Phase II trial of the farnesyltransferase inhibitor tipifarnib plus fulvestrant in hormone receptor-positive metastatic breast cancer: New York Cancer Consortium Trial P6205

BACKGROUND

Fulvestrant produces a clinical benefit rate (CBR) of approximately 45% in tamoxifen-resistant, hormone receptor (HR)-positive metastatic breast cancer (MBC) and 32% in aromatase inhibitor (AI)-resistant disease. The farnesyltransferase inhibitor tipifarnib inhibits Ras signaling and has preclinical and clinical activity in endocrine therapy-resistant disease. The objective of this study was to determine the efficacy and safety of tipifarnib-fulvestrant combination in HR-positive MBC.

PATIENTS AND METHODS

Postmenopausal women with no prior chemotherapy for metastatic disease received i.m. fulvestrant 250 mg on day 1 plus oral tipifarnib 300 mg twice daily on days 1-21 every 28 days. The primary end point was CBR.

RESULTS

The CBR was 51.6% [95% confidence interval (CI) 34.0% to 69.2%] in 31 eligible patients and 47.6% (95% CI 26.3% to 69.0%) in 21 patients with AI-resistant disease. A futility analysis indicated that it was unlikely to achieve the prespecified 70% CBR. Tipifarnib dose modification was required in 8 of 33 treated patients (24%).

CONCLUSIONS

The target CBR of 70% for the tipifarnib-fulvestrant combination in HR-positive MBC was set too high and was not achieved. The 48% CBR in AI-resistant disease compares favorably with the 32% CBR observed with fulvestrant alone in prior studies and merit further clinical and translational evaluation.

Harmonisation of multi-centre real-time reverse-transcribed PCR results of a candidate prognostic marker in breast cancer: an EU-FP6 supported study of members of the EORTC - PathoBiology Group

AIM

Assessment of intra- and inter-laboratory variation in multi-centre real-time reverse-transcribed PCR (qRT-PCR)-based mRNA quantification of a prognostic marker in breast cancer using external quality assurance (EQA).

METHODS

A questionnaire on the methodologies used and EQA calibrators were sent to 5 participating laboratories from 4 European countries, which measured mRNA levels of PITX2 splice variants and reference genes by qRT-PCR.

RESULTS

Differences in the methodology included PCR quantification methodology and equipment, RNA extraction and cDNA synthesis procedures. The intra-laboratory coefficient of variation (CV) ranged from 5 to 23%, and the inter-laboratory CV ranged from 17 to 30%. The inter-laboratory CV was reduced to 13% by using prediluted calibrators and by harmonising the data in the central QA laboratory. Additional normalisation using reference genes did not decrease the variation further.

CONCLUSIONS

Both externally provided calibrators and centralised harmonisation are required to reduce the intra-laboratory variation in multi-centre qRT-PCR results to an acceptable level.

The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis

The aim of this systematic review was to determine if eccentric exercise is superior to concentric exercise in stimulating gains in muscle strength and mass. Meta-analyses were performed for comparisons between eccentric and concentric training as means to improve muscle strength and mass. In order to determine the importance of different parameters of training, subgroup analyses of intensity of exercise, velocity of movement and mode of contraction were also performed. Twenty randomised controlled trials studies met the inclusion criteria. Meta-analyses showed that when eccentric exercise was performed at higher intensities compared with concentric training, total strength and eccentric strength increased more significantly. However, compared with concentric training, strength gains after eccentric training appeared more specific in terms of velocity and mode of contraction. Eccentric training performed at high intensities was shown to be more effective in promoting increases in muscle mass measured as muscle girth. In addition, eccentric training also showed a trend towards increased muscle cross-sectional area measured with magnetic resonance imaging or computerised tomography. Subgroup analyses suggest that the superiority of eccentric training to increase muscle strength and mass appears to be related to the higher loads developed during eccentric contractions. The specialised neural pattern of eccentric actions possibly explains the high specificity of strength gains after eccentric training. Further research is required to investigate the underlying mechanisms of this specificity and its functional significance in terms of transferability of strength gains to more complex human movements.

Is the Royal London Space Analysis reliable and does it influence orthodontic treatment decisions?

The purpose of this study was to investigate the reliability of the Royal London Space Analysis (RLSA) and to evaluate its influence on orthodontic treatment decisions. Thirty-one case records were collected to represent various levels of crowding and different types of malocclusions. Seventeen examiners assessed these records and completed a data sheet that recorded information on their treatment decision. One month later, the examiners attended a course on the RLSA and then used the analysis to rescore the 31 cases. The models were also scored by the expert who led the course and these were then considered the 'gold standard' scores. After a further month, the examiners reapplied the RLSA and formulated a treatment plan for each set of patient records. A paired Student's t-test and intraclass correlation coefficient (ICC) were used to assess the agreement in scoring RLSA, a paired sample t-test was used to compare the scores with the gold standard, and finally the reliability in treatment planning was determined using kappa (kappa) statistics. The scores for lower arch crowding showed the highest inter-examiner agreement with an ICC of 0.93 whereas the lowest level of agreement was for upper arch space requirement with an ICC of 0.77. Intra-examiner agreement was generally high, particularly for the assessment of lower arch crowding (ICC = 0.93) and lower arch space requirement (ICC = 0.88). There was excellent validity for all the examiners against the gold standard scores with a paired samples correlation ranging between 0.96 for lower arch crowding and 0.79 for upper arch space requirement. The intra-examiner reliability in treatment decision was only moderate, with an average kappa value of 0.52 (maximum 0.82, minimum 0.24). Intra- and inter-examiner agreement for scoring the RLSA was acceptable. Nevertheless, the additional information obtained from the application of the RLSA did not have a substantial impact on the treatment decisions.

Sickness certification in the general practice consultation: the patients' perspective, a qualitative study

BACKGROUND

Up to a third of general practice consultations involve issuing sickness certificates. Recent research has looked at the GPs' perspective of sickness certification but there has been no in-depth research exploring patients' views of these consultations.

AIM

To explore patients' views of sickness certification within general practice consultations, and how these could be improved.

METHODS

A qualitative study was carried out with 12 general practices in South Wales; interview study of 19 patients who had recently received a sick note from a GP.

RESULTS

Patients rarely attended just for a sick note, more often wanting advice or an opportunity to ask questions. Patients valued continuity of care, a good doctor-patient relationship, adequate consultation time and discussion about their illness, social situation and work-related issues when consulting with their GP for a sick note. Many patients felt doctors did not have enough time or knowledge of the patient to the able to address this issue adequately and this increased feelings of anxiety. Patients did not feel that being questioned by their GP or discussing return to work threatened the doctor-patient relationship.

CONCLUSIONS

GPs who simply give out sick notes without question or discussion are not necessarily giving the patient what they want. More time should be spent discussing work and illness-related issues. Policy makers should recognize that continuity of care a good doctor-patient relationship and adequate consultation time are important to patients and any initiatives aimed at GPs to improve return to work rates should take these into consideration.

An observational study of empirical antibiotics for adult women with uncomplicated UTI in general practice

OBJECTIVES

Women presenting in primary care with symptoms suggestive of uncomplicated urinary tract infection (UTI) are commonly managed without urine culture. We therefore do not know how successful general practitioners (GPs) are at targeting antibiotic treatment to women who would have had a microbiologically confirmed UTI, or at avoiding antibiotics in those who would have had a negative culture, had all patients with a suspected UTI been sampled. We therefore explored the association between antibiotic prescribing and urine culture results when culture was performed in all symptomatic patients.

METHODS

GPs in nine general practices in South Wales were asked to submit urine specimens from all women consulting with clinically suspected, uncomplicated UTI. Patients were followed up 2 weeks later by questionnaire.

RESULTS AND CONCLUSIONS

One hundred and thirteen adult women with a median age of 54 years were included and 61% received empirical antibiotics. There was very low agreement between the decision to prescribe empirically and subsequent culture result (Kappa = 0.04), with 60% of those prescribed empirical antibiotics subsequently found to have a negative culture, and 25% of those found to have a positive culture not prescribed empirical antibiotics. Current strategies to target empirical antibiotic prescribing in clinically suspected, uncomplicated UTI require review.

Efficacy and safety of etoricoxib 30 mg and celecoxib 200 mg in the treatment of osteoarthritis in two identically designed, randomized, placebo-controlled, non-inferiority studies

OBJECTIVE

To compare the efficacy of etoricoxib 30 mg with the generally maximum recommended dose of celecoxib, 200 mg, in the treatment of osteoarthritis (OA) in two identically designed studies.

METHODS

Two multi-centre, 26-week, double-blind, placebo-controlled, non-inferiority studies were conducted, enrolling patients who were prior non-steroidal anti-inflammatory drug (NSAID) or acetaminophen users. There were 599 patients in study 1 and 608 patients in study 2 randomized 4:4:1:1 to etoricoxib 30 mg qd, celecoxib 200 mg qd or one of two placebo groups for 12 weeks. After 12 weeks, placebo patients were evenly distributed to etoricoxib or celecoxib based on their initial enrollment randomization schedule. The primary hypothesis was that etoricoxib 30 mg would be at least as effective as celecoxib 200 mg for the time-weighted average change from baseline over 12 weeks for Western Ontario and McMaster (WOMAC) Pain Subscale, WOMAC Physical Function Subscale and Patient Global Assessment of Disease Status. Active treatments were also assessed over the full 26 weeks. Adverse experiences were collected for safety assessment.

RESULTS

In both studies, etoricoxib was non-inferior to celecoxib for all three efficacy outcomes over 12 and 26 weeks; both were superior to placebo (P < 0.001) for all three outcomes in each study over 12 weeks. The safety and tolerability of etoricoxib 30 mg qd and celecoxib 200 mg qd were similar over 12 and 26 weeks.

CONCLUSIONS

Etoricoxib 30 mg qd was at least as effective as celecoxib 200 mg qd and had similar safety in the treatment of knee and hip OA; both were superior to placebo. ClinicalTrials.gov Identifiers: NCT00092768; NCT00092791.

Male sexual function improves after ileal pouch anal anastomosis

PURPOSE

Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis has become the gold standard surgical therapy for the majority of patients with mucosal ulcerative colitis. However sexual functional disturbances after this procedure can be a concern for patients. Therefore the aim of this study was to determine the outcome of sexual-function related quality of life in male patients undergoing restorative proctocolectomy.

METHODS

One hundred and twenty-two male patients who underwent restorative proctocolectomy with ileal pouch anal anastomosis between 1995 and 2000 were evaluated by the validated International Index of Erectile Function (IIEF) scoring instrument. This index scale examines sexual function in five categories. These are erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. The IIEF instrument was administered after surgery and then scores before and after RP/IPAA were evaluated and compared. The significance of age at the time of the surgery, type of surgery, type of anastomotic technique (mucosectomy vs stapled) and septic complications on sexual functional outcome were also investigated.

RESULTS

Mean age at the time of the surgery was 39.9 +/- 11.5 years. The mean follow-up period (time between pouch surgery and IIEF completed) was 3.6 +/- 1.8 years. There was statistically significant improvement in 4 of 5 categories of sexual function (erectile function, sexual desire, intercourse satisfaction, and overall satisfaction) where patients had improved scores after surgery compared to prior to surgery. The mean erectile function score increased pre to post surgery by 2.12 points (P = 0.02), which indicates better sexual results. Anastomotic technique and septic complication did not influence the results, however, older age had a negative impact on results.

CONCLUSIONS

Despite some adverse sexual functions, male patients who undergo RP/IPAA for the surgical management of their colitis may preserve or improve their overall sexual functional outcome.

Rate of progression of cognitive decline in Alzheimer's disease: effect of butyrylcholinesterase K gene variation

OBJECTIVE

To determine whether individuals with Alzheimer's disease (AD) and the K variant allele of butyrylcholinesterase have a slower rate of cognitive decline than those without the K variant allele of butyrylcholinesterase.

METHOD

The cognitive status of 339 community based subjects with AD was assessed with the Mini Mental State Examination at baseline and yearly over a three year follow up period. The rates of cognitive decline of subjects with and without the K variant allele were compared.

RESULT

Presence of the K allele was associated with a slower average rate of cognitive decline in subjects with severe AD.

CONCLUSIONS

This finding is consistent with the suggestion that the K variant of butyrylcholinesterase has an important role in disease progression in AD, and this may have implications for treatment.

Aerobic exercise interventions for adults living with HIV/AIDS

BACKGROUND

The profile of HIV infection is constantly changing. Although once viewed as an illness progressing to death, among those with access to antiretroviral therapy, HIV can now present as a disease with an uncertain natural history, perhaps a chronic manageable disease for some. This increased chronicity of HIV infection has been mirrored by increased prevalence of disablement in the HIV-infected population (Rusch 2004). Thus, the needs of these individuals have increasingly included the management of impairments (problems with body function or structure as a significant deviation or loss, such as pain or weakness), activity limitations (difficulties an individual may have in executing activities, such as inability to walk) and participation restrictions (problems an individual may experiences in involvement in life situations, such as inability to work) (WHO 2001). Exercise is a key strategy employed by people living with HIV/AIDS and by rehabilitation professionals to address these issues. Exercise has been shown to improve strength, cardiovascular function and psychological status in seronegative populations (Bouchard 1993), but what are the effects of exercise for adults living with HIV? If the risks and benefits of exercise for people living with HIV are better understood, appropriate exercise may be undertaken by those living with HIV/AIDS and appropriate exercise prescription may be practiced by healthcare providers. If effective and safe, exercise may enhance the effectiveness of HIV management, thus improving the overall outcome for adults living with HIV.

OBJECTIVES

To examine the safety and effectiveness of aerobic exercise interventions on immunological/virological, cardiopulmonary and psychological parameters in adults living with HIV/AIDS.

SEARCH STRATEGY

To identify the appropriate studies, we conducted a search using MEDLINE, EMBASE, SCIENCE CITATION INDEX, AIDSLINE, CINAHL, HEALTHSTAR, PSYCHLIT, SOCIOFILE, SCI, SSCI, ERIC and DAI. We also reviewed both published and unpublished abstracts and proceedings from major international and national HIV/AIDS conferences such as the Intersciences Conference on Antimicrobial Agents and Chemotherapy (ICAAC), the Conference on Retroviruses and Opportunistic Infections (CROI), the Infectious Diseases Society of America Conference (IDSA) and the International AIDS Conference (IAC). Reference lists from pertinent articles and books were reviewed and personal contacts with authors were used, as well as Collaborative Review Group databases. Targeted journals were handsearched for relevant articles. There were no language restrictions. Searches for the original review covered the period from 1980 to July 1999. The first update of this review included an additional search of the literature, followed by identification of included studies that met the inclusion criteria from August 1999 to January 2001. For the second update, we conducted a search to identify additional studies published from February 2001 to August 2003.

SELECTION CRITERIA

Studies were included if they were randomized controlled trials (RCTs) comparing aerobic exercise interventions with no aerobic exercise interventions or another exercise or treatment modality, performed at least three times per week for at least four weeks among adults (18 years of age or older) living with HIV/AIDS.

DATA COLLECTION AND ANALYSIS

Data on study design, participants, interventions, outcomes and methodological quality were abstracted from studies that met the inclusion criteria onto specifically designed data collection forms by at least two reviewers. Meta-analysis was conducted using RevMan 4.2 computer software on outcomes whenever possible.

MAIN RESULTS

A total of 10 studies (six from the original search, two from the first updated search and two from this second updated search) met the inclusion criteria for this review. Main results indicated that performing constant or interval aerobic exercise, or a combination of constant aerobic exercise and progressive resistive exercise for at least 20 minutes, at least three times per week for four weeks appears to be safe and may lead to significant reductions in depressive symptoms and potentially clinically important improvements in cardiopulmonary fitness. These findings are limited to those participants who continued to exercise and for whom there was adequate follow-up data.

AUTHORS' CONCLUSIONS

Aerobic exercise appears to be safe and may be beneficial for adults living with HIV/AIDS. These findings are limited by the small sample sizes and large withdrawal rates of the included studies. Future research would benefit from an increased attention to participant follow-up and intention-to-treat analysis. Further research is required to determine the optimal parameters of aerobic exercise and stage of disease in which aerobic exercise may be most beneficial for adults living with HIV.

Cytomegalovirus transmission to extremely low-birthweight infants through breast milk

AIM

To determine the incidence, timing and clinical significance of acquired postnatal cytomegalovirus (CMV) in extremely low-birthweight (ELBW) infants.

METHODS

Prospective, longitudinal surveillance study. ELBW infants were recruited in the first week of life. Maternal blood was tested for CMV-specific IgG antibodies. Weekly urine samples were obtained from infants for CMV culture and rapid antigen testing. Data were collected regarding clinical course and breast milk intake.

RESULTS

Of 181 eligible infants, 119 infants, born to 101 mothers, were enrolled. Eighty of the 101 mothers had their serum checked for CMV status. Seventy percent of those tested were seropositive for CMV. Of the 65 infants born to seropositive mothers, 94% received breast milk during their hospital stay. Complete urine collection was obtained in 92 infants. CMV was cultured from the urine of only four infants, all of whom were born to seropositive mothers. Only one of these four infants was symptomatic. The range at which CMV was first detected was between 48 and 72 postnatal days of age.

CONCLUSIONS

Despite a very high CMV seropositivity rate in mothers of ELBW infants, and the previously reported high rate of CMV excretion into breast milk, the incidence of postnatal CMV transmission was extremely low in our study.

Etoricoxib reduced pain and disability and improved quality of life in patients with chronic low back pain: a 3 month, randomized, controlled trial

BACKGROUND

Chronic low back pain (LBP) is a growing health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat this condition, but have not demonstrated efficacy beyond 2 weeks, and no studies have shown that NSAIDs produce durable improvements in disability.

METHODS

To evaluate the efficacy and durability of effect of etoricoxib for chronic LBP, a randomized, double blind, placebo-controlled trial was conducted at 46 centres. Three hundred and twenty-five patients with chronic LBP requiring treatment with an NSAID or paracetamol were randomized 1:1:1 to etoricoxib 60 mg (n=109), 90 mg (n=106), or placebo (n=110), daily for 3 months. Pre-specified endpoints over 3 months included LBP intensity scale (visual analog scale 0-100 mm) time-weighted average change from baseline, the Roland-Morris Disability Questionnaire (RMDQ), the LBP bothersomeness scale, patient and investigator global assessments, and measures of quality of life.

RESULTS

Both etoricoxib groups experienced significant reductions in LBP intensity at 4 weeks versus placebo [-15.15 mm and -13.03 mm for 60 and 90 mg, respectively, probability (p)<0.001 for each], which was maintained over 3 months. Treatment resulted in significant improvement from baseline compared to placebo in RMDQ scores (etoricoxib 60 mg, -2.82 and 90 mg, -2.38, p<0.001 for each) over 12 weeks and most other efficacy endpoints. There were no significant differences between treatments in incidence of adverse events (AEs) or discontinuations due to AEs.

CONCLUSION

Etoricoxib provided significant relief of symptoms and disability associated with chronic LBP detected at 1 week, confirmed at 4 weeks, and maintained over 3 months. Reductions in chronic LBP severity corresponded to improvements in physical functioning and quality of life. All treatments were generally well tolerated.

Progressive resistive exercise interventions for adults living with HIV/AIDS

BACKGROUND

Due to medical advancements, many people living with HIV infection in developed countries are living longer (Palella 1998). HIV infection can now present as a chronic illness with an uncertain natural disease history. The changing course of HIV infection has lead to a potential increase in the prevalence and impact of disability in people living with HIV infection. Exercise is one key management strategy used by health care professionals to address impairments (problems with body function or structure as a significant deviation or loss such as pain or weakness), activity limitations (difficulties an individual may have in executing activities such as inability to walk) and participation restrictions (problems an individual may experience in life situations such as inability to work) in this population (World Health Organization 2001). Exercise may also be used to address unwanted changes in weight and body composition in people living with HIV infection. Aerobic exercise has been associated with improvements in strength, cardiovascular function, and psychological status in general populations (Bouchard 1993). Results of a systematic review suggested that aerobic exercise interventions appeared to be safe and may lead to improvements in cardiopulmonary fitness for adults living with HIV/AIDS (Nixon 2002). But what are the effects of progressive resistive exercise (PRE) for adults living with HIV infection?A better understanding of the effectiveness and safety of progressive resistive exercise will enable people living with HIV and their health care workers to practice effective and appropriate exercise prescription, thus contributing to improved overall outcomes for adults living with HIV infection.

OBJECTIVES

To examine the safety and effectiveness of progressive resistive exercise interventions on weight, body composition, strength, immunological/virological, cardiopulmonary and psychological parameters in adults living with HIV infection.

SEARCH STRATEGY

To identify studies to be included in this review, we searched the following databases: MEDLINE, EMBASE, CINAHL, COCHRANE, SCIENCE CITATION INDEX, PSYCHINFO, SOCIOLOGICAL ABSTRACTS, SSCI, ERIC, DAI and HEALTHSTAR. We also reviewed both published and unpublished abstracts and proceedings from major international and national HIV/AIDS conferences such as the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), the Conference on Retroviruses and Opportunistic Infections (CROI), the Infectious Diseases Society of America Conference (IDSA), and the International AIDS Conference (IAC). Reference lists from pertinent articles and books were reviewed, as well as Collaborative Review Group databases. Targeted journals were also hand searched for relevant articles. No language restriction was applied. The search strategy covered literature from 1980-August 2003.

SELECTION CRITERIA

We included studies that were randomized controlled trials (RCTs) comparing progressive resistive exercise interventions with no progressive resistive exercise or another exercise or treatment modality, performed at least three times per week, and lasting at least four weeks among adults (18 years of age or older) living with HIV/AIDS.

DATA COLLECTION AND ANALYSIS

Data collection forms were used by reviewers to abstract data pertaining to study design, participants, interventions, outcomes and methodological quality from the studies that met inclusion criteria. Whenever possible, meta-analyses were conducted on outcomes using RevMan 4.2.2 computer software.

MAIN RESULTS

Seven studies met the inclusion criteria for this systematic review. Meta-analysis was limited due to the following differences among the studies: types of exercise interventions, inclusion of co-intervention groups, level of exercise supervision, baseline body composition and testosterone levels of participants, types of outcomes assessed, and methodological quality of the individual studies.Main results indicated that performing progressive resistive exercise or a combination of progressive resistive exercise and aerobic exercise at least three times a week for at least four weeks appears to be safe and may lead to statistically and possibly clinically important increases in body weight and composition. Results also indicate exercise interventions may lead to clinically important improvements in cardiopulmonary fitness. Individual studies included in this review suggest that progressive resistive exercise interventions with or without aerobic exercise also contribute to improvements in strength and psychological status for adults living with HIV/AIDS. Individual studies indicate that progressive resistive exercise or a combination of progressive resistive and aerobic exercise appears to be safe for adults living with HIV/AIDS who are medically stable as a result of no change seen in immunological/virological status. These results are limited to those who continued to exercise and for whom there were adequate follow-up data.

REVIEWERS' CONCLUSIONS

Progressive resistive exercise or a combination of progressive resistive exercise and aerobic exercise appear to be safe and may be beneficial for adults living with HIV/AIDS. These findings are limited by the small number of studies that could be included in meta-analyses, small sample sizes and variable participant withdrawal rates among included studies. Future research would benefit from including participants at various stages of HIV infection, a greater proportion of female participants, and participants in a variety of age groups to increase the generalizability of results. Furthermore, future research would benefit from studies with larger sample sizes that conduct an "intention-to-treat" analysis (analysis of participants based on the groups to which they were originally allocated) to better understand outcomes of participants that withdraw from exercise interventions.

Unplanned hospital admission in children undergoing day-case surgery

BACKGROUND AND OBJECTIVE

Unplanned hospital admission is a measure of quality of care in the setting of day-case surgery. We set out to identify the incidence and causes of unplanned hospital admission in a paediatric day-case unit.

METHODS

A retrospective survey to determine the incidence and causes of unplanned hospital admissions in children undergoing day-case surgery. The survey covered the period from January 1996 until December 1999 inclusive in a university affiliated children's hospital. This hospital is the second largest paediatric referral centre in Ireland with total admissions across all specialities during the study period of 42 738.

RESULTS

During the study period 10 772 children underwent day-case surgery, of whom 242 (2.2%) experienced unplanned hospital admission. The reasons for admission were surgical 146 (54%), anaesthetic 44 (16%), social 38 (14%), medical 31 (11%) and unclassified 10 (4%). Pain, surgical complications and/or further management, admission for observation, extensive surgery and oozing were the commonest surgical reasons. Postoperative nausea and vomiting, anaesthetic-related complication and somnolence were the commonest anaesthetic causes responsible for admission. Surgery performed after 15:00 h was an important factor associated with admission for social reasons. Orthopaedic surgery accounted for the largest absolute number of unplanned admissions with 61 (25%), followed by urology with 46 (19%) and general surgery with 46 (19%). However, measured as percentage of caseload, urology had the highest proportion of unplanned hospital admissions.

CONCLUSION

This study demonstrated that the incidence and causes of unplanned hospital admission following day-case surgery in children are similar to those for adults.

Cancer statistics for Hispanics, 2003

In this article, the American Cancer Society (ACS) provides estimates on the number of new cancer cases and deaths, and compiles health statistics on the US Hispanic population. The compiled statistics include cancer incidence, mortality, and behaviors relevant to cancer using the most recent data on incidence from the National Cancer Institute's (NCI) Surveillance, Epidemiolgy, and End Results (SEER) Program, mortality data from the National Center for Health Statistics, and behavioral information from the Behavior Risk Factor Surveillance System (Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System [BRFSS], Youth Risk Behavior Surveillance System [YRBSS], and National Health Interview Survey [NHIS].) An estimated 67,400 new cases of cancer and 22,100 cancer deaths will occur among Hispanics in 2003. Hispanics have lower incidence and death rates from all cancers combined and from the four most common cancers (breast, prostate, lung and bronchus, and colon and rectum) than non-Hispanic whites. However, Hispanics have higher incidence and mortality rates from cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting in part greater exposure to specific infectious agents and lower rates of screening for cervical cancer, as well as dietary patterns and possible genetic factors. Strategies for reducing cancer risk among Hispanics include further development of effective interventions to increase screening and physical activity, reductions in tobacco use and obesity, and the development and application of effective vaccines.

World-wide radiation dosage calculations for air crew members

A greatly improved version of the computer program to calculate radiation dosage to air crew members is now available. Designated CARI-6, this program incorporates an updated geomagnetic cutoff rigidity model and a revision of the primary cosmic ray spectrum based on recent work by Gaisser and Stanev (1998). We believe CARI-6 provides the most accurate available method for calculating the radiation dosage to air crew members. The program is now utilized by airline companies around the world and provides unification for subsequent world-wide studies on the effects of natural radiation on aircrew members.

The atmospheric radiation response to solar-particle-events

High-energy solar particles, produced in association with solar flares and coronal mass ejections, occasionally bombard the earth's atmosphere. resulting in radiation intensities additional to the background cosmic radiation. Access of these particles to the earth's vicinity during times of geomagnetic disturbances are not adequately described by using static geomagnetic field models. These solar fluxes are also often distributed non uniformly in space, so that fluxes measured by satellites obtained at great distances from the earth and which sample large volumes of space around the earth cannot be used to predict fluxes locally at the earth's surface. We present here a method which uses the ground-level neutron monitor counting rates as adjoint sources of the flux in the atmosphere immediately above them to obtain solar-particle effective dose rates as a function of position over the earth's surface. We have applied this approach to the large September 29-30, 1989 ground-level event (designated GLE 42) to obtain the magnitude and distribution of the solar-particle effective dose rate from an atypically large event. The results of these calculations clearly show the effect of the softer particle spectra associated with solar particle events, as compared with galactic cosmic rays, results in a greater sensitivity to the geomagnetic field, and, unlike cosmic rays, the near-absence of a "knee" near 60 degrees geomagnetic latitude.

Development and use of a taxonomy to carry out a systematic review of the literature on methods described to effect distal movement of maxillary molars

OBJECTIVE

To devise a taxonomy for the assessment of the orthodontic literature on methods described to effect distal movement of maxillary molars, to test the taxonomy for inter-assessor reliability, and to use it to classify studies in a systematic review of the literature.

DATA SOURCES

Articles appearing in the American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, (British) Journal of Orthodontics, European Journal of Orthodontics, and the Journal of Clinical Orthodontics between 1988 and 1998. Data selection Articles describing or evaluating the effect of appliances known or thought to have a distalizing effect on maxillary molars.

DATA EXTRACTION

A taxonomy was designed, tested by two reviewers independently to assess levels of agreement, and then used to record the features of the articles in a systematic review of the literature.

DATA SYNTHESIS

Kappa scores were used to assess the level of agreement between reviewers and found to be satisfactory. Studies were grouped according to study design and features of their methodology quantified.

CONCLUSIONS

Having devised and tested the taxonomy, we found that the quality of evidence for any method of moving maxillary molars distally was not high.

Aerobic exercise interventions for adults living with HIV/AIDS

BACKGROUND

The profile of HIV infection is constantly changing. Although once viewed as an illness progressing to death, among those with access to antiretroviral therapy, HIV infection can now present as a disease with an uncertain natural history, perhaps a chronic manageable disease for some. Thus, the needs of persons infected with HIV have increasingly included management of impairments, disabilities and handicaps. Exercise is a key management strategy employed by rehabilitation professionals to address these issues and assist persons living with HIV/AIDS. Exercise has been shown to improve strength, cardiovascular function, and psychological status in seronegative populations (~~Bouchard 1993~~) but what are the effects of exercise for adults living with HIV infection? If the risks and benefits of exercise for people living with HIV infection are better understood, appropriate exercise prescription may be practiced by health care providers, and may enhance the effectiveness of HIV management, thus improving the overall outcome for adults living with HIV infection.

OBJECTIVES

To examine the effect of aerobic exercise interventions on cardiopulmonary, immunological/virological and psychological parameters in adults living with HIV infection.

SEARCH STRATEGY

To identify the appropriate studies, we conducted a search using MEDLINE, EMBASE, SCIENCE CITATION INDEX, AIDSLINE, CINAHL, HEALTHSTAR, PSYCHLIT, SOCIOFILE, SCI, SSCI, ERIC and DAI. We also reviewed abstracts from international AIDS, ICAAC, and other major meetings. Reference lists from pertinent articles and books and personal contact with authors were also used, as were Collaborative Review Group databases and results of hand searching of targeted journals. All languages were included. Searches for the original review covered the period from 1980 to July 1999. For the purposes of this update, an additional literature search, following the same identification of studies criteria as listed above, was conducted from August 1999 to January 2001.

SELECTION CRITERIA

To be selected, studies had to be randomized controlled trials involving HIV+ adults 18 years of age or older and had to include at least one group randomized to receive aerobic exercise performed at least three times/week for at least four weeks.

DATA COLLECTION AND ANALYSIS

Data on study design, participants, interventions, and outcomes were extracted from the reports onto specifically designed data collection forms by at least two reviewers.

MAIN RESULTS

A total of eight studies (six from the original search and two from the updated search) were identified that satisfied the eligibility criteria. The main results indicated that performing constant or interval aerobic exercise, or a combination of constant aerobic exercise and progressive resistive exercise for at least 20 minutes, at least three times per week for four weeks appears to be safe and may lead to clinically significant improvements in cardiopulmonary fitness. Furthermore, individual studies suggest that aerobic exercise may improve psychological well-being for adults living with HIV/AIDS. These findings are limited to those who continued to exercise and for whom there was adequate follow-up data.

REVIEWER'S CONCLUSIONS

Aerobic exercise appears to be safe and may be beneficial for adults living with HIV/AIDS. These findings are limited by the small sample sizes and large drop-out rates of the included studies. Future research would benefit from an increased attention to participant follow-up and intention-to-treat analysis. Further research is required to determine the optimal parameters of aerobic exercise and stage of disease in which aerobic exercise may be most beneficial for adults living with HIV infection.

Effect of creatine on performance of militarily relevant tasks and soldier health

PURPOSE

Determine the short-term effects of creatine supplementation on performance of military tasks, thermoregulation, and health risks.

METHODS

Male military personnel were randomly assigned to a creatine (CR; N = 8) or a placebo (CON; N = 8) supplementation group. Testing was conducted at baseline, after a 6-day load phase (20 g/d), and after 4 weeks of taking 6 g/d. Measurements included body composition, liver/kidney function tests, core body temperatures during a 10-mile march and 5-mile run, and performance on physical tasks.

RESULTS

Serum and urine creatine increased significantly in the CR group. Body mass and number of pull-ups performed increased significantly in the CR group but not the CON group by week 4. No significant differences between the CR and CON groups were found for other performance measures, body composition, core body temperature, or other biochemical measures.

CONCLUSION

Creatine supplementation increased body mass and pull-up performance but did not cause acute health problems. Creatine did not increase core temperature compared with placebo under the environmental conditions of the study, and it is unlikely that creatine will enhance the overall readiness or performance of soldiers.

Are specialist outreach clinics for orthodontic consultation effective? A randomised controlled trial

OBJECTIVE

To develop outreach clinics for orthodontic consultation and evaluate their costs and effectiveness.

DESIGN

Single centre randomised controlled trial with random allocation of referred patients to outreach or main base consultation appointments.

SETTING

One hospital orthodontic department and three community health centre clinics in Greater Manchester. Subjects 324 patients who were referred for orthodontic treatment.

MAIN OUTCOME MEASURES

The outcome of consultation, the cost and duration of the visit and the consumer's perceptions of the visit.

RESULTS

There were no differences in outcome of the consultation. While consumer travel costs and the duration of appointments were significantly higher for the main base clinics, these differences were not great. However, consumers preferred to attend an appointment in an outreach clinic.

CONCLUSIONS

There do not appear to be marked advantages or disadvantages in providing consultation appointments for orthodontics in outreach clinics

Eukaryotic translation initiation factor 5 (eIF5) acts as a classical GTPase-activator protein

GTP hydrolysis occurs at several specific stages during the initiation, elongation, and termination stages of mRNA translation. However, it is unclear how GTP hydrolysis occurs; it has previously been suggested to involve a GTPase active center in the ribosome, although proof for this is lacking. Alternatively, it could involve the translation factors themselves, e.g., be similar to the situation for small G in which the GTPase active site involves arginine residues contributed by a further protein termed a GTPase-activator protein (GAP). During translation initiation in eukaryotes, initiation factor eIF5 is required for hydrolysis of GTP bound to eIF2 (the protein which brings the initiator Met-tRNA(i) to the 40S subunit). Here we show that eIF5 displays the hallmarks of a classical GAP (e.g., RasGAP). Firstly, its interaction with eIF2 is enhanced by AlF(4)(-). Secondly, eIF5 possesses a conserved arginine (Arg15) which, like the "arginine fingers" of classical GAPs, is flanked by hydrophobic residues. Mutation of Arg15 to methionine abolishes the ability of eIF5 either to stimulate GTP hydrolysis or to support mRNA translation in vitro. Mutation studies suggest that a second conserved arginine (Arg48) also contributes to the GTPase active site of the eIF2.eIF5 complex. Our data thus show that eIF5 behaves as a classical GAP and that GTP hydrolysis during translation involves proteins extrinsic to the ribosome. Indeed, inspection of their sequences suggests that other translation factors may also act as GAPs.

Aircrew exposure from cosmic radiation on commercial airline routes

As a result of the recent recommendations of the ICRP 60, and in anticipation of possible regulation on occupational exposure of Canadian-based aircrew, an extensive study was carried out by the Royal Military College of Canada over a one-year period to measure the cosmic radiation at commercial jet altitudes. A tissue-equivalent proportional counter was used to measure the ambient total dose equivalent rate on 62 flight routes, resulting in over 20,000 data points at one-minute intervals at various altitudes and geomagnetic latitudes (i.e. which span the full cut-off rigidity of the Earth's magnetic field). These data were then compared to similar experimental work at the Physikalisch Technische Bundesanstalt, using a different suite of equipment, to measure separately the low and high linear energy transfer components of the mixed radiation field, and to predictions with the LUIN transport code. All experimental and theoretical results were in excellent agreement. From these data, a semiempirical model was developed to allow for the interpolation of the dose rate for any global position, altitude and date (i.e. heliocentric potential). Through integration of the dose rate function over a great circle flight path, a computer code was developed to provide an estimate of the total dose equivalent on any route worldwide at any period in the solar cycle.

Radiation exposure during air travel: guidance provided by the Federal Aviation Administration for air carrier crews

Air carrier crews are occupationally exposed to ionizing radiation, principally from galactic cosmic radiation. To promote radiation safety in aviation the Federal Aviation Administration has: issued educational material on the nature of the radiation received during air travel; recommended radiation exposure limits for pregnant and nonpregnant aircrew members; developed computer programs that estimate for a given flight profile the amount of galactic radiation received on a current flight or on one flown at any time back to January 1958; published tables that enable aircrew members to estimate possible health risks associated with their occupational exposure to radiation; and conducted research on effects of radiation during pregnancy. References for this material are given in the article. In addition, graphic and tabular data in the article show how galactic radiation levels and the composition of the galactic radiation has changed between 1958 and 1999. Also given are estimates of effective doses received by air travelers on a wide variety of air carrier flights.

An improved analytical procedure for determination of total actual acidity (TAA) in acid sulfate soils

An improved analytical procedure is proposed for the determination of total actual acidity (TAA) in acid sulfate soils. The proposed method involves the use of a superior extracting solution, 0.5 M BaCl2, instead of the 1 M NaCl used by Konsten et al. (Konsten CJM, Brinkman R, Andriesse W. A field laboratory method to determine total potential and actual acidity in acid sulfate soils. In: Dost H, editor. Selected papers of the Dakar Symposium on Acid Sulfate Soils. Wageningen: ILRI Publication 44, 1988:106-134.) and improved experimental design to obtain correction factors for calculating TAA. The introduction of a multi-choice procedure also enables increased accuracy of analytical results to be obtained if more accurate TAA estimation is required.