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Propyzamide and carbetamide are essential for blackgrass control in oilseed rape production. However, both of these compounds can contaminate surface waters and pose compliance problems for water utilities. The transport of propyzamide and carbetamide to an instrumented field drain in a small clay headwater tributary of the Upper Cherwell catchment was monitored over a winter season. Despite having very different sorption and dissipation properties, both herbicides were transported rapidly to the drain outlet in the first storm event after application, although carbetamide was leached more readily than propyzamide. A simple conceptual model was constructed to represent solute displacement from mobile pore water and preferential flow to drains. The model was able to reproduce the timing and magnitude of herbicide losses well, lending support to its conceptual basis. Measured losses in drainflow in the month following application were 1.1 and 8.1%, respectively, for propyzamide and carbetamide. Differences were due to a combination of differences in herbicide mobility and due to the fact that the monitoring period for carbetamide was hydrologically more active. For both compounds, losses were greater than those typically reported elsewhere for other herbicides. The data suggest that drainflow is the dominant pathway for the transfer of these herbicides to the catchment outlet, where water is abstracted for municipal supply. This imposes considerable constraints on the management options available to reduce surface water concentrations of herbicides in this catchment.

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Symptoms of mania have been given inadequate attention as a source of agitated behavior in the dementia patient. Characterized by elevation in mood or grandiosity, pressured speech, and impulsivity, mania is common among the elderly population, with a prevalence approaching 20% in some studies. Because it is so highly associated with behavioral agitation, mania has a significant impact on patient management, and can often lead to the institutionalization of difficult patients. Here we present a case series of three elderly individuals who had signs of mania in conjunction with dementia. Refractory to psychotropic medications, all were given an acute plus maintenance courses of right-unilateral electroconvulsive therapy (ECT). The patients achieved significant improvement in signs of mania and agitation, as well as in mental status scores. We conclude that a short course of ECT, followed by maintenance treatments every 2 weeks, can contribute significantly to the management of dementia patients whose behavioral agitation is associated with signs of mania.

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26 male and 87 female college students filled out Stets' Psychological Aggression Scale, Stets' Interpersonal Control Scale, Straus' Physical Violence Scale, and Fisch and Brainerd's Use and Approval of Jealousy-inducing Behaviors Scale. Use and approval of jealousy-inducing behaviors were good predictors of high need for interpersonal control and the use of psychological aggression. The use of jealousy-inducing behaviors but not the approval of these behaviors was a strong predictor of physical aggression in romantic relationships.

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Crushing chest pain that won't go away? Go to the emergency department. Need a pregnancy test? Go to the emergency department. Anything in between? Don't worry-the emergency department will take care of it. As one patient puts it, "If you're willing to wait, they're willing to see you." Well, no more. Budgets are being slashed, and there are fewer doctors and nurses to help. What to do? Try "triage out," the latest trend to whisk patients through the emergency department doors.

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In the neonate, there are a number of age-related differences in drug disposition (bioavailability, distribution, metabolism, and excretion), and these are directly related to the degree of prematurity. This article discusses the use of drugs that are commonly administered to the neonatal patient, with special emphasis given to renal considerations. These drugs include diuretics, theophylline, converting enzyme inhibitors, calcium channel blockers, indomethacin, and dopamine.

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Clinical workstation developers may gain useful insights from studies of physician acceptance and use of computer systems that have been incorporated into daily practice. We used a physician survey, intrinsic monitors built into the system and an observational study to assess physician acceptance and use of a touchscreen workstation that was put in place in an NICU in 1985. Each of the 87 physicians assigned to the 30 bed NICU during the two academic years beginning July, 1987 was sent a questionnaire that assessed experience and attitudes about the system. The 70 responding physicians (80 percent) were unanimous in agreeing or strongly agreeing that the system was "easy to learn" (57 reported it taking less than five minutes), "easy to use", and "integrates smoothly into patient care activities". Over 94 percent of the physicians agreed or strongly agreed that the system was "fast", "saves time", and was "reliable and dependable." Sixty-three of the responding physicians (90%) reported using the system two or more times a day with 53 using it more than five times daily. The most frequently requested new feature was that of time-trend graphs (51 occurrences). The intrinsic monitors were useful in validating design decisions and survey results but also provided new insights relevant to security issues. Similarly, the observation study reinforced some of the survey results but also highlighted an additional issue not brought out by the other two assessment methods. The overall assessment indicated that the system has been both well-accepted and well-used by its intended clinical clientele.

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In order to examine technical factors that influence muscle sound recording, single twitches of muscle were utilized since their waveforms were likely to be reproducible. We observed that satisfactory recordings could be made with either Archer air interface, or Hewlett-Packard direct contact sensor, microphones. Firm contact and stability between the microphone and the skin surface were particularly important. Frequencies below 20 Hz, the lower limit of the human auditory range, must be recorded, since they account for at least 90% of the power of the muscle sound wave. The chief frequencies were below 4 Hz. The sound wave produced by a maximal twitch of human thenar muscle induced by median nerve stimulation at the wrist is maximal in amplitude over the center and recedes to near zero at the margins of the muscle. It is preceded by the muscle compound action potential and is followed by the force curve, recorded with a strain gauge attached to the thumb. The sound resembles force in total time course, and it increases with increasing strengths of nerve stimulation. However, it differs in its latency, phase relationships, and response to nerve stimulation at different frequencies. Some of the features of muscle sound suggest it relates to both the active contractile and the parallel elastic components of muscle during a twitch contraction, but not the series elastic component.

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We compared the in-hospital and postdischarge growth of 47 preterm very-low-birth-weight infants born in 1982 with that of 29 born in 1986. Infants in the two groups were of comparable gestational age, size, and illness at birth. During hospitalization, the 1986 infants began parenteral and enteral nutrition earlier, had fewer days when they received less than 252 kJ/kg, were treated earlier for patent ductus arteriosus (6.1 +/- 4.5 days vs 14.5 +/- 7.7 days), and had a lower prevalence of severe medical complications. By hospital discharge, these infants had significantly higher mean growth percentiles and fewer of them had weights and occipitofrontal circumferences below the fifth percentile. Follow-up at 4 and 12 months corrected age showed that these infants continued to have significantly higher growth percentiles, and fewer of them had weights below the fifth percentile (49% vs 24%) or major neurologic abnormalities. Infants whose weights were below the fifth percentile had significantly poorer 12-month developmental outcomes. We speculate that more aggressive early neonatal nutritional management, changes in cardiopulmonary management, and lower incidences of chronic disease promote earlier onset of and more rapid rates of postnatal growth, which extend through the first year of follow-up.

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1. The erectile response to the short-acting dopamine (DA) receptor agonist, apomorphine (Apo) HCl (0.25, 0.5, 0.75 and 1.0 mg sc), and placebo was evaluated in 28 impotent patients and penile circumference monitored using a mercury strain gauge and strip chart recording. 2. A full erection (increment in penile circumference greater than 2 cm and lasting at least one minute) occurred in 17 patients with Apo; no erection developed after placebo. An erection occurred in 6/8 patients with impaired glucose tolerance, 2/6 patients with diabetes mellitus and in both patients on lithium. 3. Nine patients who responded to Apo were treated in an open trial with bromocriptine; 6 reported improvement in potency. 4. Impairment in DA function may play a role in idiopathic impotence and in impotence associated with impaired glucose tolerance and diabetes mellitus. 5. An erectile response to Apo may predict therapeutic response to bromocriptine or other long acting dopaminergic agents. 6. Lithium, which inhibits DA-sensitive adenylate cyclase, does not prevent Apo-induced erections. This provides further support indicating that Apo induces erections by an effect on D2 receptors. 7. The yawning response to placebo and four doses of Apo HC1 (3.5, 5.0, 7.0, and 10.5 ug/kg sc) was evaluated in five normal men using a polygraphic technique. The yawning response was also assessed in normal young (less than 30 yrs; N = 16) and elderly (greater than 60 yrs; N = 12) volunteers. 8. Under experimental conditions of study, placebo induced spontaneous yawning. This was antagonized by 3.5 and 5.0 ug/kg Apo HC1 but increased by 7.0 ug/kg Apo HC1. These observations are compatible with the view that Apo HC1 in doses of 3.5-5.0 ug/kg stimulates presynaptic DA receptors whereas 7.0 ug/kg stimulates postsynaptic DA receptors. 9. Spontaneous and Apo-induced yawning were significantly decreased in the elderly which suggests that D2 receptor function declines with normal aging.

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This study analyzed the clinical characteristics of 69 neonates who were admitted to the University of Minnesota Hospital between January, 1972, and June, 1984, with early onset Group B streptococcal infection (EOGBS) and determined those features associated with fatal infection. The incidence of EOGBS was 1.6 cases/1000 live births among 7960 inborn infants; the mortality rate for inborn and outborn infants was 28%. Multivariate analysis identified five features adequately predicting fatal outcome: birth weight less than 2500 g, absolute neutrophil count less than 1500 cells/mm3, hypotension, apnea and a pleural effusion on the initial chest radiographs. With these five variables and an initial blood pH less than 7.25, a clinical score was constructed that correctly predicted outcome in 93% of patients in this study (87% sensitivity, 95% specificity). Autopsy findings in 16 of 19 infants with fatal EOGBS suggested that surfactant deficiency respiratory distress syndrome was common in preterm infants with EOGBS and contributed to their higher mortality compared with term infants.

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Four patients with chlorpromazine-induced pigmentation showed resolution of the condition on replacing chlorpromazine with haloperidol.

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To further characterize the place for furosemide in the treatment of newborn infants with respiratory distress syndrome requiring mechanical ventilation, we conducted a blinded, prospective study comparing early prophylactic use (1 mg/kg every 12 hours for four doses beginning at 24 hours of age) with prn use of this drug. Prophylactic administration of furosemide produced no beneficial effect on any measure of pulmonary function compared with use of this drug as needed (prn). However, patients receiving the prophylactic furosemide regimen were found to have more rapid postnatal weight loss, higher pulse rate, and greater sympathomimetic drug requirement during the period of diuretic administration. Patients in the prophylactic group did not demonstrate the moderate expansion in plasma volume between 48 and 96 hours of age seen in the control group. These data suggest that the prophylactic regimen produced an undesirable degree of volume depletion. Further studies should be conducted to develop objective criteria for the selection of the subgroup of patients with respiratory distress syndrome who may benefit from furosemide.

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In this prospective study 90 patients underwent 100 total knee replacements. Each patient walked and practiced rehabilitation exercises one day preoperatively and the morning of surgery. The contralateral calf was intermittently pumped during surgery followed by bilateral pulsatile calf compression postoperatively. Aspirin was administered in the recovery room and continued 600 mg twice a day until discharge. Early activity and ambulation postoperatively were expected. Routine deep venous thrombosis screening tests were not performed. No physiologically significant postoperative venous thrombosis on any of these patients were observed. A Doppler test was performed on eight patients, venogram on two patients, and V/Q lung scan on two patients in whom a thromboembolic disease problem was clinically suspected. All of these tests were negative except for one V/Q scan.

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We determined concentrations of disaturated phosphatidylcholine (DSPC) in nearly 2000 amniotic fluid samples obtained either transabdominally or as vaginal pools. Here we report our comparison of these DSPC values with the lecithin/sphingomyelin (L/S) ratios for amniotic fluid samples obtained from diabetic and nondiabetic pregnancies and also between transabdominally or vaginally collected samples uncontaminated by blood or meconium. DSPC measurement is at least as good as the L/S ratio in predicting the absence of respiratory distress syndrome. DSPC concentrations were, however, lower in diabetic than in nondiabetic pregnancies, supporting the hypothesis that DSPC synthesis may be impaired in fetuses of diabetic mothers. Visually uncontaminated samples collected transabdominally or vaginally, when grouped according to length of gestation, have similar DSPC values but different L/S ratios. Thus, even in the absence of blood or meconium, DSPC may be a more useful test than the L/S ratio for vaginally pooled samples.

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All suicides for ages 20 years and younger in Manitoba from 1971 to 1982 were studied for demographic and risk factors. Major demographic findings for Caucasian Manitobans agreed with past studies but native children showed several fold the rates for Caucasian children matched for gender and age. Both native males and rural Caucasian males suicided significantly more frequently at younger ages than their urban counterparts. Significant risk factors and demographic clusters of suicide victims were determined by statistical means and the results discussed in terms of a better understanding of childhood suicide, on a psychodynamic basis.

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Red blood cell alloantibody production was studied in 90 neonates who received a mean of 14.1 transfusions (range 2-35) from an average of 8.9 donors during the first three months after birth. Standard antibody detection procedures were done with the use of a selected red blood cell panel. No unexpected alloantibodies were detected. These findings suggest, at a 99% confidence level, that neonates do not make red blood cell alloantibodies in response to transfusion, indicating that repeated compatibility testing is probably unnecessary. Thus, following initial antibody screening and compatibility tests, further compatibility testing can be eliminated.

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