Hyperion's sponge-like appearance.

Hyperion is Saturn's largest known irregularly shaped satellite and the only moon observed to undergo chaotic rotation. Previous work has identified Hyperion's surface as distinct from other small icy objects but left the causes unsettled. Here we report high-resolution images that reveal a unique sponge-like appearance at scales of a few kilometres. Mapping shows a high surface density of relatively well-preserved craters two to ten kilometres across. We have also determined Hyperion's size and mass, and calculated the mean density as 544 +/- 50 kg m(-3), which indicates a porosity of >40 per cent. The high porosity may enhance preservation of craters by minimizing the amount of ejecta produced or retained, and accordingly may be the crucial factor in crafting this unusual surface.

Emerging models.

In all these models, the potential of child psychiatrists and other mental health professionals in decreasing student barriers to learning is promising. While expanding the traditional client service model, child psychiatrists can serve as advocates for identifying student's unmet mental health needs, encourage schools to build capacity for effective responses, be vigilant for quality assurance, develop and initiate new programs that systematically respond to needs of the school community, and provide training opportunities that demystify the psychiatric concepts that can help administrators and teachers. Relatively few child psychiatrists are active in the school setting or have developed a presence in the national movement to provide mental health services in schools. In recognition of the fact that traditional models of psychiatric care such as outpatient clinics and hospital-based programs do not reach many children and adolescents, it is hoped that child psychiatrists will be more motivated to have a more active and rewarding presence in the school setting. Even with the variety of responses to the need for increasing mental health services to children, there are a lot of unanswered questions. With only 8000 child psychiatrists in the United States and 80,000 schools, it is clear that we need to be strategic about how best to utilize our resources. The big question is whether there are predictable and alterable characteristics, mechanisms, and interactive processes that enable high-risk students to attain educational and personal success, despite seemingly poor odds. Emerging models have the potential to begin answering this question.

Stress management intervention for primary prevention of hypertension: detailed results from Phase I of Trials of Hypertension Prevention (TOHP-I).

PURPOSE: Stress Management Intervention (SMI) was one of seven nonpharmacologic approaches evaluated in Phase I Trials of Hypertension Prevention (TOHP-I) for efficacy in lowering diastolic blood pressure (BP) in healthy men and women aged 30 to 54 years with diastolic BP 80-89 mm Hg. METHODS: A total of 242 and 320 participants were randomized to SMI or an "assessment only" SMI Control, respectively, at four clinical centers. The SMI consisted of 37 contact hours in 21 group and two individual meetings over 18 months and included: training in four relaxation methods, techniques to reduce stress reactions, cognitive approaches, communication skills, time management, and anger management within a general problem-solving format. Standardized protocols detailed methods and timing for collecting BP, psychosocial measures, and urinary samples from both SMI and SMI Control participants. RESULTS: In intention-to-treat analyses, although significant baseline to termination BP reductions were observed in both groups, net differences between the SMI and SMI Control groups' BP changes (mean (95% CI)) were not significant: -0.82 (-1.86, 0.22) for diastolic BP, and -0.47 (-1.96, 1.01) for systolic BP. Extensive adherence sub-group analyses found one effect: a significant 1.36 mm Hg (p = 0.01) reduction in diastolic BP relative to SMI Controls at the end of the trial for SMI participants who completed 61% or more of intervention sessions. CONCLUSIONS: While the TOHP-I SMI was acceptable to participants as evident from high levels of session completion, the absence of demonstrated BP lowering efficacy in intention-to-treat analyses suggests that the TOHP-I SMI is an unlikely candidate for primary prevention of hypertension in a general population sample similar to study participants. The isolated finding of significant diastolic BP lowering in SMI participants with higher adherence provides very weak evidence of SMI BP lowering efficacy and may be a chance finding. Whether similar or other stress management interventions can produce significant BP lowering in populations selected for higher levels of BP, stress, or intervention adherence remains to be demonstrated.

An overview of maxillofacial trauma for nurses.

A team approach is necessary in order to maximally evaluate, treat, monitor, and rehabilitate the patient with maxillofacial injuries. An overview of the complexities of the management of patients with significant maxillofacial injuries is presented in a manner that should assist any nurse in the assessment and subsequent management of such patients.

Vasoactive effects of smoking as mediated through nicotinic stimulation of sympathetic nerve fibers.

Patients who smoke have higher complication rates than nonsmokers following many surgical procedures. It is not known if the adverse effects of smoking are caused by a nicotine effect or by some other potentially harmful agents that exist in tobacco smoke. It is also not known if these vasoactive effects are mediated through sympathetic nerve fibers (via nicotinic receptors in ganglia) or through elevated circulating levels of vasoactive hormones. We designed a 5-day protocol to measure relative blood flow both before and after a digital sympathetic block in the digits of subjects who were regular smokers following both smoking and wearing of a transdermal nicotine patch. Suitable pulse/wave tracings were recorded on 23 subjects. We also measured serum levels of nicotine, cotinine, vasopressin, norepinephrine, epinephrine, dopamine, and carboxyhemoglobin on each test day. Data for these serum levels were available in 30 test subjects. Digital sympathetic block had a significant beneficial effect in reversing the decreased digital blood flow that occurred after smoking (and also with use of the nicotine patch), despite the elevated circulating levels of vasopressin and norepinephrine seen with smoking. The vasoactive effects of smoking are probably due to the nicotinic effects on sympathetic fibers at the ganglionic levels.

The hemodynamic and hematologic effects of cigarette smoking versus a nicotine patch.

Patients who smoke have higher complication rates than nonsmokers in the postoperative period. The authors designed an experimental protocol for habitual smokers (n = 30) to determine the specific hemodynamic and hematologic adverse effects possibly caused by nicotine and whether the method of nicotine delivery and systemic nicotine levels achieved might influence these adverse effects. During the 5-day study, subjects were asked to refrain from smoking, and testing sessions were conducted as follows: on day 1, the subjects smoked two cigarettes immediately before testing; on day 3 (control day), testing was done after not smoking for 48 hours and then the subjects were instructed to wear a transdermal nicotine patch (PROSTEP 22 mg/day) for 24 hours and replace it with another so that, on day 5, testing took place after the subjects had worn the patch for approximately 34 hours. At each testing session, digital artery pulse amplitude and a number of clinical and serum blood level parameters were measured. Relative digital blood flow after smoking (69.2 +/- 5.8%) and with the patch (80.4 +/- 7.6%) was lower than on the control day (100.0 +/- 0.0%). The nicotine patch, unlike smoking, had no effect on vasopressin or fibrinogen concentrations, hematocrit, or white cell or platelet counts; both smoking and the patch resulted in elevated norepinephrine levels.

Diagnoses, symptoms, and attribution of symptoms among black and white inpatients admitted for coronary heart disease.

OBJECTIVES: This study examined health care-seeking behaviors to elucidate factors that contribute to differences in patterns of coronary heart disease between African Americans and Whites. The prevalence of diagnosed coronary heart disease, patients' perceptions of symptoms and attribution of symptoms, and predictors of painful symptoms and attribution of cardiac symptoms were examined. METHODS: The study involved 2416 patients admitted with diagnoses of coronary artery disease, ischemic heart disease, or myocardial infarction or to rule out myocardial infarction. Structured interview questions were used to obtain demographic information, symptoms precipitating admission, and patients' attribution of their symptoms. Discharge diagnoses were obtained from hospital records. RESULTS: Acute myocardial infarction, unstable angina, nonacute ischemic heart disease, and atherosclerosis were more frequent in White patients. For Blacks, the odds of reporting painful symptoms were only 64% of the odds found for Whites when other factors were controlled, and the odds of attributing symptoms to cardiac origins were almost 50% lower for Blacks than for Whites. CONCLUSIONS: The tendency of Blacks to report fewer painful symptoms and to attribute their symptoms to noncardiac origins may contribute to differences in care-seeking and in medical management of heart disease in Blacks.

Rose Questionnaire responses among black and white inpatients admitted for coronary heart disease: findings from the Birmingham-BHS Project.

Evidence of higher coronary heart disease mortality rates among blacks than among whites raises questions concerning differences in health care-seeking for heart disease between blacks and whites. As part of a larger project evaluating health care-seeking behavior for coronary heart disease, we interviewed hospitalized patients who had diagnoses of coronary artery disease, ischemic heart disease, chest pain, or myocardial infarction, or who were admitted to rule out myocardial infarction. The sample included 1140 white men, 347 black men, 574 white women, and 355 black women. The interview included demographic information, usual care, access to usual care, and chest pain items. Demographic and medical care access differences emerged between African-American and white participants. We also compared the prevalence of Rose Questionnaire angina between blacks and whites. Among patients who scored positively for Rose angina, black men reported more recent onset of their angina and fewer episodes during the past 6 months compared to all other groups, and they sought medical care less often compared with white men. Multiple logistic regression analyses suggest that African-American respondents were less likely to score positively for Rose angina and were less likely to seek treatment for their symptoms among those who had angina, when controlled for demographic, risk factor, and access to care variables. Blacks and whites in our sample also differed in factors associated with scoring positive for angina and seeking medical care for their symptoms, among those who reported angina. We interpret these findings as suggesting that promoting routine usual care among whites may be an important approach for increasing care-seeking for coronary heart disease symptoms. For blacks, improved coronary heart disease case identification and/or educational approaches to promote greater awareness of symptoms and of the need for seeking treatment for symptoms may be important to increase the likelihood that they will seek medical care for their symptoms.

Reactivity to alcohol-relevant beverage and imaginal cues in alcoholics.

This study was designed to explore three primary facets of reactivity to alcohol-relevant stimuli among alcoholics: (a) comparison of exposure to an alcohol-containing beverage vs. an appropriate, standardized control beverage; (b) efficacy of imaginally presented cues to elicit reactivity, alone and in combination with beverage cues; and (c) examination of the recovery process. Forty-eight male veterans attending an inpatient alcohol treatment program served as participants and were randomly assigned to one of four groups in a 2 (Alcohol vs. Lemonade Beverage) X 2 (High-Risk vs. Low-Risk Imagery) design. Heart rate reactivity to Beverage cues was consistent with previous research. An interaction of Beverage and Imagery manipulations during recovery revealed both experimental manipulations influenced heart rate, although the Alcohol/High-Risk Imagery exposure group did not demonstrate enhanced effects. Both manipulations also had an impact on ratings of desire to consume alcohol. These findings provide further support for the reliability of cue reactivity effects, and suggest the utility of imaginal exposure procedures as a component of a comprehensive cue reactivity assessment.

The radiology of upper airway obstruction in maxillofacial trauma.

One of the prime considerations in the management of maxillofacial trauma is the diagnosis and prevention of acute upper airway obstruction. Each division of the upper aerodigestive tract may cause respiratory obstruction. In the oral cavity, a "flail" mandible, an "Andy Gump" deformity, and a sublingual hematoma may occur. In the nasopharnynx, an impacted midface, a split palate, and a nasopharyngeal hematoma may result. In the oropharynx and hypopharynx, an expanding hematoma in the retropharyngeal or lateral pharyngeal spaces may be seen. Although airway obstruction in maxillofacial trauma is a clinical diagnosis, the judicious use of radiographs helps to identify patients at risk. In this study, we review the anatomy of the upper aerodigestive tract and the potential sites of airway obstruction. A review of the radiology of airway obstruction in maxillofacial trauma will also be presented.

Pseudomonas cervical osteomyelitis in a polytrauma patient.

Cervical osteomyelitis, an uncommon disease, is rarely associated with Pseudomonas organisms in non-drug-users. This report describes a case of cervical vertebral osteomyelitis associated with Pseudomonas aeruginosa pneumonia following panfacial trauma and closed head injury. Delays in diagnosing vertebral osteomyelitis are common because of the nonspecific nature of the history and the initial absence of clinical evidence, both of which may help to foster a generally low index of suspicion.

Cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI) profiles in a chronic headache population.

Minnesota Multiphasic Personality Inventory (MMPI) profiles from 123 chronic headache sufferers (48 migraine, 47 muscle contraction, 28 mixed) were cluster analyzed in order to replicate results from other pain populations and to examine differences among the clusters along headache parameters and demographic variables. Four homogeneous subgroups were obtained and a multiple discriminant analysis was successful in correctly classifying 97.56% of the headache subjects. Obtained clusters closely resembled those evidenced in previous pain research. Results indicated that diagnostic category was unrelated to cluster membership; however, frequency of headache occurrence was a differentiating factor. Implications for headache treatment and future research are discussed.