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The growth in the direct-to-consumer genetic testing industry poses a number of challenges for healthcare practice, among a number of other areas of concern. Several companies providing this service send their customers reports including information variously referred to as genetic ethnicity, genetic heritage, biogeographic ancestry, and genetic ancestry. In this article, we argue that such information should not be used in healthcare consultations or to assess health risks. Far from representing a move toward personalized medicine, use of this information poses risks both to patients as individuals and to racialized ethnic groups because of the way it misrepresents human genetic diversity.

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SUMMARY: We performed high-resolution DIR-BBI of the cervical arteries at 3T in 19 subjects with cervical dissection. It offered excellent visualization of both the lumen and arterial wall, allowing detection of the primary and secondary features of dissection. We suggest that this is a highly useful technique for diagnosis of cervical dissection, either routinely or in equivocal cases of suspected dissection. It also offers further insight into the pathogenesis of this disorder.

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One of the main challenges in working memory research has been to understand the degree of separation and overlap between the neural systems involved in encoding and maintenance. In the current study we used a variable load version of the Sternberg item recognition test (two, four, six, or eight letters) and a functional connectivity method based on constrained principal component analysis to extract load-dependent neural systems underlying encoding and maintenance, and to characterize their anatomical overlap and functional interaction. Based on the pattern of functional connectivity, constrained principal component analysis identified a load-dependent encoding system comprising bilateral occipital (Brodmann's area (BA) 17, 18), bilateral superior parietal (BA 7), bilateral dorsolateral prefrontal (BA 46), and dorsal anterior cingulate (BA 24, 32) regions. For maintenance, in contrast, constrained principal component analysis identified a system that was characterized by both load-dependent increases and decreases in activation. The structures in this system jointly activated by maintenance load involved left posterior parietal (BA 40), left inferior prefrontal (BA 44), left premotor and supplementary motor areas (BA 6), and dorsal cingulate regions (BA 24, 32), while the regions displaying maintenance-load-dependent activity decreases involved bilateral occipital (BA 17, 18), posterior cingulate (BA 23) and rostral anterior cingulate/orbitofrontal (BA 10, 11, 32) regions. The correlation between the encoding and maintenance systems was strong and negative (Pearson's r = -.55), indicting that some regions important for visual processing during encoding displayed reduced activity during maintenance, while subvocal rehearsal and phonological storage regions important for maintenance showed a reduction in activity during encoding. In summary, our analyses suggest that separable and complementary subsystems underlie encoding and maintenance in verbal working memory, and they demonstrate how constrained principal component analysis can be employed to characterize neuronal systems and their functional contributions to higher-level cognition.

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Studies of cognitive performance among persons with chronic fatigue syndrome (CFS) have yielded inconsistent results. We sought to contribute to findings in this area by examining intraindividual variability as well as level of performance in cognitive functioning. A battery of cognitive measures was administered to 14 CFS patients and 16 healthy individuals on 10 weekly occasions. Analyses comparing the two groups in terms of level of performance defined by latency and accuracy scores revealed that the CFS patients were slower but not less accurate than healthy persons. The CFS group showed greater intraindividual variability (as measured by intraindividual standard deviations and coefficients of variation) than the healthy group, although the results varied by task and time frame. Intraindividual variability was found to be stable across time and correlated across tasks at each testing occasion. Intraindividual variability also uniquely differentiated the groups. The present findings support the proposition that intraindividual variability is a meaningful indicator of cognitive functioning in CFS patients.

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Intraindividual variability in latency and accuracy of cognitive performance across both trials and occasions was examined in 3 groups of older adults: healthy adults, adults with arthritis, and adults diagnosed with mild dementia. Participants completed 2 reaction-time and 2 episodic-memory tasks on 4 occasions. Results indicated that intraindividual variability in latency was greater in individuals diagnosed with mild dementia than in adults who were neurologically intact, regardless of their health status. Individual differences in variability were stable over time and across cognitive domains. Intraindividual variability was also related to level of performance and was uniquely predictive of neurological status, independent of level of performance. Results suggest that intraindividual variability may be a behavioral indicator of compromised neurological mechanisms.

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Increased competition in the United States has led to increased interest in women's perceptions of their obstetric experience. Family-centered postpartum care (FCPPC) was originated to improve women's perceptions of care quality. This study examined differences in and the hypothesized relationship between quality and beneficence in a group receiving traditional postpartum care (TPPC) and a group receiving FCPPC in a safety-net hospital in West Tennessee. Both groups had high mean quality and beneficence scores; however, the FCPPC group's scores were significantly higher than those of the TPPC group. There was a relationship between quality and beneficence for the combined sample. The findings suggest that nurses should incorporate FCPPC approaches as a means of improving perceived quality and benefits.

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This study was done to determine if chronic intermittent in utero exposure to morphine (MOR) during the last half of gestation results in hypoventilation and decreased ventilatory sensitivity to CO2 in the neonate. Pregnant guinea pigs were randomly assigned to once-daily treatment with saline and 1.5, 5.0, or 15.0 mg/kg MOR. Neonates were studied for 3 weeks. Prenatal exposure to 5.0 and 15.0 mg/kg MOR significantly increased neonatal minute ventilation and central inspiratory drive on day 7 while breathing room air or 5% CO2. The increase in minute ventilation was part of a withdrawal syndrome that included increased locomotor activity, but was not due to an increase in metabolic rate or sensitivity to CO2. We conclude that neonatal guinea pigs exposed once daily to MOR during the last half of gestation hyperventilate during the 1st week after birth. These changes are neither permanent nor followed by hypoventilation or depressed sensitivity to CO2.

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The identification of psychological and interpersonal factors that predict cooperation and agreement between ex-spouses is important to understanding, and eventually promoting, healthy postdivorce adjustment of parents and their children. By drawing on object relations theory, the authors identified differences between 16 ex-couples who were able to negotiate and maintain a cooperative parenting plan after separation ("agreed ex-couples") and 16 ex-couples who disagree about parenting arrangements ("disagreed ex-couples") but were similar in age, educational background, age of their children, and time since separation. As expected, disagreed ex-couples were more narcissistic, more interpersonally vulnerable, less able to take another's perspective, less concerned about the feelings and needs of others, more self-oriented, and less child-oriented and more self-important in their parenting attitudes than agreed ex-couples. Our findings also supported a process mediational model of "child-centeredness" that attempts to elucidate the pathways through which these variables are interrelated. This model suggests that ex-couples' empathy is associated directly with child-oriented but not self-important parenting attitudes, whereas self-orientation is associated directly with self-important but not child-oriented attitudes. A self-servicing orientation on the part of ex-couples does, however, relate to child-oriented parenting attitudes indirectly through self-important parenting attitudes.

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Radiographs obtained at definitive and boost irradiation in 50 patients with stage I-II breast cancer were retrospectively examined. Tangent target fields planned on the basis of surgical clips placed at excision biopsy were evaluated with simulation radiographs. Four (8%) of 50 tangent target fields would have been inadequate without clips, and 23 (46%) of the boost targets would have been missed (12 [24%], totally; 11 (22%), marginally). Radiopaque surgical clips placed at excision biopsy help plan boost-irradiation target fields.

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The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC), in its revised Code of Professional Conduct (June 1992) states that, 'As a registered nurse ... you are personally accountable for your practice', and goes on to identify sixteen clauses which define how we are now obliged to exercise that accountability. The inclusion of the word 'personally' in the revised text places the responsibility for professional development and standards of care firmly in the hands of the individual practitioner. The aim of this paper is to explore the relevance of professional accountability to the nurse practitioner in the operating department, and how the care she gives, the skills she uses and her relationships with other members of the theatre team, are affected by its implications.

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Two experiments addressed the effects of task information and experience on younger and older adults' ability to predict their memory for words. The first study examined the effects of normative task information on subjects' predictions for 30-word lists across three trials. The second study looked at the effects of making predictions and recalling either an easy (15) or a difficult (45) word list prior to making predictions and recalling a moderately difficult (30) word list. The results from both studies showed that task information and experience affected subjects' predictions and that elderly adults predicted their performance more accurately than younger adults.

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Macrophage inflammatory protein-1 alpha (MIP-1 alpha) has been assessed for its potential in vivo to protect hematopoietic progenitor cells from the cytotoxic effects of a cycle-specific drug--in this case hydroxyurea (HU). Two doses of HU, 7 hours apart, were administered to mice to induce spleen colony-forming unit (CFU-S) cycling and then to kill them during DNA-synthesis. MIP-1 alpha, in a variety of dose and time combinations, was injected before the second dose of HU in an attempt to prevent recruitment or maintain CFU-S quiescence, and thus protect them from the second dose of HU. Without MIP-1 alpha, recovery of the CFU-S population was complete in 7 days. In a dose-dependent manner, MIP-1 alpha either reduced the initial kill and accelerated recovery, or completely protected the CFU-S population. We conclude that MIP-1 alpha does protect multipotent progenitor cells in vivo and that these observations provide a base from which to build practical clinical applications.

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Previously employed techniques for the measurement of body image are briefly described, with a short consideration of methodological or procedural limitations associated with each technique. A new procedure is described which employs a simple modification to a standard video camera to produce an image which appears from 20% thinner to 40% fatter than the actual person, without other distortion of the image. Reliability and preliminary validity data for the new procedure are presented.

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Anthropometric measurements were obtained within 12 h of birth in 52 infants of non-diabetic mothers and 61 infants of diabetic mothers. Most of the diabetic patients were under good control, only ten of 61 having postpartum hemoglobin A1c levels in excess of normal. Neonates were grouped as normally-grown or macrosomic. Birthweight, crown-heel length, head circumference and skinfold thickness were measured. In each diabetes class, macrosomic neonates had larger mean length, head circumference and skinfold thickness than their normally-grown peers. At equal birthweight, neonates of gestational diabetic mothers and of non-diabetic mothers were similar in length, head circumference and skinfold thickness. Neonates of permanently insulin-requiring diabetics were similar to their non-diabetic peers in length and head circumference but had thicker skinfold thicknesses. Anthropometric measurements do not permit differentiation of the origin of neonatal macrosomia.

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Body water estimates were obtained within 12 h of birth in 52 infants of non-diabetic mothers and 61 infants of diabetic mothers. Neonates were grouped as normally-grown or macrosomic. Total body water and extracellular water were estimated from antipyrine space and corrected bromide space, respectively. Intracellular water was assumed to be the difference between total and extracellular water. Infants of diabetic mothers, whether normally-grown or macrosomic, had markedly less mean total body water than normally-grown neonates of non-diabetic mothers. No effect of neonatal macrosomia or maternal diabetes on extracellular and intracellular water estimates could be detected with the techniques used. It is suggested that changes in total body water occur as a result of excessive fat accretion during fetal life.

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To determine whether neonatal polycythemia and its treatment by partial exchange transfusion affect body water estimates, 10 normocythemic and eight polycythemic neonates were studied within 12 hours of birth. Total body water, extracellular water, and plasma volume were estimated immediately prior to and following exchange. Intracellular and interstitial water contents were calculated. There were no significant differences between normocythemic and preexchange polycythemic neonates in mean total body water, extracellular water, interstitial water, and intracellular water contents. In the polycythemic group, exchange did not affect mean total body water, but was associated with decreases in mean extracellular water and mean interstitial water and an increase in mean intracellular water. Mean transcapillary escape rate of T-1824 was not affected by exchange but was quite rapid both before (35 +/- SE 3%/hr) and after the procedure (30 +/- 4.9%/hr). These data suggest that moderate polycythemia in normal term neonates does not affect total and extravascular body water estimates, but that a fluid shift from the extracellular to the intracellular space may accompany the exchange procedure.

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Concentrations of various plasma lipid fractions were determined during 96 hours of continuous parenteral infusions of lipid emulsions in 10 normally-grown neonates whose birth-weights ranged from 960 to 1760 g and whose gestational ages ranged from 26 to 32 weeks. Total lipid, triglyceride, free glycerol, and free fatty acid concentrations were measured. During lipid infusions, mean plasma concentrations of all lipid fractions increased above the mean preinfusion values if 2 g/kg a day or more of lipid emulsion was used. There were no further significant increases in mean plasma lipid levels if the infused dosage was increased to 3 or 4 g/kg a day. At these higher infusion rates however, there were considerable individual variations. The only neonate less than 27 weeks of gestation had plasma lipid levels severalfold higher than any of his peers, his plasma was frankly creamy on visual inspection, and the study had to be stopped. Further investigations are needed to determine the optimal modalities of parenteral nutrition with fat emulsions.

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Hemoglobin A1c (HgbA1c) levels were determined within 24 hours after delivery in 88 nondiabetic and 73 diabetic women belonging to White's classes A to D. Diet-controlled gestational diabetic women had mean (+/- SE) Hgb A1c levels similar to those of nondiabetics (5.8 +/- 0.18% vs 5.7 +/- 0.08%). Mean Hgb A1c levels were higher in insulin-requiring gestational (6.4 +/- 0.20%, P less than .05) and permanent (6.5 +/- 0.27%, P less than .05) diabetics than in nondiabetics. The proportions of subjects with levels above the normal range were also larger in the insulin-requiring groups. Mean Hgb A1c levels and the proportions of abnormally high levels were similar for mothers of macrosomic and of normally grown neonates in the nondiabetic as well as in the various diabetes groups. There was no correlation between maternal Hgb A1c level and neonatal birth weight, either real or relative. There were also no statistically significant differences in mean Hgb A1c levels between mothers of neonates with or without hypoglycemia within four hours of birth. Hgb A1c measurement did not permit differentiation between those mothers of macrosomic neonates who were diabetic and those who were not. In conclusion, although Hgb A1c level has been shown to reflect diabetic control, our data suggest that it may not be reliable as an indicator of fine tuning during the third trimester of pregnancy or as a predictor of the effects of diabetes on the fetus.

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