success rates, we applied "tree-structured survival analysis" (TSSA) to data from a previously published trial of transdermal nicotine. The subjects who received active treatment (14 mg patch, n 275, or the 21 mg patch, n 262) constituted the sample for this analysis. Using age, gender, the Fagerstrom Tolerance Questionnaire (FTQ), motivation to quit, number of cigarettes smoked at baseline, and body mass index (BMI) as classification variables, TSSA identified two subgroups within the 14 mg patch group and four subgroups of smokers within the 21 mg patch group. Among those receiving the 14 mg patch, individuals with a BMI greater than 26.4 kg/m relapsed sooner than did those with a BMI less than or equal to this value. Within the 21 mg patch group, the survival curve for males was significantly different from that observed in females, with males experiencing a longer time to relapse after treatment than did females. Among males, those who were less dependent relapsed significantly later than did those men who were more dependent. Among females, those with a higher motivation to quit relapsed more slowly than did those women with less motivation to quit. This information may be helpful to clinicians seeking to match specific patients to specific treatments with transdermal nicotine in order to maximize treatment outcomes.     

Individual differences in differentiation among alcohol expectancy domains

Prior research indicates that alcohol-related outcome expectancies represent important etiological factors in the understanding of alcohol use/abuse. Although current multidimensional measures assess several substantively different domains of alcohol-related outcome expectancies, there is growing evidence that they may not possess adequate levels of discriminant validity. Therefore, the present study sought to examine whether reliable between-person differences exist in the ability to differentiate among alcohol expectancy domains. The focus of the study was on three sets of intrapersonal characteristics: cognitive resources, cognitive constraints, and alcohol-related experience. Data were collected via household interviews with a random sample of 1125 adults. Multiple regression analysis revealed that higher levels of cognitive resources were associated with increasing levels of differentiation among alcohol expectancy domains. Results are discussed in terms of implications for the development of new or revised multidimensional alcohol expectancy questionnaires. Directions for future research are also discussed.     

A Comment on the Need for Father-Infant Postpartal Interaction

Paternal participation in postpartal activities may enhance the formation of affectional bonds between the father and the newborn. The father's expression of love, warmth, and compassion for his infant have often been inhibited by a heretofore limited definition of the paternal role by certain socioeconomic events and by gaps in our implementation of family-centered maternity care. Research is needed to investigate paternal needs postpartally and to identify alternatives that nursing can provide to best fulfill these needs. The focus of family-centered maternity care must be broadened in order to more directly reject the needs of the father.     

Profile of the Alcoholic Jew

One factor contributing to low rates of alcoholism among Jewsis the understanding that this in not a Jewish problem. Recognitionand treatment of the disease, when it does occur, is delayedwhen the Jewish community and/or professionals deny its existence.Sixteen recovered alcoholic Jews described their family background,exposure to alcohol, attitudes about drinking and drunkenness,history of alcoholism and recovery. They drank primarily torelieve stress and psychic discomfort; social drinking was minimal.Shame was increased because they interpreted their behaviouras non-Jewish. Treatment was impaired because of the lack ofculturally congruent facilities. No differences in attitudewere detected between Orthodox, Conservative, Reform and secularJews.     

Subcutaneous liposarcoma

Liposarcomas uncommonly present as tumours of the subcutaneous tissues. We report our findings from twelve cases diagnosed in the Departments of Histopathology and Geographical Pathology at St Thomas' Hospital Medical School.     

The Effect of Promoting Intrauterine Attachment in Primiparas on Postdelivery Attachment

Twenty-two women participated in a modified replicate study which examined the effects of prenatal maternal attachment behaviors during first pregnancies. A pretest reflected the degree of maternal-fetal attachment behaviors and attitudes already formed. The women in the experimental group received three interventions aimed at directing the mothers' attentions toward their fetuses. The remaining women received routine prenatal care only. All mothers were observed once in the first few days postpartum to assess maternal attachment behaviors. Data analysis did not substantiate the findings of the earlier study. Factors identified in the added pretest may have accounted for this difference.     

Lower‐extremity selective voluntary motor control in patients with spastic cerebral palsy: increased distal motor impairment

Aim Multiple impairments contribute to motor deficits in spastic cerebral palsy (CP). Selective voluntary motor control (SVMC), namely isolation of joint movement upon request, is important, but frequently overlooked. This study evaluated the proximal to distal distribution of SVMC impairment among lower extremity joints. Method Using a recently developed tool, the Selective Control Assessment of the Lower Extremity (SCALE), we evaluated the SVMC of the hip, knee, ankle, subtalar joint, and toes in a cross‐sectional, observational study of 47 participants with spastic, diplegic, hemiplegic, and quadriplegic CP (22 males, 25 females; mean age 11y 9mo, SD 4y 8mo; Gross Motor Function Classification System levels I–IV). Results Statistically significant decreases in SCALE scores from hip to toes were found using the Page statistical test for trend (p<0.001). Statistically significant differences (p<0.05) were found between all joint pairs, except toes versus subtalar, toes versus ankle, and right ankle versus subtalar joints. Cross‐tabulation of score frequencies for all pairs revealed that proximal joint scores were higher or equal to distal ones 81 to 100% of the time. Excluding toes versus subtalar joints, proximal scores exceeded distal ones 94 to 100% of the time. Interpretation We confirmed increasing proximal to distal SVMC impairment, which may have implications for treatment and research.     

The heparin target organ - the endothelium. Studies in a rat model

Plasma levels of the antithrombotic drug heparin, as estimatedby coagulation tests, are a poor indicator of antithromboticeffectiveness. The interaction of heparin with endothelium isa poorly studied but important factor in the clinical activityof heparin. This study describes the interaction of heparinwith endothelium, following intragastric administration. Theconcentrations of heparin in endothelium and plasma were determinedby gel electrophoresis following administration of heparin torats by various routes. Heparin concentrations in endotheliumversus plasma were approximately 100 times greater followingintravenous or ex vivo administration and more than 1000 timesgreater when administered by intrapulmonary, subcutaneous, intraperitonealand intragastric routes indicating that the route of administrationaffects the distribution of the drug. At 2.4 and 6 min afterintravenous administration, 88 and 51% respectively of the administereddose was found associated with endothelium. Heparin was rapidlyabsorbed following intragastric administration and could bedetected associated with endothelium at 2.4 min. At 6 min lessthan 1% of the administered dose was found in plasma, and 45%was associated with endothelium. These results show that endotheliumis the main site of heparin distribution. Heparins could alsobe detected in cellular and pericellular fractions of culturedporcine aortic endothelial cells when ¹²⁵l-heparin was addedto medium. Bound radioactivity was released to medium from bothcellular and pericellular fractions suggesting that heparintaken up by endothelium can be released. Intragastric administrationof heparin and dextran sulphates significantly prevented thrombusformation in a rat model of thrombosis without significant changesin activated partial thromboplastin times. Administration ofheparin by oral or intrapulmonary routes can deliver large amountsto the vasculature for therapeutic effectiveness without incurringhigh concentrations in plasma which may lead to bleeding.     

Inhibition of homotypic adhesion of T-cells: secondary structure of an ICAM-1-derived cyclic peptide

The objective of this study was to elucidate the solution conformation of cyclo-(1, 12) Pen1-Pro2-Ser3-Lys4-Val5-Ile6-Leu7-Pro8-Arg9-Gly10-Gly11-Cys12 (1) derived from the intercellular adhesion molecule-1 (ICAM-1). Cyclic peptide 1 inhibits homotypic adhesion of T-cells (Molt-3) mediated by ICAM-1 and the leukocyte function-associated antigen-1 (LFA-1) on the surface of T-cells. Cyclic peptide 1 is more potent than is the linear peptide Pen1-Pro2-Ser3-Lys4-Val5-Ile6-Leu7-Pro8-Arg9-Gly10-Gly11-Cys12 (2) in inhibiting homotypic adhesion. The difference in biological activity of peptides 1 and 2 may be due to the more stable conformation of cyclic peptide 1 compared to linear peptide 2 or because cyclization prevents the peptide from adopting non-productive conformation. Therefore, conformational studies of cyclic peptide 1 will give a better understanding of its biological active conformation. The conformational studies of cyclic peptide 1 were done by NMR, CD and molecular dynamics simulations. NMR studies indicated that the major conformation of cyclic peptide 1 contained trans-configuration at both X-Pro peptide bonds. Type I β-turns at Lys4-Val5-Ile6-Leu7 and Leu7-Pro8-Arg9-Gly10 were found in cyclic peptide 1. The C- and N-terminal regions of this peptide were stabilized by antiparallel β-sheet-like structure with the presence of intramolecular hydrogen bonds. The overall structure of this peptide exposed the hydrophobic side chains on one face of the molecule and the hydrophilic side chains on the other.