Impacts of Wildfire Events on California Radiation Oncology Clinics and Patients

PURPOSE/OBJECTIVE(S)

The impact of climate-related disasters such as wildfires on healthcare delivery and cancer care is a growing concern. Patients undergoing radiotherapy are particularly vulnerable to treatment interruptions which are known to have a direct impact on survival outcomes. We report results of the first pilot study characterizing the impact of wildfires on radiation oncology clinics and their patients.

MATERIALS/METHODS

A survey was sent to 415 California radiation oncologists representing 144 clinics identified using the ASTRO member directory to gather information about clinic and radiation oncologist demographics, wildfires' impacts on the clinic (physical/operational), physicians, staff, and patients between 2017 and 2022, as well as clinics' disaster preparedness efforts.

RESULTS

A total of 51 radiation oncologists completed the survey, representing 43 clinics (30% of clinics) in 24 (41%) of California counties. 35 (69%) of respondents self-identified as male, 27 (53%) worked at hospital-affiliated centers, 19 (37%) worked in academic centers, with 49 (96%) practicing in metropolitan areas. A total of 31 clinics were impacted by a wildfire between 2017 and 2020. The two rural clinics (100%) and 29 (59%) of metro practices reported being impacted by wildfires in the last 5 years, with 9 (18%) reporting a clinic closure and 15 (29%) reporting staffing shortages. 28 (55%) of respondents reported impacts on patients including having to evacuate, 27 (53%) having to cancel or reschedule treatments, and 23 (45%) experiencing physical, mental, or financial hardship due to the wildfires. Among the 25 clinics impacted by wildfires, 12 (24%) reported physical/operational impacts including being forced to evacuate patients to another treatment center, transportation interruptions (19, 37%), community and regional evacuations (18, 35%), school closures (18, 35%), and physical/mental health impacts (14, 27%) on staff due to the wildfires. Small clinics (25 staff or less) that experienced a wildfire were twice as likely to experience closures (6 of 16 clinics, 38%) but equally likely to experience staffing shortages (8 of 16, 50 %) as compared to larger practices (7 of 15, 47%). Nearly half of respondents 25 (47%) reported their workplace had a wildfire emergency preparedness plan.

CONCLUSION

The results of this study demonstrate the significant impact wildfires have on patient care in both rural and metropolitan areas. The findings emphasize the importance of emergency preparedness planning to minimize the consequences of such disasters and underscores the need for further research to explore risk factors associated with patient and community vulnerability to climate-related crises. Such research will be essential to informing and developing future emergency preparedness plans.

The State of Health, Burnout, Healthy Behaviors, Workplace Wellness Support, and Concerns of Medication Errors in Pharmacists During the COVID-19 Pandemic

OBJECTIVES

The aims of the study were to describe the well-being and lifestyle behaviors of health-system pharmacists during the COVID-19 pandemic and to determine the relationships among well-being, perceptions of workplace wellness support, and self-reported concern of having made a medication error.

METHODS

Pharmacist ( N = 10,445) were randomly sampled for a health and well-being survey. Multiple logistic regression assessed associations with wellness support and concerns of medication error.

RESULTS

The response rate was 6.4% ( N = 665). Pharmacists whose workplaces very much supported wellness were 3× more likely to have no depression, anxiety, and stress; 10× more likely to have no burnout; and 15× more likely to have a higher professional quality of life. Those with burnout had double the concern of having made a medication error in the last 3 months.

CONCLUSIONS

Healthcare leadership must fix system issues that cause burnout and actualize wellness cultures to improve pharmacist well-being.

Determination of Methylcellulose and Hydroxypropyl Methylcellulose Food Gums in Food and Food Products: Collaborative Study

A collaborative study was performed to determine the reproducibility of a method for the determination of methylcellulose (MC) and hydroxypropyl methylcellulose (HPMC) in food. These widely used food gums possess unusual solubility characteristics and cannot accurately be determined by existing dietary fiber methods. The new method uses the enzyme-digestion procedure of AOAC Official Method 991.43. Digestate solutions must be refrigerated to fully hydrate MC or HPMC. The chilled solutions are filtered and analyzed by size-exclusion liquid chromatography. Collaborating laboratories received 28 samples containing MC or HPMC in the range of 0100%. The sample set included blind duplicates of 5 food matrixes (bread, milk, fish, potato, and powdered juice drink). Cochran and Grubbs tests were used to eliminate outliers. For food samples containing MC, values for within-laboratory precision, repeatability relative standard deviation (RSDr), ranged from 4.2 to 16%, and values for among-laboratories precision, reproducibility relative standard deviation (RSDR), ranged from 11 to 20%. For HPMC samples, RSDr values ranged from 6.4 to 27%, and RSDR values ranged from 17 to 39%. Recoveries of MC and HPMC from the food matrixes ranged from 78 to 101%. These results show acceptable precision and reproducibility for the determination of MC and HPMC, for which no Official AOAC Methods exist. It is recommended that this method be adopted as AOAC Official First Action.

Small increase in dolutegravir trough, but equivalent total dolutegravir exposure with simeprevir in HIV/HCV seronegative volunteers

Background

Dolutegravir, an HIV integrase strand-transfer inhibitor, and simeprevir, an HCV NS3/4A PI, have the potential to interact as dolutegravir is a P-glycoprotein, uridine glucuronosyl transferase 1A1 and cytochrome P4503A substrate and simeprevir has been shown to mildly inhibit these.

Objectives

To compare dolutegravir and simeprevir pharmacokinetics (PK) when given separately versus in combination.

Methods

Healthy volunteers received: (i) 150 mg of simeprevir once daily for 7 days; (ii) 50 mg of dolutegravir once daily for 7 days; and (iii) 150 mg of simeprevir once daily plus 50 mg of dolutegravir once daily for 7 days, with randomization to treatment sequence. Twenty-four hour intensive PK sampling was performed on day 7 of each sequence following observed dosing and a standardized meal. PK parameters were determined using non-compartmental methods and compared using paired t-tests. Bioequivalence for area under the curve (AUCtau) and maximum concentration (Cmax) were also assessed. NCT02404805.

Results

Twenty-four subjects completed all three sequences. Dolutegravir trough was increased 24% (P = 0.0003) with simeprevir. Dolutegravir AUCtau was increased 15% (P = 0.002), but was deemed bioequivalent as the 90% CI for the geometric mean ratio was 107%-123%. Dolutegravir Cmax was bioequivalent. Simeprevir PK was unaffected by dolutegravir. There were no discontinuations due to adverse events and all adverse events were mild to moderate in severity.

Conclusions

Dolutegravir trough was increased slightly with simeprevir, but AUCtau was bioequivalent. Despite the increase in trough, dolutegravir concentrations were well within the range with established safety data. Suggesting that simeprevir and dolutegravir can be safely co-administered.

Stability of Ribavirin for Inhalation Packaged in Syringes or Glass Vials when Stored Frozen, Refrigerated, and at Room Temperature

The primary aim of this study was to investigate ribavirin solution for inhalation stability under three different conditions (frozen, refrigerated, room temperature) over a 45-day period. A ribavirin 6000-mg vial was reconstituted with 90 mL of Sterile Water for Injection per the package insert to yield a concentration of approximately 67 mg/mL. The solution was then placed in either syringes or empty glass vials and stored in the freezer (-20°C), in the refrigerator (~0°C to 4°C), or at room temperature (~20°C to 25°C). Original concentrations were measured on day 0 and subsequent concentrations were measured on day 2, 14, and 45 utilizing a validated liquid chromatography with tandem mass spectrometry assay. All analyses were performed in triplicate for each storage condition. Additionally, at each time point the physical stability was evaluated and the pH of solution was measured. The solution was considered stable if =90% of the original concentration was retained over the study period. A validated liquid chromatography with tandem mass spectrometry analysis demonstrated that >95% of the original ribavirin concentration was preserved over the 45-day period for all study conditions. The ribavirin concentration remained within the United States Pharmacopeia (USP)-required range of 95% to 105% of the original labeled product amount throughout the entire study period for all study conditions. Precipitation of ribavirin was noted during the thawing cycle for frozen samples, but the drug went back into solution once the thawing process was completed. No changes in color or turbidity were observed in any of the prepared solutions. Values for pH remained stable over the study period and ranged from 4.1 to 5.3. Ribavirin for inhalation solution is physically and chemically stable for at least 45 days when frozen, refrigerated, or kept at room temperature after reconstitution to a concentration of approximately 67 mg/mL and placed in syringes or glass vials.

Detection of skin cancer margins in Mohs excisions with high-speed strip mosaicing confocal microscopy: a feasibility study

BACKGROUND

Fluorescence confocal mosaicing microscopy is an emerging technology for rapid imaging of nuclear and morphological detail directly in excised tissue, without the need for frozen or fixed section processing. Basal cell carcinomas (BCCs) can be detected with high sensitivity and specificity in Mohs excisions with this approach. For translation to clinical trials and towards potentially routine implementation, a new and faster approach called strip mosaicing confocal microscopy was recently developed.

OBJECTIVES

To perform a preliminary assessment of fluorescence strip mosaicing confocal microscopy for detecting skin cancer margins in Mohs excisions.

METHODS

Tissue samples from 17 Mohs cases were imaged in the form of strip mosaics. Each mosaic was divided into two halves (submosaics) and graded by a Mohs surgeon and a dermatologist who were blinded to the pathology. The 34 submosaics were compared with the corresponding Mohs pathology.

RESULTS

The overall image quality was excellent for resolution, contrast and stitching in the 34 submosaics. Components of normal skin including the epidermis, dermis, dermal appendages and subcutaneous tissue were easily visualized. The preliminary measures of sensitivity and specificity were both 94% for detecting skin cancer margins.

CONCLUSIONS

The new strip mosaicing approach represents another advance in confocal microscopy for imaging of large areas of excised tissue. Strip mosaicing may enable rapid assessment of BCC margins in fresh excisions during Mohs surgery and may serve as an adjunct to frozen pathology.

Abstract P2-03-03: Feasibility of evaluation of breast tissue using confocal microscopy with strip mosaicing

Background: Confocal microscopic strip mosaicing (CSM) provides noninvasive optical sectioning and high resolution, which allows for imaging of nuclear and morphological detail in freshly excised tissue. CSM can image large areas of tissue at micron-level resolution in minutes, which may offer an advantage over standard histology that requires days. We have conducted a preliminary investigation of the feasibility of this technology for the evaluation of breast tissue from surgical excision specimens.

Design: In a prospective study, 80 fresh human breast tissue samples from surgical excision specimens of 24 patients were imaged using a prototype confocal strip scanner. Fresh tissue specimens were immersed in Acridine Orange (AO) for 45 seconds to stain the nuclei, then pressed against the glass imaging window and imaged with a 30X, 0.75 numerical aperture (measured) objective lens and a 488 nm laser. Images were acquired in two modes of contrast: in fluorescence (with AO), showing nuclear morphology, and in reflectance (endogenous), showing stroma. The use of fluorescence for nuclear staining mimics the use of hematoxylin in pathology, and the use of reflectance eosin. Use of two contrast modes allows the fluorescence image to be colorized purple and the reflectance image pink, producing confocal strip mosaics that mimic H&E histology in appearance. Specimens were subsequently fixed in formalin and routinely processed to obtain H&E stained sections. H&E and confocal images were compared by the study pathologist (M.M.)

Results: Freshly excised breast tissue samples as large as 2 cm x 2 cm were imaged in less than five minutes, with 1-micron resolution and measured optical sectioning of 6 microns. We compared the CSM images against standard histopathology images. In our series we evaluated the following histologies: 12 invasive carcinoma (11 ductal, 1 lobular), 3 ductal carcinoma in-situ, 3 lobular carcinoma in situ, 1 atypical lobular hyperplasia, 1 atypical ductal hyperplasia and various benign lesions such as fat necrosis, fibrocystic changes, and ductal hyperplasia. In confocal images invasive and in situ carcinoma as well as benign ducts and lobules were distinguished from surrounding stromal tissue. Limitations that are typically encountered in standard histology, such as distinguishing low grade ductal carcinoma in situ (DCIS) from lobular carcinoma in situ (LCIS) or atypical proliferations were encountered in the grayscale confocal images as well.

Conclusion: In this initial feasibility study, CSM produced images that could be diagnosed as benign or neoplastic by the study pathologist. Further study is needed to build an image library of breast histology and compare reproducibility of histologic diagnoses between CSM (grayscale and colorized images) and traditional optical microscopy, and assess interobserver reproducibility in diagnosis. CSM potentially provides rapid and noninvasive evaluation of breast parenchyma, and has a potential application for intraoperative margin assessment of resected breast specimens.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-03-03.

Producer survey of bird-livestock interactions in commercial dairies

The objective of this producer survey was to identify and estimate damage caused by bird-livestock interactions in commercial dairies. The interactions between birds and livestock have previously been implicated in causing economic damage while contributing to the environmental dissemination of microorganisms pathogenic to livestock and humans. Very little research exists to help producers understand what bird species use dairies, why they use dairies, or the scope and nature of damage created as a result of bird-livestock interactions. To better characterize these interactions, we surveyed dairy operators within Pennsylvania, New York, and Wisconsin. Survey results suggest that the most common and destructive bird species found on commercial dairies are invasive to North America, and their use of dairies is associated with the loss of cattle feed, increased operating costs, and an increase in dairies self-reporting Salmonella spp. and Mycobacterium avium ssp. paratuberculosis. Cattle feed loss estimates generated from this survey were used to parameterize an input-output (IO) economic model using data from 10 counties in the state of Pennsylvania (Bedford, Berks, Blair, Bradford, Chester, Cumberland, Franklin, Lancaster, Lebanon, and Somerset). This IO model allowed us to estimate direct, indirect, and induced economic effects of feed loss from bird damage to dairies within these counties. The IO model output suggests that feed loss costs Pennsylvania between $4.11 and $12.08 million (mean $10.6 million) in total economic damage, with approximately 43 to 128 jobs (mean 112) forgone statewide in 2009.

Early prediction of 30-day mortality after Q-wave myocardial infarction by echocardiographic assessment of left ventricular function--a pilot investigation

BACKGROUND

The GUSTO angiographic substudy demonstrated that left ventricular function measured 90 min after thrombolytic therapy was given had important prognostic implications at 30 days in patients with an acute myocardial infarction (MI).

HYPOTHESIS

Thirty-day prognosis after Q-wave MI can be determined by early echocardiographic assessment of left ventricular function.

METHODS

Using transthoracic echocardiography, semiquantitative ejection fraction and wall motion score index was assessed prospectively in 201 consecutive patients within 24 h following Q-wave MI. Independent experts blinded to the patient's status performed the echocardiographic assessment. All patients received standard medical care as dictated by the attending cardiologist.

RESULTS

Of the 201 patients, 24 (11.9%) died within 30 days, with 70% of the deaths occurring within 10 days after the infarction. Three deaths occurred in the 120 patients with an ejection fraction > or = 45% (2.5% mortality rate). In contrast, 21 deaths occurred among the 81 patients with an ejection fraction <45% (25.9% mortality rate) p = 0.0003. Two of the three patients who died in the high ejection fraction group died as a result of intracerebral hemorrhage from thrombolytic therapy. Ejection fraction was lower in nonsurvivors (32.3+/-10.3 vs. 46.3+/-13%) than in survivors, p < 0.0002. Wall motion score index (WMSI) of < 1.4 was associated with a 2.9% 30-day mortality (two deaths in 76 patients); WMSI of > or = 1.4 was associated with a 17.6% 30-day mortality (22 deaths in 125 patients), p = 0.0007. Average WMSI was higher in the nonsurvivors (1.95+/-0.5) than in survivors (1.52+/-0.45), p = 0.00001.

CONCLUSIONS

Echocardiographic assessment of left ventricular function during the first 24 h after an acute Q-wave MI can be performed in all patients regardless of stability. High-risk patients are identified early in the hospital course, with relative ease, at no risk and at an acceptable cost. An ejection fraction < 45% or WMSI > or = 1.4 identifies patients who are at a high risk of dying within 30 days. These are the patients who may benefit most from aggressive medical therapy and early angiography to assess coronary pathology.

Influence of physical activity on urinary leakage in primiparous women

The impact of physical activity on urinary leakage (UL) has previously been considered, but not in relation to first pregnancy and delivery. The aim of this study was to describe physical activity and urinary leakage before, during and after the first childbirth. The subjects who were invited to participate in the study were taken consecutively from nine maternity clinics in the northwest part of Stockholm County, and the study group included 665 primiparous women. The mean age of the women was 28 (range 17-43) years. The women answered one questionnaire during the 36th gestation week and another 1 year post partum. Physical activity/exercises were classified according to their impact on the pelvic floor, and the women were divided into three groups: high-impact exercise (n=327), low-impact exercise (n=84) and the inactive group (n=254). The results showed a high intensity and frequency of physical activity in the participating primiparous women. Risk factors for UL were symptoms of a dysfunctional pelvic floor and connective tissue disorders and high-impact physical activity before pregnancy, while low-impact activity seemed to promote continence. If urinary leakage was present before pregnancy, it persisted in most women during pregnancy and 1 year post partum.

Quantitative analyses of GFRα-1 and GFRα-2 mRNAs and tyrosine hydroxylase protein in the nigrostriatal system reveal bilateral compensatory changes following unilateral 6-OHDA lesions in the rat

Copy numbers of mRNAs for GFRalpha-1 and GFRalpha-2, the preferred receptors for glial cell line-derived neurotrophic factor (GDNF) and neurturin (NTN) were determined by real-time quantitative RT-PCR (QRT-PCR). Receptor expression was assessed in striatum (ST) and substantia nigra (SN) of normal rats and rats acutely or progressively lesioned by 6-OHDA injected into the medial forebrain bundle or ST, respectively. GFRalpha-1 mRNA was clearly detected in normal ST. In normal SN, significantly higher expression of both receptors was observed. At 4 weeks after acute lesion, GFRalpha-2 mRNA was markedly decreased in SN bilaterally, whereas GFRalpha-1 mRNA in SN and ST was not affected. A progressive lesion resulted in a progressive decrease of GFRalpha1 mRNA in ST bilaterally. In SN, levels of GFRalpha-1 mRNA were not significantly affected by a progressive lesion, whereas GFRalpha-2 mRNA was markedly decreased bilaterally. Quantitative western blotting standardized against tyrosine hydroxylase (TH) protein from PC12 cells revealed the expected decrease in TH protein in lesioned SN, but also significant increases in TH protein in contralateral, unlesioned SNs at 4 weeks after both acute and progressive lesions. These data suggest that previously unrecognized compensatory changes in the nigrostriatal system occur in response to unilateral dopamine depletion. Since the changes observed in receptor expression did not always parallel loss of dopamine neurons, cells in addition to the nigral dopamine neurons appear to be affected by a 6-OHDA insult and are potential targets for the neurotrophic factors, GDNF and NTN.

Prevalence of urinary leakage in nulliparous women with respect to physical activity and micturition habits

In order to survey the influence of physical activity and micturition habits on urinary leakage (UL) in women before their first pregnancy, a study including 725 women attending nine maternity clinics in the northwest area of Stockholm was performed. During the 36th gestational week the women answered a questionnaire regarding the pre-pregnancy situation regarding UL, micturition habits and physical activity. Thirty-nine percent of the women, mean age of 28 (range 17-43) years, had experienced occasional UL. Of these, the majority (79%) had symptoms of stress urinary leakage and 21% had urge symptoms. Two percent were incontinent according to the definition of the International Continence Society (ICS). In a multivariate analysis age, inability to interrupt the urine flow and high-impact physical activity turned out to be independent risk factors for UL and thus should be observed together with traditional factors concerning UL in nulliparous women.

Preoperative treatment of anemic women with epoetin beta

AIM

To compare the effects of preoperative treatment with recombinant human erythropoietin (EPO) and iron with iron only on hemoglobin levels (Hb) in anemic women prior to hysterectomy.

METHODS

The study was an open-labelled randomized parallel study. Fifteen women scheduled for hysterectomy due to uterine myoma were given oral iron and EPO (NeoRecormon) 4 weeks prior to surgery (group I) and 16 women were given oral iron only (group II).

RESULTS

Group I showed a significantly greater increase in mean Hb during the pre-surgery study period compared with group II (p=0.007). Two weeks postoperatively, however, there was no significant difference in mean Hb between the two groups.

CONCLUSION

We found that a significantly greater increase in Hb was achieved with iron in combination with EPO, although in most cases iron only seemed to be as efficacious as iron+EPO in correcting anemia in myoma patients pre-operatively.

Preoperative treatment of anemic women with epoetin beta

AIM

To compare the effects of preoperative treatment with recombinant human erythropoietin (EPO) and iron with iron only on hemoglobin levels (Hb) in anemic women prior to hysterectomy.

METHODS

The study was an open-labelled randomized parallel study. Fifteen women scheduled for hysterectomy due to uterine myoma were given oral iron and EPO (NeoRecormon) 4 weeks prior to surgery (group I) and 16 women were given oral iron only (group II).

RESULTS

Group I showed a significantly greater increase in mean Hb during the pre-surgery study period compared with group II (p=0.007). Two weeks postoperatively, however, there was no significant difference in mean Hb between the two groups.

CONCLUSION

We found that a significantly greater increase in Hb was achieved with iron in combination with EPO, although in most cases iron only seemed to be as efficacious as iron+EPO in correcting anemia in myoma patients pre-operatively.

Quantitative analysis of transgene protein, mRNA, and vector DNA following injection of an adenoviral vector harboring glial cell line-derived neurotrophic factor into the primate caudate nucleus

Gene therapy for neurodegenerative diseases relies on stable expression of a vector-mediated transgene in the human central nervous system (CNS). In nonhuman primate CNS, transgene expression has been primarily assessed using descriptive histological methods. Here, we quantified the expression of a human glial cell line-derived neurotrophic factor (hGDNF) transgene using an ELISA specific for hGDNF protein and real-time quantitative RT-PCR and PCR for hGDNF mRNA and vector DNA, respectively. Transgene expression was assessed 1 week after injection of an E1-, E3-deleted adenovirus harboring hGDNF into the caudate nucleus of St. Kitts green monkey. We found that 57-147 million and 116-771 million copies of hGDNF mRNA and vector DNA, respectively, were present per 10,000 copies of the beta-actin gene. In the same sites, 40-152 pg of hGDNF protein per milligram of tissue was measured. Comparisons of these measures among monkeys demonstrated variable vector DNA and protein levels, but consistent mRNA levels at one-third of the level of vector DNA. This suggests that local responses to the vector play a role in the level of transgene expression and that high levels of vector DNA do not necessarily predict a high level of transgene protein. However, the results of this study do show that neuroprotective levels of GDNF transgene expression can be achieved following injection of an adenoviral vector into nonhuman primate caudate. Moreover, these assays provide quantitative methods for evaluating and comparing viral vectors in primate CNS.

Reasons that orthodontic faculty teach and consider leaving teaching

To assess reasons why orthodontic faculty consider leaving academia, a pretested questionnaire was mailed to 200 full-time (FT) and 200 part-time (PT) faculty randomly selected from the United States and Canada. A total of 144 (72 percent) of FT and 120 (60 percent) PT responded. About 38 percent FT and 25 percent PT were currently considering leaving academia. The average age of each group was about fifty years. Although significant differences were found in fifteen factors affecting the decision to leave, three factors ranked as most important (means> or =3.4) for FTs: salary support, financial support of department, and control over work or destiny. The three factors most important (means>3. 1) for PTs were: challenge of private practice, family commitments, and personal. FT and PT were similar in the most important and least important factors influencing their initial reasons to teach and satisfaction in teaching. However, the reasons why FT considered leaving were work related, while the PT's reasons were more personal. With the current shortage of FT orthodontic faculty becoming imminently greater, it appears that work-related issues could be addressed directly by administration.

Primary reconstructive surgery with a sliding flap for carcinoma of the Bartholin gland

Bartholin gland tumours are rare and therefore recommendations concerning management have been based on small series. Although there is a tendency today to perform less radical surgery, meaning hemivulvectomy or a wide local excision, the anatomical position of these tumours often leads to a large postoperative defect. The objective of this report is to present data on three patients but mainly to describe our surgical technique where a sliding flap obtained from the gluteal region is used for primary closure. This surgical procedure offers a functional and cosmetically acceptable vulva which is of importance considering the relative young age of patients with Bartholin gland tumours.

Autonomic nervous influence of the female guinea-pig urinary bladder during the oestrus cycle

The mammalian urinary bladder receives dual innervation. The excitatory innervation is considered to be partly cholinergic and partly mediated via NANC-receptors. Several (co-)transmitters have been suggested. The adrenergic inhibitory innervation is mediated via alpha- and beta-receptors. Female sex hormones could change autonomic influence of urogenital organs. It was considered to be of interest to characterize the spontaneous and nerve stimulation-induced muscular activity in the urinary bladder of the female guinea-pig during the oestrus cycle. Both the spontaneous activity and nerve-induced activity varied according to the hormonal status of the animal. An alpha-adrenergic inhibitory influence was identified. It was further confirmed that the excitatory innervation could not be blocked by the cholinergic antagonist scopolamine, while alpha-beta-methylene ATP partly inhibited nerve stimulation-induced smooth muscle response, most prominent at cycle day 6. Indomethacin did not impair spontaneous activity or nerve stimulation-induced activity. Nitric oxide reduced nerve stimulation-induced responses on cycle day 12. Imperative urinary bladder contractions are reported to diminish after oestrogen use and in the female a hormonal effect of the nervous influence on the urinary bladder smooth muscle is suggested.

Urogenital and vasomotor symptoms in relation to menopausal status and the use of hormone replacement therapy (HRT) in healthy women during transition to menopause

OBJECTIVE

To investigate the relationship between climacteric status, hormonal levels, vasomotor symptoms, vaginal dryness and urinary incontinence in a cohort of healthy women during transition to menopause, and further to evaluate the effects of hormone replacement therapy on these symptoms.

METHODS

A total of 147 women were followed for 4 years during transition to menopause. They were all 49 years old when entering the study. Each annual visit included a general health screening, gynecological examination and blood sampling. The subjects were questioned about sociodemographic background, obstetric and gynecological history and they kept bleeding diary cards.

RESULTS

Urinary incontinence was reported by 57% at the first visit and decreased to 34% at the last visit. No correlation to hormonal levels or to the use of HRT (hormone replacement therapy) was seen, but parity was significantly (P = 0.05) correlated to urinary incontinence. Vaginal dryness occurred in 37% at the first visit. Vaginal dryness was experienced by 1/3 of the premenopausal women. Vasomotor symptoms were reported by 56% at the first visit and were associated with high levels of FSH and LH (P < 0.001 and P = 0.002, respectively). One third of premenopausal women reported on vasomotor symptoms. Hormone replacement therapy did not relieve hot flushes in these women.

CONCLUSIONS

Urogenital and vasomotor symptoms experienced by premenopausal women do not seem to be relieved by hormone replacement therapy.

Aggressive endometrial cancer in a young patient

An unusually aggressive case of endometrial cancer in a 30 year old woman is presented. The patient experienced abnormal uterine bleeding, at times requiring blood transfusions, for almost half a year before the diagnosis was revealed. For obvious reasons there is a reluctancy to perform invasive examinations in young women. The diagnostic options are discussed.

Human ex vivo carcinoma cells produce transforming growth factor beta and thereby can inhibit lymphocyte functions in vitro

We tested 20 human carcinoma samples for the production of transforming growth factor beta (TGFbeta) in vitro. Tumour cell suspensions without obvious contamination with non-malignant cells were kept in culture conditions for 16 h and their supernatants were added to CCL-64 cells. The proliferation of these cells is inhibited by TGFbeta. According to this assay, the supernatants contained both active and latent TGFbeta. In addition, the supernatants were found to suppress the spontaneous cytotoxic function and activation of T-cell-enriched lymphocyte populations. A specific monoclonal antibody (mAb) counteracted these effects and therefore we concluded that they were mediated to a large extent by TGFbeta. In line with the results obtained with the supernatants, activation of lymphocytes could also be inhibited by tumour cells and their inhibitory effect was weaker in the presence of the TGFbeta-specific mAb. It is important to note that, when TGFbeta-specific mAb was added to autologous mixed lymphocyte/tumour cell cultures, lymphocyte activation occurred more often. These results thus substantiate the assumption that production of TGFbeta may help the survival of potentially immunogenic tumour cells in immunocompetent patients.

HPV-types, cytological and histopathological findings in three groups of women with possible HPV-related disease

OBJECTIVE

The aim of this investigation was to study three groups of women presenting with possible HPV-infection with regard to HPV-types and cervical dysplasia.

METHODS

Eighty women were included. Eighteen of them were present partners to men with condylomas, 20 had clinical vulvar HPV-lesions and 42 were referred due to an abnormal PAP-smear. Samples for HPV-analysis by PCR-technique were taken from the vulva, the portio and the cervical canal. A universal HPV-primer as well as specific primers for HPV 6/11, 16, 18, 31, and 33 were utilized. PAP-smears were taken as well as biopsies from cervix/portio.

RESULTS

Seventy-eight percent had HPV-DNA identified. Sixty-seven percent of those with HPV 16 and/or 18 had dysplasia verified by histopathology and 50% of those with 31 and/or 33. Twenty of 21 women with dysplasia had HPV 16, 18, 31 and/or 33 identified. One woman with dysplasia was HPV-negative. Histopathologically verified CIN were diagnosed in all groups investigated. Women referred for suspicion of CIN significantly more often had HPV detected at the cervix/portio. HPV 6/11 was mostly found in women with condylomas. Apart from this the occurrence of the different HPV types were alike in the three groups.

CONCLUSION

Infection with HPV is a process and the usefulness of different diagnostic methods seems to depend on when during the course of the disease they are used. HPV-findings in women with dysplasia were all associated with oncogenic virus-types. High-risk virus was often found simultaneously with low-risk virus indicating a covariation in the acquisition of the different HPV-types.

Team building with information system departments: a hospital librarian's experience in coexisting, collaborating, and cooperating

Hospital librarians and information systems (IS) staff regard themselves as information professionals and have coexisted in the same institutions for many years. While hospital librarians have increased their computer literacy, IS staff have begun to recognize the value of knowledge-based information as an IS resource. Parallel growth and mutual interest have resulted in increased opportunities for information professionals to share skills and network for mutual advantage. Creating positive relationships between the hospital librarian and IS staff can be critical to the success of the hospital library. This paper provides a framework in which to explore the levels of relationship that exist within institutions between hospital librarians and IS staff. The "knowing/caring ladder" is presented as a model to illustrate levels of relationship and their consequences. The authors contend that recognition of the levels of professional relationship determines the success or failure of team building.

Cross-national comparisons of ageing mothers of adults with intellectual disabilities

Ageing (55+ years) mothers of adults with intellectual disabilities in the Republic of Ireland, Northern Ireland and the United States were compared with respect to three general issues. Firstly, to what extent do the adults in these three countries differ in their level of reliance on their mothers? Secondly, do the mothers differ in the extent to which they have made plans for the future care of their son or daughter with intellectual disabilities? Thirdly, do the mothers differ in physical, social and psychological well-being? These cross-national comparisons were undertaken to examine the extent to which lifelong caregiving has either a common influence on mothers across national boundaries, or, alternatively, whether the cultural context exerts a unique influence on mothers in each country. Findings supported the latter explanation, even when background characteristics were statistically controlled.

The effects of fescue toxicosis on beef cattle productivity

Consumption of tall fescue forage infested with the endophytic fungus Acremonium coenophialum can result in a condition termed "fescue toxicosis," which is characterized by decreased weight gains, milk production, conception, and serum prolactin and an inability to dissipate body heat by beef cattle. These decreases in productivity have been estimated to cost beef producers more than $600 million annually. The unthrifty appearance of cattle consuming endophyte-infected tall fescue (E+) is most evident during periods of environmental heat or cold stress, suggesting an interaction with environmental conditions. Without temperature stress, cows consumed similar amounts of E+ and endophyte-free tall fescue (E-). But, when temperatures exceeded 32 degrees C, cows that grazed E+ consumed less forage than cows that grazed E-. After removal of E+ from the diet of steers, compensatory growth was observed, indicating no long-term negative effects of E+. A decrease in serum prolactin but apparently little change in other hormones has been measured after consumption of E+. Under periods of heat stress, animals had reduced ability to dissipate body heat, and blood flow to peripheral (rib skin), core-body (duodenum colon), and brain (cerebellum) tissues was decreased. Due to the depressive effects of E+ on prolactin and heat dissipation, dopamine antagonist therapy has been used in an attempt to rectify these changes. Dopamine antagonists have increased serum prolactin but there is limited evidence to suggest an improvement in heat dissipation. Experiments to elucidate the effects of E+ on alpha-1 and -2 adrenergic receptors may also offer insights into developing strategies to overcome the negative effects of E+ consumption. Preliminary results suggest that injections of an alpha-1 adrenergic antagonist (prazosin) in rats fed E+ under 32 degrees C conditions increased DM intake and reduced rectal temperature.