Life expectancy of major league baseball umpires.

UNLABELLED: Analysis of umpires' age at death suggests that fears regarding risks of their profession are unfounded. BACKGROUND: The on-field death 4 years ago of a veteran Major League Baseball (MLB) umpire raised questions regarding the mortality risks of this profession. OBJECTIVE: To determine if the life expectancy of MLB umpires differs from that of the general population. DESIGN: Ages of death of MLB umpires were determined, and the differences between the ages of death and age-adjusted life expectancies were calculated. T-score analysis was performed on these differences. Correlational analysis was also done on many different factors, including umpire debut year, debut age, life expectancy at debut, and length of career. RESULTS: No significant difference was found between the age at death of MLB umpires and their age-adjusted life expectancy. Correlational analyses showed that only length of career correlated with age at death. CONCLUSION: MLB umpiring is not associated with a shortened life expectancy. While this is most likely attributable to the profession having no inherent risk, it could also be explained by inherent risks being overcome by yet unidentified, unique factors.

The physician and unconventional medicine.

BACKGROUND: Unconventional medical therapies, that is, health interventions not normally taught in medical school, consume more than $10 billion per year; yet, little is known of physician involvement with these therapies. METHOD: A national mailed survey of primary care internists with single board certification and of board-certified family physicians was undertaken to determine physician attitude and behavior toward unconventional therapies. The survey identified 16 unconventional therapies. RESULTS: A total of 572 responses were analyzed. These indicated that more than half of these physicians would encourage patients who raise the possibility of unconventional therapy. A large proportion (57%) were willing to refer their patients for treatment for six or more unconventional therapies. CONCLUSIONS: This study indicates considerable physician interest and participation in unconventional medicine, suggesting a need for research and education to help them guide their patients.

Comparison of persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for ectopic pregnancy.

OBJECTIVE: To compare persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for the treatment of intact ampullary ectopic pregnancy. METHODS: We reviewed the medical records of 157 patients who had undergone salpingostomy for intact ampullary ectopic pregnancy at Yale-New Haven Hospital between September 1, 1986 and August 31, 1991. One hundred three women had laparoscopic salpingostomy and 54 had salpingostomy at laparotomy. RESULTS: Sixteen of 103 women (15.5%) undergoing laparoscopic salpingostomy were treated for persistent ectopic pregnancy, in contrast to one of 54 women (1.8%) who had salpingostomy by laparotomy. The adjusted odds ratio for persistent ectopic pregnancy after laparoscopic salpingostomy versus salpingostomy at laparotomy for an intact ampullary ectopic pregnancy was 8.4, with 95% confidence interval 1.1-62 (P < .02). Stepwise logistic regression demonstrated that a laparoscopic approach to salpingostomy (P < .05), smaller ectopic size (P < .01), and fewer days of amenorrhea (P < .05) predicted persistent ectopic pregnancy. CONCLUSION: Persistent ectopic pregnancy is more likely after laparoscopic salpingostomy than after salpingostomy at laparotomy for intact ampullary ectopic pregnancy.

Oligomerization and transport of the envelope protein of Moloney murine leukemia virus-TB and of ts1, a neurovirulent temperature-sensitive mutant of MoMuLV-TB.

Ts1, a temperature-sensitive mutant of Moloney murine leukemia virus-TB (MoMuLV-TB), causes a progressive hindlimb paralytic disease in susceptible strains of mice. Previously, it has been shown that a single amino acid substitution, Val-25----Ile in gPr80env, is responsible for the temperature sensitivity, inefficient transport, and processing of gPr80env at the restrictive temperature and the neurovirulence of ts1. Since the neurovirulence of ts1 is associated with inefficient transport and processing of gPr80env and since in other systems involving viral envelope proteins it has been shown that correct folding and oligomerization of envelope monomers are required for efficient transport, we have investigated the ability of gPr80env derived from either wild-type MoMuLV-TB or ts1 to associate into oligomeric complexes. In these experiments, we establish that at both the restrictive and the nonrestrictive temperatures gPr80env molecules derived from MoMuLV-TB associate to form oligomeric complexes and these oligomers are most likely trimers. gPr80env molecules derived from ts1 also oligomerize at both temperatures; however, at the restrictive temperature, most of the molecules within the trimeric complexes remain as gPr80env and are not processed to gp70 and Prp15E. These results indicate that lack of oligomerization of gPr80env is not responsible for the transport defect of ts1. Therefore, by interacting specifically with critical sites within target cells, oligomers of mutant gPr80env rather than "tangles" of monomeric viral envelope proteins may be involved in the neurodegenerative disorder produced by ts1.

Outpatient geriatric assessment: associations between referral sources and assessment findings.

A review of 431 outpatient geriatric assessments conducted over 2 years examined the associations of referral problems, assessment diagnoses, and therapeutic recommendations with the source of patient referral, as well as that referral source's diagnostic accuracy in identifying the referral problems. Families referred 52% of patients, primarily for problems of memory and behavior, whereas social service agencies made 32.9% of all referrals, primarily for bladder control problems or safety-related concerns. Physicians made only 6% of referrals in this setting. Referral source was found not to be associated with any of the seven categories of medical diagnoses resulting from the assessment process and was associated with only two of the functional diagnostic categories. Therapeutic recommendations were also broadly distributed among referral sources, though social service agencies did refer more patients who required urgent nursing home placement, financial representation, or adult protective service involvement. The performance of family referral sources in accurately referring patients with dementia and psychiatric impairment was comparable to that of physicians, though all referral sources frequently missed patients with incontinence. Non-physician referral sources appear to serve as important and quite valid case-finders for outpatient geriatric assessment.

Construction and characterization of expression systems for the env gene of ts1, a mutant of Moloney murine leukemia virus-TB.

A temperature-sensitive mutant of the Moloney murine leukemia virus-TB, ts1, causes hindlimb paralysis and immunodeficiency in mice. At the restrictive temperature, the envelope precursor polyprotein, gPr80env, is inefficiently processed intracellularly, and this is associated with the neurovirulence of ts1. To test the hypothesis that expression of the envelope proteins of ts1 alone without infectious virus production can induce paralysis, it is necessary to use either transmissible retroviral expression vectors or microinjection of eukaryotic gene expression plasmid to introduce the env gene of ts1 into germlines of mice. In this study, we have constructed three retrovirus vectors and three gene expression plasmids, all of which contain the env gene of ts1. By comparing the different expression systems, we found that one construct, pts1-env(F) can express the envelope proteins at a level comparable to the level expressed in ts1-infected cells. Furthermore, the expressed envelope proteins of pts1-env(F)-transfected cells possess the phenotypes of the proteins expressed by the env gene of ts1.