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Global labor mobility is a logical outgrowth of the globalization of the world’s workforce. With an increase in global labor mobility, internationally educated nurses continually seek employment in the United States. This article presents the challenges and regulatory implications of nurses entering the United States on an occupational visa and in applying for a license to practice.

Cardiovascular disease continues to be a major cause of morbidity and mortality in patients with Type 2 Diabetes Mellitus. Whilst a focus on improved glucose control and HbA1c has led to a reduction in the progression and development of microvascular complications, the potential for this strategy to reduce cardiovascular event rates is less clearly defined. Identification of the incretin axis has facilitated the development of several novel therapeutic agents which target glucagon-like peptide-1 (GLP-1) pathways. The effects on glucose homeostasis are now established, but there is also now an increasing body of evidence to support a number of pleiotropic effects on the heart that may have the potential to influence cardiovascular outcomes. In this article, we review myocardial energy metabolism with particular emphasis on the potential benefits associated with a shift towards increased glucose utilisation and present the pre-clinical and clinical evidence regarding incretin effects on the heart. In addition we discuss the potential mechanism of action and benefit of drugs that modulate GLP-1 in patients with type 2 diabetes mellitus and coronary artery disease.

With the broadening diversity of internationally educated nurses seeking to practice in the United States, state boards of nursing have turned to credential evaluation to determine if these nurses meet regulatory requirements.This article provides a critical analysis of the components of credential evaluation and discusses current issues and future trends. Examples are drawn from different countries to illustrate divergent approaches to preparing nurses for practice and the challenge in harmonizing these differences. Credential evaluation can assist regulatory authorities in determining the eligibility of these nurses for entry to practice.

Introduction The literature suggests that individuals with history of cleft lip and palate who present with midfacial growth deficiency are at higher risk of presenting lisping. The relationship between distortions during production of linguoalveolar fricative sounds and the severity of malocclusion, however, has not been established for the population with cleft.Objective To study the association between lisping and dental arch relationship.Methodology Speech samples and dental arch casts were obtained from 106 children with operated unilateral cleft lip and palate (UCLP) during the stage of mixed dentition and before orthodontic treatment. Videotaped productions of the phrase lu saci saiw sedulwere rated by speech-language pathologists for the identification of lisping during [s]. Dental arch casts were rated by orthodontists using the Goslon Yardstick and the Five-Year Index to establish dental arch relationship.Results Multiple logistic regression showed no significant association between lisping and dento-occlusal index (p= .802) and age (p= .662). Substantial interjudge agreement during auditory-perceptual ratings was found (kappa = .63). Almost perfect agreement was found between orthodontists while establishing the dental arch relationship (kappa = .81).Discussion This study failed to reveal an association between lisping and dental arch relationship in children with operated UCLP. Multiple variables may play a role in determining occurrence of lisping, warranting further investigation.

Objective Cleft palate increases the risk of chronic middle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip and palate at 5 to 6 years of age.Design Subjects were randomly assigned to the von Langenbeck with intravelar veloplasty or Furlow palate repair, to palate surgery at 9 to 12 months or 15 to 18 months of age, and to the Spina or Millard lip repair.Setting Centralized, tertiary care craniofacial treatment center.Patients A total of 673 infants with unilateral cleft lip and palate.Interventions Palate and lip were repaired using established techniques. Serial otoscopic and audiometric evaluations were performed.Main Outcome Measures Hearing and otoscopic findings at 5 to 6 years old.Results There were 370 children available for analysis. Hearing and need for tympanostomy tube placement did not differ by palatoplasty, age at palatoplasty, cheiloplasty, or surgeon. Risk of developing cholesteatoma or perforation was higher with Millard cheiloplasty (odds ratio = 5.1, 95% confidence interval = 1.44 to 18.11, p= .012). Type and age at palatoplasty were not significantly associated with either the rate of developing these sequelae or the rate of achieving bilaterally normal hearing and ear examinations.Conclusions Type of palatoplasty did not influence otologic and audiologic outcomes in 5- to 6-year-olds with unilateral cleft lip and palate. The potential influence of lip repair on otologic outcomes warrants further investigation.

Left ventricular (LV) lead placement to areas of scar has detrimental effects on response to cardiac resynchronization therapy (CRT). Speckle-tracking radial two-dimensional strain offers assessment of the extent of regional myocardial deformation. The aim of this study was to assess the impact of LV lead placement at areas of low-amplitude strain on CRT response.

Objective: To study the growth of children with complete unilateral cleft lip and palate (UCLP) from birth to 2 years of age and to construct specific UCLP growth curves.Design: Physical growth was a secondary outcome measure of a National Institutes of Health–sponsored longitudinal, prospective clinical trial involving the University of Florida (United States) and the University of São Paulo (Brazil).Patients: Six hundred twenty-seven children with UCLP, nonsyndromic, both genders.Methods: Length, weight, and head circumference were prospectively measured for a group of children enrolled in a clinical trial. Median growth curves for the three parameters (length, weight, head circumference) were performed and compared with the median for the National Center for Health Statistics (NCHS) curves. The median values for length, weight, and head circumference at birth and 6, 12, 18, and 24 months of age were plotted against NCHS median values and statistically compared at birth and 24 months.Setting: Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil (HRAC-USP).Results: At birth, children of both genders with UCLP presented with smaller body dimensions in relation to NCHS median values, but the results suggest a catch-up growth for length, weight, and head circumference for girls and for weight (to some degree) and head circumference for boys.Conclusions: Weight was the most compromised parameter for both genders, followed by length and then head circumference. There was no evidence of short stature. This study established growth curves for children with UCLP.

Objective The purpose of this study was to evaluate the effect of nasal decongestant on nasalance scores for a group of 100 individuals.Participants Forty-one subjects with hypernasality and 59 subjects without hypernasality underwent nasometric assessment at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.Design Nasalance scores were obtained for each subject before the application of a nasal decongestant and again 10 minutes after subjects received a topical nasal decongestant applied into both nostrils.Results The nasalance scores obtained after the application of the nasal decongestant were significantly higher than those obtained before the decongestant.Conclusions Nasal decongestion had a small but statistically significant effect on nasalance scores, suggesting that in some individuals, nasal congestion should be a variable of concern when using the Nasometer. Both nasal congestion (i.e., due to nasal rhinitis) and the effects of nasal decongestant sprays may influence Nasometer test results. Interpretation of nasalance scores, therefore, should be done carefully. Furthermore, nasometry, with and without nasal decongestant, can be a valuable clinical tool for screening anterior nasal obstruction, helping to isolate obstruction due to nasal congestion from structural obstruction in the nasal cavities.

Objective To determine the immediate and longer-term effect(s) on tongue movement following the placement of an experimental opening through a palatal obturator (replicate of subject's prosthesis) worn by an adult male with an unrepaired cleft of the hard and soft palate.Methods Tongue movements associated with an anterior experimental opening of 20 mm2were examined under three conditions: a control condition in which the subject wore the experimental obturator completely occluded, a condition immediately after drilling the experimental openings through the obturator, and a condition after 5 days in which the subject wore the experimental obturator with the experimental opening. An Electromagnetic Articulograph was used for obtaining tongue movements during speech.Results The findings partly revealed that the immediate introduction of a perturbation to the speech system (experimental fistula) had a temporary effect on tongue movement. After sustained perturbation (for 5 days), the system normalized (going back toward control condition's behavior). Perceptual data were consistent with kinematic tongue movement direction in most of the cases.Conclusions Although the immediate response can be interpreted as indicative of the subject's attempts to move the tongue toward the opening to compensate for air loss, the findings following a sustained perturbation indicate that with time, other physiological adjustments (such as respiratory adjustments, for example) may help reestablish the requirements of a pressure-regulating system.

In the paper the problem of detecting and isolating multiple faults for nonlinear systems is considered. A strategy of state filtering is derived in order to detect and isolate multiple faults which appear simultaneously or sequentially in a discrete time nonlinear systems with unknown inputs. For the considered system for which a fault isolation condition is fulfilled the proposed method can isolate p simultaneous faults with at least p+q output measurements, where q is the number of unknown inputs or disturbances. A reduced output residual vector of dimension p+q is generated and the elements of this vector are decoupled in a way that each element of the vector is associated with only one fault or un measured input.

The effect of hypercapnia on the cerebral metabolic rate of oxygen consumption (CMRO2) remains incompletely understood. This study examined the relationship between susceptibility (blood oxygenation level dependent (BOLD)) and perfusion-weighted (flow-sensitive alternating inversion recovery (FAIR)) MRI techniques both during induction of repeated transient hypercapnia (THC) and after return to normocapnia during whisker barrel functional activation. During induction of THC the FAIR signal became significantly elevated over control after 100 s of hypercapnia (P = 0.039), with a trend of increasing significance to 5 min (P = 0.000008). The FAIR signal in the activated cortex during subsequent normocapnia was significantly increased compared to pre-THC control after each successive period of THC. The mean grouped FAIR signal increased by 81% ± 63% after one exposure (P = 0.021), by 163% ± 55% after the second exposure (P = 0.0002), and by 240% ± 54% after the third exposure (P = 0.000002). The mean grouped BOLD signal trended upward, but did not increase significantly during or after exposure 1, 2, or 3. These data demonstrate increased uncoupling of perfusion-weighted from susceptibility imaging techniques, both in nonactivated cortex during hypercapnia, and with activation after multiple exposures to THC. These results are consistent with saturation of BOLD contrast as well as with increases in CMRO2 with stimulation after multiple exposures to THC. Magn Reson Med 48:262–270, 2002. © 2002 Wiley-Liss, Inc.

ABSTRACTThe mechanism of resistance to the streptogramin antibiotics quinupristin and dalfopristin was studied in a Staphylococcus aureusclinical isolate selected under quinupristin-dalfopristin therapy, in four derivatives of S. aureusRN4220 selected in vitro, and in a mutant selected in a model of rabbit aortic endocarditis. For all strains the MICs of erythromycin, quinupristin, and quinupristin-dalfopristin were higher than those for the parental strains but the MICs of dalfopristin and lincomycin were similar. Portions of genes for domains II and V of 23S rRNA and the genes for ribosomal proteins L4 and L22 were amplified and sequenced. All mutants contained insertions or deletions in a protruding β hairpin that is part of the conserved C terminus of the L22 protein and that interacts with 23S rRNA. Susceptible S. aureusRN4220 was transformed with plasmid DNA encoding the L22 alteration, resulting in transformants that were erythromycin and quinupristin resistant. Synergistic ribosomal binding of streptogramins A and B, studied by analyzing the fluorescence kinetics of pristinamycin IA-ribosome complexes, was abolished in the mutant strain, providing an explanation for quinupristin-dalfopristin resistance.

Cardiac imaging with positron emission tomography offers unrivaled sensitivity and specificity to probe cardiovascular physiology in health and disease. The use of positron emission tomography to noninvasively measure regional myocardial blood flow and assess myocardial viability in patients with ventricular dysfunction and coronary artery disease has contributed greatly to our understanding of the pathophysiology of ischemic heart failure. The advances and the need for further studies to establish both the natural history of such ventricular dysfunction and the role of coronary revascularization are discussed. Copyright © 2001 by W.B. Saunders Company

A practical synthesis of the anti-methicillin resistant Staphylococcus aureus cephem (6R-trans)-E-7-[[[[2,5-dichloro-4-[3-[(carboxymethyl)amino]-3-oxo-1-propenyl]phenyl]-thio]-acetyl]amino]-4-[[(2-carboxy-8-oxo-5-thia-1-azabicyclo-[4.2.0]oct-2-en-3-yl)methyl]thio]-2,6-dimethyl-1-[3-(4-methylmorpholino-4-yl)propyl]-1-pyridinium, hydroxide, inner salt (BMS-247243) was developed. A process was developed for the interchange of the iodide counterion in 3a to chloride 3b that was essential for an efficient synthesis of the C-3 side chain 4-mercaptopyridone 6b. Use of catalytic Bu4NCl in the reaction of chlorocinnamide 14 with the Li-salt of methylthioglycolate formed the methyl ester of the C-7 side chain 12b in high yield. Reaction with the dianion of thioglycolic acid gave an increased level of the corresponding Michael addition byproduct that led to lower quality thermodynamic product 12b by the reverse reaction. Cephem nucleus 16 was acylated with the acid chloride of acid 12b in a biphasic system to circumvent the cumbersome workup involved in reactions mediated by carbodiimdes DCC or EDAC for the synthesis of diester 17. An unusual degradation product diacid 20 was obtained during the deprotection of diester 17 with TFA to amorphous diacid 19. Reaction of diacid 19 with 4-mercaptopyridone 6b formed BMS-247243 in moderate yield. Alternately, an efficient coupling of diester 17 with 4-mercaptopyridone 6b gave crystalline diester 21 with minimal (<1%) contamination of the double bond isomer 22. Double deprotection of diester 21 followed by crystallization furnished the double zwitterion BMS-247243 in high yield.

ObjectiveTo determine whether pharmacological stress leads to prolonged but reversible left ventricular dysfunction in patients with coronary artery disease, similar to that seen after exercise. DesignA randomised crossover study of recovery time of systolic and diastolic left ventricular function after exercise and dobutamine induced ischaemia. Subjects10 patients with stable angina, angiographically proven coronary artery disease, and normal left ventricular function. InterventionsTreadmill exercise and dobutamine stress were performed on different days. Quantitative assessment of systolic and diastolic left ventricular function was performed using transthoracic echocardiography at baseline and at regular intervals after each test. ResultsBoth forms of stress led to prolonged but reversible systolic and diastolic dysfunction. There was no difference in the maximum double product (p = 0.53) or ST depression (p = 0.63) with either form of stress. After exercise, ejection fraction was reduced at 15 and 30 minutes compared with baseline (mean (SEM), -5.6 (1.5)%, p < 0.05; and -6.1 (2.2)%, p < 0.01), and at 30 and 45 minutes after dobutamine (-10.8 (1.8)% and -5.5 (1.8)%, both p < 0.01). Regional analysis showed a reduction in the worst affected segment 15 and 30 minutes after exercise (-27.9 (7.2)% and -28.6 (5.7)%, both p < 0.01), and at 30 minutes after dobutamine (-32 (5.3)%, p < 0.01). The isovolumic relaxation period was prolonged 45 minutes after each form of stress (p < 0.05). ConclusionsIn patients with coronary artery disease, dobutamine induced ischaemia results in prolonged reversible left ventricular dysfunction, presumed to be myocardial stunning, similar to that seen after exercise. Dobutamine induced ischaemia could therefore be used to study the pathophysiology of this phenomenon further in patients with coronary artery disease.

Background: Measurable residual disease (MRD) is an important biomarker in acute myeloid leukemia (AML). Among patients who achieve remission after standard chemotherapy, detection of MRD (MRD+) after two cycles of intensive chemotherapy, at the end of consolidation and before allogeneic stem cell transplantation (alloHSCT) is a strong prognostic factor for relapse and shorter overall survival (OS) (Short NJ, JAMA Oncol. 2020). The optimal time-points to asses MRD, and MRD cut-offs as well as whether eliminating of MRD due to further chemotherapy improves an outcome still remain open questions. PALG-AML1/2016 study aims to compare the safety and efficacy of two commonly used induction and salvage regimens in AML (NCT03257241). This is also the first international randomized trial in AML induction to prospectively evaluate the impact of MRD on overall survival, using multi-modality testing (flow-cytometry, FC; next-generation sequencing, NGS) of serial samples.

Toxicity of Combined Sewer Overflows (CSOs) and stormwater was studied at 15 sites in Southern Ontario, using a battery of seven bioassays. The highest frequencies of severe and moderate toxicity (19% and 24%, respectively) were found at highway runoff sites; frequencies of CSO toxicity were much lower (from 6.6% to 13%, for moderate and severe toxicity combined). Stormwater ponds contributed to toxicity reduction, with respect to both water and sediment downstream of ponds. Conventional toxicity testing was found useful for screening and assessing potential receiving water impacts, but was somewhat limited by the dynamic nature and large variety of wet-weather pollution sources.

The surgical technique of cardiopulmonary bypass with either an empty beating or an empty fibrillating ventricle produces marked changes in the regional blood flow and oxygen demand of the left ventricle. This paper describes the changes which occurred in the regional perfusion of both the normal and the hypertrophied left ventricle during these conditions and relates them to the known changes in oxygen demand. It also correlates the changes in flow with the measurable changes in myocardial tissue pressure—systolic when the heart is beating and continuous when fibrillating. The various types of fibrillation had identical effects on both regional tissue pressure and regional flow. The subendocardial blood supply was adequate or more than adequate under each of these conditions so long as the coronary perfusion pressure was maintained at an adequate level. A low perfusion pressure during ventricular fibrillation of any type led to a marked reduction in flow to the subendocardial portion of the left ventricle: The presence of ventricular hypertrophy accentuated this danger.

• We define the concept of reperfusion injury, and we present a background chronology of experimental work supporting and questioning this concept. We identify several new influences, such as current clinical interest in thrombolytic therapy for acute ischemia of heart and brain and the growing recognition of endothelium as a regulator of homeostasis. We propose that these influences will encourage a reexamination of reperfusion injury as a factor in the ultimate outcome of tissue exposed to reversible ischemia. We briefly discuss the major mechanisms presently implicated in reperfusion injury—loss of calcium homeostasis, free radical generation, leukocyte-mediated injury, and acute hypercholesterolemia.

Anatomical and physiological changes of the speech production mechanism that occur with aging may result in phonatory distinctions between older and younger speakers. This investigation examined amplitude-based glottal airflow characteristics from sustained vowel production in healthy adult women. Sixty women participated in this study, 10 each in six age groups of 20-, 30-, 40-, 50-, 60-, and 70-year-olds. Measures included peak, alternating, and minimum glottal airflow. Additionally, a ratio of minimum to peak glottal airflow was calculated. Results from an analysis of variance indicated no significant group mean difference for any of the dependent measures. A greater variability in peak glottal airflow for the 70-year-old age group as compared to the 20-year-old age group was found. None of the dependent variables were significantly related to age and therefore were not good predictors of age. The results imply that laryngeal senescence in healthy women may not be significant enough to affect the magnitude of phonatory function parameters. Either the assumed anatomical changes produce less significant phonatory change in the healthy individual or the healthy individual is more capable of using strategies to counteract degenerative laryngeal changes.

Conclusive evidence for involvement of the peripheral nervous system in decompression illness is lacking. We report a case of decompression illness associated with shoulder pain and the clinical features of median nerve injury at the wrist. Initial recompression and hyperbaric oxygen treatment produced prompt relief of all symptoms and signs, but carpal tunnel syndrome subsequently recurred. Nerve conduction studies confirmed median nerve conduction delay at the wrist. Repeat measurements after treatment with hyperbaric oxygen showed electrophysiologic improvement that was consistent with improvement in symptoms. We believe this is the first objectively substantiated case of injury to the peripheral nervous system caused by decompression illness. [Isakov AP, Broome JR, Dutka AJ: Acute carpal tunnel syndrome in a diver: Evidence of peripheral nervous system involvement in decompression illness. Ann Emerg MedJuly 1996;28:90-93.]

Fragments of plasmid pIP816, which confers high-level glycopeptide resistance in Enterococcus faecium BM4147, were cloned into a conjugative gram-negative-gram-positive shuttle vector. The resulting hybrids were transferred by conjugation from Escherichia coli to Enterococcus faecalis and Bacillus thuringiensis. A 4-kilobase EcoRI fragment from pIP816 was found to confer vancomycin resistance in these hosts but not in E. coli or Bacillus subtilis.

Coprostanol is a fecal sterol formed by microbial reduction of cholesterol in the intestines of man and higher animals. The fact that this sterol is ubiquitously present in the feces of man and is excreted at the rate of about 1 g/capita/day has prompted investigators to suggest the use of this sterol as an indicator of fecal pollution. It has been found to be particularly useful in problem situations such as toxic or heated effluents and seawater environments where the use of the usual indicator bacteria is suspect. This review discusses the advantages and disadvantages of using coprostanol as an indicator sterol, details the results of numerous field studies, and examines the future prospects for this pollution indicator.

This article considers pharmacologic therapy for the prevention and treatment of ischemic cerebrovascular disease. The emphasis is on prevention of stroke, since current pharmacologic treatments do not reliably reduce morbidity or mortality once a stroke has occurred. Antihypertensive treatment, anticoagulants, and antiplatelet agents are discussed along with general guidelines for poststroke therapy.

Over the past eight years we have been evaluating a variety of sediment extraction procedures and have finally settled for a three phase sequential procedure which involves pore water extraction followed by Milli-Q water extraction. Then the dewatered sediment is extracted by a solution containing 10% methanol, 10% DMSO and 80% Milli-Q water. This three phase sequential extraction procedure was applied to Hamilton Harbour sediments and the extracts were tested for toxicant activity by the battery of tests approach. Based on these samples, it would appear that pore water bioassay results are probably most indicative of the bioavailable toxicants load in Hamilton Harbour sediments.

Abstract: The labelled compound was prepared by chlorination of [2-14C]acetone obtained from the barium salt of [1-14C]acetic acid by pyrolysis. The reaction product 1,1-dichloro [2-14C]acetone was converted to 2-dichloromethyl-2-methyl [2-14C]-1,3-dioxolane by condensation with ethylene glycol in the presence of thionyl chloride. Radiochemical yield: 62% based on [1-14C]acetic acid.

There is a need to monitor quickly and inexpensively the toxicity of the myriad of exotic chemicals that are introduced daily into the environment. A wide range of microbial ecotoxicity tests have been developed to assess the impact of these toxicants on natural and manmade ecosystems. Criteria used for assessing the ideal microbial ecotoxicity test are simplicity, sensitivity, rapidity, and low cost. Much work has been done to develop simple short-term and low-cost ecotoxicity tests, but less is known about ways to increase the sensitivity of the test microorganisms, which are mostly Gram-negative bacteria. During the past 3 decades, efforts have been made toward obtaining a better understanding of the structure of the outer membrane of Gram-negative bacteria. There are serveral approaches for increasing the permeability of the outer membrane to hydrophilic, hyrophobic, and surface active compounds. This review explores these methods and their potential application to enhance the sensitivity of the test bacteria to environmental toxicants.

To illustrate the difficulties and problems involved in assessing the effect of biodegradation processes in sediments on the toxicity potential of targeted chemicals, a study was carried out to examine the relationship of aerobic and anaerobic biodegradation (on the ecotoxicity) of two priority organic chemicals (nonylphenol and aniline). The chemicals were spiked into heavily polluted Hamilton Harbour sediments and over a period of 6 six months the changes in toxicity and genotoxicity (as assessed by 10 short-term bioassays) of the spiked sediments and their metabolites were monitored. The results indicated that under anaerobic conditions nonylphenol levels increased in concentration, while aniline quickly degraded under aerobic conditions and a little slower under anaerobic conditions.The data also revealed the inherent wide variability in toxicant distribution in homogenized sediment samples. © 1998 John Wiley & Sons, Inc. Environ Toxicol Water Qual 13: 313–322, 1998

Nearly all strains of Enterococcus gallinarum are resistant to low levels of vancomycin. The glycopeptide resistance gene vanC from E. gallinarum BM4174 has recently been cloned and sequenced. A probe specific for vanC hybridized with a 2.7-kb EcoRI and a 4.5-kb HindIII fragment of total DNA from the 42 strains of E. gallinarum studied. No homology was detected with DNA of strains belonging to other species intrinsically resistant to vancomycin, including Enterococcus casseliflavus, a species that expresses a vancomycin resistance phenotype similar to that of E. gallinarum. No hybridization with DNA of enterococcal strains with acquired resistance to high or low levels of vancomycin was observed. The specificity of the vanC probe allowed us to distinguish E. gallinarum from 12 other species of enterococci, indicating that this probe is a useful tool for species identification within the genus Enterococcus.

Gram-positive glycopeptide-resistant bacteria isolated in various hospitals in Europe and in the United States between 1986 and 1988 were collected. Three resistance phenotypes could be distinguished. Thirty-one enterococci were highly resistant to vancomycin and teicoplanin. Resistance was transferable to other enterococci by conjugation for 16 of the 22 isolates that were tested. Homology was detected by hybridization between a probe specific for the vanA gene, which encodes an inducible high-level glycopeptide resistance protein in Enterococcus faecium BM4147, and DNA of the 31 clinical isolates and the 16 corresponding transconjugants. This indicates that a single class of resistance determinants accounts for high-level glycopeptide resistance in enterococci. The strains differed in their biotypes and resistance phenotypes and harbored resistance plasmids of various sizes, suggesting that spread of this resistance phenotype is due to dissemination of a gene rather than of a bacterial clone or of a single plasmid. Four enterococcal isolates were resistant to low levels of vancomycin and susceptible to teicoplanin. Twenty-three coagulase-negative staphylococcal isolates were resistant to teicoplanin and susceptible to vancomycin. These two groups of strains did not hybridize with the vanA probe and did not transfer resistance at a detectable frequency. The vanA gene was not detected in the glycopeptide-producing strains of Amycolatopsis orientalis (vancomycin) and Actinoplanes teichomyceticus (teicoplanin) or in various gram-positive bacteria intrinsically resistant to glycopeptides.

Although detailed examinations have been published on structure-activity relationships of herbicide safeners, only a few data are available on chemical reactivity-safener activity relationships. Chemical reactivity of acetamide type compounds as well as their safener activity against thiocarbamate herbicides change with the number of chlorine substituents in the order: non-chlorinated < monochloro < dichloro. Several compounds of another chemical group, acetals (e.g. MG-191, 2-dichloromethyl-2-methyl-1,3-dioxolane), are also effective safeners for thiocarbamate herbicides. According to our growth room studies, the safener activity of acetals also increases with increasing chlorine content up to two chlorine atoms on the same carbon. A number of differently chlorinated acetals have been synthesized and their acid-catalyzed hydrolysis rate determined in order to establish a relationship between their bioactivity and chemical reactivity. The hydrolysis rate order of acetals containing no, one or two chlorine atoms: non-chlorinated > monochloro > dichloro, is just the opposite than what has been found for acetamides. Thus, safener activity of acetals increases with decreasing chemical reactivity. The opposite reactivity order of acetamides and acetals can be explained by the different mechanisms of their hydrolysis. Dichloroacetals may not be effective safeners in their original structure. In plants, however, they can be biologically activated to active safeners by a transformation other than hydrolysis.

Acetals and ketals involving a dichloromethyl group on their central carbon atom were found to be active or highly active as safeners of corn against thiocarbamate and chloroacet-anilide herbicide injury. A mechanism for the biotransformation of these compounds as pro­safeners to the actual dichloroacetic ester safeners is proposed.

Twenty-four clinical isolates of Staphylococcus aureuscollected from various geographic areas and four reference strains were studied by (i) agar diffusion with disks impregnated with 5 μg oxacillin and reading after incubation at 30°C for 24 hours, (ii) Southern hybridization with a probe specific for the mecAgene, and (iii) the BBLCrystalTMMRSA ID system. There was perfect correlation between the three methods: the BBLCrystalTMMRSA ID system detected methicillin resistance in the fifteen strains hybridizing with the mecAprobe and classified as resistant by the oxacillin disk diffusion test; the thirteen remaining strains were susceptible by agar diffusion and by the BBLtest and did not hybridize with the mecAprobe. The BBLCrystalTMMRSA ID System, therefore, appears to be an accurate method for rapid detection of Staphylococcus aureusexhibiting homogeneous resistance to methicillin.

Effects of incubation time, temperature, and organic substrate on the enumeration of total and metabolizing aquatic bacteria were evaluated with a reduction technique using 2-(p-iodophenyl)-3-(p-nitrophenyl)-5-phenyl tetrazolium chloride and formazan. Data indicated that there were no apparent differences in metabolizing bacterial numbers when water samples were incubated for up to 24 h at 4 or 20°C with or without the addition of glucose. However, increasing numbers of detectable metabolizing bacteria were noted when the water samples were incubated at 37°C for 4 h with or without added glucose. Implications of the observations as they relate to point source nutrient discharges on the nearshore-offshore bacterial populations are discussed.

This review describes the use of biochemical and microbial tests to assess the toxicity of aquatic pollutants. Biochemical assays include the use of enzymes (dehydrogenase, ATPases, and others), luminescence, and ATP for measuring chemical toxicity in the aquatic environment. Bacterial tests also can serve as a tool for toxicity testing. These tests are based on measurement of growth inhibition or viability of bacteria and alteration of bacterial metabolism. These tests are relatively simple, rapid, and inexpensive as compared to fish bioassays.

Autoclave and ethylene oxide-sterilized membrane filters manufactured by Gelman, Millipore, and Sartorius were field tested for their recovery of total coliforms, fecal coliforms, fecal streptococci, and heterotrophs. The data were analyzed by using split-plot analysis of variance and significance tests. Membranes were also tested for pH and toxicity using Escherichia coli. The mean data summaries indicated that Gelman membrane filters generally produced the highest counts during the field studies. Statistical analyses of the March data showed that there were significant differences between membrane filters at 1% level; however, statistical analyses of June data revealed no significant differences except in total coliform recoveries. Toxicity tests at 35 C indicated that Gelman and Millipore autoclaved membrane filters were able to recover 92% of the test organisms. Toxicity tests performed at 44.5 C revealed that no membranes were able to recover more than 40% of the test organisms. Since differences were found in the ability of the three brands of membrane filters to recover bacteria from natural and controlled sources, membrane filters from different manufacturers cannot be readily interchanged. There is a need for a standardized procedure for testing bacterial recovery by membrane filters.

Vancomycin resistance in enterococci is an increasing clinical problem, and several phenotypes have been identified. We demonstrate here that the resistance mechanism in the constitutively vancomycin-resistant Enterococcus gallinarum BM4174 involves an altered pathway of peptidoglycan synthesis and hydrolysis of the normal precursors in the vancomycin-sensitive pathway. A ligase encoded by the vanC gene catalyses synthesis of D-Ala-D-Ser and substitutes this dipeptide for D-Ala-D-Ala in peptidoglycan precursors. It is presumed that this substitution lowers the affinity of vancomycin for its target site. Destruction of D-Ala-D-Ala (D,D-peptidase activity) and of UDP-MurNAc-L-Ala-D-isoGlu-L-Lys-D-Ala-D-Ala by removal of the terminal D-Ala residue (D,D-carboxypeptidase activity) ensures that the normal vancomycin-sensitive pathway of peptidoglycan synthesis cannot function in the resistant strain.

Background: Intravenous immunoglobulin (IVIg) has been used in recent years to treat an increasing number of autoimmune diseases to decrease cytokine secretion and to neutralize toxins, in addition to the therapy of immunodeficiency disorders. In addition to angioedema-like hypersensitivity eruptions, there have been reports of eczematous, purpuric, petechial/purpuric, and vasculitic reactions to IVIg; however, there has been only one previous report of a case in which the patient developed a lichenoid dermatitis after infusion of IVIg.Observations: We present two patients with chronic inflammatory, demyelinating polyneuropathy, who after the first course of IVIg developed a folliculocentric interface/lichenoid eruption that cleared without therapy or with topical steroids. The eruption did not recur with subsequent IVIg infusions in either patient.Conclusions: The multiple diverse effects of IVIg on the immune system, and the re-regulation of the anti-idiotype network with repeat IVIg infusions, may explain why this eruption occurred with the initial infusion of IVIg and not with repeated infusions.

E. J. Dobson / F. LI. Harrison, Medieval English Songs. Faber and Faber, London, 1979. 336 pp.Robert de Beaugrande and Wolfgang Dressier, Introduction to Text Linguistics. Longmans, London, 1981.Bengt Altenberg, The Genitive vs. the of-Construction. A Study of Syntactic Variation in 17th Century English (Lund Studies in English 62). Gleerup, Lund, 1982. 318 pp.Christopher D. Heath, The Pronunciation of English in Cannock, Staffordshire. A Socio-Linguistic Survey of an Urban Speech-Community. Publications of the Philological Society XXXIV. Oxford: Basil Blackwell, 1980. XII+141 pp.Christine Palm, Greule, Golch und Geigerich. Die Nabelschnur zur Sprach-Wirklichkeit in der grotesken Lyrik von Christian Morgenstern. Acta Universitatis Upsaliensis. Studia Germanistica Upsaliensia, 27. Uppsala 1983, 211 S.

A PCR assay that allows simultaneous detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci (Enterococcus faecium, E. faecalis, E. gallinarum, and E. casseliflavus) was developed. This assay was based on specific amplification of internal fragments of genes encoding D-alanine:D-alanine ligases and related glycopeptide resistance proteins. The specificity of the assay was tested on 5 well-characterized glycopeptide-resistant strains and on 15 susceptible enterococcal type strains. Clinical isolates of enterococci that could not be identified to the species level by conventional methods were identified by the PCR test. This assay offers a specific and rapid alternative to antibiotic susceptibility tests, in particular for detection of low-level vancomycin resistance.

Objective To document the cardiac phenotype associated with Friedreich's ataxia, a recessively inherited disorder characterised by spinocerebellar degeneration. Setting Individuals with Friedreich's ataxia who accepted the invitation to participate in the study. Hypothesis The cardiomyopathy associated with Friedreich's ataxia may offer a human model for the study of factors modulating cardiac hypertrophy. Methods55 patients (mean (SD) age 30 (9) years) with a clinical diagnosis of Friedreich's ataxia were studied by clinical examination, electrocardiography, cross sectional and Doppler echocardiography, and analysis of the GAA repeat in the first intron of the frataxin gene. ResultsA wide variety of cardiac morphology was documented. Subjects with normal frataxin alleles had no evidence of cardiomyopathy. In homozygous subjects, a relation was found between the thickness of the interventricular septum (r = 0.53, p &lt; 0.005), left ventricular mass (r = 0.48, p &lt; 0.01), and the number of GAA repeats on the smaller allele of the frataxin gene. No relation was shown between the presence of electrocardiographic abnormalities (mainly repolarisation changes) and either the pattern of ventricular hypertrophy (if present) and degree of neurological disability or the length of time since diagnosis. No tendency to ventricular thinning or dilatation with age was found. Although ventricular systolic function appeared impaired in some cases, Doppler studies of ventricular filling were within the normal range for age. Conclusions The cardiomyopathy associated with Friedreich's ataxia shows a variable phenotype which is not concordant with the presence of ECG abnormalities or the neurological features of the condition. As the genetic basis for Friedreich's ataxia has been established, further studies will help to clarify the molecular mechanisms of the cardiac hypertrophy.