Management of life-threatening haemoptysis in an area of high tuberculosis incidence.

BACKGROUND: Emergency admissions with life-threatening haemoptysis in an area of high tuberculosis (TB) incidence at the University of Stellenbosch and Tygerberg Academic Hospital, South Africa. It is unclear if lung resection is regularly indicated to prevent recurrence following bronchial artery embolisation (BAE). OBJECTIVE: To prospectively evaluate risk factors for recurrence as selection criteria for surgery following embolisation: lack of complete cessation of haemoptysis, need for blood transfusion, presence of aspergilloma and absence of active TB. DESIGN: Prospective interventional study with 1-year follow-up. RESULTS: Within a 7-month period, 101 consecutive patients were admitted. Seven were excluded and 12 died shortly after admission. Haemoptysis ceased on medical treatment alone within 24 h in 21 of the remaining 82 patients. Their 1-year mortality was 10%. Eleven of 61 patients referred for emergency embolisation died before discharge. Of the 50 patients remaining at risk of recurrence, 38 (76%) were at low risk and 12 (24%) at high risk. Five of these patients (10% of those at risk) underwent surgery. Patients at low risk and operated patients had an uneventful course over 1 year, but two deaths occurred among the seven inoperable patients at high risk. CONCLUSION: Lung resection surgery following successful BAE for life-threatening haemoptysis can safely be avoided in patients at low risk of recurrence.

Child sociometric status and parent behaviors. An observational study.

The relationship between parent-child interaction and child sociometric status was examined. Third- and fourth-grade children rated as socially neglected, rejected, or average by both peer and teacher nomination were videotaped working on a task with their parents. Parents of children identified as neglected engaged in fewer overall interactions with their children than parents of both rejected and average children. Mothers of neglected and rejected boys issued more commands than mothers of average children. Fathers of neglected boys issued more negative statements than fathers of either rejected or average children. Moreover, mothers and fathers of neglected and rejected children exhibited greater differences between one another in their use of commands than parents of average children. Mothers and fathers of rejected children exhibited greater differences between parents in their use of questions than parents of neglected or average children. The implications of these findings are discussed.

The impact of alcohol and alcohol expectancies on male perception of female sexual arousal in a date rape analog.

The impact of alcohol and alcohol expectancies on men's perception of female sexual arousal and men's ability to discriminate accurately female sexual intentions in a dating situation was examined. In a 2 (alcohol) x 2 (expectancy) balanced placebo design, men were exposed to an audiotape of a date rape and asked to signal when the man should stop making sexual advances. On 4 occasions during the vignette, participants rated how sexually aroused the woman on the tape was at that moment. Relative to controls, participants who consumed alcohol or expected to consume alcohol took significantly longer to identify the inappropriateness of the man's sexual behavior toward his date. Similarly, alcohol participants also rated the woman's arousal level significantly higher at the first 2 refusals. Implications of the results are discussed.

The effect of luminol on presumptive tests and DNA analysis using the polymerase chain reaction.

This study was designed to test the following factors involved with processing luminol treated bloodstained evidence: 1) The reactivity of other presumptive chemical color tests, phenolphthalin (PT) and tetramethylbenzidine (TMB), following the application of the light emitting luminol presumptive test. 2) The effect of different cleanings of various bloody substrates on the luminol test. 3) The effect of different cleanings of various bloody substrates on the ability to obtain DNA suitable for PCR testing. 4) The ability to extract DNA from luminol treated bloodstained substrates using three extraction techniques. 5) The effect of spraying washed and unwashed bloodstains on various substrates with luminol on the ability to correctly type the DNA using PCR. Our findings indicated that luminol did not adversely effect the PCR testing and did not interfere with the PT and TMB presumptive tests for blood. It was determined that the substrate and the method of cleaning were the major factors affecting DNA yield and the ability to type the bloodstains using PCR based technologies.

The effect of alcohol on the responses of sexually coercive and noncoercive men to an experimental rape analogue.

This study examined the impact of the psychological and pharmacological effects of alcohol on the ability of sexually coercive and noncoercive men to discriminate when a female wants a partner to stop sexual advances. In a 2 (alcohol vs. no alcohol) x 2 (expectancy vs. no expectancy) x 2 (sexually coercive vs. noncoercive status) randomized factorial design, male college students were exposed to an audiotape of a date rape. Participants who consumed, or expected to consume, alcohol took significantly longer to determine that the man should refrain from attempting further sexual contact. In addition, nonsexually coercive participants assigned to conditions in which they expected to consume alcohol responded similarly to their sexually coercive counterparts in their responses. The implications of these findings are discussed.

A review of methods and instruments for assessing externalizing disorders: theoretical and practical considerations in rendering a diagnosis.

This review addresses the most current and widely used methods of assessing childhood and adolescent externalizing disorders. Interviews, rating scales, and self-report instruments are described, and their strengths and weaknesses are discussed. Direct observational techniques in naturalistic and analogue settings are also reviewed. Throughout the article, commentary is offered regarding the psychometric adequacy and clinical validity of these instruments. It is suggested that, although the instruments presently used to assist in diagnosing externalizing disorders generally possess adequate reliability and representational validity, evidence of elaborative validity is lacking. Clinicians and researchers are encouraged to adopt a broader conceptualization of the diagnostic process, to question existing standards for establishing validity, and to consider alternative means of demonstrating diagnostic utility.

Validation studies for the genetic typing of the D1S80 locus for implementation into forensic casework.

A series of validation experiments were designed to evaluate, according to the Technical Working Group on DNA Analysis Methods (TWGDAM) guidelines, the analysis of the D1S80 locus for casework implementation. Approximately 400 samples from three different populations (Minnesota Caucasian, Minnesota African Americans, and Minnesota Native Americans) were typed to determine allele frequencies. Simulated forensic type specimens (blood, saliva, hair and semen, or vaginal secretions) were typed to demonstrate that deoxyribonucleic acid (DNA) extracted from various tissues of an individual yield the same D1S80 type. Dilution studies were performed and it was determined that a wide range of input DNA (0.5 ng to 40.0 ng) will consistently yield typeable results. The evaluation of DNA from various animals showed that the D1S80 locus is specific to human DNA within the limits of the parameters tested. The reproducibility of the system was tested by duplicate analysis of approximately 200 population samples. Duplicate samples were analyzed on both horizontal and vertical gel systems. In addition, simulated forensic specimens were analyzed by two independent laboratories: the Minnesota Forensic Science Laboratory (MFSL) and the Roche Biomedical Laboratories (RBL). All analyses, including extraction, quantitation, amplification and typing, were performed independently. All typing results for both laboratories were in agreement. By the analysis of mixtures from various simulated casework type mixtures, it was demonstrated that the D1S80 typing system is suitable for analyzing mixtures. In addition to the simulated casework, evidentiary samples from several adjudicated cases previously analyzed by restriction fragment length polymorphism (RFLP) analysis and/or DQA1 were typed at the D1S80 locus. The D1S80 results were consistent with previous RFLP and/or DQA1 results regarding inclusions/exclusions.

HLA DQA1 and Polymarker validations for forensic casework: standard specimens, reproducibility, and mixed specimens.

This study describes the testing performed by the Minnesota Forensic Science Laboratory (MFSL) to validate the Amplitype DQA1 and Amplitype Polymarker (PM) PCR Amplification and Typing Kits before implementation for casework. All studies were based on the analysis of mock forensic case samples, which were assembled from various biological samples from individuals at the MFSL. To address the validation of standard specimens, DNA was isolated from semen, vaginal secretions, saliva, urine, and blood samples. Typing results from all tissues from a particular individual yielded the same typing results using both the DQA1 and PM systems. Reproducibility between laboratories was evaluated by having duplicate samples analyzed by a second laboratory. The Roche Biomedical Laboratories (RBL) were sent a duplicate set of mock cases and all analyses including extraction, quantitation, amplification, and typing were performed at the RBL using their established testing procedures. All typing results for both laboratories, from the approximate 30 single source samples analyzed, were in agreement. Mixed specimens were evaluated by examining the results obtained from semen/vaginal, semen/saliva, semen/blood, semen/ urine, and semen/vaginal/blood mixtures. All typing results of these mixtures for both laboratories were in agreement. It was determined that by incorporating a wash step of the sperm cell pellet, a complete separation of the nonsperm cell fraction was more likely to be attained. After completing the above studies, as well as population studies, environmental insult studies, and proficiency testing, the MFSL determined that both kits were suitable for use on forensic casework.

The effects of glucose on nonmemory cognitive functioning in the elderly.

The present study evaluated the role of glucose in the performance of a series of memory and nonmemory neuropsychological tasks. Each of the 28 healthy (no evidence of diabetic or dementing disease), elderly (mean age = 73), subjects participating in the study were tested under each of two conditions (50 g glucose or 27.3 mg saccharin) in a counterbalanced fashion. While actively manipulating glucose levels in participants, blood glucose (BG) levels were monitored to evaluate the effectiveness of individual subject's regulation of ingested glucose. It was hypothesized that glucose would enhance performance on a memory measure (Rey/Taylor Figure) as well as other nonmemory measures (e.g. design fluency, trail making test, etc.). A repeated measures, counterbalanced design was used to evaluate the direct manipulation of glycemic condition. Results reveal an enhancement effect on both the recall of the Rey/Taylor Figure as well as verbal fluency and figural fluency. A significant correlation between glycemic regulation and performance on a test of divided attention (dichotic listening) was also evident (r = -0.47). These findings suggest that a specific facilitation of retrieval mechanisms may account for enhancement of both memory and fluency performance.

Parental correlates of socially neglected, rejected, and average children. A laboratory study.

The present study examined the relationship between parent-child interaction and a child's social status. A sample of children was screened to identify three groups rated as neglected, rejected, or average by both peer and teacher nomination. Children were observed interacting with their mothers while working on a cooperative task. Parent behaviors were coded for commands, suggestions, explanations, questions, and praise. Results indicated that relative to parents of neglected and rejected children, parents of average youngsters emitted significantly more commands, suggestions, explanations, questions, and praise. These findings suggest that a relationship may exist between parent behavior and children's social status. Implications of these findings are discussed.

Delayed outcomes and rule-governed behavior among "noncompliant" and "compliant" boys: a replication and extension.

The present research investigated the effects of verbal, contingency-specifying, stimuli on compliance among two groups of preschool-aged boys. Experiment 1 assessed the joint influence of prior compliance history and reinforcement parameters on compliance, and Experiment 2 explored the utility of distinguishing between the evocative and function-altering effects of verbal stimuli. Results from Experiment 1 showed that statements specifying a behavior and an outcome controlled similar levels of compliance in "compliant" and "noncompliant" boys under conditions of immediate reinforcement, but as the opportunity for reinforcement became more delayed (or nonexistent), the performance of "noncompliant" boys deteriorated. Results from Experiment 2 showed that statements specifying immediate and delayed reinforcers, but not statements specifying no reinforcer, controlled high levels of compliance in both compliant and noncompliant boys, even after a 15-20 minute delay in the opportunity to respond. These results suggest that rules, or contingency specifying stimuli with function-altering, rather than evocative effects, reliably control the behavior of boys as young as 4 or 5 years-old.

Females' perception of date rape: an examination of two contextual variables.

PIP: This study examined the role of perceived token resistance and previous sexual contact on women's ability to discriminate when a female wants her partner to stop his sexual advances. Participants included 101 White female undergraduate students and were randomly assigned to one of the four conditions: 1) perceived resistance with genital contact; 2) no resistance with genital contact; 3) perceived resistance with no genital contact; and 4) no resistance without genital contact. Subjects listened to an audiotaped date rape after being informed of the couple's sexual history based on the condition assigned to them. They were also informed that the couple had been on five previous dates, in which the man had manipulated the woman's breasts or genitals. In addition, the woman did not object to this contact, or the woman initially objected to the contact but subsequently stopped resisting contact. Participants in the perceived token resistance conditions took significantly longer to determine when the man should refrain from attempting further sexual contact. The findings of this study could be used to increase information on date rape, to educate individuals about the responses associated with date rape, and to reinforce rules concerning appropriate sexual behavior.^ieng

Open-mouth posture and maxillary arch width in young children: a three-year evaluation.

A large biracial sample of children were assessed for open mouth posture and maxillary arch width once a year for 3 years. Analyses revealed that although the youngsters exhibited open-mouth posture at high levels, over time, there was a significant decrease in this behavior. Racial and gender differences, as well as a race-by-time interaction, were also evidenced. The children displayed a significant increase in maxillary arch width across time, with gender and racial differences seen in this growth pattern. Finally, when the youngsters were classified as exhibiting primarily open-mouth or closed-mouth posture, it was observed that children with open-mouth posture displayed a significantly slower pattern of maxillary growth compared with children who display anterior lip seal posture. The implications of the findings were discussed.

Thumbsucking as related to placement and acoustic aspects of /s, z/ and lingual rest postures.

Three hundred seventy-one second graders in rural public schools were evaluated for thumbsucking, rest and swallow postures of the tongue, and articulatory placement and acoustic aspects of /s,z/. Significant relationships were observed between thumbsucking and lower dental or interdental rest and swallow postures as well as acoustic errors for /s,z/. The implications of these relationships are discussed.

Caregivers of Alzheimer's disease and stroke patients: immunological and psychological considerations.

Demands of caregiving for Alzheimer's Disease (AD) patients have been reported to affect the psychological and immunological health of the caregivers. The question of whether the observed psychological and immunological changes were unique to AD caregivers was addressed in this study. The subjects were 25 caregivers of AD patients, 25 caregivers of stroke patients, and 25 noncaregiving individuals. Comparisons of all subjects made on several psychologic and immunologic indices indicated that the AD caregiving group was more psychologically distressed than the stroke group, and both of these groups were more psychologically distressed than a control group. With respect to immunologic function, there were no differences among the three groups. Implications of the findings are discussed.

Childhood depression and aggression: a covariance structure analysis.

The purpose of the present study was to: (a) evaluate the comorbidity of depression and aggression in a community sample of school-age children; (b) demonstrate the use of confirmatory factor analysis as a statistical tool in the assessment of the construct validity of childhood depression and aggression measures; and (c) using multisample analysis and structural equation modeling, examine the generalizability of comorbidity across two potential moderating or mediating variables (i.e. gender and peer unpopularity). A series of hypothetical models was tested to identify the number of factors represented by the data, the convergent and discriminant validity of the measures, the relationship between the latent variables of childhood depression and aggression, the influence of method-specific variation, and structural relationships among the latent constructs. Results supported a two-factor comorbidity model (childhood depression and aggression) and the presence of method effects (i.e. rater bias). Though the basic measurement model identified substantial comorbid symptoms and was generally invariant across gender, boys' self-reports of symptomatology evidenced poor validity. The structural equation models supported the independent effects of peer aggression and unpopularity on depression for both boys and girls, though aggression may be somewhat more strongly related to unpopularity among girls. Results were consistent with psychiatric investigations of comorbid depressive and aggressive disorders and emerging developmental psychopathology research on the socioemotional development of aggression and depression in youth.

Assessment of coping with high-risk situations for exercise relapse among healthy women.

Twenty-nine healthy women's coping responses to situations interfering with planned exercise and subsequent patterns of relapse were evaluated. Participants adopted exercise without formal intervention; their activity was monitored prospectively for 14 weeks. Cardiovascular fitness was assessed at baseline, 3 months, and 9 months. At 1-week exercise activity lapse was experienced by 66% of participants, and 41% experienced a 3-week relapse episode. Relapsers initially reported significantly fewer behavioral and cognitive coping strategies in response to high-risk situations compared with nonrelapsers, controlling for baseline level of self-motivation. Coping responses also predicted short-term fitness. These data demonstrate the importance of coping or problem-solving ability in exercise and suggest that relapse may result from ineffective coping with exercise barriers.

A longitudinal evaluation of open mouth posture and maxillary arch width in children.

Open mouth posture and maxillary arch width were assessed annually for 4 years in a group of children. While younger children exhibited high levels of open mouth posture, this behavior decreased significantly over time. Racial and sex differences, as well as a race-by-time interaction were also evident. The children displayed a significant increase in maxillary arch width across time with sex and racial differences in this growth pattern. Subjects were classified as exhibiting primarily open mouth or closed mouth posture. Although both groups showed increased maxillary arch widths over time, the closed mouth subjects showed significantly greater maxillary arch growth.

Open mouth posture and cross-sectional nasal area in young children.

A biracial sample of two-hundred ninety-six children were assessed for open-mouth posture (OMP) in the natural environment. In addition, rhinometry was performed on 288 of the youngsters. Means were computed for percent OMP and cross-sectional nasal airway. Results indicated that in general these children exhibited relatively high rates of OMP. Boys displayed significantly greater OMP than girls. However, children exhibiting OMP on 80% of the observation intervals had significantly smaller cross-sectional nasal areas than the youngsters who displayed OMP on fewer than 20% of observation intervals. The implications of the findings were discussed.

Rhinometry and open-mouth posture in young children.

A biracial sample of 348 elementary school children who were in the first grade were assessed for open-mouth posture (OMP) in the natural environment. In addition, rhinometry was performed on 296 of the children. Means were computed for percent OMP and cross-sectional nasal airway. Results indicated that, in general, these children exhibited relatively high rates of OMP. Boys displayed significantly greater OMP than girls, and black children showed significantly larger cross-sectional nasal areas than white children. A significant correlation between OMP and nasal area only was evident for children exhibiting OMP during more than 80% of the observation intervals. The implications of the findings were discussed.