Work participation, social roles, and empowerment of Q-fever fatigue syndrome patients ≥10 years after infection

OBJECTIVE

To determine work participation, social roles, and empowerment of QFS patients ≥10-year after infection.

METHODS

QFS patients ≥10-year after acute infection, who were of working age, participated in a cross-sectional survey study. Work participation, fulfilment of social roles, and empowerment outcomes were studied for the total population, as well as for subgroups based on employment type and current work status. Associations between empowerment, work and social roles were examined.

RESULTS

291 participants were included. Of the 250 participants who had paid work before Q-fever, 80.4% stopped working or worked less hours due to QFS. For each social role, more than half of the participants (56.6-87.8%) spent less time on the role compared to before Q-fever. The median empowerment score was 41.0 (IQR: 37.0-44.0) out of 60. A higher empowerment score was significantly associated with lower odds of performing all social roles less due to QFS (OR = 0.871-0.933; p<0.001-0.026), except for parenting and informal care provision (p = 0.070-0.460). No associations were found between empowerment and current work status.

CONCLUSION

Work participation and fulfilment of social roles is generally low in QFS patients. Many of the participants stopped working or are working less hours due to QFS, and most spent less time on social roles compared to before Q-fever. Minor variation was seen in total empowerment scores of participants; however, these slight differences were associated with the fulfilment of social roles, but not work participation. This new insight should be further explored in future studies.

Search for a Dark-Matter-Induced Cosmic Axion Background with ADMX

We report the first result of a direct search for a cosmic axion background (CaB)-a relativistic background of axions that is not dark matter-performed with the axion haloscope, the Axion Dark Matter eXperiment (ADMX). Conventional haloscope analyses search for a signal with a narrow bandwidth, as predicted for dark matter, whereas the CaB will be broad. We introduce a novel analysis strategy, which searches for a CaB induced daily modulation in the power measured by the haloscope. Using this, we repurpose data collected to search for dark matter to set a limit on the axion photon coupling of a CaB originating from dark matter cascade decay via a mediator in the 800-995 MHz frequency range. We find that the present sensitivity is limited by fluctuations in the cavity readout as the instrument scans across dark matter masses. Nevertheless, we suggest that these challenges can be surmounted using superconducting qubits as single photon counters, and allow ADMX to operate as a telescope searching for axions emerging from the decay of dark matter. The daily modulation analysis technique we introduce can be deployed for various broadband rf signals, such as other forms of a CaB or even high-frequency gravitational waves.

Differential effects of long-term aerobic versus cognitively-engaging physical activity on children's visuospatial working memory related brain activation: A cluster RCT

Different types of physical activity are thought to differentially affect children's brain activation, via physiological mechanisms, or by activating similar brain areas during physical and cognitive tasks. Despite many behavioral studies relying on these mechanisms, they have been rarely studied. This study looks at both mechanisms simultaneously, by examining effects of two physical activity interventions (aerobic vs. cognitively-engaging) on children's brain activation. Functional Magnetic Resonance Imaging (fMRI) data of 62 children (48.4% boys, mean age 9.2 years) was analyzed. Children's visuospatial working memory related brain activity patterns were tested using a Spatial Span Task before and after the 14-week interventions consisting of four physical education lessons per week. The control group followed their regular program of two lessons per week. Analyses of activation patterns in SPM 12.0 revealed no activation changes between pretest and posttest (p > .05), and no differences between the three conditions in pretest-posttest changes in brain activation (p > .05). Large inter-individual differences were found, suggesting that not every child benefited from the interventions in the same way. To get more insight into the assumed mechanisms, further research is needed to understand whether, when, for whom, and how physical activity results in changed brain activation patterns.

Cardiac biomarkers of disordered eating as a function of diagnostic subtypes

OBJECTIVE

The purpose of this study was to identify cardiac biomarkers of disordered eating as a function of diagnostic subtype as assessed via self-report inventory.

METHOD

Mean heart rate (HR), systolic and diastolic blood pressure, mean R wave amplitude (mV), mean T wave amplitude (mV), QTc interval (sec), Tpeak-Tend interval prolongation (sec), QTc interval prolongation (sec), QRS prolongation (sec), and spectral indicators of cardiac dysfunction (LF/HF spectral ratio, HF spectral power) were assessed via electrocardiography among women with no eating disorder symptoms (n = 32), subclinical eating disorder symptoms (n = 92), anorexia nervosa (n = 7), bulimia nervosa (n = 89), binge eating disorder (BED: n = 20), and other specified feeding and eating disorders (OSFED: n = 19).

RESULTS

MANOVA results showed statistically significant group differences. Follow-up tests revealed significantly decreased mean R wave amplitude among participants with self-indicated clinical (bulimia nervosa, binge eating disorder) and subclinical forms of disordered eating compared to asymptomatic controls.

DISCUSSION

Results suggest decreased mean R wave amplitude is a promising cardiac biomarker of disordered eating.

Relationships between gross motor skills, cardiovascular fitness, and visuospatial working memory-related brain activation in 8- to 10-year-old children

Relationships between gross motor skills and cardiovascular fitness with visuospatial working memory (VSWM) in children are hypothesized to be mediated by underlying functional brain mechanisms. Because there is little experimental evidence to support this mechanism, the present study was designed to investigate the relationships of gross motor skills and cardiovascular fitness with VSWM-related brain activation in 8- to 10-year-old children. Functional magnetic resonance imaging data obtained during a VSWM-task were analyzed for 80 children from grades 3 (47.5%) and 4 of 21 primary schools in the Netherlands (51.3% girls). Gross motor skills (Korper Koordinationstest für Kinder and Bruininks-Oseretsky Test of Motor Proficiency - 2nd Edition) and cardiovascular fitness (20-meter Shuttle Run Test) were assessed. VSWM-related brain activation was found in a network involving the angular gyrus, the superior parietal cortex, and the thalamus; deactivation was found in the inferior and middle temporal gyri. Although behavioral results showed significant relations of gross motor skills and cardiovascular fitness with VSWM performance, gross motor skills and cardiovascular fitness were not related to VSWM-related brain activation. Therefore, we could not confirm the hypothesis that brain activation underlies the relationship of gross motor skills and cardiovascular fitness with VSWM performance. Our results suggest that either the effects of physical activity on cognition do not necessarily go via changes in gross motor skills and/or cardiovascular fitness, or that brain activation patterns as measured with the blood-oxygen-level dependent (BOLD) signal may not be the mechanism underlying the relationships of gross motor skills and cardiovascular fitness with VSWM.

5222A distinct LDL profile to predict the risk of cardiovascular disease in familial hypercholesterolemia subjects: initial pre-clinical results

Aim

Cardiovascular disease development is highly variable between patients with familial hypercholesterolemia (FH). Since current risk prediction methods fail to estimate the risk of individual patients, all patients are treated with high-intensity lipid-lowering medication like statins and PCSK9-inhibitors. To prevent overtreatment (with its associated costs and side effects) of patients with a low risk, reliable biomarkers are urgently needed. While studying atherosclerosis development in an FH porcine model, we discovered a specific LDL profile that was directly associated with the severity of atherosclerosis development.

Methods

10 adult pigs with an LDLR mutation received a high-fat diet for 12 months. Atherosclerosis development in the three main coronary arteries was monitored with intravascular ultrasound (IVUS) and optical coherence tomography at three time points. After sacrifice, tissue was harvested for detailed histological analysis of the coronary plaque composition. Size-exclusion chromatography (SEC, n=10) and LC-MSMS (n=4) were used to assess the plasma lipoprotein profile, and the sphingolipid content of LDL, relative to cholesterol.

Results

Imaging and histology revealed a marked difference in pigs that developed large, lumen intruding plaques (IVUS-based plaque burden 13–77%) within 9 months (n=5) and pigs (n=5) that only developed early lesions (IVUS-based plaque burden 8–34%), even after 12 months of follow-up. The plaques seen in the fast responding pigs possessed distinct characteristics of advanced disease (i.e. heavy macrophage infiltration, large lipid-rich necrotic cores, neovascularisation, micro- and macrocalcifications and intraplaque haemorrhage, see figure). In these fast responders, fibrous cap atheroma occupied 34% of the total artery.

SEC revealed two distinct LDL subclasses: regular and “larger” LDL particles. Fast responding pigs with advanced atherosclerosis displayed a significantly higher ratio in cholesterol concentration of regular/'larger' LDL than slow responding pigs (1.7 (1.3–1.9) vs. 0.8 (0.6–1.2); (p=0.004), see figure). Compared to regular LDL, “larger” LDL contained relatively more sphingolipids in the fast responding than in the slow responding animals (regular LDL/'larger' LDL: S1P 0.5 (0.5–0.5) vs. 1.0 (0.8–1.2); Cer16:0 0.70 (0.67–0.73) vs. 1.04 (0.95–1.13); Cer18:0 0.60 (0.58–0.61) vs. 1.15 (1.13–1.16); Cer20:0 0.73 (0.73–0.74) vs. 0.94 (0.94–0.94)). “Larger” LDL particles and comparable sphingolipid ratios were also observed in FH patients. Cardiovascular data from our FH patient cohort, coupled to the LDL subclass distribution, will provide more insight into the potential of this novel biomarker.

Conclusion

A distinct difference in LDL subclasses, including a new “larger” LDL particle, was found in fast versus slow responding FH animals. This finding can potentially be used to identify FH patients at the highest risk of CVD to avoid overtreatement of low risk patients.

Acknowledgement/Funding

ERC- starter grant (grant agreement 310457)

Mindfulness and fear of hypoglycaemia in parents of children with Type 1 diabetes: results from Diabetes MILES Youth - The Netherlands

AIMS

To identify the sociodemographic and clinical correlates of fear of hypoglycaemia among parents of children (aged 4-18 years) with Type 1 diabetes and to examine the relationships between parental fear of hypoglycaemia, mindfulness and mindful parenting.

METHODS

Sociodemographic, self-reported clinical and psychological data were extracted from the cross-sectional Diabetes MILES Youth - The Netherlands dataset. Questionnaires included the Hypoglycaemia Fear Survey - Parent Worry (parental fear of hypoglycaemia), the Freiburg Mindfulness Inventory - Short version (mindfulness) and the Interpersonal Mindfulness in Parenting Scale (mindful parenting).

RESULTS

A total of 421 parents (359 mothers) participated. Hierarchical linear regression analyses showed that greater parental fear of hypoglycaemia was related to younger parental age, low educational level, non-Dutch nationality, more frequent blood glucose monitoring, and less general mindfulness. Adding mindful parenting to the model negated the previous contribution of general mindfulness. In this model, lower mindful parenting was related to greater parental fear of hypoglycaemia. In particular, parents with an increased ability to be less judgemental of themselves as parents and less reactive to emotions within parenting interactions reported less fear of hypoglycaemia. In total, 21% of the variance in parental fear of hypoglycaemia was explained.

CONCLUSION

Parental fear of hypoglycaemia was associated largely with parental characteristics, including non-modifiable sociodemographics (i.e. age, education, nationality) and modifiable psychological factors (i.e. mindful parenting). These findings suggest that it is important to further explore mindfulness-based interventions for parents to reduce fear of hypoglycaemia next to interventions to reduce hypoglycaemia.

Paediatric parenting stress in fathers and mothers of young children with Type 1 diabetes: a longitudinal study

AIM

To compare levels of paediatric parenting stress in the fathers and mothers of young children with Type 1 diabetes and study the variation in this stress over time.

METHODS

One hundred and twelve parents (56 mothers and 56 fathers) of young children (0-7 years) with Type 1 diabetes participated in this study. They completed the Pediatric Inventory for Parents to assess paediatric parenting stress (frequency and difficulty scores on the Communication, Emotional Distress, Medical Care and Role Functioning subscales and Total Score); 44 mothers (79%) and 31 fathers (55%) completed the questionnaire again, 1 year later. Independent and paired sample t-tests were used to examine the differences between fathers and mothers and the changes over time. Cohen's d effect sizes were also calculated.

RESULTS

Mothers scored significantly higher than fathers on the stress subscales for Communication frequency and difficulty, Emotional Distress frequency and difficulty, Medical Care frequency and Total Score frequency and difficulty (d ranged from -0.44 to -0.56). Furthermore, fathers reported a decrease in Medical Care frequency (d = 0.10) and an increase in Emotional Distress difficulty (d = -0.32) and Total Score difficulty (d = -0.29), whereas mothers reported a decrease in Emotional Distress frequency, Medical Care frequency and Total Score frequency (d ranged from 0.31 to 0.66) over a 1-year period.

CONCLUSIONS

These results show that within families with a young child with Type 1 diabetes, the burden of care increases in fathers and decreases in mothers, suggesting that fathers assume more responsibility for care of their child with Type 1 diabetes as the child grows.

Disrupting Mating Behavior of Diaphorina citri (Liviidae)

Severe economic damage from citrus greening disease, caused by 'Candidatus Liberibacter asiaticus' bacteria, has stimulated development of methods to reduce mating and reproduction in populations of its insect vector, Diaphorina citri (Hemiptera: Liviidae). Male D. citri find mating partners by walking on host plants, intermittently producing vibrational calls that stimulate duetting replies by receptive females. The replies provide orientational feedback, assisting the search process. To test a hypothesis that D. citri mating can be disrupted using vibrational signals that compete with and/or mask female replies, courtship bioassays were conducted in citrus trees with or without interference from female reply mimics produced by a vibrating buzzer. Statistically significant reductions occurred in the rates and proportions of mating when the buzzer produced reply mimics within 0.4 s after male courtship calls compared with undisturbed controls. Observations of courtship behaviors in the two bioassays revealed activity patterns that likely contributed to the reductions. In both disruption and control tests, males reciprocated frequently between structural bifurcations and other transition points where signal amplitudes changed. Males in the disruption bioassay had to select among vibrational signals combined from the buzzer and the female at each transition point. They often turned towards the buzzer instead of the female. There was a statistically significant reduction in the proportion of males mating if they contacted the buzzer, possibly due to its higher vibration amplitude and duration in comparison with female replies. Potential applications of D. citri mating disruption technology in citrus groves are discussed.

Long-term effects of physically active academic lessons on physical fitness and executive functions in primary school children

Integrating physical activity into the curriculum has potential health and cognitive benefits in primary school children. The aim of this study was to investigate the effects of physically active academic lessons on cardiovascular fitness, muscular fitness and executive functions. In the current randomized controlled trial, 499 second and third graders within 12 primary schools (mean age = 8.1 ± 0.7) were randomized to the intervention (n = 249) or control condition (n = 250). The physically active academic lessons were given for 2 consecutive school years, 22 weeks per year, three times a week, with a duration of 20-30 min per lesson. Multiple tests were administered before, between and after the intervention period, measuring cardiovascular fitness, muscular fitness and executive functions. Multilevel analysis accounted for the nested structure of the children within classes and schools. Results showed a larger improvement in speed-coordination (B = -0.70,P = 0.002) and a lower improvement in static strength (B = -0.92,P < : 0.001) for the intervention group compared with the control group. The current lessons did not result in a significant change in executive functions.

Development of physical fitness in children with intellectual disabilities

BACKGROUND

Few studies examined the development of physical fitness in children and youth with intellectual disabilities (ID), but the developmental patterns of physical fitness are largely unknown. The first aim was to examine physical fitness of primary school children with ID, aged 8-12, and compare the results with typically developing children in order to determine the performance level of children with ID. The second aim was to investigate the developmental trajectory of physical fitness in children with ID and the possible influence of gender and severity of cognitive impairment in a 4-year during longitudinal study.

METHOD

Seventy-three children with borderline or mild ID (51 boys, 22 girls; age range 8-11 in the year of enrolment) were measured annually on running speed, aerobic endurance (cardiovascular endurance), explosive strength, handgrip strength and trunk strength. Physical fitness scores of 515 typically developing children (266 boys, 249 girls; age range 8-12) were collected for reference values.

RESULTS

The results indicated statistically significant differences (with moderate to large Effect Sizes) between children with ID and typically developing children in all ages, favouring the typically developing children, and showed that the gap remained stable across the ages or decreased with increasing age. Multilevel models showed that the children with ID developed statistically significant on all items of physical fitness between age 8 and age 12. There was no statistically significant effect of gender on physical fitness, and the developmental trajectories were similar for boys and girls. For children with borderline and mild ID the developmental trajectories were parallel, but children with mild ID scored statistically significant worse on running speed, explosive strength and handgrip strength.

CONCLUSIONS

Despite statistically significant development of physical fitness in children with ID, their physical fitness levels should be stimulated. This should start already in young children (<8 years) and the children with the most severe cognitive impairments need special attention.

Physical fitness and academic performance in primary school children with and without a social disadvantage

This study examined the differences between children with a low socioeconomic status [socially disadvantaged children (SDC)] and children without this disadvantage (non-SDC) on physical fitness and academic performance. In addition, this study determined the association between physical fitness and academic performance, and investigated the possible moderator effect of SDC. Data on 544 children were collected and analysed (130 SDC, 414 non-SDC, mean age = 8.0 ± 0.7). Physical fitness was measured with tests for cardiovascular and muscular fitness. Academic performance was evaluated using scores on mathematics, spelling and reading. SDC did not differ on physical fitness, compared with non-SDC, but scored significantly lower on academic performance. In the total group, multilevel analysis showed positive associations between cardiovascular fitness and mathematics (β = 0.23), and between cardiovascular fitness and spelling (β = 0.16), but not with reading. No associations were found between muscular fitness and academic performance. A significant interaction effect between SDC and cardiovascular fitness was found for spelling. To conclude, results showed a specific link between cardiovascular fitness and mathematics, regardless of socioeconomic status. SDC did moderate the relationship between cardiovascular fitness and spelling.

Motor performance of children with mild intellectual disability and borderline intellectual functioning

BACKGROUND

There is a relatively small body of research on the motor performance of children with mild intellectual disabilities (MID) and borderline intellectual functioning (BIF). Adequate levels of motor skills may contribute to lifelong enjoyment of physical activity, participation in sports and healthy lifestyles. The present study compares the motor skills of children with intellectual disability (ID) to the abilities observed in typically developing children. It also aimed to determine whether there is an association between degree of ID and motor performance.

METHODS

A total of 170 children between 7 and 12 years old with MID or BIF, who attended schools for special education, were examined on the test component of the Movement Assessment Battery for Children (MABC) test. Both groups were compared with the norm scores of the total score, sub-scale scores and individual items of the MABC test.

RESULTS

Of the children, 81.8% with MID and 60.0% with BIF performed below the 16th percentile on the total score of the MABC. Both groups demonstrated a relative weakness in the area of manual dexterity. Comparisons between both groups showed small to moderate effect sizes on the total score of the MABC, as well as for all three sub-scales, favouring the children with BIF.

CONCLUSIONS

Children with ID had significantly more borderline and definite motor problems than the normative sample and there was an association between degree of ID and performance of manual dexterity, ball skills and balance skills. This study highlights the importance of improving motor skill performance in both children with borderline and mild ID, and the results support the notion that the level of motor and cognitive functioning are related in children with ID.

On the relationship between motor performance and executive functioning in children with intellectual disabilities

BACKGROUND

It has been suggested that children with intellectual disabilities (ID) have motor problems and higher-order cognitive deficits. The aim of this study was to examine the motor skills and executive functions in school-age children with borderline and mild ID. The second aim was to investigate the relationship between the two performance domains.

METHODS

Sixty-one children aged between 7 and 12 years diagnosed with borderline ID (33 boys and 28 girls; 71 < IQ < 79) and 36 age peers with mild ID (24 boys and 12 girls; 54 < IQ < 70) were assessed. Their abilities were compared with those of 97 age- and gender-matched typically developing children. Qualitative motor skills, i.e. locomotor ability and object control, were evaluated with the Test of Gross Motor Development (TGMD-2). Executive functioning (EF), in terms of planning ability, strategic decision-making and problem solving, was gauged with the Tower of London (TOL) task.

RESULTS

Compared with the reference group, the full ID cohort scored significantly lower on all assessments. For the locomotor skills, the children with mild ID scored significantly lower than the children with borderline ID, but for the object control skills and the TOL score, no significant differences between the two groups were found. Motor performance and EF correlated positively. At the most complex level, the TOL showed decision time to be a mediator between motor performance and EF: the children with the lower motor scores had significantly shorter decision times and lower EF scores. Analogously, the children with the lower object control scores had longer execution times and lower EF scores.

CONCLUSIONS

The current results support the notion that besides being impaired in qualitative motor skills intellectually challenged children are also impaired in higher-order executive functions. The deficits in the two domains are interrelated, so early interventions boosting their motor and cognitive development are recommended.

Motor skill performance of school-age children with visual impairments

The aim of this study was to examine the performance of children with visual impairments (VI) aged 7 to 10 years on different types of motor skills. Furthermore, the association between the degree of the VI and motor performance was examined. The motor performance of 48 children with VI (32 males, 16 females; mean age 8y 10mo [SD 1y 1mo]) was assessed using the Movement Assessment Battery for Children (MABC). Their performance was compared with 48 children without VI (33 males, 15 females; mean age 8y 9mo [SD 1y 1mo]). Children with VI showed the poorest performance compared with peers without VI on unimanual speed, eye-hand coordination, catching, static balance, and dynamic balance while moving slowly. There was no significant difference between children with moderate and severe VI, except for bimanual coordination in 7- to 8-year-olds and eye-hand coordination in both the 7- to 8-year-olds and 9- to 10-year-olds, favouring the children with moderate VI. The poor performance compared with children without VI is related to vision, but the degree of the VI does not appear to relate to motor performance, except when associated with bimanual and eye-hand coordination. For children with VI, it seems very important to adjust the environmental context and task to enhance motor performance.

Sick leave analysis among self-employed Dutch farmers

BACKGROUND

Agriculture is one of the most physically demanding and risky industries. Aim The objective of this study was to provide baseline data on the diagnoses, occurrence and duration of sick leave of self-employed Dutch farmers.

METHOD

A database of 22 807 sick leave claims of 12 627 farmers during the period 1994-2001 was analysed.

RESULTS

Most of the claims (61%) were for musculo-skeletal injuries and disorders. The mean cumulative incidence (CI) was 10.2 claims per year per 100 farmers and did not change over time. However, it varied per agricultural sector and per age category, being lowest in arable farming and in the youngest age category and highest in mushroom farming and in the oldest age category. The duration of sick leave depended both on diagnosis and age category: the slowest recovery from sick leave was seen in farmers with respiratory diseases and farmers in the oldest age category.

CONCLUSION

The results make it easier to identify groups of farmers to be targeted to prevent sick leave. To reduce the occurrence of sick leave in agriculture, the strategy should be to prevent musculo-skeletal injuries and disorders. Furthermore, a sector-specific approach is recommended, so that preventive actions can be focused on working conditions-specifically on workload and work safety. Efforts to shorten the duration of sick leave will also be valuable to obtain a reduction of sick leave.

The intracellular domain of cadherin-11 is not required for the induction of cell aggregation, adhesion or gap-junction formation

The cadherin family of cell adhesion molecules demonstrates calcium-dependent homophilic binding, leading to cellular recognition and adhesion. The adhesion mediated by the classical type I cadherins is strengthened through catenin-mediated coupling of the cytoplasmic domain to the cytoskeleton. This cytoskeletal interaction may not be essential for the adhesion promoted by all cadherins, several of which lack cytosolic catenin-binding sequences. Cadherin-11, a classical cadherin, possesses a cytoplasmic domain that interacts with catenins, but may also occur as a variant form expressing a truncated cytoplasmic domain. To study the role of the cytoplasmic sequence in cadherin-11 mediated adhesion we have constructed and expressed a truncated cadherin-11 protein lacking the cytoplasmic domain and unable to bind beta-catenin. Expression of the truncated cadherin-11 in MDA-MB-435S human mammary carcinoma cells reduced their motility and promoted calcium-dependent cell aggregation, frequent cell contacts, and functional gap-junctions. We conclude that the intracellular catenin-binding domain of cadherin-11, and by inference cytoskeletal interaction, is not required for the initiation and formation of cell adhesion.

Effect of preculture freezing and incubation on bacteriological isolation from subclinical mastitis samples

In this study the sensitivity of three methods of isolation of udder pathogens from milk samples from subclinical mastitis cases was compared. For analysis 1827 quarter milk samples were selected. Milk was cultured using a standard culture technique (0.01 ml of fresh milk streaked on a sheep blood agar plate and on Edward's medium). In addition, an inoculum of 0.01 ml of the original milk sample was incubated for 24h at 37 degrees C in broth, followed by culture using the standard culture technique. In the third method, the whole milk sample was frozen for 24h, and then incubated for 24h at 37 degrees C, followed by culture using standard culture technique. The isolation percentage of Staphylococcus aureus was 4.7% for standard culture technique, 14.2% for incubation in broth, and 21.5% for the combination of freezing plus incubation. Isolation percentage of Streptococcus dysgalactiae and Streptococcus agalactiae was highest using the standard culture technique, while isolation rate of Streptococcus uberis was not different among the three methods used. With increasing somatic cell count, the likelihood of S. aureus, S. dysgalactiae and S. uberis isolation increased. Based on the relative sensitivity, defined as the isolation rate using a single technique compared to the isolation rate of the three techniques together, a combination of standard culture technique and freezing plus incubation was most attractive for achieving a high isolation rate of S. agalactiae and S. dysgalactiae. Relative sensitivity of S. uberis isolation was highest using the standard culture technique and incubation in broth, while S. aureus was most often isolated using a combination of incubation in broth and freezing plus incubation. A combination of the three methods increased the isolation rate for S. dysgalactiae, S. uberis and S. aureus. The standard culture technique, together with the combination of freezing plus incubation, can be recommended for isolating major udder pathogens. If S. aureus is the pathogen of main interest, using incubation in broth together with the combination of freezing plus incubation performed best.

Intestinal mucosa on top of a rudimentary occipital meningocele in amniotic rupture sequence: disorganization-like syndrome, homeotic transformation, abnormal surface encounter or endoectodermal adhesion?

We present a case of a peculiar rudimentary occipital meningocele that was surgically removed when the patient (a boy) was 5 months of age. The patient also had distal transverse defects of both hands. The association of congenital scalp defects and distal congenital hand anomalies is relatively rare and one form is known as the Adams-Oliver syndrome. To our surprise, microscopic examination revealed intestinal mucosa on top of the skin tag containing the rudimentary meningocele. No comparable cases were found in the literature. We discuss the following possible explanations for this peculiar situation: 1) disorganization-like syndrome; 2) homeotic transformation; 3) abnormal surface encounter between the epidermis and remnants of the yolk sac or omphalo-enteric duct; and 4) endoectodermal adhesion in the presomite embryo.

In vitro antibiotic sensitivity of strains of Ornithobacterium rhinotracheale isolated in The Netherlands between 1996 and 1999

All the strains of Ornithobacterium rhinotracheale isolated in the Netherlands between 1996 and 1999 were tested in the agar gel diffusion test for their sensitivity to amoxycillin, tetracycline, enrofloxacin and trimethoprim/sulphonamide (TMP/S). The percentages of strains sensitive to amoxycillin and tetracycline decreased in successive years from approximately 62 per cent to 14 per cent, and four strains were resistant to enrofloxacin or TMP/S. Twelve multiresistant strains were tested against seven alternative antibiotics; they were resistant to all of them except clavulanic acid-potentiated amoxycillin.

Training feed-forward neural networks with gain constraints

Inaccurate input-output gains (partial derivatives of outputs with respect to inputs) are common in neural network models when input variables are correlated or when data are incomplete or inaccurate. Accurate gains are essential for optimization, control, and other purposes. We develop and explore a method for training feedforward neural networks subject to inequality or equality-bound constraints on the gains of the learned mapping. Gain constraints are implemented as penalty terms added to the objective function, and training is done using gradient descent. Adaptive and robust procedures are devised for balancing the relative strengths of the various terms in the objective function, which is essential when the constraints are inconsistent with the data. The approach has the virtue that the model domain of validity can be extended via extrapolation training, which can dramatically improve generalization. The algorithm is demonstrated here on artificial and real-world problems with very good results and has been advantageously applied to dozens of models currently in commercial use.

Massive biatrial myxomas in a child

Cardiac myxomas are rarely diagnosed in children, and biatrial tumors are an unusual presentation in any age group. An 8-year-old boy with massive biatrial cardiac myxomas, who presented in acute cardiogenic shock with no preceding cardiac symptomatology, is reported.

Beyond labeling: the role of maternal input in the acquisition of richly structured categories

Recent research shows that preschool children are skilled classifiers, using categories both to organize information efficiently and to extend knowledge beyond what is already known. Moreover, by 2 1/2 years of age, children are sensitive to nonobvious properties of categories and assume that category members share underlying similarities. Why do children expect categories to have this rich structure, and how do children appropriately limit this expectation to certain domains (i.e., animals vs. artifacts)? The present studies explore the role of maternal input, providing one of the first detailed looks at how mothers convey information about category structure during naturalistic interactions. Forty-six mothers and their 20- or 35-month-old children read picture books together. Sessions were videotaped, and the resulting transcripts were coded for explicit and implicit discussion of animal and artifact categories. Sequences of gestures toward pictures were also examined in order to reveal the focus of attention and implicit links. drawn between items. Results indicate that mothers provided a rich array of information beyond simple labeling routines. Taxonomic categories were stressed in subtle and indirect ways, in both speech and gesture, especially for animals. Statements and gestures that linked two pictures were more frequent for taxonomically related animal pictures than for other picture pairs. Mothers also generalized category information using generic noun phrases, again more for animals than for artifacts. However, mothers provided little explicit discussion of nonobvious similarities, underlying properties, or inductive potential among category members. These data suggest possible mechanisms by which a notion of kind is conveyed in the absence of detailed information about category essences.

CCU patient survey tool: all-out recovery

Studies show that patients' recall of their CCU stays is extremely limited due to various factors. To monitor patient satisfaction in this area, a team of CCU managers developed a survey and began an "All-Out Recovery Program."

Feasibility of prenatal diagnosis and carrier detection in South African haemophilia A patients

The feasibility of DNA diagnosis for haemophilia A was tested in South African patients and families by screening for the common inversion mutation in the factor VIII gene and for the intragenic microsatellite markers in introns 13 and 22. The allele frequencies at the two microsatellite loci were significantly different, with informativity being higher in the Negroid (100%) than the Caucasoid group (67%). In severely affected haemophiliacs the inversion was found in 43% (6/14) of Negroids but in only 32% (13/41) of Caucasoids. Presence of a second common unidentified mutation may account for the low frequency in the latter. Haplotype analysis shows a disproportionately high frequency of an (AC)20 intron 13-(AC)26 intron 22 inversion negative Caucasoid haemophilia chromosome, supporting a founder effect.

Outcomes measurement and management with a large Medicaid population: a public/private collaboration

Recipients, consumer advocates and purchasers expect managed care companies, in partnership with their provider networks, to measure and to continuously improve quality of care. This task is especially challenging when the beneficiaries of that care are covered by a publicly funded program. Yet this will be an increasingly common occurrence as more states contract with managed care companies for the care management of their Medicaid populations. In this article, the authors describe the outcomes measurement and management program of the first statewide managed Medicaid behavioral health carve-out program. Much of the foundation of that program has been built through collaborative efforts between the Massachusetts Division of Medical Assistance as purchaser, MHMA as managed care vendor, recipients, providers and other stakeholders. The authors report on the FMH/MHMA experience and what they learned. The principles derived from this outcomes program may be helpful to other states and to managed care companies undertaking similar public/private partnerships.

Preservation of sustainable inspiratory muscle pressure at increased end-expiratory lung volume

Previous studies in isolated muscles have shown that decreases in muscle length reduce the loss of force resulting from fatigue in response to repeated maximal stimulations. However, increases in end-expiratory lung volume (EEV), which presumably decrease the length of the inspiratory muscles, appear to make the inspiratory muscles more susceptible to fatigue. To address this paradox, we studied the influence of changes in EEV on inspiratory muscle fatigue resulting from repeated maximal voluntary inspirations for 15 min in normal humans. Tidal volume and breath timing were constant between runs. Fatigue runs were compared with atmospheric, positive or negative pressures applied to the mouth, sufficient to change EEV by approximately +30% or -20% of inspiratory capacity. Although the maximal initial pressure-time product for the inspiratory muscles (PTmus) was reduced by increased EEV, sustainable PTmus was not significantly affected. In contrast, both initial and sustainable pressure-time products for the diaphragm were reduced at elevated EEV. The rate at which the fatigue process developed was also reduced at increased EEV. There were no significant effects of decreased EEV on any measured pressures. We conclude that when EEV is elevated, within a moderate range, sustainable inspiratory muscle pressure is preserved. However, the contribution of the diaphragm to inspiratory pressure development during fatigue may be uniquely compromised by increased EEV.

Transfusion-related human immunodeficiency virus in patients with haemophilia in Johannesburg

Tests were carried out on 198 patients with inherited coagulation disorders attending haemophilia clinics of Johannesburg and Baragwanath Hospitals for the prevalence of antibodies to the human immunodeficiency virus (HIV). This cohort of patients has been treated with locally produced (South African) blood products from volunteer donors, except for a 15-month period in 1982-1984 when, owing to a shortage of locally produced material, an imported large donor-pool US factor VIII concentrate was used. Not all patients received this material. Of the haemophilia A patients who received the imported factor VIII concentrate, 85% were seropositive, while only 3% of the patients who received locally produced small donor-pool products were seropositive. No factor VIII-deficient patients have seroconverted while using small donor-pool products, since the introduction of routine screening of blood donations and strict exclusion criteria of donors. However, despite testing of blood products, 3 patients receiving locally produced factor IX concentrate (4,000 donors) seroconverted in 1988, having previously been HIV-negative. Factors influencing the choice of blood products to be used, especially in South Africa, are discussed.

Biochemical characterisation of the haemophilias on the Witwatersrand

Blood samples obtained from patients on the Witwatersrand with haemophilia A, haemophilia B and von Willebrand disease were analysed. Factor activities were assayed by conventional methods. Immunoradiometric assay using labelled monoclonal anti-VIIIC:Ag was developed to assay factor VIIIC:Ag in haemophilia A. Factor IX:Ag levels were determined by a commercial ELISA kit. Multimer pattern analysis of von Willebrand factor was performed by agarose gel electrophoresis and Western blotting. In 43 patients haemophilia A was severe, in 8 it was moderate and in 2 it was mild. Factor VIIIC:Ag was undetected in 36 haemophiliacs (CRM-) while VIIIC:Ag was detected in levels exceeding or correlating with those of VIII:C in 17 cases (CRM+). Four severe, CRM- haemophiliacs were found to have inhibitors. An assay of IX:Ag in 6 severely and 2 moderately affected patients with haemophilia B revealed 6 to be CRM- while 2 were CRM+. Multimer pattern analysis was performed on 11 von Willebrand disease patients, of which 5 were type I, 5 were type II and 1 was type III. More informative techniques for the diagnosis and classification of haemophilia are now available. In addition, these results will assist in further molecular studies of these disorders.

Comparison of diltiazem and hydrochlorothiazide for treatment of patients 60 years of age or older with systemic hypertension

This randomized, double-blind, parallel design trial compared the efficacy and safety of monotherapy with either sustained-release diltiazem or hydrochlorothiazide in 61 men greater than or equal to 60 years of age with a diastolic blood pressure (BP) between 94 and 104 mm Hg. BP, heart rate, laboratory blood and urine tests, left ventricular wall thickness and mass index (as estimated by M-mode echocardiography) and rate and type of ventricular premature complexes (via ambulatory electrocardiographic monitoring) were determined before, during and after drug treatment. Both drugs produced highly significant (p less than 0.001) decreases in supine and upright systolic and diastolic BP. The mean dosages of diltiazem and hydrochlorothiazide used were 260 and 52 mg/day, respectively; at these dosages, 80% of diltiazem-treated versus 71% of hydrochlorothiazide-treated patients achieved goal reduction in BP (supine diastolic BP reduction of greater than 10 mm Hg and to less than 90 mm Hg). Both drugs were well tolerated, although hydrochlorothiazide therapy was associated with multiple biochemical abnormalities not seen with diltiazem. Neither drug affected left ventricular mass index or the rate of ventricular ectopic activity. Diltiazem and hydrochlorothiazide are both effective and safe agents when used as monotherapy in older patients with systemic hypertension unaccompanied by other clinically significant cardiovascular disease.

Summer diarrhoea in African infants and children

Of 70 black South African infants and children with acute summer diarrhoea, 30 (43%) were infected with enteropathogenic serogroups of Escherichia coli (EPEC), 13 (19%) with enterotoxigenic Gram-negative bacilli, 12 (17%) with Salmonella sp., 6 (9%) with Shigella sp., and 3 (4%) with rotaviruses. 13 (19%) patients were infected simultaneously with more than one enteropathogen, and no pathogen was detected in 22 (31%). In addition, 6 (15%) of 41 unselected patients were excreting Campylobacter fetus. Of 30 age-matched controls drawn from the same population, 5 (17%) were infected with EPEC serotypes, and 1 each with Salmonella sp. and rotavirus. This study stresses the polymicrobial nature of paediatric diarrhoea in a developing community and shows the continued importance of EPEC in this setting.

Detection of enteric campylobacteriosis in children

Campylobacter fetus subsp. jejuni was recovered as the sole bacterial pathogen from 31% of 0- to 8-month-old children with acute gastroenteritis and from 5% of asymptomatic children (P less than 0.05). In children 8 to 24 months old, the respective recovery rates were 38 and 40%. With the exception of one case of simultaneous bacteremia, the clinical course of the symptomatic infection was benign and rarely lasted more than a week. The isolates were sensitive to most commonly used antibiotics. Several isolates shared antigenic determinants with C. fetus subsp. intestinalis. A bacteriophage specific for C. fetus subsp. jejuni lysed 73% of the strains. Several phage-resistant isolates carried a phage that lysed the stock strain of C. fetus subsp. jejuni (NADC 917).

A microbiological study of gastro-enteritis in Black infants

A survey was carried out to determine the aetiological agents responsible for acute gastro-enteritis in Black infants. Bacteriological examination of 191 patients and 178 age-matched controls showed that salmonellae and shigellae together accounted for only 15% of cases and were harboured by almost 7% of controls. Seropositive 'enteropathogenic' Escherichia coli was an important cause of diarrhoea, especially in the summer months. Enterotoxin-producing E. coli was not a significant cause of gastro-enteritis in this study. This study suggests that routine serotyping of E. coli from infantile gastro-enteritis should be continued until the relationship of serotype and enterotoxigenicity with enteropathogenicity has been established. Rotaviruses were detected by electron microscopy in 14,4% of children. The clinical features associated with the different infectious agents are described.

A comparative study of tuberculin tine and Mantoux tests

The tuberculin tine (old tuberculin) and the Mantoux (stabilised purified protein derivative-PPD) tests were compared by using them in two simultaneous skin tests on patients with tuberculosis. The tine is sterile, disposable, and easy to administer and the agreement between the two tests was satisfactory. The tuberculin tine test is recommended as a useful screening test when tuberculosis is suspected.