A study was undertaken to investigate compliance in patients receiving growth hormone treatment. Two hundred patients completed a questionnaire designed to establish understanding about and compliance with treatment; 50% of our patients failed to comply with ali aspects of their treatment. Failure to respond to treatment seems to be associated with poor compliance. (Arch Dis Child 1993;68:91-3) Embarking on a course of recombinant human growth hormone (rhGH) treatment is a major commitment not only for the child and parents but also for the health care team. rhGH is administered by subcutaneous injection on a daily basis, often for a period of time stretching over many years. The initial perception about the treatment may effect subsequent compliance with the treatment regimen.We had suspected for some time that some of our patients for whom we had prescribed rhGH were not complying fully with their therapeutic regimen. To investigate this we designed a questionnaire to assess the level ofunderstanding about and compliance with treatment. Methods and resultsConsecutive patients attending the paediatric endocrinology clinic of the Middlesex Hospital were asked if they were receiving rhGH and, if they were, whether the person responsible for administering the hormone would complete our questionnaire (appendix). We studied understanding of the treatment regimen and compliance with the treatment by combining answers from several of the questions that were designed to obtain the information in different ways.Two hundred patients accepted the questionnaire and none refused. Of the patients who accepted only 188 were on rhGH; the remainder were receiving an assortment of other treatments including somatostatin and testosterone (Sustanon, Organon

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Carbon-13 nuclear magnetic resonance (13C-NMR) and 13C-enriched formaldehyde (13CH2O) were utilized to observe cross-linking in gelatin. Thus, when a 6% solution of gelatin in water was treated with 2000 ppm 13CH2O at 20 degrees C, the 15 hr 13C-NMR spectrum of the crosslinked gel showed peaks representing carbinolamines (methylols) of arginine and lysine, as well as a peak ascribed to a methylene cross-link between arginine and lysine. Similar results were obtained when these cross-linking reactions were conducted using only 100 ppm 13CH2O. When pancreatin (1% w/v) was added to the solution of 6% gelatin cross-linked with 2000 ppm 13CH2O, the gel began to revert to a clear fluid solution. After incubation for 24 hr at 37 degrees C, the 13C-NMR spectrum of this solution confirmed the presence of the methylols of lysine and arginine, and the lysine-arginine cross-link. When 13CH2O (2000 ppm) was added to a 6% solution of gelatin at pH 13.0, the arginine methylol and the lysine-arginine crosslinks were produced. The 13CH2O-induced crosslinking of gelatin at pH 2.0, however, yielded the lysine methylol as the sole product.

Solventand temperature-induced variations of H-H, H-F, and F-F coupling constants in cis-and trans-1,2-difluoroethylene and 1,1-difluoroethylene are reported. These data, in conjunction with previous results, confirm that orientation of the solute dipole affects the magnitude of the solvent effect on geminal H-H and H-F coupling constants. Dipole orientation is not a factor in determining solvent effects on vicinal H-F and F-F coupling constants. The changes observed for vicinal H-F coupling constants are proportional to /Vhf• The dipole-induced solvent electric field is the primary causative factor producing the observed changes, but dispersion forces and specific interactions are also important. The best fit for a regression analysis of coupling constants against solvent parameters is of the form /"bsd = Jo + AR + BD, where R and D represent reaction field and dispersion field terms. A and B are opposite in sign. Rough values of AH and AS are reported for weak solutesolvent complexes characterizing specific interactions effects. An apparent dichotomy is reported where one coupling constant in a molecule is solvent dependent but another is not, even though the same nuclei are involved in