An exploration of the effects of weighted garments on balance and gait of stroke patients with residual disability

OBJECTIVE

To explore the effects of weighted garments on the balance and gait of stroke patients.

DESIGN

A pilot randomized controlled study with blinded measurement.

SETTING

Weighted garments were worn by patients living in the community and measurement was made in a hospital-based gait laboratory.

SUBJECTS

Twenty-four adults who were at least six months post stroke and were able to walk 10 metres with or without assistance or a walking aid.

INTERVENTION

The six-week treatment-phase subjects were given a set of weighted garments which they were shown how to apply and instructed to wear on their paretic side. Subjects randomly allocated to the six-week control phase were not given any weighted garments.

MAIN OUTCOME MEASURES

Balance was measured with the Berg Balance Scale. Gait was measured using GaitMat II, an instrumented walkway. Gait parameters of interest were velocity and symmetry of: step length; single support time; double support time; and support base width. Measures were made at baseline before randomization (baseline) and at the end of the six weeks of intervention (outcome).

RESULTS

No statistically significant differences were found between the treatment and control groups at outcome for balance (Mann-Whitney U-test; p = 0.74), gait velocity (p = 0.68) or symmetry of gait parameters (p = 0.33 to p = 0.75).

CONCLUSIONS

We found no evidence to support the clinical use of these weighted garments for stroke survivors.

Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England

OBJECTIVE

To assess the impact of the sexual component of AIDS and HIV campaigns on transmission of HIV and other sexually transmitted infections (STIs).

DESIGN

Comparison of time series data.

SETTING

England, 1971-1999.

OUTCOME MEASURES

HIV transmission and diagnoses among men who have sex with men (MSMs), rates of attendances and specific STI diagnoses (per 100 000 total population) at genitourinary medicine (GUM) clinics.

RESULTS

Awareness of AIDS and campaigns in 1983-4 among homosexual men coincided with substantial declines in transmission of HIV and diagnoses of syphilis among MSMs. During general population campaigns in 1986-7 new GUM clinic attendances requiring treatment fell by 117/10(5) in men and 42/10(5) in women. Rates for gonorrhoea fell by 81/10(5) and 43/10(5) and genital herpes by 6/10(5) and 4/10(5), respectively. Previous rises in genital wart rates were interrupted, while rates of attendances not requiring treatment (the "worried well") increased by 47/10(5) and 58/10(5) for men and women, respectively. Since 1987 diagnoses of HIV among MSMs have not declined, averaging 1300-1400 annually. Following a period of unchanging rates there have been substantial increases in GUM attendances requiring treatment, notably for gonorrhoea, syphilis, and viral STIs since 1995.

CONCLUSIONS

Self help initiatives and awareness among homosexual men in 1983-4 contributed significantly to a fall in HIV transmission among MSMs, and the general campaigns of 1986-7 were associated with similar effects on all STI transmission. Both effects seem to have occurred through changing sexual behaviour, and probably contributed to the UK's low national HIV prevalence. Bacterial STI incidence has increased significantly since 1995 and there is no evidence that recent prevention initiatives have reduced HIV transmission among MSMs, hence sexual health initiatives need to be comprehensively reinvigorated in England.

Seroconversion to HIV-1 following a needlestick injury despite combination post-exposure prophylaxis

Post-exposure prophylaxis with antiretroviral drugs for at-risk needlestick injuries has become routine practice and is usually empirical. With increasing numbers of treatment-experienced patients, the choice of antiretroviral may need to be individually tailored. Infection can still occur despite attempts to optimize the drug combination used.

Identification of a potent and selective oxytocin antagonist, from screening a fully encoded differential release combinatorial chemical library

A library of 1,296 1,4-benzodiazepines was prepared on 160 microM Tentagel beads. Compounds are attached to the beads using orthogonally cleavable linkers. The library was first screened as pools of 30 beads where 50% of the material is released and screened. GW405212X, a selective oxytocin antagonist, was identified by picking single beads from active pools.

Formulation and process optimization to eliminate picking from market image tablets

A tablet formulation when compressed using market image tooling may cause picking of powder. A D-optimal statistical experiment was designed to optimize the direct compression formulation and the process to alleviate picking of powder. The effects of levels of magnesium stearate, colloidal silicon dioxide (CSD), and lubrication time on picking were investigated using original compression tooling. These optimization results provided a small robust manufacturing region, hence a change in the cut angles of embossed letters and numbers from 70 degrees to 90 degrees in the modified compression tooling was evaluated. A statistical analysis of the data identified a robust manufacturing region that included formulations containing magnesium stearate 1-1.25% w/w, CSD 0.1-0.3% w/w, with a lubrication time of 5-10 min when compressed using modified compression tooling. The results indicate a significant reduction in picking by increasing the cut angles of embossed letters and numbers in the modified compression tooling. By evaluating interactions between various variables, we demonstrate a concentration dependent effect of CSD on the lubrication efficiency of magnesium stearate and compactability of microcrystalline cellulose containing formulation. In addition, the lubrication efficiency of magnesium stearate is maintained by blending CSD with powder blend prior to lubrication with magnesium stearate.

National assessment of prevalent diagnosed HIV infections

HIV infection is associated with high treatment and care costs and subject to large differences in prevalence between health districts. Equitable distribution of resources requires information provided by an annual national survey of prevalent diagnosed HIV infections (SOPHID). This measures HIV caseloads by health district of residence throughout England, Wales, and Northern Ireland and is used to inform local public health professionals and to improve allocation of government funding for HIV prevention and care. Survey totals are adjusted by underreporting and non-attendance factors to produce a more accurate assessment of the total caseloads. On average the combined adjustments increase the reported caseload by 14.7% annually. Adjusted prevalence estimates ranged from 14,164 in 1995 to 18,460 in 1998, an increase of 30%.

Variable absorption of carbidopa affects both peripheral and central levodopa metabolism

Carbidopa (CD), a competitive inhibitor of aromatic l-amino acid decarboxylase that does not cross the blood-brain barrier, is routinely administered with levodopa (LD) to patients with Parkinson disease (PD) to reduce the peripheral decarboxylation of LD to dopamine. Using a stable isotope-labeled form of LD, the authors examined in 9 PD patients the effects of variable CD absorption on peripheral and central LD metabolism. Subjects were administered orally 50 mg of CD followed in 1 hour by a slow bolus intravenous infusion of 150 mg stable isotope-labeled LD (ring 1',2',3',4',5',6'-13C). Eight patients underwent a lumbar puncture 6 hours following the infusion. Blood and cerebrospinal fluid (CSF) samples were analyzed for labeled and unlabeled metabolites using a combination of high-performance liquid chromatography and mass spectrometry. When patients were divided into "slow" and "rapid" CD absorption groups, significantly greater peripheral LD decarboxylation (as measured by area under the curve [AUC]-labeled serum HVA) was noted in the poor absorbers (p = 0.05, Mann-Whitney U test). Elimination half-lives for serum LD did not differ between groups, suggesting a further capacity for decarboxylation inhibition in the "rapid" absorbers. A significant correlation between AUC serum CD and percent-labeled HVA in CSF was found for all patients (R = 0.786, p = 0.02). "Rapid" as compared to "slow" CD absorbers had significantly more percent-labeled CSF HVA (60 vs. 49, p = 0.02, Mann-Whitney U test), indicating greater central-labeled DA production in the better CD absorbers. The data suggest that peripheral aromatic l-amino acid decarboxylase activity is not saturated at CD doses used in current practice. The authors believe that future studies to better examine a dose dependence of CD on peripheral LD decarboxylation and LD brain uptake are warranted.

Manners. "Well, no one would mistake him for Richard the Lionhearted."

Bad manners and shin kicking have been evident in the job market since Adam departed The Garden in search of greater challenges

Mortality in young adults in England and Wales: the impact of the HIV epidemic

OBJECTIVE

To quantify the contribution of the HIV epidemic to premature mortality in England and Wales 1985-1996.

DESIGN

Surveillance of deaths in HIV-infected individuals and causes of death from death certificates.

MAIN OUTCOME MEASURES

Time trends in age-specific mortality rates among 15-44 year olds and years of potential life lost (YPLL) to age 65 associated with HIV infection and other important causes of death in young adults.

RESULTS

The crude age-specific mortality rates for all causes of death in the 15-44 year age band remained fairly constant between 1985 and 1996: in other age bands a decrease was seen. Deaths from both suicide and HIV increased in men aged 15-44 years. Although suicide accounted for a greater number of deaths throughout the period investigated, the largest proportional and absolute increase was seen for deaths in HIV-infected people. By 1996, the contribution of HIV to YPLL to age 65 varied from less than 0.5% in most rural localities to 20% of total YPLL in one London health authority.

CONCLUSIONS

While part of the adverse trend in mortality in younger adults since 1985 was attributable to suicide, most resulted from HIV infection. The impact of HIV infection on mortality was greatest in London.

Analysis of phyto-oestrogens by gas chromatography-mass spectrometry

The metabolites of oestrogenic substances of plant origin, phyto-oestrogens, have been proposed as cancer-protective agents in Asian and vegetarian populations. The two principle classes of these weak oestrogens are isoflavonoids and mammalian lignans. The former is derived from soya-based foods and the latter from oilseeds, cereals and whole grains. Asian populations such as the Japanese have high plasma concentrations of the isoflavones, daidzein and genistein, whereas vegetarians excrete large quantities of the lignan enterolactone, in their urine. The concentrations of these compounds in biological samples and foods are usually determined by GC-MS, although other techniques such as HPLC and LC-MS have also been used. A simple, robust method employing isotope dilution GC-MS will be described which could be applied to the determination of phyto-oestrogens in biological samples and food matrices. Briefly, samples are hydrolysed with β-glucuronidase, the aglycones extracted and the phyto-oestrogen fraction isolated by chromatography on Sephadex LH20. This fraction is then derivatised for GC-MS by reaction with N,O-bistrimethylsilyl-triflouroacetatamide to form trimethylsilyl derivatives. Using this technique we have determined the concentrations of the lignans, enterodiol and enterolactone, and the isoflavonoids, equol, daidzein and genistein, in the serum of men from Japan (n=42). The mean levels of daidzein and genistein in these men were 82.5 ng/ml (range 1.9-577) and 158.6 ng/ml (range 5.3-852), respectively. The majority of these men (57%) produced equol concentrations of >5 ng/ml, with a mean value of 26.7 ng/ml. Mean Levels of enterodiol and enterolactone were 0.6 and 9.4 ng/ml, respectively. The levels of daidzein and genistein produced from the hydrolysis of soya bean hulls, soya bean hypocotyl, dehulled soya beans, soya flour, soya grit and soya concentrates have also been determined by this method. Soya bean hypocotyl, for example, produces 2.1 mg/g of daidzein and 1.2 mg/g genistein, whereas some concentrates yield as much as 40% isoflavones.

A new approach to vision screening in schools

PURPOSE

To determine the prevalence of visual "defects" among a sample of young schoolchildren and evaluate a new system for vision screening in schools.

METHODS

A new system for vision screening in schools has been developed. The system is based on a computer program which may be run on a low specification personal computer. Information about the child's symptoms, history and family history is acquired by means of a parental questionnaire and entered into the program prior to the vision screening. Distance visual acuity and stereopsis are measured directly on the computer screen and colour vision is assessed using a reduced Ishihara test. The program carries out an "expert" analysis of the questionnaire data and the vision test results and determines the most likely diagnosis. Reports for parents, teachers, optometrists, doctors can be generated automatically and statistics relating to the overall screening program are available. An evaluation of a prototype version of the system was carried out on 245 schoolchildren aged between 5 and 8 years.

RESULTS

Overall, 48 children failed the screening (excluding colour vision deficiencies), 32 of whom were unaware of any problem with their eyes. Comparison of the result of the vision screening with the outcome of a full eye examination gave a sensitivity of 93.8% and a specificity of 96.1%.

CONCLUSION

A significant number of young school children have unsuspected remediable visual defects. The computer-based vision screener provides an efficient, sensitive and specific method for screening in schools.

Bacterial vaginosis in lesbians: evidence for lack of sexual transmission

The effect of non-heterosexual factors on the vaginal flora has been studied. Ninety-one lesbians attending a specialist genitourinary medicine service for lesbians were studied. Bacterial vaginosis (BV) was diagnosed in 51.6% of them. While most of the women had previously had a male sexual partner, the presence of BV was not associated with a male sexual partner in the previous 12 months. A detailed analysis of lesbian sexual practices in the group did not relate BV to any sexual practice which would have the propensity to pass vaginal secretions from one to the other.

An early developmental role for eph-ephrin interaction during vertebrate gastrulation

Eph receptor tyrosine kinases (RTK) and their ephrin ligands are involved in the transmission of signals which regulate cytoskeletal organisation and cell migration, and are expressed in spatially restricted patterns at discrete phases during embryogenesis. Loss of function mutants of Eph RTK or ephrin genes result in defects in neuronal pathfinding or cell migration. In this report we show that soluble forms of human EphA3 and ephrin-A5, acting as dominant negative inhibitors, interfere with early events in zebrafish embryogenesis. Exogenous expression of both proteins results in dose-dependent defects in somite development and organisation of the midbrain-hindbrain boundary and hindbrain. The nature of the defects as well as the distribution and timing of expression of endogenous ligands/receptors for both proteins suggest that Eph-ephrin interaction is required for the organisation of embryonic structures by coordinating the cellular movements of convergence during gastrulation.

Explaining community-level variance in group randomized trials

Between-community variance or community-by-time variance is one of the key factors driving the cost of conducting group randomized trials, which are often very expensive. We investigated empirically whether between-community variance could be reduced by controlling individual- and/or community-level covariates and identified these covariates from four large community-based group randomized trials or surveys: the Working Well Trial; Kaiser Adolescent Survey; Kaiser Adults Survey; and the Eating Patterns Study. We found that adjusting for covariates will often substantially reduce the between-community variance component. Therefore investigators could block the communities according to these covariates, or adjust for these covariates to improve the power of community trials. We found that the community-by-time variance components are always near zero in these data sets, especially for the surveys where a cohort was followed over time. The covariate adjustment had less impact on reducing the community-by-time variance for the cohort samples than for the cross-sectional samples. This suggests that blocking may not be necessary for the design of the group randomized trials where the change from baseline is of primary interest. The Working Well Trial data were used to illustrate this point.