PURPOSE:Although high rates of smoking have been reported among psychiatric patients, only a few studies examined the prevalence of smoking in bipolar disorder, and findings are inconsistent. We investigated smoking among bipolar patients. METHODS:We examined the prevalence of smoking in of 102 patients that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for bipolar I disorder in Israel and evaluated the relationship between smoking and demographic and clinical data. RESULTS:Fifty-five of the bipolar patients (53.9%) smoked, with a rate that is 2.36 times higher than among the general population in Israel (22.8%). Significant relationships were revealed between smoking and lifetime history of alcohol dependence/abuse (P = .02), between smoking and history of drug use (P ≤ .01), and between smoking and age of illness onset (P = .04). LIMITATIONS:The cross-sectional nature of the study and the relatively small sample size preclude generalization of the findings. Nicotine levels were not measured; thus, the information regarding smoking was subjective. CONCLUSIONS:Bipolar patients smoke more than the general population. Bipolar patients that are moderate or heavy smokers are more likely than nonsmokers to consume alcohol and abuse psychoactive substances. Contrary to findings of previous studies, no association was found between clinical variables of bipolar patients and smoking.

Background: Ectopic breast tissue is a rare occurrence in pregnant women and should not be confused with abscess or other causes. Ectopic breast tissue is present at birth but often only diagnosed after puberty, pregnancy, or lactation. Objective: Misdiagnosis is of concern due to the fact that ectopic breast tissue may undergo pathological changes with increased risk of malignancy. Therefore, it is vital for emergency physicians to be able to recognize this process and ensure proper follow-up care. Case Report: We present a case of ectopic breast tissue in a 19-year-old primigravida. Conclusion: Surgical removal for the purpose of prophylaxis of malignant changes is not currently recommended. Definitive diagnosis is established by fine-needle aspiration and excisional biopsy. (C) 2011 Elsevier Inc.

Introduction\r\nWhile premature ejaculation (PE) is the most common sexual dysfunction in men under 40, there is currently no government-approved therapy for its treatment. Is a cure possible?

INTRODUCTION:While premature ejaculation (PE) is the most common sexual dysfunction in men under 40, there is currently no government-approved therapy for its treatment. Is a cure possible?METHODS:Four experts in the area of PE and its treatment were asked to contribute their opinions.MAIN OUTCOME MEASURE:To provide food for thought, discussion, and possible further research in a poorly understood area of sexual medicine.RESULTS:Differences among the different types of PE, and the ability to cure them are discussed. One expert examines the possible differences in lifelong and acquired PE as an explanation as to why treatment for the former does not carry over after termination of treatment whereas the latter can be treated successfully. The second and third experts break PE into four categories, explaining that those forms that are curable at present are not true PE or are based on anxiety. The last expert discusses the potential of a combined clinical and research platform to better understand the relative contributions of biological, behavioral, and couple factors to the disorder for potential curability.CONCLUSION:Improved understanding of the types of PE and their various etiologies and pathophysiologies would improve the potential for cure.

We present the design and deployment of the Julia locality aware content distribution algorithm. Our novel contributions are locality aware node selection, forming a dynamically changing topology and division of the file into varying length chunks based on locality of the transfer. We present a large scale WAN deployment on over than 250 PlanetLab machines. We show that our technique can improve average download speed up by a factor of two compared with non locality aware solutions. Finally we compare our prototype’s performance with that of BitTorrent, presently one of the most stable and efficient deployed content dissemination tools.

In the light of the growing interest in professionalism and non-cognitive attributes in medical education, a focus group (FG) methodology was used to achieve a database of desired physician attributes. Ten FGs, consisting of medical faculty, service heads, residents, general practitioners, students and patients, took place, producing 169 desired attributes; further attributes were derived from a literature search, and the Mission and Vision Statement (MVS) of the authors’ medical faculty. A total of 254 separate attributes finally emerged, after a process of combining and collapsing similar items. Attributes appearing with the highest frequency were: honest, empathic, patient, capacity to be an attentive listener, understanding, able to work in a team, intellectual curiosity, egalitarian. The high number of attributes generated in this study provides an indication of what the profession is wanting of itself. This database is multipotential and preliminary in nature and requires further processing before achieving full relevance.

In this paper we introduce Aquarius, a fault tolerant CORBA software. Aquarius seamlessly wraps legacy software using portable inteceptors to provide a smooth migration path for robustifying existing services. The replication technique it employs is data-centric, which means that a service is considered a shared object, copies of which are stored on independent servers. The shared object is manipulated by clients, without any communication among replicated servers. The data-centric approach differs from other replication systems, in which active replication is implemented by the server replicas. The Aquarius architecture is demonstrated using a test-case replicated SQL database.

The use of trigger films (TFs) for undergraduate teaching is well established in the Technion School of Medicine and elsewhere. These are typically based on a written script highlighting diverse issues within the patient-physician relationship (PPR). We report here on the staging of a filmed script-free encounter between a physician and an actress-patient as a further development of the TF approach. This involved the creation of a clinical interaction in which the patient's revealed cultural background demanded an adaptive response from the physician in order to achieve a stable PPR and to institute effective treatment. Considerable improvisation was thus required. Prior directorial manipulation of the conditions of the interview enhanced the didactic power and goals of the TF. After completion of the filming, the physician and the actress studied the video and then repeated the interview within the same situation free of directorial input. The two sequential videotaped interviews constitute the final product. These TFs appear to carry a wide spectrum of didactic messages at many levels including the need to relate effectively to the cultural aspects in the PPR, and the importance of self-observation as a tool for change and learning.

A glycopeptide fraction has been prepared from human chorionic gonadotropin (HCG) by digesting the reduced, S-carboxymethylated hormone with pronase and fractionating the digest by gel exclusion chromatography. The glycopeptide fraction was estimated to contain (w/w) 29% sialic acid, 31% hexose, 23% hexosamine, and 17% amino acids and/or peptides; thus, the glycopeptide mixture is 83% carbohydrate compared to intact HCG which is about 30% carbohdyrate. There was no cross-reactivity of the glycopeptide fraction with an antiserum directed against HCG. Also, when corrected for minimal non-specific effects, the fraction failed to displace 125I-HCG from a rat testicular preparation even when tested at a 10,000-fold (w/w) excess. Thus, any model involving carbohydrate effects in gonadotropin action must include the protein moiety as a necessary component.

Purified preparations of human luteinizing hormone (hLH), Hartree IRC-2, and NIH LER-960, have been examined after gel filtration of unlabelled and iodinated hormone. Several peaks of radioactivity were observed corresponding to dimeric (peak I), monomeric (peak II), and sub-unit (peak III) lLH forms. The immunologic and receptor activities of each fraction have been evaluated, Receptor activity was found in peaks I and II but not in peak III. Within peak II all fractions were not equally active in the receptor assay, and maximum activity appeared to correspond to molecules with elution characteristics similar to the unlabelled molecule. All fractions of peak II were immunologically active when tested against rabbit anti-hCG in excess. Two immunoassay systems with improved specificity for hLH and hLH-alpha, respectively, have been employed to show the presence of alpha subunit in one of the hLH preparations. These data have relevance with respect to testing of immuno and receptor potencies of hLH preparations.

Journal Article Free Fatty Acids: A Possible Regulator of Free Thyroid Hormone Levels in Man Get access CHARLES S. HOLLANDER, CHARLES S. HOLLANDER 2Rochester General Hospital, University of Rochester School of Medicine Rochester, N. Y.; Johns Hopkins Hospital, Johns Hopkins University School of Medicine Baltimore, Md.; Montefiore Hospital and Medical Center, Albert Einstein College of Medicine New York City. Search for other works by this author on: Oxford Academic Google Scholar ROBERT L. SCOTT, ROBERT L. SCOTT 2Rochester General Hospital, University of Rochester School of Medicine Rochester, N. Y.; Johns Hopkins Hospital, Johns Hopkins University School of Medicine Baltimore, Md.; Montefiore Hospital and Medical Center, Albert Einstein College of Medicine New York City. Search for other works by this author on: Oxford Academic Google Scholar JOHN A. BURGESS, JOHN A. BURGESS 2Rochester General Hospital, University of Rochester School of Medicine Rochester, N. Y.; Johns Hopkins Hospital, Johns Hopkins University School of Medicine Baltimore, Md.; Montefiore Hospital and Medical Center, Albert Einstein College of Medicine New York City. Search for other works by this author on: Oxford Academic Google Scholar DAVID RABINOWITZ, DAVID RABINOWITZ 2Rochester General Hospital, University of Rochester School of Medicine Rochester, N. Y.; Johns Hopkins Hospital, Johns Hopkins University School of Medicine Baltimore, Md.; Montefiore Hospital and Medical Center, Albert Einstein College of Medicine New York City. Search for other works by this author on: Oxford Academic Google Scholar THOMAS J. MERIMEE, THOMAS J. MERIMEE 2Rochester General Hospital, University of Rochester School of Medicine Rochester, N. Y.; Johns Hopkins Hospital, Johns Hopkins University School of Medicine Baltimore, Md.; Montefiore Hospital and Medical Center, Albert Einstein College of Medicine New York City. Search for other works by this author on: Oxford Academic Google Scholar JACK H. OPPENHEIMER JACK H. OPPENHEIMER 2Rochester General Hospital, University of Rochester School of Medicine Rochester, N. Y.; Johns Hopkins Hospital, Johns Hopkins University School of Medicine Baltimore, Md.; Montefiore Hospital and Medical Center, Albert Einstein College of Medicine New York City. Search for other works by this author on: Oxford Academic Google Scholar The Journal of Clinical Endocrinology & Metabolism, Volume 27, Issue 8, 1 August 1967, Pages 1219–1223, https://doi.org/10.1210/jcem-27-8-1219 Published: 01 August 1967 Article history Received: 20 March 1967 Accepted: 15 May 1967 Published: 01 August 1967

Objectives—To ascertain whether there are differences in child seating location between selected cities in the US and continental Europe, and if differences exist, to ascertain what factors predict them. Setting—Boston and New Orleans, which have no laws regarding child seating location, and Paris, Frankfurt, and Brussels, which for approximately 20 years have had laws requiring children under the ages of 10 or 12 to sit in the rear. Methods—Observations were made in the first quarter of 1997 at several locations in or near each city. The vehicle seating capacity, total number of occupants, the seating location of adults and children, and driver shoulder belt use were recorded for each vehicle with at least one child. The predictors of a vehicle having a child in the front were estimated using logistic regression. Results—Data on 5501 children riding in 3778 vehicles were collected. Adjusting for differences in vehicle seating capacity, occupant mix, and driver shoulder belt use, vehicles in the European cities are significantly less likely to have a child in the front seat than vehicles in the American cities. Conclusions—Cities with no history of laws prohibiting children from sitting in the front, vehicles with low seating capacity, vehicles with no adult (other than the driver) or many child passengers, and unbelted drivers were associated with a higher likelihood of children riding in the front seat. It is feasible for a society to insist, through custom and/or law, that children sit in the back seat.

Journal Article The Action of Insulin in Man in the Postabsorptive and Postprandial States: With a note on some applications of its action in determining muscle fuel in manBased on a talk given by D.R. during the tenure of a Wellcome Research Travel Grant. These studies were supported by PHS Research Grants AM 00750 and AM 05524 and Graduate Training Grant 2A-5232, National Institute of Arthritis and Metabolic Disease, U.S. Public Health Service and by a grant-in-aid from the Muscular Dystrophy Associations of America, Inc. The senior author is an established investigator of the American Heart Association. Get access David Rabinowitz, MD, MRCP, MRCPE, David Rabinowitz, MD, MRCP, MRCPE Department of Medicine, The Johns Hopkins University and Hospital, Baltimore, Maryland Search for other works by this author on: Oxford Academic Google Scholar Kenneth L Zierler, MD Kenneth L Zierler, MD Department of Medicine, The Johns Hopkins University and Hospital, Baltimore, Maryland Search for other works by this author on: Oxford Academic Google Scholar Postgraduate Medical Journal, Volume 41, Issue 472, February 1965, Pages 67–72, https://doi.org/10.1136/pgmj.41.472.67 Published: 01 February 1965

Previous studies (1, 2) have demonstrated that glucose uptake by muscle of the forearm of man is inadequate to account for more than about 10 per cent of its observed oxygen consumption. Because forearm respiratory quotient (RQ) is approximately 0.7, which suggests combustion of long-chain fatty acids, it was predicted that the fraction of plasma lipid known as free fatty acids (FFA) would prove to be the missing substrate of forearm muscle. Extensive examination of this problem has, however, failed to demonstrate consistently positive arterio-deep venous (A DV) FFA differences across the human forearm (2). There is evidence, based on isotopic studies by Friedberg, Klein, Trout, Bogdonoff, and Estes (3), that the human forearm does remove FFA from arterial blood, and the possible factors responsible for our failure to demonstrate this by simple measurement of A DV concentration differences have been treated in detail elsewhere (2). In brief, while FFA is being extracted from plasma by forearm muscle, adipose tissue, intimately surrounding muscle, adds fatty acid to venous plasma. The net A DV FFA difference is determined by the relative rates of these two processes. The validity of this hypothesis could be tested if there were an agent that inhibited release of FFA from adipose tissue without also affecting FFA uptake by peripheral tissues. Insulin may be such an agent.

1.1. A case is reported showing marked electrical, alternans, unassociated with tachycardia, and, in addition, group alternans and intermittent complexes resembling right bundle branch block.2.2. Electrical alternans is explained on the hypothesis that recovery of a bundle branch is facilitated by complete lack of transmission, or only partial transmission, throuth the bundle branch.3.3. The relationship between intermittent bundle branch block and electrical alternans is discussed. It is postulated that the underlying mechanism in both conditions is a marked prolongation of the refractory period of one bundle branch.