Participatory monitoring in community-based fisheries management through a gender lens

In small-scale fisheries management, the significance of participation is widely recognised but we are still learning how this can be better operationalised to include different groups, such as women or Indigenous peoples. Participatory monitoring is one tool which has been used to increase participation in fisheries management. The aim of this review is to use critical interpretive synthesis to examine the literature on participatory monitoring within community-based fisheries management from a gender perspective. The synthesis identified and discussed several key areas: reasons presented in the literature for engaging with the themes of gender or participatory monitoring, gendered aspects of participatory monitoring, knowledge valuation and prioritisation in management, replicability and transparency of programme or research methods, and marginalisation narratives. Our findings show the complexities of conducting gender-aware participatory monitoring. Participatory monitoring has the potential to be a transformative and empowering process if the power dynamics involved are considered and addressed.

A framework for evaluation of on-farm mastitis diagnostics in Australia

Numerous culture-based diagnostics are available on the Australian and international markets for on-farm detection of bacterial pathogens in milk. Use of such diagnostics may provide an opportunity to improve the prudent use of antimicrobials in udder health management. Farms are low-resource settings in terms of diagnostic microbiology capacity. The World Health Organisation has identified criteria for the evaluation of diagnostic tests in low resource settings based on Accuracy, Sensitivity, Specificity, User-friendliness, being Rapid or Robust, Equipment-free and being Deliverable (ASSURED). Here, we review how those criteria can be interpreted in the context of microbiological diagnosis of mastitis pathogens, and how on-farm diagnostics that are currently available in Australia perform relative to ASSURED criteria. This evaluation identifies multiple trade-offs, both with regard to scientific criteria and with regards to convenience criteria. More importantly, the purpose of testing may differ between farms, and test performance should be evaluated relative to its intended use. The ability of on-farm mastitis diagnostics to inform mastitis treatment decision-making in a timely and cost-effective manner depends not just on test characteristics but also on farm-specific pathogen prevalence, and on the farm enterprise's priorities and the farm manager's potential courses of action. With most assay evaluations to date conducted in professional laboratories, there is a surprising dearth of information on how well any of the diagnostic tests perform on-farm and, indeed, of the on-farm decision-making processes that they aim to inform.

Goals, challenges, and next steps in transdisciplinary fisheries research: perspectives and experiences from early-career researchers

Fisheries are highly complex social-ecological systems that often face 'wicked' problems from unsustainable resource management to climate change. Addressing these challenges requires transdisciplinary approaches that integrate perspectives across scientific disciplines and knowledge systems. Despite widespread calls for transdisciplinary fisheries research (TFR), there are still limitations in personal and institutional capacity to conduct and support this work to the highest potential. The viewpoints of early career researchers (ECRs) in this field can illuminate challenges and promote systemic change within fisheries research. This paper presents the perspectives of ECRs from across the globe, gathered through a virtual workshop held during the 2021 World Fisheries Congress, on goals, challenges, and future potential for TFR. Big picture goals for TFR were guided by principles of co-production and included (i) integrating transdisciplinary thinking at all stages of the research process, (ii) ensuring that research is inclusive and equitable, (iii) co-creating knowledge that is credible, relevant, actionable, and impactful, and (iv) consistently communicating with partners. Institutional inertia, lack of recognition of the extra time and labour required for TFR, and lack of skill development opportunities were identified as three key barriers in conducting TFR. Several critical actions were identified to help ECRs, established researchers, and institutions reach these goals. We encourage ECRs to form peer-mentorship networks to guide each other along the way. We suggest that established researchers ensure consistent mentorship while also giving space to ECR voices. Actions for institutions include retooling education programs, developing and implementing new metrics of impact, and critically examining individualism and privilege in academia. We suggest that the opportunities and actions identified here, if widely embraced now, can enable research that addresses complex challenges facing fishery systems contributing to a healthier future for fish and humans alike.

Suitability of somatic cell count, electrical conductivity, and lactate dehydrogenase activity in foremilk before versus after alveolar milk ejection for mastitis detection

Mastitis is responsible for substantial economic loss and significant animal welfare concerns for the dairy industry. Sensors that measure electrical conductivity (EC) and enzyme concentrations of lactate dehydrogenase (LDH) are presently used for automatic detection of mastitis. However, EC is not sensitive enough to detect mastitis, and the ability of LDH activity to identify mastitis caused by different pathogens is a potential option that needs to be investigated. This study was conducted to test the following hypotheses: (a) strict foremilk before milk ejection is more informative in detecting mastitis, in general, than foremilk removed after cows were stimulated for milk ejection; and (b) the value of LDH activity as a mastitis indicator depends on the type of pathogen associated with the infection. Milk samples (before afternoon milking) from 48 Holstein-Friesian cows at the University of Sydney's dairy farm (Camden, New South Wales, Australia) with EC > 7.5 mS/cm in any of the 4 quarters were collected over a period of 2 mo. Quarter milk samples (n = 343) from 48 cows were collected manually in the automatic milking rotary in 3 steps: foremilk before (strict foremilk) and after milk ejection, followed by an aseptic sample for bacteriological culture. The EC (mS), LDH (U/L), SCC (cells/mL), and milk protein and fat content (%) of foremilk in both sampling times were compared and used as predictors for gram-positive and gram-negative mastitis. Quarter (n = 515) observations from 44 cows were analyzed using a logistic mixed or linear mixed model, with cow and quarter nested within cow as random effects. Milk from both sampling times was also assessed by producing a receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC) to determine ability to detect mastitis. Overall, EC and LDH were greater and milk protein (%) was lower in strict foremilk than in milk fractions obtained after milk ejection. Data from strict foremilk samples had slightly higher AUC values (0.98 to 0.99 vs. 0.97 to 0.98, respectively) than did the after-ejection milk samples. Although gram-negative coliform mastitis had significantly higher LDH activity than did gram-positive mastitis (6.19 vs. 5.34 log₁₀ U/L), the robustness of this result is questionable due to limited sample size. We concluded that milk samples taken before ejection can influence major mastitis indicators, suggesting that automatic milking system sensors could be modified to monitor milk before ejection for more efficient mastitis detection.

Quantitation of spatial and temporal variability of biomarkers for Barrett's Esophagus

Chemoprevention and risk-stratification studies in Barrett's esophagus (BE) rely on biomarkers but the variability in their temporal and spatial expression is unknown. If such variability exists, it will impact sampling techniques and sample size calculations. Specimens from three levels of biopsies over two serial endoscopies in nondysplastic BE patients were analyzed for aneuploidy, proliferation markers (Ki67, Mcm2), and cell cycle markers (cyclin A and cyclin D1). A modification of the image cytometry technique, where cytokeratin staining automatically distinguished epithelial and stromal cells, measured aneuploidy on whole tissue sections. Other biomarkers were studied by immunohistochemistry. Coefficient of variability (SD/mean) was calculated; a value <10% indicated low variability. A total of 120 specimens (20 subjects each with three biopsy levels at two time points) from nondysplastic BE patients (71 ± 8.8 years, all Caucasian, 90% males, C5.1M7.5 ± 3.4 cm) were analyzed. The mean interval between endoscopies was 32.8 ± 8.4 months. Aneuploidy had a spatial variability of 6.8% at visit 1 (mean diploid index: 1.1 ± 0.09) and 7.9% at visit 2 (mean diploid index: 1.1 ± 0.06) and a temporal variability of 7.0-8.1% for the three levels. For other biomarkers, the spatial variability ranged from ∼5 to 30% at visit 1 and 11-92% at visit 2 and the temporal variability ranged from 0 to 77%. To conclude, of all the biomarkers, only aneuploidy had both spatial and temporal variability of <10%. Spatial and temporal variability were biomarker dependent and could be as high as 90% even without progression. These data will be useful to design chemoprevention and risk-stratification studies in BE.

Presence or absence of intestinal metaplasia but not its burden is associated with prevalent high-grade dysplasia and cancer in Barrett's esophagus

Universal agreement on the inclusion of intestinal metaplasia to diagnose Barrett's esophagus (BE) is lacking. Our aim was to determine the association of intestinal metaplasia and its density with the prevalence of dysplasia/cancer in columnar lined esophagus (CLE). Patients with CLE but no intestinal metaplasia (CLE-no IM) were identified by querying the clinical pathology database using SNOMED codes for distal esophageal biopsies. CLE-IM patients were identified from a prospectively maintained database of BE patients. Subsequently, relative risks for prevalent dysplasia and cancer were calculated. Since patients with CLE-no IM are not usually enrolled in surveillance, only prevalent dysplasia/cancer on index endoscopy was analyzed. Goblet cell density and percent intestinal metaplasia were estimated. All biopsy slides were reviewed for dysplasia by two experienced gastrointestinal pathologists. Two hundred sixty-two CLE-IM and 260 CLE-no IM patients were included (age 64±12 vs. 60±11 years, P=0.001; whites 92% vs. 82%, P=0.001; males 99.7% vs. 99.3%, P=NS; CLE length 3.4±3.2 vears 1.4±0.4 cm, P=0.001 and hiatus hernia 64% vs. 56%, P=0.013). The odds of finding low-grade dysplasia and of high-grade dysplasia (HGD)/cancer were 12.5-fold (2.9-53.8, P=0.007) and 4.2-fold (95% CI 1.4-13, P=0.01) higher, respectively, in the CLE-IM group. Reanalysis after controlling for important variables of age, race, and length did not significantly alter the overall results. In CLE-IM group, when patients with high (>50/LPF) versus low goblet cell density (<50/LPF) and <10% versus >10% intestinal metaplasia were compared, the odds of HGD/cancer, OR 1.5 (0.5-4.9, P=0.5) and 1.97 (0.54-7.22), respectively, were not significantly higher. Demonstration of intestinal metaplasia continues to be an essential element in the definition of BE, but its quantification may not be useful for risk stratification of HGD/cancer in BE.

Earthy odor compounds production and loss in three cyanobacterial cultures

Geosmin and 2-methylisoborneol (MIB) related odor events caused by cyanobacteria have been a very common problem to water supply. This paper investigated the effects of temperature (18 and 25 °C) and light intensity (10 and 100 μmol photons m(-2) s(-1)) on the production behaviors of earthy odor compounds by three odorous cyanobacteria, i.e., the geosmin-producing planktonic Anabaena circinalis (Ana 318), geosmin-producing benthic Phormidium amoenum (Pho 012) and MIB-producing benthic Phormidium sp. (Pho 689). At the same time, the effects of biodegradation and volatilization on the fates of the released odor compounds in water were also evaluated. The combination of high temperature (25 °C) and light intensity (100 μmol photons m(-2) s(-1)) favored the growth of the three cyanobacteria and the production of chl-a and odor compounds. However, higher chl-a and odor yields (average odor compounds per cell) were achieved for the two benthic cyanobacteria at the temperature of 18 °C. Most of geosmin was included within the cells for Ana 318 (95-99%) and Pho 012 (85-60%), while only 20-40% MIB was bound to the cells for Pho 689. The half-life times of MIB and geosmin due to volatilization varied between 18.8 and 35.4 days, while 8 out of 10 samples exhibited a half-life time (t(1/2)) for geosmin biodegradation shorter than 1 day (0.38-15.0 h), showing that biodegradation could affect the fate of geosmin significantly in aquatic environments. In comparison, biodegradation of MIB was much slower (t(1/2): 122-2166 h). Denaturing gradient gel electrophoresis (DGGE) analysis showed that Pseudomonas- and Sphingomonas-like bacteria coexisted with cyanobacteria in the cultures, and may have played an important role in geosmin/MIB biodegradation. The result of this study will be helpful for better understanding and managing the earthy odor problems caused by cyanobacteria in water supply.

A case of epigastric heteropagus twinning with other congenital abnormalities in a Chihuahua puppy

A two-year-old Chihuahua was presented on day 58 of pregnancy due to very marked abdominal distension. A cesarean section was performed and five normal and one clearly abnormal puppy were delivered. Examination of the abnormal puppy revealed a combination of congenital anomalies including epigastric heteropagus twinning. The autosite showed focal cranial aplasia cutis, anasarca, lissencephaly, palatoschisis, sternal agenesis and eventeratio (gastroschisis/schistocoelia). The partly formed parasitic twin was attached at the sternal region of the autosite and demonstrated four formed limbs, atresia rectum, atresia ani, a single kidney, tail agenesis and atresia vulvae. To the authors’ knowledge, this is only the third reported case of heteropagus conjoined twinning in the dog and the first reported case of canine epigastric heteropagus twinning. In addition, there appear to be no reports in the veterinary literature noting an association with conjoined twinning in the dog with focal cranial aplasia cutis, eventeratio, lissencephaly, palatoschisis and anasarca. An in-depth literature review was hampered by the lack of a uniform nomenclature to identify this type of conjoined twinning.

"A computer isn't gonna judge you": a qualitative study of users' views of an internet-based cognitive behavioural guided self-care treatment package for bulimia nervosa and related disorders

Little is known about what determines uptake and acceptability of internet-based treatments in eating disorders, and users' experience with such treatments. We investigated these factors in participants of a randomized controlled trial of an internet-based cognitive- behavioural treatment (iCBT) package (Overcoming bulimia online). Nine participants were interviewed using purposive sampling. The content of interviews were analyzed using thematic analysis. Additionally, participants received questionnaires about their impressions of iCBT. Participants talked about their experience of using iCBT, its impact and compared it to other treatments. Questionnaire responses echoed themes identified in the interviews. iCBT was received positively as a way of fitting treatment into busy lives. Comments on the layout of some of the package content and the practitioner support offered were identified as areas that could be modified or improved.

Exposure to fine particulate matter and acute effects on blood pressure: effect modification by measures of obesity and location

BACKGROUND

Observational studies and controlled experiments have provided evidence that airborne particulate matter (PM) is capable of acutely increasing blood pressure (BP) in certain scenarios. The goal of this study was to evaluate whether and to what extent obesity and community location affect relationships between fine particulate matter (PM(2.5)) and blood pressure (BP) measures.

METHODS

Using data from a stratified random sample survey of adults conducted in 2002-3 in Detroit, Michigan, we tested body mass index (BMI) and waist circumference (WCIR) in separate models as effect modifiers of the relationship between PM(2.5) exposure and BP. We also tested interactions with community location. Models were adjusted for covariates with established pro-hypertensive effects.

RESULTS

PM(2.5) exposure was positively associated with increased pulse pressure (PP) for those categorised as obese (BMI> or =30) across lags 2 (beta 4.16, p<0.05) and 3 days (beta 2.55, p<0.05) prior to BP measure. WCIR similarly modified the effect of exposure to PM(2.5) on PP (beta 4.34, p<0.003). The observed effects were enhanced in the community with closer proximity to local emissions of PM(2.5), and for residents classified as obese (BMI> or =30) or with WCIR above high-risk cuts points.

CONCLUSIONS

This community-based study suggests that positive associations between PM(2.5) exposure and PP and systolic BP are enhanced in areas proximate to sources of PM (2.5) emissions. These patterns were observed for all residents, but were more visible and consistent among those who were obese. Research is needed to examine the mechanistic pathways by which air particles interact with obesity and location to affect BP, and inform community interventions to reduce the population burden of hypertension and related co-morbidities.

A randomized controlled trial of internet-based cognitive-behavioural therapy for bulimia nervosa or related disorders in a student population

BACKGROUND

Bulimic eating disorders are common among female students, yet the majority do not access effective treatment. Internet-based cognitive-behavioural therapy (iCBT) may be able to bridge this gap.

METHOD

Seventy-six students with bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) were randomly assigned to immediate iCBT with e-mail support over 3 months or to a 3-month waiting list followed by iCBT [waiting list/delayed treatment control (WL/DTC)]. ED outcomes were assessed with the Eating Disorder Examination (EDE) at baseline, 3 months and 6 months. Other outcomes included depression, anxiety and quality of life.

RESULTS

Students who had immediate iCBT showed significantly greater improvements at 3 and 6 months than those receiving WL/DTC in ED and other symptoms.

CONCLUSIONS

iCBT with e-mail support is efficacious in students with bulimic disorders and has lasting effects.

The effect of healthcare provider education on diabetes management of hospitalised patients

BACKGROUND

The importance of optimising blood glucose (BG) control in hospitalised patients is widely accepted. To determine whether focused education of physicians and nurses would result in measurable changes in glycaemic control, the effect of a diabetes-focused educational programme on point of care (POC) BG measures was monitored.

METHODS

This programme included 2 h symposium and 2 h interactive session. The POC BG measures were determined at 2-month period prior to implementing the programme and the ensuing 7 months after. Outcome parameters included the mean BG values, the incidence of hyperglycaemia (BG > 180 mg/dl) and hypoglycaemia (BG < 60 mg/dl). The outcome parameters were analysed by comparing the Internal Medicine (target service) to other such as Neurology and Surgical Trauma where no programme was offered.

RESULTS

On Internal Medicine, the mean BG decreased soon after implementing the programme and stayed lower than the baseline values over 7 months. The changes were significant at the third, fourth, seventh and the ninth month of the study. Hyperglycaemia decreased significantly (p < 0.05) on the third, fourth, seventh and eighth month, while hypoglycaemia increased following the education programmes. On Neurology and Surgical Trauma, the mean BG values were significantly higher, and hypoglycaemia was significantly lower during the same time frame.

CONCLUSIONS

Implementing an educational programme for healthcare providers had significant effects on the lowering of mean BG values and the incidence of hyperglycaemia, but increased the risk of hypoglycaemia. The merits of such programmes need to be tested before their widespread implementation.

Assessing airway patency and breathing in NBC category 4R--the RG method

INTRODUCTION

Confirming airway patency and the presence of breathing has significant limitations when both the casualty and medical personnel are in NBC category 4R. In casualties with limited signs of breathing, IPE may adversely affect the efficiency of clinical assessment, and when the triage sieve is used this could result in the misdiagnosis of death. This manuscript describes and evaluates the Respirator-Glove (RG) method, of assessing airway patency and breathing in NBC category 4R.

METHODS

A medical examination glove was fitted over the primary speech module of the S10 NBC respirator of a volunteer casualty dressed in 4R. Two groups were studied; the first used an intact glove the second used a glove minus one finger. Breathing patterns A, B and C, representing normal breathing, hypoventilation and apnoea respectively, were randomly performed by the casualty for 15 seconds. A blinded observer recorded the glove inflation and movement and using these signs determined if breathing was present.

RESULTS

All of the randomly performed breathing pattern simulations were correctly identified in both groups, with glove inflation only occurring during exhalation. In the perforated glove group, the large expiratory air leak through the hole limited the development of continuous positive airway pressure and the respirator seal was maintained. In the non-perforated glove group the respirator seal was compromised. No difficulty was encountered attaching the gloves to the respirator speech module.

DISCUSSION

As an aid to clinical examination, the Respirator-Glove (RG) method provides a reproducible visual assessment of airway patency and spontaneous ventilation in unconscious 4R casualties. It can be utilised at any point in the evacuation chain, may improve the identification of T1 casualties and could reduce the risk of death being misdiagnosed. The efficiency of clinical assessment in 4R will improve by introducing the RG method into CBRN medical training programmes.

Rural residents' utilisation of health and visiting specialist health services

INTRODUCTION AND OBJECTIVES

The purpose of the study was to identify the demographic and health service characteristics impacting on rural residents' utilisation of health and visiting specialist services in Western Australia.

METHOD

Focus group discussions were held with an age-stratified, randomly selected group of forty-eight residents in four rural Western Australian towns between May and June 2000.

RESULTS

Discussions revealed a preference to use local health services for basic care and to travel for the treatment of major or severe illnesses. The focus group participants supported visiting specialist services, indicating a willingness to use them for consultations, diagnostic and minor procedures. Utilisation of visiting services was conditional on the provision of information on specialist reputation, service outcomes, integration of the service into local facilities, and recommendation by the local general practitioner.

CONCLUSION

Numerous factors influence the service-seeking behaviour of rural patients. These factors need to be recognised and considered in the design and promotion of resident and visiting specialist services if the migration for health care is to be rationalised.

Costs of accessing surgical specialists by rural and remote residents

INTRODUCTION

Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting.

METHODS

A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non-clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan-based service.

RESULTS

An estimated saving of AU$1,077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time.

CONCLUSION

The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available.

The relative cost of outpatient telemedicine services

OBJECTIVE

This study compares the costs of offering outpatient care to primarily orthopedic and dermatology patients via live, interactive telemedicine to the estimated costs of direct face-to-face care for the same patients.

MATERIALS AND METHODS

A simple, yet detailed methodology was used to evaluate the cost of adding telemedicine to a health care delivery system, using a "hub-and-spoke" model located in Minnesota. The costs and cost savings of telemedicine were evaluated from the perspectives of patients, providers, insurers, employers, and society as a whole. Sensitivity analysis was used to investigate the impact of various factors on the model.

RESULTS

The variable cost of a telemedicine referral was $144, versus an estimated face-to-face referral cost of $183. Reductions in patient travel costs and in lost employee productivity were the principal benefits of the system. The break-even point, where total costs equal total cost savings, equalled 1,449 consultations annually. Sensitivity analyses indicated that the breakeven point varies from a low of 152 telemedicine consultations for a "best case" scenario to no possible breakeven point for a "worst case" scenario.

CONCLUSIONS

At the system's current level of 300 consultations per year, the telemedicine system is estimated to add $45,000 to society's costs of providing medical care for these patients. The additional cost is primarily due to personnel expenses and an increase in the volume of specialty care. Patients see specialists more often due to improved access to care and lower transportation costs. Providers bear the cost while patients and employers enjoy substantial savings.

Improving basic surgical skills for final year medical students: the value of a rural weekend

BACKGROUND

Hospitals employing medical graduates often express concern at the inexperience of new interns in basic surgical skills. In self assessment questionnaires, our senior medical students reported little clinical procedural experience. A practical skills workshop was staged in order to set learning goals for the final study year. This gave the students an opportunity to learn, revise and practice basic surgical techniques.

METHOD

The Bruce Rock rural community sponsored a surgical camp at the beginning of the academic year. Ninety-five (80%) of the class registered at the workshop, which rotated them through teaching modules, with private study opportunities and the capacity to cater for varied skill levels. Eight teaching stations with multiple access points were provided, and ten mock trauma scenarios were staged to augment the learning process.

RESULTS

The teaching weekend was rated by students on an evaluative entrance and exit questionnaire. Sixty-five (73%) students returned questionnaires. They recorded significant improvement (P < 0.05) in their ability to handle the teaching stations. All students had inserted intravenous lines in practice prior to the camp, so the rating change in intravenous line insertion ability was not statistically significant.

CONCLUSIONS

The weekend retreat offers students a chance to focus on surgical skills, free from the pressures of a clinical setting or the classroom. The emphasis was on the value of practice and primary skills learning. Students endorsed the camp as relevant, practical and an enjoyable learning experience for basic surgical skills.

Split flexor pollicus longus tendon transfer for stabilization of the thumb interphalangeal joint: a cadaveric and clinical study

The split flexor pollicus longus (FPL) tendon transfer is a surgical technique using the radial half of the FPL tendon rerouted dorsally and inserted into the extensor pollicis longus tendon for correction of Froment's sign. A cadaveric model was designed to investigate the effects of the split FPL tendon transfer on pinch strength. Pinch strength was compared for extrinsic thumb flexion (1) without the split FPL and (2) with the split FPL, tensioned at 3 different positions (0 degrees flexion, 30 degrees flexion, and 60 degrees flexion). We report the clinical results of key pinch strength using split FPL tendon transfer as part of thumb reconstruction for 12 thumbs in 10 patients at an average follow-up time of 2 years. The cadaveric study showed no significant difference in pinch force between specimens with or without split FPL transfer or when comparing tensioning at 0 degrees versus 30 degrees versus 60 degrees. Froment's sign wa s reproduced in all cadavers with pinch activation without split FPL transfer and was eliminated in all specimens after the split FPL transfer. In the clinical portion of this study 12 transfers in 10 patients had an average follow-up pinch strength of 33.7 N (range, 18-80 N) and no evidence of Froment's sign. We conclude that the split FPL tendon transfer is an effective method for correction of Froment's sign due to intrinsic paralysis of the thumb.

Differentiation of convalescent animals from those vaccinated against foot-and-mouth disease by a peptide ELISA

We have identified continuous antigenic determinants within the amino acid sequences of the conserved nonstructural region containing proteins 2C and 3ABC of foot-and-mouth disease virus which can distinguish between the sera from vaccinated and infected animals. An ELISA based on a 3B peptide gave a positive reaction with sera from cattle, pigs, sheep and guinea pigs infected with all seven serotypes of the virus, but not with sera from vaccinated animals. In experiments with cattle and pigs to determine the duration of the antibody response, positive reactions were obtained as late as one year after infection. The advantages of using peptides from the nonstructural viral proteins instead of recombinant proteins for differentiating vaccinees from infected animals include their exquisite specificity, nonreactivity with antibodies against host cell-derived proteins (e.g. E. coli and insect cell proteins), and their ease of preparation.

Asymptomatic carotid artery stenosis associated with peripheral vascular disease: a prospective study

This study aimed to determine the prevalence of symptomless internal carotid artery stenosis in consecutive patients presenting with peripheral vascular disease. Duplex ultrasound screening of the carotid arteries was used to determine the degree of stenosis. Co-morbidities were recorded together with age, sex and tobacco use. Internal carotid artery stenosis of > 50% was found in 35% of patients. Among these there was > or = 70% stenosis in 18% of patients and of this group 5% had an occluded carotid vessel at first presentation. Males presented with peripheral vascular disease and associated carotid stenoses at a younger age than females. Male smokers had a higher prevalence of stenosis (P = 0.036) but all smokers had developed stenoses 3-5 years before non-smokers. Females with abdominal aortic aneurysms had a greater prevalence of carotid stenosis (P = 0.037), and male aneurysmal disease diminished stenosis prevalence (P = 0.023). Men with an elevated serum creatinine were more likely to have a stenosis (P = 0.019), but not women. The other co-morbidities were not specifically associated with carotid artery stenosis.

Developing visiting surgical services for rural and remote Australian communities

The University Department of Surgery at Queen Elizabeth II Medical Centre (Perth, Western Australia) has undertaken a pilot project to provide surgical services to country communities where no such service exists. Three surgeons undertake a regular schedule of appointments, and are accompanied by final-year medical students to give them experience with common conditions rarely managed in teaching hospitals. The service is supported by a central administrative office and coordinated by a general practitioner, who negotiates with the regional healthcare providers. Patients are referred by their general practitioner, who may work with the surgeon as anaesthetist or surgical assistant.

Surgical treatment of carpal tunnel syndrome and trigger digits in children with mucopolysaccharide storage disorders

The role of surgical intervention for carpal tunnel syndrome (CTS) and trigger digits in children with mucopolysaccharide storage disorders (MPSDs) has not been clearly defined, particularly as the treatment of the underlying disease has advanced to include bone marrow transplantation. This study reviews our experience in the treatment of CTS and trigger digits in 22 children with MPSDs who were evaluated for CTS by electromyographic (EMG)/nerve conduction velocity (NCV) testing. Seventeen children were diagnosed with CTS by EMG/NCV testing and were treated with bilateral open surgical release with or without flexor tenosynovectomy. The EMG/NCV testing revealed normal results in 5 patients who are subsequently being monitored. Forty-five digits in 8 children were diagnosed clinically with trigger digits. Nineteen digits were treated by annular pulley release alone. Twenty-six digits were treated by annular pulley release with partial flexor digitorum superficialis tendon resection. The average age at the time of hand surgery was 6.3 years, and at the time of follow-up, 9.6 years. Postoperative EMG/NCV testing in 7 children showed 1 with improvement and 6 with normalization. None of the patients undergoing carpal tunnel release went on to develop thenar atrophy or absent sensibility, as has been reported in untreated cases. Patients were evaluated for triggering digits both by preoperative tendon palpation and by intraoperative flexor tendon excursion at the time of open carpal tunnel release. All patients undergoing trigger release had improved active digital flexion seen at the final follow-up visit. Because of the very high incidence of CTS and trigger digits in this population, the authors currently recommend routine screening of EMG/NCV for all children with MPSDs. Early surgical intervention for nerve compression and stenosing flexor tenosynovitis can maximize hand function in these children.

Income dynamics and adult mortality in the United States, 1972 through 1989

OBJECTIVES

The aim of this study was to examine relationships between income and mortality, focusing on the predictive utility of single-year and multiyear measures of income, the shape of the income gradient in mortality, trends in this gradient over time, the impact of income change on mortality, and the joint effects of income and age, race, and sex on mortality risk.

METHODS

Data were taken from the Panel Study of Income Dynamics for the years 1968 through 1989. Fourteen 10-year panels were constructed in which predictors were measured over the first 5 years and vital status over the subsequent 5 years. The panels were pooled and logistic regression was used in the analysis.

RESULTS

Income level was a strong predictor of mortality, especially for persons under the age of 65 years. Persistent low income was particularly consequential for mortality. Income instability was also important among middle-income individuals. Single-year and multiyear income measures had comparable predictive power. All effects persisted after adjustment for education and initial health status.

CONCLUSIONS

The issues of low income and income instability should be addressed in population health policy.

Fulminant hepatic failure associated with oral administration of diazepam in 11 cats

Acute fulminant hepatic necrosis was associated with repeated oral administration of diazepam (1.25 to 2 mg, PO, q 24 or 12 h), prescribed for behavioral modification or to facilitate urination. Five of 11 cats became lethargic, atactic, and anorectic within 96 hours of initial treatment. All cats became jaundiced during the first 11 days of illness. Serum biochemical analysis revealed profoundly high alanine transaminase and aspartate transaminase activities. Results of coagulation tests in 3 cats revealed marked abnormalities. Ten cats died or were euthanatized within 15 days of initial drug administration, and only 1 cat survived. Histologic evaluation of hepatic tissue specimens from each cat revealed florid centrilobular hepatic necrosis, profound biliary ductule proliferation and hyperplasia, and suppurative intraductal inflammation. Idiosyncratic hepatotoxicosis was suspected because of the rarity of this condition. Prior sensitization to diazepam was possible in only 1 cat, and consistent risk factors that could explain susceptibility to drug toxicosis were not identified. On the basis of the presumption that diazepam was hepatotoxic in these cats, an increase in serum transaminase activity within 5 days of treatment initiation indicates a need to suspend drug administration and to provide supportive care.

African horse sickness and African carnivores

African horse sickness (AHS) is a disease that affects equids, and is principally transmitted by Culicoides spp. that are biological vectors of AHS viruses (AHSV). The repeated spread of AHSV from sub-Saharan Africa to the Middle East, northern Africa and the Iberian peninsula indicate that a better understanding of AHS epizootiology is needed. African horse sickness has long been known to infect and cause mortality among domestic dogs that ingest virus contaminated meat, but it is uncertain what role carnivores play in transmission of the virus. We present evidence of widespread natural AHS infection among a diversity of African carnivore species. We hypothesize that such infection resulted from ingestion of meat and organs from AHS-infected prey species. The effect of AHS on the carnivores is unknown, as is their role in the maintenance cycle of the disease.

Safety and immunogenicity of a combined hepatitis B virus-Haemophilus influenzae type B vaccine formulation in healthy adults

We administered a combined preparation of hepatitis B virus (HBV) vaccine and Haemophilus influenzae type b (Hib) conjugate vaccine (meningococcal protein conjugate) to 20 healthy adult volunteers. Participants received two doses of vaccine one month apart, and had serum samples drawn each time they received the vaccine and 1 month after the second dose. In 18 of 19 persons who were positive for antibody to hepatitis B surface antigen (anti-HBs), these levels had a median fold increase of 23.4 (range 0.69 to 270) 1 month after the first dose of vaccine. Anti-HBs levels generally fell slightly one month after the second dose was given. All of the study participants initially had detectable levels of antibody to Hib capsular polysaccharide (anti-PRP), and 19 of the 20 exhibited a median fold increase of 11.2 (range 0.81 to 740) in anti-PRP 1 month after vaccination. Over half (65%) continued to demonstrate increased levels of anti-PRP with the second dose of vaccine. Most participants experienced some slight to moderate discomfort at the injection site. The results indicate that the combined Hib/HBV vaccine produces increased antibody levels in healthy adults who have previously been exposed to these two antigens.

Synthetic prostaglandin E1 misoprostol as a treatment for tinnitus

OBJECTIVE

A pilot study to determine if the synthetic prostaglandin E1 misoprostol is effective in treating severe tinnitus, to test the hypothesis that tinnitus production is related to prostaglandin metabolism.

DESIGN

Blinded, placebo controlled, hemicrossover.

SETTING

House Ear Clinic, Los Angeles, Calif.

PATIENTS

A volunteer and convenience sample of 24 subjects complaining of severe tinnitus was recruited from mailings, telephone calls, and the clinic population. The patients were not preselected except to be in otherwise good health.

INTERVENTION

Subjects were started on a regimen of placebo or 200 micrograms/d of misoprostol. The dosage was increased every 5 days by 200 micrograms until a total of 800 micrograms/d was achieved. After 1 month of drug administration, the placebo group was crossed over to the active drug phase.

MAIN OUTCOME MEASURES

Outcome was measured in terms of subjective reports of tinnitus severity, sleep patterns, and ability to concentrate.

RESULTS

Eight (33%) of the 24 patients reported improvement during the active drug phase. There were no placebo responders. Responders reported improvement in tinnitus severity, sleep, and concentration.

CONCLUSIONS

Findings support the contention that prostaglandins may be useful in the treatment of tinnitus. Further studies with larger samples are needed before widespread use of this intervention can be recommended.

Sensibility deficiencies in the hands of children with spastic hemiplegia

We evaluated 40 children with spastic hemiplegia due to cerebral palsy for sensory function and relative limb size in the affected and unaffected upper extremities. Sensory function of each limb was evaluated with respect to stereognosis (12 objects), two-point discrimination, and proprioception. Four size measurements of each limb were made: arm and forearm circumference and forearm and forearm-hand length. This study showed that 97% of the spastic limbs had a stereognosis deficit, 90% had a two-point discrimination deficit, and 46% had a proprioception deficit. Thus sensory deficits are the rule rather than the exception in children with spastic hemiplegia. Those children with severe stereognosis deficits had significantly smaller limbs in all four measurement parameters than the children with mild or moderate stereognosis deficits. In the preoperative evaluation of children with spastic hemiplegia, severe size discrepancy is a physical examination tool that can be used as a predictor of severe sensory deficits. This information is helpful for the hand surgeon in establishing realistic surgical goals.

Suprascapular neuropathy after intensive progressive resistive exercise: case report

A healthy 30-year-old man developed pain in the posterior shoulder region approximately one month after initiating an intensive weightlifting program to increase upper extremity strength. This program especially emphasized shoulder abduction exercises. The pain intensified as he continued and finally he noted weakness of the involved shoulder, which led him to seek medical advice. Examination was normal except for atrophy of the infraspinatus muscle on the involved side and decreased strength of shoulder abduction and external rotation. Electromyographic examination demonstrated 3+ positive sharp waves in the infraspinatus muscle, delayed conduction to the supraspinatus muscle, and absence of an evoked response to the infraspinatus muscle. Surgical decompression of the suprascapular nerve within the suprascapular notch was then performed. Two weeks after surgery the pain was much less and the conduction velocities had improved. Eight months after surgery the patient was free of pain, the conduction velocities had returned to normal, and electromyography revealed reinnervation of the denervated muscle fibers. Intensive shoulder exercise, especially involving repeated forceful abduction movements, should be considered in the etiology of suprascapular neuropathy.

Health practices, risk factors, and chronic disease in Tecumseh

Seven health practices previously found to be associated with a self-report index of good health and with lower mortality in the Alameda County studies were related to several measures of health in a cohort of 880 men and 973 women, ages 35-69, who were participants in the Tecumseh Community Health Study. The health measures were prevalence of three diagnoses--coronary heart disease (CHD), hypertension, and chronic bronchitis--and levels of five risk factors--systolic and diastolic blood pressures, serum total cholesterol, blood glucose, and FEV1. Four of the practices--desirable relative weight, physical activity, never having smoked, and moderate or no alcohol drinking--were associated significantly with one or more of the health measures. Eating breakfast, limited between-meal eating, and sleeping 7 or 8 hr were not related to the health measures. Combining all seven health practices into an index produced a measure that was more strongly associated negatively with CHD prevalence than was any one of the component practices. However, the index was no more strongly associated with any of the other health measures than were the relevant separate practices. Desirable weight was more highly associated (negatively) with hypertension and blood pressure than the index was, as was never having smoked with chronic bronchitis (negatively) and FEV1 (positively).

A Comparison of Soybean Agglutinin in Cultivars Resistant and Susceptible to Phytophthora megasperma var. sojae (Race 1)

The amount of soybean agglutinin (SBA) detectable by radioimmunoassay in seeds of resistant cultivars to Phytophthora megasperma var. sojae was approximately twice that of susceptible cultivars. SBA was preferentially released at earlier times (6-9 hours) and in higher amounts in the imbibate from resistant cultivars as compared to susceptible cultivars. The lectin in the imbibate was immunologically identical to the seed lectin, indicating little or no proteolysis had occurred, and was active in hemagglutination. Binding of fluorescein isothiocyanate-labeled SBA to mycelial cell walls could be abolished by adding N-acetyl galactosamine or galactose. Purified SBA at concentrations of 150 to 300 micrograms inhibited mycelial growth by 50%, and the imbibate from Govan (resistant) cultivar was more inhibitory than the imbibate from Shore (susceptible) cultivar. Removal of SBA from the imbibate by affinity chromatography abolished the inhibition of mycelial growth, but the inhibition could be recovered from the eluant containing lectin.

Immediate postembolization excision of glomus jugulare tumors: advantages of new combined techniques

Preoperative percutaneous transfemoral catheter embolization of feeding vessels in glomus jugulare tumors, followed by immediate application of standard surgical techniques, presents the treatment of choice, allowing meticulous microsurgery with virtually complete hemostasis. Therefore, the surgeon can operate in a bloodless environment throughout the compressed and intricate anatomic field, amidst such important yet vulnerable structures as cranial nerves, inner ear, carotid artery, jugular bulb, venous sinuses, and dura, while reducing surgical error and functional deficit for the patient. Review of the last 11 cases of glomus jugulare tumors at UCLA shows that even extensive Alford grade 2 tumors of the middle ear, jugular bulb, and mastoid had only minor blood losses with this combined technique of embolization-immediate surgery, as compared with earlier surgical methods. Pertinent literature on glomus jugulare and its treatment is reviewed. Combined embolization and immediate surgery offer the best approach for treatment of resectable glomus jugulare tumors.

Meniere's disease: clinical course, auditory findings, and hearing aid fitting

Results of a five-year longitudinal study of Meniere's disease in 95 patients is presented. Tests utilized in diagnosis and in determining specific etiology are described. Clinical treatment for patients with Meniere's disease symptoms is discussed. Auditory test results for 101 ears are analyzed. The fluctuating nature of the hearing loss, the poor discrimination for speech, and the limited tolerance for amplification because of the narrow dynamic range present significant problems in utilization of hearing aids for patients with Meniere's disease. A practical approach is suggested for the fitting of hearing aids for these patients.