CYP3A5 as a candidate gene for hypertension: no support from an unselected indigenous West African population.

CYP3A5 (cytochrome P450, family 3, subfamily A, polypeptide 5) expression stimulates the sodium retentive actions of the mineralocorticoid receptor causative of hypertension, probably by means of its ability to substantially increase the level of 6ß-hydroxylase activity. Most Black individuals are functional CYP3A5 expressers, and this is a candidate gene for the high incidence of hypertension in Black populations. The study investigates whether CYP3A5 expression results in higher blood pressure in a Ghanaian population. Real-time PCR was used to genotype 898 DNA samples for the CYP3A5*3 and CYP3A5*6 single-nucleotide polymorphisms with technically adequate genotyping for 881 samples. Of these, 803 were genetic CYP3A5 expressers, 44 nonexpressers and 34 uncertain (CYP3A5*3/*6). Although there was a trend in the proportion of hypertensive individuals as CYP3A5 expression decreased, using a two-sided t-test, no statistically significant relationship was established between systolic or diastolic pressure and CYP3A5*3 or CYP3A5*6 genotypes, or their haplotypes (Systolic confidence interval: -8.44 to -7.70, P=0.93, Diastolic confidence interval: -4.89 to 4.85, P=0.99). We conclude, therefore, that there is either no association between CYP3A5 expression and blood pressure or, if there is a relationship, the strength of the association is very small.

Measles-induced encephalitis.

Encephalitis is the most frequent neurological complication of measles virus infection. This review examines the pathophysiology of measles infection and the presentations, diagnosis and treatment of the four types of measles-induced encephalitis including primary measles encephalitis, acute post-measles encephalitis, measles inclusion body encephalitis and subacute sclerosing panencephalitis. The early symptoms of encephalitis may be non-specific and can be mistakenly attributed to a systemic infection leading to a delay in diagnosis. This review provides a summary of the symptoms that should cause health care workers to suspect measles-induced encephalitis.

The view from the road: the contribution of on-road glance-monitoring technologies to understanding driver behavior.

Using glance-monitoring technologies for on-road studies is an excellent way to investigate driver behaviors in an ecologically valid setting. Recent advances in glance-monitoring technologies have made it possible to conduct on-road studies of drivers' glance behavior that heretofore were simply not possible. Yet it is not always easy to determine which glance-monitoring technology to use for a particular application. Here, we first identify the generic capabilities of the various glance-monitoring technologies. We then describe how particular glance-monitoring technologies have been used in the field to (a) identify the skill deficiencies of novice and older drivers, (b) evaluate the effectiveness of training programs that are designed to reduce deficits in these skills, and (c) address interface issues both inside (e.g., collision warning systems) and outside (e.g., yield markings) the vehicle. The limitations and advantages of on-road eye-tracking and the associated glance-monitoring technologies are identified throughout. A comparison, where possible, is made between the results of on-road eye-tracking studies of drivers' behaviors and the results of those studies conducted in the laboratory. Overall, the use of appropriate on-road glance-monitoring technologies has greatly enhanced our theoretical understanding of why drivers behave the way they do, and this knowledge has paved the way for significant improvements in road user safety.

The effects of focused attention training on the duration of novice drivers' glances inside the vehicle.

Several studies have documented that the failure of drivers to attend to the forward roadway for a period lasting longer than 2-3 s is a major cause of highway crashes. Moreover, several studies have demonstrated that novice drivers are more likely to glance away from the roadway than the experienced drivers for extended periods when attempting to do a task inside the vehicle. The present study examines the efficacy of a PC-based training programme (FOrward Concentration and Attention Learning, FOCAL) designed to teach novice drivers not to glance away forthese extended periods of time. A FOCAL-trained group was compared with a placebo-trained group in an on-road test, and the FOCAL-trained group made significantly fewer glances away from the roadway that were more than 2 s than the placebo-trained group. Other measures indicated an advantage for the FOCAL-trained group as well. Statement of relevance: Distracted driving is increasingly a problem, as cell phones, navigation systems, and other in-vehicle devices are introduced into the cabin of the automobile. A training programme is described that has beentested on the open road and can reduce the behaviours that lead to crashes caused by the distracted driving.

Evaluation of different speech and touch interfaces to in-vehicle music retrieval systems.

In-vehicle music retrieval systems are becoming more and more popular. Previous studies have shown that they pose a real hazard to drivers when the interface is a tactile one which requires multiple entries and a combination of manual control and visual feedback. Voice interfaces exist as an alternative. Such interfaces can require either multiple or single conversational turns. In this study, each of 17 participants between the ages of 18 and 30 years old was asked to use three different music retrieval systems (one with a multiple entry touch interface, the iPod, one with a multiple turn voice interface, interface B, and one with a single turn voice interface, interface C) while driving through a virtual world. Measures of secondary task performance, eye behavior, vehicle control, and workload were recorded. When compared with the touch interface, the voice interfaces reduced the total time drivers spent with their eyes off the forward roadway, especially in prolonged glances, as well as both the total number of glances away from the forward roadway and the perceived workload. Furthermore, when compared with driving without a secondary task, both voice interfaces did not significantly impact hazard anticipation, the frequency of long glances away from the forward roadway, or vehicle control. The multiple turn voice interface (B) significantly increased both the time it took drivers to complete the task and the workload. The implications for interface design and safety are discussed.

Can younger drivers be trained to scan for information that will reduce their risk in roadway traffic scenarios that are hard to identify as hazardous?

Younger drivers (18-21 years) are over-involved in crashes. Research suggests that one of the reasons for this over-involvement is their failure to scan areas of the roadway for information about potential risks in situations that are hazardous, but not obviously so. The primary objective of the present study is to develop and evaluate a training program that addresses this failure. It was hypothesised that PC-based hazard anticipation training would increase the likelihood that younger drivers would scan for potential hazards on the open road. In order to test this hypothesis, 12 trained and 12 untrained drivers' eye movements were measured as they drove a vehicle on local residential, feeder and arterial roads. Overall, the trained drivers were significantly more likely to gaze at areas of the roadway that contained information relevant to the reduction of risks (64.4%) than were the untrained drivers (37.4%). Significant training effects were observed even in situations on the road that were quite different from those shown in training. These findings have clear implications for the type of training of teen drivers that is necessary in order to increase their anticipation of hazards.

Can novice drivers be trained to scan for information that will reduce their likelihood of a crash?

Sixteen year old drivers are involved in 10.3 fatal crashes per 100 million vehicle miles, a rate almost double that of 18 year olds and almost eight times that of 45-64 year olds, who are the safest group of drivers. Crash rates are particularly higher during the first month of licensure and decline rapidly for about six months and 1000 miles and then much more slowly for at least two years, consistent with a typical learning curve. Research indicates that drivers who have their learner's permit or are just newly licensed have particular difficulties identifying areas of a scenario from which hidden risks could emerge. Standard driver education programs do not appear to address these difficulties adequately. This suggests that some alternative form of driver training could reduce the crashes, either in the classroom or on the road. A PC based program designed to teach drivers to recognize risks early on is shown to improve their awareness of hazards, both on an advanced driving simulator and on the road.

Evaluation of graft patency during minimally invasive coronary artery bypass grafting with Doppler flow analysis.

BACKGROUND: An objective method for determining intraoperative graft patency is an essential part of minimally invasive direct coronary artery bypass. This study compares angiography and Doppler methods for graft analysis during minimally invasive direct coronary artery bypass and presents long-term outcome in a cohort of patients. METHODS: Between March and October 1997, 35 patients had elective minimally invasive direct coronary artery bypass procedures in which the left internal mammary artery was anastomosed to the left anterior descending coronary artery. Immediate graft patency was determined with intraoperative angiography using selective injection of the left internal mammary artery from a femoral approach and with Doppler flow analysis using a 1-mm, 20-MHz Doppler probe placed directly on the graft. RESULTS: There was immediate perfect patency with brisk flow in 91% of patients (32 of 35). A normal Doppler study, defined as a diastolic predominant pattern with a diastolic flow velocity of greater than 15 cm/second, was found in all patients with normal angiograms. All patients with abnormal angiograms also had abnormal Doppler flow. Thus, Doppler analysis was 100% accurate for confirming graft patency and for detecting failed grafts. All abnormal grafts were successfully revised, which allowed 100% early patency. Operative mortality was 2.8% (1 of 35) and there have been no late deaths at a follow-up of more than 2 years. One patient required angioplasty of the anastomosis (1 of 34, 2.9%), but none have required subsequent surgical intervention. CONCLUSIONS: Objective analysis of graft flow in the operating room is necessary to achieve 100% early graft patency with minimally invasive direct coronary artery bypass operations. Doppler analysis is the preferred initial method, because it is safe, accurate, and rapid.

Hsp90 is required for c-Mos activation and biphasic MAP kinase activation in Xenopus oocytes.

During Xenopus oocyte maturation, the Mos protein kinase is synthesized and activates the MAP kinase cascade. In this report, we demonstrate that the synthesis and activation of Mos are two separable processes. We find that Hsp90 function is required for activation and phosphorylation of Mos and full activation of the MAP kinase cascade. Once Mos is activated, Hsp90 function is no longer required. We show that Mos interacts with both Hsp90 and Hsp70, and that there is an inverse relationship between association of Mos with these two chaperones. We propose that Mos protein kinase is activated by a novel mechanism involving sequential association with Hsp70 and Hsp90 as well as phosphorylation. We also present evidence for a two-phase activation of MAP kinase in Xenopus oocytes.

The framing of drivers' route choices when travel time information is provided under varying degrees of cognitive load.

In two experiments, participants chose between staying on a main route with a certain travel time and diverting to an alternative route that could take a range of travel times. In the first experiment, travel time information was displayed on a sheet of paper to participants seated at a desk. In the second experiment, the same information was displayed in a virtual environment through which participants drove. Overall, participants were risk-averse when the average travel time along the alternative route was shorter than the certain travel time of the main route but risk-seeking when the average travel time of the alternative route was longer than the certain travel time along the main route. In the second experiment, in which cognitive load was higher, participants simplified their decision-making strategies. A simple probabilistic model describes the risk-taking behavior and the load effects. Actual or potential applications of this research include the development of efficient travel time information systems for drivers.

Imaging of the cervical spine and its role in clinical decision making.

Thorough imaging of the cervical spine often requires more than one test. The many available options from which to choose can often lead to redundancy and confusion regarding the best test series. In an effort to make the process of choosing the most effective imaging series more efficient, we review the current literature on cervical imaging and, from the information gathered, construct a diagnostic imaging algorithm for evaluating the cervical spine.

Integrating patient satisfaction into performance measurement to meet improvement challenges.

BACKGROUND: A Value Compass has been proposed to guide health care data collection. The "compass corners" represent the four types of data needed to meet health care customer expectations: appropriate clinical outcomes, improved functional status, patient satisfaction, and appropriate costs. Collection of all four types of data is necessary to select processes in need of improvement, guide improvement teams, and monitor the success of improvement efforts. INTEGRATED DATA AT BRYANLGH: BryanLGH Medical Center in Lincoln, Nebraska, has adopted multiple performance measurement systems to collect clinical outcome, financial, and patient satisfaction data into integrated databases. Data integration allows quality professionals at BryanLGH to identify quality issues from multiple perspectives and track the interrelated effects of improvement efforts. A CASE EXAMPLE: Data from the fourth quarter of 1997 indicated the need to improve processes related to cesarean section (C-section) deliveries. An interdisciplinary team was formed, which focused on educating nurses, physicians, and the community about labor support measures. Physicians were given their own rates of C-section deliveries. RESULTS: The C-section rate decreased from 27% to 19%, but per-case cost increased. PickerPLUS+ results indicated that BryanLGH obstetric patients reported fewer problems with receiving information than the Picker norm, but they reported more problems with the involvement of family members and friends. CONCLUSIONS: The data collected so far have indicated a decrease in the C-section rate and a need to continue to work on cost and psychosocial issues. A complete analysis of results was facilitated by integrated performance management systems. Successes have been easily tracked over time, and the need for further work on related processes has been clearly identified.

Dissociation of MAP kinase activation and MPF activation in hormone-stimulated maturation of Xenopus oocytes.

MAP kinase activation occurs during meiotic maturation of oocytes from all animals, but the requirement for MAP kinase activation in reinitiation of meiosis appears to vary between different classes. In particular, it has become accepted that MAP kinase activation is necessary for progesterone-stimulated meiotic maturation of Xenopus oocytes, while this is clearly not the case in other systems. In this paper, we demonstrate that MAP kinase activation in Xenopus oocytes is an early response to progesterone and can be temporally dissociated from MPF activation. We show that MAP kinase activation can be suppressed by treatment with geldanamycin or by overexpression of the MAP kinase phosphatase Pyst1. A transient and low-level early activation of MAP kinase increases the efficiency of cell cycle activation later on, when MAP kinase activity is no longer essential. Many oocytes can still undergo reinitiation of meiosis in the absence of active MAP kinase. Suppression of MAP kinase activation does not affect the formation or activation of Cdc2-cyclin B complexes, but reduces the level of active Cdc2 kinase. We discuss these findings in the context of a universal mechanism for meiotic maturation in oocytes throughout the animal kingdom.

A novel role for glycogen synthase kinase-3 in Xenopus development: maintenance of oocyte cell cycle arrest by a beta-catenin-independent mechanism.

We have examined the expression of glycogen synthase kinase-3beta in oocytes and early embryos of Xenopus and found that the protein is developmentally regulated. In resting oocytes, GSK-3beta is active and it is inactivated on maturation in response to progesterone. GSK-3beta inactivation is necessary and rate limiting for the cell cycle response to this hormone and the subsequent accumulation of beta-catenin. Overexpression of a dominant negative form of the kinase accelerates maturation, as does inactivation by expression of Xenopus Dishevelled or microinjection of an inactivating antibody. Cell cycle inhibition by GSK-3beta is not mediated by the level of beta-catenin or by a direct effect on either the MAP kinase pathway or translation of mos and cyclin B1. These data indicate a novel role for GSK-3beta in Xenopus development: in addition to controlling specification of the dorsoventral axis in embryos, it mediates cell cycle arrest in oocytes.

Reliability of magnetic resonance imaging in predicting disc material posterior to the posterior longitudinal ligament in the cervical spine. A prospective study.

STUDY DESIGN: This was a prospective study to evaluate the accuracy of magnetic resonance imaging in predicting the presence of disc material posterior to the posterior longitudinal ligament (PLL), compared with the accuracy of intraoperative visual and tactile examination of the PLL. OBJECTIVES: To determine the accuracy of magnetic resonance imaging in predicting the presence of disc material posterior to the PLL. SUMMARY OF BACKGROUND DATA: Whether removal of the disc to the PLL is sufficient when performing an anterior cervical discectomy and fusion or it is necessary to explore the spinal canal by taking down the PLL is controversial. METHODS: Fifty-four cervical levels were examined by magnetic resonance imaging before surgery to determine whether there was disc material posterior to the PLL. During surgery, the PLL was examined and probed for disruption. The ligament was taken down, and free fragments were identified and removed. RESULTS: Of 54 levels, 12 were correctly identified by magnetic resonance imaging as having disc material posterior to the PLL, and 26 were correctly identified as not having disc material posterior to the PLL. Surgery confirmed that at 26 levels there was disc material posterior to the PLL. Of these 26, 23 (88.5%) had visual or palpable disruption of the PLL. Magnetic resonance imaging failed to predict disc material posterior to the PLL in 14 of the cases in which its presence was confirmed during surgery. Magnetic resonance imaging had 46.2% sensitivity and 92.9% specificity rates. CONCLUSIONS: Because of low sensitivity, magnetic resonance imaging should be used cautiously for predicting free disc material posterior to the PLL. Visual or palpable examination of the PLL during surgery is more accurate for this prediction.

The acute phase response in the Sudan plated lizard, Gerrhosaurus major.

The Sudan plated lizard (Gerrhosaurus major), previously reported to be an afebrile species, was utilized in a series of experiments to test for various aspects of the acute phase response. Treatment of individuals with the antibiotic Baytril resulted in a slight (0.5 degree C) but significant reduction in mean selected body temperature (MSBT), while treatment with saline did not lower MSBT. Nonantibiotic treatment individuals had depressed plasma iron levels (86.6 +/- 22.4 micrograms Fe 100 ml-1 plasma) and treatment with Baytril produced a significant increase in plasma iron concentration (186.8 +/- 19.5 micrograms Fe 100 ml-1 plasma). Necropsy of randomly selected individuals indicated that animals obtained from the commercial supplier had Aeromonas, Arthrobacter, Pseudomonas and Salmonella infections and antibiotic treatment eliminated these infections. The growth rate of Aeromonas sobria is reduced when the bacteria are grown at 32 degrees C and reduced iron concentration compared to 34.5 degrees C and low iron concentration, which suggests that a fever response may not be beneficial in reducing bacterial growth. Saline injected, bacteria injected and antibiotic injected Gerrhosaurus major have high plasma zinc concentrations compared to the previously studied febrile species, Dipsosaurus dorsalis. This difference suggests that zinc concentrations in afebrile species deserve further study.

Improving nursing education classroom environments.

This study describes the first use of a classroom environment questionnaire with a class in nursing education. An instructor of nursing students monitored classes using such a questionnaire. The questionnaire used was the College and University Classroom Environment Inventory and it was used to obtain practical and useful information about the learning environment in two different classes. Collaborative changes were made in the classes to improve the classroom environment and consequently the learning situation. Any instructor of nursing students could use this same process with this instrument.

Visual search tasks: slowing of strategic and nonstrategic processes in the nonlexical domain.

Some investigators have argued that aging affects the slowing of processes in nonlexical tasks more than it does the slowing of processes in lexical tasks, but that within task domains, the slowing is identical. Other investigators have argued that even within nonlexical tasks there is differential slowing such that aging affects processing speed more in (nonlexical) coordinative tasks than it does in (nonlexical) sequential tasks. Perhaps, more finely still, there is a differential slowing in coordinative nonlexical tasks. Toward this end, latent models of general and process-specific slowing in coordinative nonlexical tasks were formulated for older adults. A visual search task was then used to test the two types of models. It was found that a latent model of process-specific slowing explained significantly more of the variability than a latent model of general slowing, indicating that there is a differential slowing of processes among coordinative tasks within the nonlexical domain. It was also discovered that the coordinative process most greatly affected was that of deciding to terminate the search when no target was present in the display, indicating together with other studies a possible difference in the slowing of strategic processes among both coordinative and sequential tasks within the nonlexical domain, but no difference in the slowing of nonstrategic processes.

Sound localization: information theory analysis.

Sound localization has been studied extensively. Curiously, although much is known about factors that affect errors, little is known about factors that influence response time. Three experiments were performed in an attempt to identify the separate influence of each of several different factors. All trials used a single broadband noise signal emanating from one of a subset of six loudspeakers equally spaced around the participant in the azimuthal plane. Both the size of the subset and the balance of relative probabilities from speaker to speaker were altered to evaluate the relationship between information content and the dependent variable, choice reaction time. Choice reaction time was found to be related to the information content of the sound stimulus in all cases. It was also found to be related to the presence of pairs of speakers that were symmetrically opposed in front of the behind the participant. Models of choice reaction time in a sound localization task have clear implications for practice. For example, they suggest that multiple auditory collision warnings may endanger drivers.