First Measurement of Monoenergetic Muon Neutrino Charged Current Interactions.

We report the first measurement of monoenergetic muon neutrino charged current interactions. MiniBooNE has isolated 236 MeV muon neutrino events originating from charged kaon decay at rest (K^{+}→µ^{+}ν_{µ}) at the NuMI beamline absorber. These signal ν_{µ}-carbon events are distinguished from primarily pion decay in flight ν_{µ} and ν[over ¯]_{µ} backgrounds produced at the target station and decay pipe using their arrival time and reconstructed muon energy. The significance of the signal observation is at the 3.9σ level. The muon kinetic energy, neutrino-nucleus energy transfer (ω=E_{ν}-E_{µ}), and total cross section for these events are extracted. This result is the first known-energy, weak-interaction-only probe of the nucleus to yield a measurement of ω using neutrinos, a quantity thus far only accessible through electron scattering.

Genetic relatedness of artichoke (Cynara scolymus L.) hybrids using random amplified polymorphic DNA (RAPD) fingerprinting.

The artichoke (Cynara scolymus L.) is an important food and medicinal crop that is cultivated in Mediterranean countries. Morphological characteristics, such as head shape and diameter, leaf shape, and bract shape, are mainly affected by environmental conditions. A molecular marker approach was used to analyze the degree of polymorphism between artichoke hybrid lines. The degree of genetic difference among three artichoke hybrids was evaluated using random amplified polymorphic DNA-PCR (RAPD-PCR). In this study, the DNA fingerprints of three artichoke lines (A13-010, A11-018, and A12-179) were generated, and a total of 10 decamer primers were applied for RAPD-PCR analyses. Polymorphism  (16.66 to 62.50%) was identified using eight arbitrary decamers and total genomic DNA extracted from the hybrids. Of the 59 loci detected, there were 25 polymorphic and 34 monomorphic loci. Jaccard's similarity index (JSI) ranged between 1.0 and 0.84. Based on the unweighted pair group method with arithmetic mean (UPGMA) similarity matrix and dendrogram, the results indicated that two hybrids (A13-010 and A11-018) were closely related to each other, and the A12-179 line showed more divergence. When identifying correct accessions, consideration of the genetic variation and genetic relationships among the genotypes are required. The RAPD-PCR fingerprinting of artichoke lines clearly showed that it is possible to analyze the RAPD patterns for correlation between genetic means and differences or resemblance between close accessions (A13-010 and A11- 018) at the genomic level.

Spontaneously remitting dermatomyositis.

Dermatomyositis (DM) is an inflammatory myopathy of skeletal muscle with characteristic cutaneous findings. It is a rare disorder with a bimodal age distribution that affects almost twice as many women as men. One category of DM, normal-enzyme DM, is characterized by cutaneous changes only at baseline, normal serum muscle enzyme levels and myositis demonstrated by electromyography (EMG) and/or muscle biopsy specimens. Typically, patients with normal-enzyme DM progress to severe muscle involvement and require systemic corticosteroid therapy. The patient we report has normal-enzyme DM confirmed by serial serum enzymes, EMG, and skin and muscle biopsies but is unique in that she never experienced progression of muscle weakness although muscle involvement was documented histologically and by EMG. Follow-up examination after 1 year revealed near-complete resolution of cutaneous involvement after topical therapy and no evidence of muscle weakness.

Is suicide bereavement different? A reassessment of the literature.

The question of whether suicide bereavement is different from mourning after other types of deaths has important theoretical and clinical implications. Some recent literature reviews have argued that the differences may be minimal. In contrast, this article suggests that suicide bereavement is distinct in three significant ways: the thematic content of the grief, the social processes surrounding the survivor, and the impact suicide has on family systems. In addition, problems in the methodology used to compare different bereavement experiences are addressed. Some clinical implications of these conclusions, including the need for homogeneous support groups, psychoeducational services, and family and social network interventions are also discussed.

Research that matters: bridging the gap between research and practice in thanatology.

This article serves as an Introduction to this two-issue special series of Death Studies on the integration of research and practice in thanatology. After discussing the lack of dialogue between researchers and practitioners in the field, the author identifies some common elements of the research and clinical processes in thanatology. These include the central role of pragmatic theory building and the universal human encounter with loss. The author then offers suggestions for enhancing the exchange between researchers and clinicians, including improvements in theory, methodology, and the dissemination of research findings. Lastly, the individual articles in the series are introduced to the reader.

Ramblings from the trenches: a clinical perspective on thanatological research.

Is thanatological research helpful in clinical practice, or do clinicians feel researchers are from some "other planet"? Written from the perspective of two practicing clinicians, this article explores the problems and potential of research to enhance clinical practice in end-of-life and bereavement care. Using a case example as a starting point, the article highlights important choice points where good research could assist the clinician. It also discusses several domains of theory and research where advances in knowledge are likely to be particularly helpful to caregivers "in the trenches." Finally, some of the barriers to dissemination of new information to practitioners are described, and suggestions for reducing these barriers are discussed.

Frequency and causes of discrepancy between Kt/V and creatinine clearance.

UNLABELLED: This study examines the frequency of discrepancy between Kt/V urea and creatinine clearance (Ccr) measurements in patients on peritoneal dialysis (PD) and the reasons for this discrepancy. DESIGN: Nonrandomized, retrospective data analysis. SETTING: Single PD unit of a university teaching hospital. PATIENTS: All adult patients receiving PD at our center from January 1995 to December 1996. METHODS: Actual (a) and desired (d) body weight (BW) were used to calculate urea volume of distribution (V) and body surface area (BSA). Patients were divided into four groups based upon their total small solute clearances (Kt/V and Ccr, normalized by actual weight) and three additional groups based upon actual/desired (a/d) body weight ratio. An additional analysis was performed for the subset of anuric patients. Data collected for all patients included the following: total Kt, total Ccr, 4-hour dialysate/ plasma (D/P) creatinine, serum albumin concentration, duration of PD, actual body weight, age, and height. RESULTS: Twenty-three percent of the clearance measurements in our study were discrepant, defined as having values for either Kt/V or Ccr (but not both) above the accepted targets of Kt/V > or = 2.0/wk and Ccr > or = 60 L/wk/ 1.73 m2. Patients with both values above target are more likely to have higher residual renal function. Patients who are significantly less than BWd and patients on PD for a longer time are more likely to have adequate Kt/V but not Ccr. Furthermore, patients who are less than 90% or greater than 110% of BWd have markedly different values for Kt/V and Ccr when BWa versus BWd values are used. CONCLUSIONS: Kt/V and Ccr values are frequently discrepant; a number of factors affect these two measurements to varying degrees, including weight, degree of residual renal function, and duration of PD.

Evidence for a physical interaction between the Escherichia coli methyl-directed mismatch repair proteins MutL and UvrD.

UvrD (DNA helicase II) is an essential component of two major DNA repair pathways in Escherichia coli: methyl-directed mismatch repair and UvrABC-mediated nucleotide excision repair. In addition, it has an undefined role in the RecF recombination pathway and possibly in replication. In an effort to better understand the role of UvrD in these various aspects of DNA metabolism, a yeast two-hybrid screen was used to search for interacting protein partners. Screening of an E.coli genomic library revealed a potential interaction between UvrD and MutL, a component of the methyl-directed mismatch repair pathway. The interaction was confirmed by affinity chromatography using purified proteins. Deletion analysis demonstrated that the C-terminal 218 amino acids (residues 398-615) of MutL were sufficient to produce the two-hybrid interaction with UvrD. On the other hand, both the N- and C-termini of UvrD were required for interaction with MutL. The implications of this interaction for the mismatch repair mechanism are discussed.

24-hour dialysate collection for determination of peritoneal membrane transport characteristics: longitudinal follow-up data for the dialysis adequacy and transport test (DATT).

OBJECTIVE: To determine the ability of the dialysis adequacy and transport test (DATT) to monitor changes in peritoneal transport characteristics over time. SETTING: University-based peritoneal dialysis program. PATIENTS: One hundred patients on continuous ambulatory peritoneal dialysis who underwent 226 simultaneous DATTs and peritoneal equilibration tests (PET). METHODS: Retrospective analysis of DATT and PET data. RESULTS: The mean 24-hour dialysate-to-plasma creatinine (cr) concentration ratio (D/P cr) from the DATT was 0.70 +/- 0.10, and the mean four-hour D/P cr from the PET was 0.68 +/- 0.10. The correlation coefficient between the four-hour and 24-hour D/P cr was 0.81, and the standard error of estimate was 0.065. The mean (+/- SD) difference between the four-hour and 24-hour D/P cr was 0.023 +/- 0.061. Fifty-eight patients had two or more sequential DATTs and PETs. For these 94 sets of sequential DATTs and PETs, the mean (+/- SD) difference between the change in the four-hour D/P cr and the change in the 24-hour D/P cr was 0.020 +/- 0.024, and the standard error of estimate was 0.064. In 17 patients a change in dwell volume from 2.0 L to 2.5 L occurred between the first and second measures of peritoneal membrane transport characteristics. The mean (+/- SD) difference between the change in the four-hour D/P cr and the change in the 24-hour D/P cr was 0.036 +/- 0.055, and the standard error of estimate was 0.087. CONCLUSION: The DATT can be used to monitor for changes in peritoneal transport over time. It should not be used in patients receiving cycler therapy or in patients whose dwell times and dextrose concentrations vary markedly from day to day.

An elevated ratio of measured to predicted creatinine production in CAPD patients is not a sensitive predictor of noncompliance with the dialysis prescription.

OBJECTIVE: To determine the effect a period of "intentional noncompliance" in stable continuous ambulatory peritoneal dialysis (CAPD) patients has on the ratio of measured to predicted creatinine generation. DESIGN: Prospective study that compares baseline to noncompliant periods in individual CAPD patients. PATIENTS: Nine chronic, stable CAPD patients. STUDY DESIGN: At baseline, measured creatinine production and adequacy parameters (KT/V, creatinine clearance, lean body mass, and protein equivalent of nitrogen appearance) were calculated from 24-hour collections of dialysate and urine while patients were performing their routine dialysis prescriptions. After three days of intentional noncompliance (one less exchange/day) the patients repeated their 24-hour collections, again performing their routine number of exchanges. Measured creatinine production and adequacy parameters were again calculated. Predicted creatinine production for each patient was calculated from standard equations. All parameters at baseline were compared to corresponding parameters after intentional noncompliance. RESULTS: In all patients, except one where there was no change, there was a statistically significant increase in not only the ratio of measured to predicted creatinine production but also all other parameters. CONCLUSION: As suspected by previous investigators, this study suggests that one cause of an elevated ratio of measured to predicted creatinine production may be a recent period of noncompliance with the patient's dialysis prescription. However, these data suggest that an isolated ratio of measured to predicted creatinine generation is not a sensitive predictor of noncompliance with the peritoneal dialysis prescription.

Changes in peritoneal transport during the first month of peritoneal dialysis.

OBJECTIVE: To determine if peritoneal transport characteristics change during the initial month of peritoneal dialysis. DESIGN: Retrospective review of peritoneal equilibration test (PET) results in patients who received their first PET during the first two weeks of peritoneal dialysis (early PET group) versus patients who received their first PET between four and 28 weeks after the initiation of dialysis (late PET group). The initial PET values were compared to subsequent PET results obtained approximately seven months after the initial PET. SETTING: Peritoneal dialysis unit of a tertiary medical center. OUTCOME MEASURES: PET results and calculated mass transfer area coefficient (MTAC) values. PATIENTS: Thirty-four peritoneal dialysis patients in the early PET group and 17 peritoneal dialysis patients in the late PET group. RESULTS: In the early PET group, there was a statistically significant increase from the initial to follow-up values for both dialysate-to-plasma (D/P) creatinine and MTAC creatinine (p < 0.01) as well as a significant decrease for four-hour dialysate to initial dialysate ratios (D/Do) glucose (p = 0.08) and MTAC glucose (p < 0.05). In the late PET group, there was no significant change in any of these parameters with time. However, in the late PET group, there was a significant decrease in D/P urea values with time (p < 0.01), but not with MTAC urea. In addition, there were no differences over time in either group for serum albumin or hematocrit values. CONCLUSION: During the first two weeks of peritoneal dialysis, there tends to be a change in peritoneal transport characteristics in some patients. PET data obtained during this time period should be interpreted as preliminary.

Determination of peritoneal transport characteristics with 24-hour dialysate collections: dialysis adequacy and transport test.

Although the 24-hour collection of dialysate provides a very accurate measure of the adequacy of dialysis, it is not known if it can also determine peritoneal membrane transport characteristics. In this prospective study, 101 24-hour dialysate collections were immediately followed by a standard peritoneal equilibration test (PET). Four- and 24-h dialysate-to-plasma (D/P) ratios were determined for creatinine and urea. The correlation coefficients between these two tests were 0.86 for the adjusted D/P creatinine and 0.71 for the D/P urea, whereas the standard errors of estimate were 0.054 and 0.060, respectively. Patients were classified into one of four transport groups on the basis of the mean and standard deviation of the adjusted D/P creatinine values, and these values were similar to those generated from the PET data. Rates of ultrafiltration were also defined for patients undergoing 2.0- and 2.5-L dwells. A survey of a subset of these patients demonstrated that the 24-h collection was preferred to the PET for determining transport characteristics. Therefore, the 24-h dialysate collection can be used to monitor both peritoneal membrane transport characteristics and adequacy. This technique, which has been named the "dialysis adequacy and transport test," has the potential for significant cost savings when it is used for the routine follow-up of both peritoneal transport and adequacy of dialysis.

Pleomorphic adenoma: effect of tumor spill and inadequate resection on tumor recurrence.

Intraoperative tumor spill or inadequate resection may be associated with an increase in the recurrence rate of pleomorphic adenoma. An attempt was made to determine the recurrence rate when such factors were identified at the time of operation. From 1970 through 1989, 17 cases were identified in which there was a question of intraoperative tumor spill or inadequate resection of a salivary gland pleomorphic adenoma. Patients were either observed or given postoperative irradiation with a mean follow-up of 7.4 years. The overall initial local recurrence rate was 24%, and all recurrences were successfully salvaged. Inadequate resection, particularly enucleation, was predictive of local recurrence, but tumor spill was not. Postoperative irradiation after inadequate resection appeared to decrease the probability of recurrence. We conclude that recurrence of pleomorphic adenoma is not increased by tumor spill as compared with inadequate resection.

Observations on loss and family development.

This article examines the role of death and loss in family developmental processes. Aspects of family development are described, followed by an exploration of the impact of loss on family functioning and development. We present a typology of initial family response styles to the death of a member as well as some immediate and long-term patterns of adaptation after a loss. The article concludes with a case example and a discussion of multigenerational sequelae of unresolved bereavement in family systems.

The efficacy number as a predictor of morbidity and mortality in peritoneal dialysis patients.

The efficacy number has been proposed as a predictor of clinical outcome in patients on chronic ambulatory peritoneal dialysis (CAPD). The usefulness of this parameter in a large group of CAPD patients was analyzed. Forty-five patients who have received chronic CAPD therapy for at least 1 yr were included in the study. The efficacy number was compared with outcome as defined by mortality and days of hospitalization. Other demographic and laboratory parameters, including gender; race; presence of diabetes; serum albumin, serum creatinine, and BUN levels; and measures of peritoneal transport, including dialysate-to-plasma creatinine and dialysate-to-plasma urea ratios, were also assessed for their role in predicting outcome. Laboratory values were obtained at the initiation of CAPD and at 12 months after the start of CAPD. By univariate analysis, a low 12-month serum albumin level was the best predictor of mortality (P < 0.005), followed by a high 12-month efficacy number (P < 0.05). After adjusting for age and the presence of diabetes, these two variables remained the best predictors of mortality (P < 0.08 and < 0.09, respectively). A low initial serum albumin level was also a strong predictor of mortality (P < 0.09). By univariate analysis, the best predictor of hospitalization was a low serum albumin level obtained either initially or at 12 months (P < 0.005 for both time periods). After adjusting for age and the presence of diabetes, the 12-month serum albumin level remained a significant predictor of hospitalization (P < 0.03), whereas efficacy number was not a strong predictor (P = 0.27).(ABSTRACT TRUNCATED AT 250 WORDS)

A transducer for detecting foetal breathing movements using PVDF film.

Foetal breathing movement (FBM) in utero has come to play an important role in foetal diagnosis. FBM may be monitored using real time ultrasound imaging of the foetus in utero. Foetal breathing activities can also be detected by monitoring maternal abdominal wall movement in the frequency range of 0.5-2.5 Hz. This paper presents a transducer which detects FBM non-invasively by monitoring maternal abdominal wall movements. Foetal heart sounds can also be monitored. The transducer presented uses piezo-electric film as the transducing medium. Results from preliminary clinical trials of prototype transducers on 10 patients are discussed.

Malignant schwannoma of the ethmoid sinus associated with AIDS.

We have presented an uncommon case of a low-grade malignant schwannoma arising in the ethmoid sinus in a patient with AIDS. The use of the nasal endoscope provides a safe, expedient way to diagnose nasal and paranasal sinus neoplasms. This case demonstrates that peripheral nerve sheath tumors must be included in the differential diagnosis of sinus masses in patients with AIDS.

Assessment of dialysis dose by measured clearance versus extrapolated data.

OBJECTIVE: To determine whether estimates of daily dialysis clearance of creatinine and urea, based on data from the 4-hour peritoneal equilibration test, correlate well with daily dialysis clearance measured by 24-hour dialysate collection in chronic ambulatory peritoneal dialysis patients. DESIGN: Prospective study in which each subject collected all dialysate from a 24-hour period and then immediately thereafter underwent a standard peritoneal equilibration test (PET). Daily clearances of creatinine and urea were calculated from 24-hour dialysate collections by standard methods and then were compared with several estimates of 24-hour clearance based on PET data. SETTING: Single peritoneal dialysis unit of a university teaching hospital. PATIENTS: Thirty-six stable patients on continuous ambulatory peritoneal dialysis (CAPD). MAIN OUTCOME: The estimated values for daily dialysis clearance both overestimated and underestimated the measured 24-hour clearance. The correlation coefficient between the extrapolations and the actual 24-hour clearances ranged from 0.63-0.68. The range of discordance for daily creatinine clearance was from -2530 mL/day to +2199 mL/day. For daily urea clearance, the range of discordance was from -2103 mL/day to +1940 mL/day. The peritoneal membrane transport characteristics of the individual patient did not predict whether the extrapolation overestimated or underestimated the measured daily clearance. CONCLUSION: Extrapolation of PET data is not a reliable method to estimate the dose of dialysis delivered to the patient. A 24-hour collection of dialysis is necessary for this determination.

Mandibular lingual releasing approach.

The mandibular lingual releasing approach to oral cavity and oropharyngeal tumors provides excellent visualization for resection while integrity of the mandibular arch is preserved. A lingual floor-of-mouth flap is created, which allows delivery of these structures directly into the neck without lip splitting, mandibulotomy, or mandibulectomy. The procedure was carried out on 15 patients between 1987 and 1991, with followup ranging from 2 to 50 months. Nine patients had received previous radiation, whereas planned postoperative radiation was administered to five patients. The visualization afforded by this technique was very good, in that 12 patients had clear margins of resection. Three patients had close margins; recurrent disease developed in one of these patients 18 months later. Twelve of the patients were able to maintain their weight with an oral diet alone. Four postoperative fistulae occurred, three of these were in patients who had not been previously irradiated. The single fistula that did not spontaneously heal occurred in a patient who had received previous radiation and was also on long-term corticosteroids. Mandibular osteoradionecrosis developed in two patients who received postoperative radiation. The complication rate after previous radiation is acceptable; however, there is risk of mandibular osteoradionecrosis after high-dose postoperative radiation.

Comparison of exit-site infections in disconnect versus nondisconnect systems for peritoneal dialysis.

OBJECTIVE: To determine if disconnect systems reduce the incidence of exit-site infections when compared to nondisconnect systems. DESIGN: We prospectively monitored exit-site infections and peritonitis rates in 96 disconnect patients (Y-set, automated peritoneal dialysis (APD)) and 60 nondisconnect patients (spike, ultraviolet connection device (UVXD)). SETTING: A freestanding chronic peritoneal dialysis unit staffed by physicians from both a medical school and a private setting. PATIENTS: All patients who began peritoneal dialysis at our unit were monitored, regardless of cause of end-stage renal disease (ESRD) or age. INTERVENTION: Patients were dialyzed using the system (Y-set, spike, etc.) most appropriate for their life-style and their ability to administer self-care. MAIN OUTCOME: We attempted to follow disconnect and nondisconnect patients for a similar median time on dialysis and compared differences in exit-site infections. RESULTS: Peritonitis rates (episodes/pt year) were reduced for disconnect (0.60) versus nondisconnect (0.99) systems (p = 0.0006). Despite the marked reduction in peritonitis rates, there was no difference in exit-site infection rates (0.35 vs 0.38), the time to the first exit-site infection, or the time to the first catheter removal for disconnect versus nondisconnect groups. When individual systems were compared, differences in exit-site infection rates (episodes/pt years) were noted (0.62,spike; 0.26,UVXD; 0.32,Y-set; 0.41,APD). CONCLUSION: We found no overall difference in exit-site infection rates for disconnect versus nondisconnect systems, despite a reduction in peritonitis rates for disconnect systems.