Showing papers by "University of Washington published in 1983"

Assessing Social Support: The Social Support Questionnaire.

Abstract: : A measure of social support, the Social Support Questionnaire (SSQ), is described and four empirical studies employing it are described. The SSQ yields scores for (a) number of social supports, and (b) satisfaction with social support that is available. Three of the studies deal with the SSQ's psychometric properties, its correations with measures of personality and adjustment, and the relationship of the SSQ to positive and negative life changes. The fourth study was an experimental investigation of the relationship between social support and persistence in working on a complex, frustrating task. The research reported suggests that the SSQ is a reliable instrument, and that social support is (1) more strongly related to positive than negative life changes, (2) more related in a negative direction to psychological discomfort among women than men, and (3) an asset in enabling a person to persist at a task under frustrating conditions. Research and clinical implications are discussed. (Author)

Spontaneous Creation of Almost Scale - Free Density Perturbations in an Inflationary Universe

Abstract: The creation and evolution of energy-density perturbations are analyzed for the "new inflationary universe" scenario proposed by Linde, and Albrecht and Steinhardt. According to the scenario, the Universe underwent a strongly first-order phase transition and entered a "de Sitter phase" of exponential expansion during which all previously existing energy-density perturbations expanded to distance scales very large compared to the size of our observable Universe. The existence of an event horizon during the de Sitter phase gives rise to zero-point fluctuations in the scalar field $\ensuremath{\varphi}$, whose slowly growing expectation value signals the transition to the spontaneous-symmetry-breaking (SSB) phase of a grand unified theory (GUT). The fluctuations in $\ensuremath{\varphi}$ are created on small distance scales and expanded to large scales, eventually giving rise to an almost scale-free spectrum of adiabatic density perturbations (the so-called Zel'dovich spectrum). When a fluctuation reenters the horizon ($\mathrm{radius}\ensuremath{\simeq}{H}^{\ensuremath{-}1}$) during the Friedmann-Robertson-Walker (FRW) phase that follows the exponential expansion, it has a perturbation amplitude ${\frac{\ensuremath{\delta}\ensuremath{\rho}}{\ensuremath{\rho}}|}_{H}=(4 or \frac{2}{5})H\frac{\ensuremath{\Delta}\ensuremath{\varphi}}{\stackrel{\ifmmode \dot{}\else \.{}\fi{}}{\ensuremath{\varphi}}({t}_{1})}$, where $H$ is the Hubble constant during the de Sitter phase (${H}^{\ensuremath{-}1}$ is the radius of the event horizon), $\stackrel{\ifmmode \dot{}\else \.{}\fi{}}{\ensuremath{\varphi}}({t}_{1})$ is the mean value of $\stackrel{\ifmmode \dot{}\else \.{}\fi{}}{\ensuremath{\varphi}}$ at the time (${t}_{1}$) that the wavelength of the perturbation expanded beyond the Hubble radius during the de Sitter epoch, $\ensuremath{\Delta}\ensuremath{\varphi}$ is the fluctuation in $\ensuremath{\varphi}$ at time ${t}_{1}$ on the same scale, and $4(\frac{2}{5})$ applies if the Universe is radiation (matter) dominated when the scale in question reenters the horizon. Scales larger than about ${10}^{15}\ensuremath{-}{10}^{16}{M}_{\ensuremath{\bigodot}}$ reenter the horizon when the Universe is matter dominated. Owing to the Sachs-Wolfe effect, these density perturbations give rise to temperature fluctuations in the microwave background which, on all angular scales \ensuremath{\gg}1\ifmmode^\circ\else\textdegree\fi{}, are $\frac{\ensuremath{\delta}T}{T}\ensuremath{\simeq}(\frac{1}{5})H\frac{\ensuremath{\Delta}\ensuremath{\varphi}}{\stackrel{\ifmmode \dot{}\else \.{}\fi{}}{\ensuremath{\varphi}}({t}_{1})}$. The value of $\ensuremath{\Delta}\ensuremath{\varphi}$ expected from de Sitter fluctuations is $O(\frac{H}{2\ensuremath{\pi}})$. For the simplest model of "new inflation," that based on an SU(5) GUT with Coleman-Weinberg SSB, $\stackrel{\ifmmode \dot{}\else \.{}\fi{}}{\ensuremath{\varphi}}({t}_{1})\ensuremath{\ll}{H}^{2}$ so that $\frac{\ensuremath{\delta}T}{T}\ensuremath{\gg}1$---in obvious conflict with the large-scale isotropy of the microwave background. One remedy for this is a model in which the inflation occurs when $\stackrel{\ifmmode \dot{}\else \.{}\fi{}}{\ensuremath{\varphi}}({t}_{1})\ensuremath{\gg}{H}^{2}$. We analyze a supersymmetric model which has this feature, and show that a value of ${\frac{\ensuremath{\delta}\ensuremath{\rho}}{\ensuremath{\rho}}|}_{H}\ensuremath{\simeq}{10}^{\ensuremath{-}4}\ensuremath{-}{10}^{\ensuremath{-}3}$ on all observable scales is not implausible.

Quantization of particle transport

Abstract: The integrated particle current produced by a slow periodic variation of the potential of a Schr\"odinger equation is evaluated. It is shown that in a finite torus the integral of the current over a period can vary continuously, but in an infinite periodic system with full bands it must have an integer value. This quantization of particle transport is used to classify the energy gaps in a one-dimensional system with competing or incommensurate periods. It is also used to rederive Prange's results for the fractional charge of a soliton.

Insulin antibodies in insulin-dependent diabetics before insulin treatment

Abstract: A sensitive assay was used to measure the binding of iodine-125-labeled insulin in serum obtained from 112 newly diagnosed insulin-dependent diabetics before insulin treatment was initiated. Two groups of nondiabetics served as controls: children with a variety of diseases other than diabetes and nondiabetic siblings of insulin-dependent diabetics. Eighteen of the diabetics were found to have elevated binding and 36 were above the 95th percentile of control values. The insulin-binding protein is precipitated by antibody to human immunoglobulin G, has a displacement curve that is parallel and over the same concentration range as serum from long-standing insulin-dependent diabetics, and elutes from a Sephacryl S-300 column at the position of gamma globulin. These insulin antibodies are present in a large percentage of newly diagnosed, untreated diabetics and may be an immune marker of B-cell damage.

Newborn infants imitate adult facial gestures

Abstract: Newborn infants ranging in age from 0.7 to 71 hours old were tested for their ability to imitate 2 adult facial gestures: mouth opening and tongue protrusion. Each subject acted as his or her own control in a repeated-measures design counterbalanced for order of stimulus presentation. The subjects were tested in low illumination using infrared-sensitive video equipment. The videotaped records were scored by an observer who was uninformed about the gesture shown to the infants. Both frequency and duration of neonatal mouth openings and tongue protrusions were tallied. The results showed that newborn infants can imitate both adult displays. 3 possible mechanisms underlying this early imitative behavior are suggested: instrumental or associative learning, innate releasing mechanisms, and active intermodal matching. It is argued that the data favor the third account.

Reasons for Staying Alive When You Are Thinking of Killing Yourself: The Reasons for Living Inventory

Abstract: University of Washington Catholic University of AmericaStevan Lars Nielsen and John A. ChilesUniversity of WashingtonThe studies presented here describe the development of an instrument to measurea range of beliefs potentially important as reasons for not committing suicide.Sixty-five individuals generated 72 distinct reasons; these were reduced to 48 byfactor analyses performed on two additional samples, and the items were arrangedinto the Reasons for Living Inventory (RFL), which requires a rating of howimportant each reason would be for living if suicide was contemplated. In ad-dition, factor analyses indicated six primary reasons for living: Survival and Cop-ing Beliefs, Responsibility to Family, Child-Related Concerns, Fear of Suicide,Fear of Social Disapproval, and Moral Objections. The RFL was then given totwo additional samples, 197 Seattle shoppers and 175 psychiatric inpatients. Bothsamples were divided into several suicidal (ideators and parasuicides) and non-suicidal groups. Separate multivariate analyses of variance indicated that the RFLdifferentiated suicidal from nonsuicidal individuals in both samples. In the shop-ping-center sample, the Fear of Suicide scale further differentiated between pre-vious ideators and previous parasuicides. In the clinical sample, the Child-RelatedConcerns scales differentiated between current suicide ideators and current para-suicides. In both samples, the Survival and Coping, the Responsibility to Family,and the Child-Related Concerns scales were most useful in differentiating thegroups. Results were maintained when the effect of recent stress was held constant.The frequency of suicidal behavior sug- point in their lifetime; between 53% and 67%gests that it is a phenomenon that cannot be report seriously considering it.ignored. Over 25,000 individuals a year kill The majority of research in the field ofthemselves in the United States (U.S. Vital suicidology, to date, has been directed atStatistics, 1973, 1975), and it is estimated identifying characteristics of suicidal personsthat two to eight times this number, or from to enhance prediction of suicidal behavior50,000 to 200,000 persons a year parasuicide (Beck, Resnick, & Lettieri, 1974; Kreitman,(i.e., intentionally self-injure, behavior usu- 1977;Neuringer, 1974). With few exceptionsally labeled in the U.S. as attempted suicide; (e.g., Goodstein, 1982) almost all of this workBerman, 1975). Linehan and colleagues (Li- has focused on identifying maladaptive at-nehan & Laffaw, in press; Linehan & Nielsen, tributes of suicidal persons. Little attention1981; Linehan, Note 1) found that from 10% has been given the question of whether sui-to 16% of an adult, general population in cidal persons lack important adaptive char-Seattle report attempting suicide at some acteristics present among nonsuicidal indi-viduals, and, if so, what these characteristicsThis research was supported by National Institute might be.Grant MH34486. Focusing on adaptive, life-maintaining

Genital herpes simplex virus infections: clinical manifestations, course, and complications.

Abstract: The clinical course and complications of 268 patients with first episodes and 362 with recurrent episodes of genital herpes infection were reviewed. Symptoms of genital herpes were more severe in women than in men. Primary first-episode genital herpes was accompanied by systemic symptoms (67%), local pain and itching (98%), dysuria (63%), and tender adenopathy (80%). Patients presented with several bilaterally distributed postular ulcerative lesions that lasted a mean of 19.0 days. Herpes simplex virus was isolated from the urethra, cervix, and pharynx of 82%, 88%, and 13% of women with first-episode primary genital herpes, and the urethra and pharynx of 28% and 7% of men. Complications included aseptic meningitis (8%), sacral autonomic nervous system dysfunction (2%), development of extragenital lesions (20%), and secondary yeast infections (11%). Recurrent episodes were characterized by small vesicular or ulcerative unilaterally distributed lesions that lasted a mean of 10.1 days. Systemic symptoms were uncommon and 25% of recurrent episodes were asymptomatic. The major concerns of patients were the frequency of recurrences and fear of transmitting infection to partners or infants.

Barotropic Wave Propagation and Instability, and Atmospheric Teleconnection Patterns.

Abstract: A global barotropic model, linearized about the 300 mb climatological mean January flow, is perturbed by applying a series of localized forcings distributed throughout the tropics and subtropics Structures which resemble the observed “Pacific/North American” and “East Atlantic” teleconnection patterns noted by Wallace and Gutzler (1981) tend to recur in the responses Similar patterns are found to result from the dispersion of isolated initial perturbations placed at a variety of locations in the tropics and midlatitudes It is shown that these structures are related to the most rapidly growing mode associated with barotropic instability of the zonally-varying climatological basic state In the absence of damping, this mode has an e-folding time of about a week and a period close to 50 days In localized regions the instantaneous growth rates can be competitive with those of baroclinic instability These episodes of rapid local barotropic growth are interspersed with intervals in which the local

Dissonance processes as self-affirmation

Abstract: Can an experience that simply affirms a valued aspect of the self eliminate dissonance and its accompanying cognitive changes? Three experiments used the conventional forced-compliance procedure to test this question. In the first experiment, some subjects were allowed to affirm an important, self-relevant value (by completing a self-relevant value scale) immediately after having written unrelated dissonant essays and prior to recording their attitudes on the postmeasure. Other subjects underwent an identical procedure but were selected so that the value affirmed by the scale was not part of their self-concept. The value scale eliminated dissonance-reducing attitude change among subjects for whom it was self-relevant but not among subjects for whom it was not self-relevant. This occurred even though the value scale could not resolve or reduce the objective importance of the dissonance-provoking inconsistency. Study 2 showed that the self-affirmation effect was strong enough to prevent the reinstatement of dissonance. Study 3, testing generalizability, replicated the effect by using a different attitude issue, a different value for affirmation, and a different measure of dissonance reduction. These results imply that a need for psychological consistency is not a part of dissonance motivation and that salient, self-affirming cognitions may help objectify our reactions to self-threatening information.

Metallothionein-human GH fusion genes stimulate growth of mice

Abstract: The promoter or regulatory region of the mouse gene for metallothionein-I was fused to the structural gene coding for human growth hormone. These fusion genes were introduced into mice by microinjection of fertilized eggs. Twenty-three (70 percent) of the mice that stably incorporated the fusion genes showed high concentrations of human growth hormone in their serum and grew significantly larger than control mice. Synthesis of human growth hormone was induced further by cadmium or zinc, which normally induce metallothionein gene expression. Transgenic mice that expressed human growth hormone also showed increased concentrations of insulin-like growth factor I in their serum. Histology of their pituitaries suggests dysfunction of the cells that normally synthesize growth hormone. The fusion genes were expressed in all tissues examined, but the ratio of human growth hormone messenger RNA to endogenous metallothionein-I messenger RNA varied among different tissues and different animals, suggesting that expression of the foreign genes is influenced by site of integration and tissue environment.

The Mesoscale and Microscale Structure and Organization of Clouds and Precipitation in Midlatitude Cyclones. VIII: A Model for the “Seeder-Feeder” Process in Warm-Frontal Rainbands

Abstract: Previous field studies have indicated that warm-frontal rainbands form when ice particles from a “seeder” cloud grow as they fall through a lower-level “feeder” cloud. In this paper we present results from a parameterized numerical model of the growth processes that can lead to the enhancement of precipitation in a “seeder-feeder” type situation. The model is applied to two types of warm-frontal rainbands. In the first (Type 1 situation) the vertical air motions are typical of those associated with slow, widespread lifting in the vicinity of warm fronts. In the second (Type 2 situation) the vertical air motions are stronger, and more characteristic of the mesoscale. The model simulations show that in the Type 1 situations the growth of the “seed” ice crystals within the feeder zone is due to vapor deposition. The feeder zone in this case is slightly sub-saturated with respect to water due to the presence of the seed crystals. In regions where the feeder zone is not “seeded” from aloft, snow cryst...

Brain organization for language from the perspective of electrical stimulation mapping

Abstract: A model for the organization of language in the adult humans brain is derived from electrical stimulation mapping of several language-related functions: naming, reading, short-term verbal memory, mimicry of orofacial movements, and phoneme identification during neurosurgical operations under local anesthesia. A common peri-Sylvian cortex for motor and language functions is identified in the language dominant hemisphere, including sites common to sequencing of movements and identification of phonemes that may represent an anatomic substrate for the “motor theory of speech perception.” This is surrounded by sites related to short-term verbal memory, with sites specialized for such language functions as naming or syntax at the interface between these motor and memory areas. Language functions are discretely and differentially localized in association cortex, including some differential localization of the same function, naming, in multiple languages. There is substantial individual variability in the exact location of sites related to a particular function, a variability which can be partly related to the patient's sex and overall language ability and which may depend on prior brain injury and, perhaps subtly, on prior experience. A common “specific alerting response” mechanism for motor and language functions is identified in the lateral thalamus of the language–dominant hemisphere, a mechanism that may select the cortical areas appropriate for a particular language function.

Allogeneic Bone‐Marrow Transplantation

Abstract: Over the past 12 years, marrow tranplantation has been used with increasing success for the treatment of children with immunodeficiency diseases and patients with severe, aplastic anemia, leukemia and, more recently, genetic disorders of hematopoiesis. The underlying concept of marrow transplantation is simple. Toxieity to the marrow is a serious limitation of cancer therapy in patients with leukemia. Rescue by marrow transplantation allows the use of higher and potentially curative doses of chemoradiotherapy than would otherwise be possible. In the case of patients with aplastic anemia, the grafted marrow serves to repopulate the empty marrow spaces and to repair the patient's defective production of blood cells, usually following non-lethal conditioning of patients by immunosuppressive drugs. The present review will summarize the clinical results and address questions regarding mechanisms of graft rejection, the nature of the reaction of transplanted lymphoid cells against the tissues of the host (graft-versus-host disease [GVHD]), the nature of stable chimerism observed in healthy, long-term survivors, mechanisms of leukemic relapse and of eradication of leukemia in patients who are cured, the role of putative, leukemia-associated antigens and a graft-versus-leukemia effect, the nature of immunologic deficiency following transplantation, the process of immunologic reconstitution, and the origin and management of opportunistic infections, particularly cytomegalovirus infections, in transplant recipients.

The Influence of Gravity Wave Breaking on the General Circulation of the Middle Atmosphere

Abstract: The zonal mean solstice circulation of the global middle atmosphere is simulated using a semi-spectral numerical model. Radiative heating and cooling is computed by the algorithm of Wehrbein and Leovy. Mechanical dissipation is represented by the gravity wave breaking parameterization of Lindzen. An inertial adjustment parameterization is used to prevent the development of inertially unstable meridional shears near the equator. It is shown that gravity wave drag and diffusion in the mesosphere can account for the observed large departure from radiative equilibrium in both summer and winter. Experiments incorporating a forced stationary wavenumber 1 disturbance indicate that planetary wave EP flux convergences, although they may modify the mean flow profile significantly, cannot provide the major source of mechanical dissipation in the winter mesosphere. A simulated sudden warming is accompanied by an equally strong mesospheric cooling. This cooling is caused primarily by the relaxation of the polar mesosphere toward radiative equilibrium when the easterly mean winds in the polar stratosphere induced by the sudden warming reduce the transmission of gravity waves into the mesosphere.

Noninvasive Doppler determination of cardiac output in man. Clinical validation.

Abstract: A noninvasive technique for assessing cardiac output (CO) was evaluated by comparing it with thermodilution determinations in patients in the intensive care unit. The new method uses pulsed ultrasound to measure aortic diameter and continuous-wave Doppler ultrasound to obtain aortic blood velocity. An initial study evaluating just the velocity measurement showed that changes of the Doppler index of output (DI) correlated well with those of thermodilution cardiac output (TDCO). Linear regression analysis yielded delta DI = 0.87 delta TDCO + 0.14 (r = 0.83, n = 95). Using a university research instrument these measurements were possible in 54 of 60 patients (90%). A second study using a prototype commercial device incorporated the diameter measurement. Ultrasonic cardiac output (UCO), calculated as the time integral of velocity multiplied by the aortic area, was compared to TDCO. The data, obtained from 45 of 53 patients (85%), are described by the linear regression UCO = 0.95TDCO + 0.38 (r = 0.94, n = 110) over a range of 2-11 l/min. Patients with aortic stenosis, aortic insufficiency or a prosthetic valve have been excluded from the second study due to conditions likely to violate the assumptions upon which the calculation of absolute cardiac output is based. These results indicate that accurate CO can be measured by noninvasive ultrasound in most patients. The technique may be useful for extended CO monitoring in acute care patients and for CO assessment in many other types of patients undergoing diagnostic studies and therapeutic interventions.

The nature and importance of attachment relationships to parents and peers during adolescence

Abstract: The nature and quality of adolescents' attachments to peers and parents were assessed with the newly developed Inventory of Adolescent Attachments. The relative influence on measures of self-esteem and life satisfaction of relations with peers and with parents was then investigated in a hierarchical regression model. The sample consisted of 213 adolescents ranging from 12 to 19 years of age. Two hypotheses were tested: (1) The quality of perceived attachments both to parents and peers would be related to well-being, and (2) the quality of parental relationships would be a more powerful predictor of well-being than would the quality of peer relationships. Confirming the study's hypotheses, the perceived quality of the adolescents' relationships to both peers and parents, their frequency of utilization of peers, and their degree of negative life change were significantly related to both measures of well-being. The quality of attachment to parents was significantly more powerful than that to peers in predicting well-being. In addition, quality of attachment to parents showed a moderating effect under conditions of high life stress on the measures of self-esteem. The study suggests that it is useful to consider the quality of attachments to significant others as an important variable throughout the life span.

Multiplicative Models and Cohort Analysis

Abstract: Three methods of cohort analysis are presented for a statistical model wherein the explanatory or exposure variables act multiplicatively on age × calendar year specific death rates. The first method, which assumes that the baseline rates are known from national vital statistics, is a multiple regression analysis of the standardized mortality ratio. The second method is a variant of Cox's proportional hazards analysis in which the baseline rates are treated as unknown nuisance parameters. The third method consists of case-control sampling from the risk sets formed in the course of applying Cox's model. It requires substantially less computation than do the other two. In illustrative analysis of respiratory cancer deaths among a cohort of smelter workers, all three approaches yield roughly equivalent estimates of the relative risk associated with arsenic exposure. The discussion centers on the tradeoff between efficiency and bias in the selection of a particular method of analysis, and on practica...

Adaptation of fruit morphology to dispersal agents in a neotropical forest.

Abstract: Two-thirds of 258 fruit species from Peruvian tropical forest belong to one of two classes: large orange, yellow, brown, or green fruits with a husk; or small red, black, white, blue, purple, or mixed-color fruits without a husk The characteristics of the two fruit classes match the size, visual ability, and jaw morphology of mammals and birds, respectively, and the animals also prefer to eat one class of fruits Thus, most plants in this forest seem to be adapted to seed dispersal by either of two distinct broad arrays of animal taxa

Social network interactions: A buffer or a stress.

Abstract: Forty-four caregivers to spouses with a diagnosis of Alzheimer's disease provided a stressed subject population considered at high risk for depression. Unlike more typical unidirectional measures of perceived social support quality, subject ratings were elicited separately as to how helpful as well as how upsetting each network member was in five different support categories. Correlations between perceived network "upset" and depression (Beck Depression Inventory) were highly significant, while in no case did perceived "helpfulness" relate to depression. Using stepwise multiple regression, the set of five support category Upset ratings predicted depression better than did helpful/upset ratios, which in turn predicted depression better than the Helpfulness ratings as a group. The implications of these findings for the conceptualization of social support and its measurement are discussed.

Hydrodynamic processes affecting benthic recruitment1

Abstract: Recruitment of animals into initially dcfaunated sites containing simulated stalks of a marsh grass was studied on an intertidal sandflat Laboratory flume experiments were used to predict the effects of these structures on near-bed flow, the sediment size-frequency composition, and the patterns and rates of benthic recruitment The effects of simulated stalks on both rates of fluid transport near the bed and boundary shear stress change profoundly with their numerical density Patterns of sedimentation in the field and patterns and rates of rccruitment of several taxa depended strongly on the presence and numerical density of these structures, in agreement with a priori predictions assuming passive (ie purely hydrodynamic) dispersal Hydrodynamic (or other physical) effects of manipulation are important and form an additional, but infrequently posed, null hypothesis against which biological effects such as substrate selection, competition, predation, or disturbance should be tested

Crater ejecta scaling laws - Fundamental forms based on dimensional analysis

Abstract: Self-consistent scaling laws are developed for meteoroid impact crater ejecta. Attention is given to the ejection velocity of material as a function of the impact point, the volume of ejecta with a threshold velocity, and the thickness of ejecta deposit in terms of the distance from the impact. Use is made of recently developed equations for energy and momentum coupling in cratering events. Consideration is given to scaling of laboratory trials up to real-world events and formulations are developed for calculating the ejection velocities and ejecta blanket profiles in the gravity and strength regimes of crater formation. It is concluded that, in the gravity regime, the thickness of an ejecta blanket is the same in all directions if the thickness and range are expressed in terms of the crater radius. In the strength regime, however, the ejecta velocities are independent of crater size, thereby allowing for asymmetric ejecta blankets. Controlled experiments are recommended for the gravity/strength transition.

Adaptation of families with mentally retarded children: a model of stress, coping, and family ecology.

Abstract: Research concerned with families of mentally retarded children has often yielded inconsistent, and at times, contradictory findings. This inconsistency is partly due to methodological inadequacies and a narrow focus on unidimensional variables with unimodal measurements. In addition, no succinct model has been presented to explain family adaptation and the range of possible outcomes. In this paper a critical review focused on parents, siblings, parent-child interactions, and family systems was presented. A comprehensive conceptual model was proposed that accounts for (a) the range of possible familial adaptations, both positive and negative, involving the impact of perceived stress associated with the presence of a retarded child; and (b) the family's coping resources and ecological environments as interactive systems that serve to mediate the family's response to stress.

Graft-versus-host disease and survival in patients with aplastic anemia treated by marrow grafts from HLA-identical siblings. Beneficial effect of a protective environment.

Abstract: One hundred thirty patients with severe aplastic anemia were conditioned with cyclophosphamide for transplantation of marrow from HLA-identical siblings. The patients were selected for the present analysis according to the criterion of sustained marrow engraftment. Of the 130 patients, 97 are now alive between 1.4 and 11 years (median, 5) after transplantation. Twenty-nine of the thirty-three who died had either acute or chronic graft-versus-host disease (GVHD). Our analysis was directed at identifying factors predicting GVHD and survival after transplantation in patients. Our key findings were that moderately severe to severe acute GVHD had a strong adverse influence on survival; that a protective environment significantly reduced mortality, which corresponded in part to a reduction in and delayed onset of acute GVHD; that refractoriness to random-donor platelet infusions at transplantation adversely influenced survival, particularly among patients with acute GVHD; and that increasing age was associated with increased mortality.

Diagnosis of bacterial vaginosis by direct gram stain of vaginal fluid.

Abstract: To determine whether bacterial vaginosis (BV), also known as nonspecific vaginitis, could be diagnosed by evaluating a Gram stain of vaginal fluid, we examined samples from 60 women of whom 25 had clinical evidence of BV and 35 had candidal vaginitis or normal examinations. An inverse relationship between the quantity of the Lactobacillus morphotype (large gram-positive rods) and of the Gardnerella morphotype (small gram-variable rods) was noted on Gram stain (P less than 0.001). When Gram stain showed a predominance (3 to 4+) of the Lactobacillus morphotype with or without the Gardnerella morphotype, it was interpreted as normal. When Gram stain showed mixed flora consisting of gram-positive, gram-negative, or gram-variable bacteria and the Lactobacillus morphotype was decreased or absent (0 to 2+), the Gram stain was interpreted as consistent with BV. Gram stain was consistent with BV in 25 of 25 women given a clinical diagnosis of BV and in none of 35 women with candidal vaginitis or normal examinations. Duplicate slides prepared from 20 additional specimens of vaginal fluid were stained by two methods and examined by three evaluators. Interevaluator interpretations and intraevaluator interpretations of duplicate slides were in agreement with one another and with the clinical diagnosis greater than or equal to 90% of the time. We concluded that a microscopically detectable change in vaginal microflora from the Lactobacillus morphotype, with or without the Gardnerella morphotype (normal), to a mixed flora with few or no Lactobacillus morphotypes (BV) can be used in the diagnosis of BV.