Clinical outcomes for sexual and gender minority adolescents in a dialectical behaviour therapy programme

BACKGROUND

Sexuality and gender minoritised (SGM) adolescents are at increased risk of self-injury and suicide, and experience barriers to accessing mental health support. Dialectical behaviour therapy (DBT) is an effective treatment for self-injury and emotion dysregulation in adolescent populations, but few studies have published outcomes of DBT for SGM young people.

AIMS

This study aimed to investigate treatment outcomes and completion for SGM adolescents and their cisgender and heterosexual peers, in the National & Specialist CAMHS, DBT service (UK).

METHOD

Treatment completion, and opting out before and during treatment were examined for sexual and gender identity groups, as well as changes by the end of treatment in emotion dysregulation, self-injury, in-patient bed-days, emergency department attendances, and borderline personality disorder, depression and anxiety symptoms.

RESULTS

SGM adolescents were over-represented in this service, even after considering their increased risk for self-injury. No statistically significant differences were found for treatment completion between the sexual orientation and gender identity groups, although there were patterns indicating possible lower treatment uptake and completion that warrant further investigation. Clinical outcomes for treatment-completers showed improvement by the end of DBT for each group, with few exceptions.

DISCUSSION

These results are from relatively small subsamples, and it was not possible to separate by sex assigned at birth. Findings should be treated tentatively and as early indications of effect sizes to inform future studies. This study suggests that DBT could be a useful treatment for SGM adolescents in a highly specialist treatment setting.

Gender- and Sexuality-Minoritised Adolescents in DBT: A Reflexive Thematic Analysis of Minority-Specific Treatment Targets and Experience

Gender- and sexuality-minoritised (GSM) adolescents are at increased risk of self-harm and suicidal behaviours compared to their cisgender and heterosexual peers. This increased risk is thought to be explained in part by exposure to stigma and societal oppression. Dialectical Behaviour Therapy (DBT) is an evidence-based intervention for self-harm and suicidal behaviour that may have advantages for supporting GSM young people in distress. No study has yet sought to understand what GSM-associated difficulties may be important to consider in DBT for adolescents, or the experiences of GSM young people in a standard DBT programme. Therefore, this study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Qualitative interviews were conducted with 14 GSM young people in a comprehensive DBT programme and were analysed using Reflexive Thematic Analysis. The analysis was supported by two further GSM young people who had finished DBT. The findings were split into three overarching themes (Identity, Impact of Others, and Space for Sexual and Gender Identity in DBT), each with themes within. The identity-based theme included "identity confusion and acceptance"; the relationship-based themes included "cis-Heterosexism" and "community connectedness"; and the space within DBT themes included "negotiating focus and targeting in DBT" and "creating safety in DBT". Findings are discussed in relation to implications and recommendations for therapists working with GSM young people within and outside of DBT.

Assessment of microbial plankton diversity as an ecological indicator in the NW Mediterranean coast

High-throughput sequencing of microbial assemblages has been proposed as an alternative methodology to the traditional ones used in marine monitoring and environmental assessment. Here, we evaluated pico- and nanoplankton diversity as ecological indicators in NW Mediterranean coastal waters by comparing their diversity in samples subjected to varying degrees of continental pressures. Using metabarcoding of the 16S and 18S rRNA genes, we explored whether alphadiversity indices, abundance of Operational Taxonomic Units and taxonomic groups (and their ratios) provide information on the ecological quality of coastal waters. Our results revealed that only eukaryotic diversity metrics and a limited number of prokaryotic and eukaryotic taxa displayed potential in assessing continental influences in our surveyed area, resulting thus in a restrained potential of microbial plankton diversity as an ecological indicator. Therefore, incorporating microbial plankton diversity in environmental assessment could not always result in a significant improvement of current marine monitoring strategies.

In situ Occurrence, Prevalence and Dynamics of Parvilucifera Parasitoids during Recurrent Blooms of the Toxic Dinoflagellate Alexandrium minutum

Dinoflagellate blooms are natural phenomena that often occur in coastal areas, which in addition to their large number of nutrient-rich sites are characterized by highly restricted hydrodynamics within bays, marinas, enclosed beaches, and harbors. In these areas, massive proliferations of dinoflagellates have harmful effects on humans and the ecosystem. However, the high cell density reached during blooms make them vulnerable to parasitic infections. Under laboratory conditions parasitoids are able to exterminate an entire host population. In nature, Parvilucifera parasitoids infect the toxic dinoflagellate Alexandrium minutum during bloom conditions but their prevalence and impact remain unexplored. In this study, we evaluated the in situ occurrence, prevalence, and dynamics of Parvilucifera parasitoids during recurrent blooms of A. minutum in a confined site in the NW Mediterranean Sea as well as the contribution of parasitism to bloom termination. Parvilucifera parasitoids were recurrently detected from 2009 to 2013, during seasonal outbreaks of A. minutum. Parasitic infections in surface waters occurred after the abundance of A. minutum reached 10⁴–10⁵ cells L⁻¹, suggesting a density threshold beyond which Parvilucifera transmission is enhanced and the number of infected cells increases. Moreover, host and parasitoid abundances were not in phase. Instead, there was a lag between maximum A. minutum and Parvilucifera densities, indicative of a delayed density-dependent response of the parasitoid to host abundances, similar to the temporal dynamics of predator-prey interactions. The highest parasitoid prevalence was reached after a peak in host abundance and coincided with the decay phase of the bloom, when a maximum of 38% of the A. minutum population was infected. According to our estimates, Parvilucifera infections accounted for 5–18% of the total observed A. minutum mortality, which suggested that the contribution of parasitism to bloom termination is similar to that of other biological factors, such as encystment and grazing.

Morphological and molecular characterization of Bysmatrum subsalsum (Dinophyceae) from the western Mediterranean Sea reveals the existence of cryptic species

Bysmatrum subsalsum is a cosmopolitan dinoflagellate species that inhabits marine and transitional habitats. Despite its wide distribution, information on the morphological variability, phylogeny and ecology of B. subsalsum is scarce. In this study, we provide morphological and molecular data on B. subsalsum strains and wild cells from different locations in the Mediterranean Basin. The dynamics of cell abundances and the associated environmental conditions during a field bloom are also described. Genetic sequences of B. subsalsum obtained in this study showed large intraspecific differences, clustering in two well-differentiated clades. Despite a certain degree of variation with respect to cell size, apical pore complex (APC) morphology and size, and cingulum displacement, cells from the two clades showed similar morphological traits. These findings indicated the occurrence of cryptic species. Comparisons of the morphology of our B. subsalsum specimens with the few descriptions available in the literature revealed larger than previously known intraspecific morphological variability. Phylogenetic trees inferred from the concatenated SSU, 5.8S-ITS, and LSU rRNA and the individual 5.8S-ITS regions suggested the inclusion of Bysmatrum in the Peridiniales and a close phylogenetic relationship with Peridinium sensu stricto. However, the low statistical support prevented the assignment of Bysmatrum to a particular family of Peridiniales. Ecological data obtained from a bloom in La Pletera salt marshes (Catalan Coast, Spain) suggested the species reaches high cell abundances at water temperatures >20°C and salinity levels >30. Our results add new information regarding the morphology, phylogeny, and ecology of B. subsalsum.

Oil residue contamination of continental shelf sediments of the Gulf of Mexico

We have investigated the distribution of a heavy oil residue in the coastal sediments of the Gulf of Mexico. The amount of the contamination was determined by high-temperature pyrolysis coupled with the Gas Chromatography-Mass Spectrometry (GCMS) of air-dried sediments. The pyrolysis products contain straight-chain saturated and unsaturated hydrocarbons, such as dodecane and 1-dodecene, resulting in a very characteristic pattern of double peaks in the GCMS. Hydrocarbons containing 8 to 23 carbon atoms were detected in the pyrolysis products. Using thermal pyrolysis we have found that the sediment samples collected along Texas, Louisiana, and Mississippi shores contain no detectable traces of oil residue, but most of the samples collected along Alabama and Florida shores contain ~200ppm of heavy oil residue.

Biomass and lipid production of dinoflagellates and raphidophytes in indoor and outdoor photobioreactors

The principal fatty acids from the lipid profiles of two autochthonous dinoflagellates (Alexandrium minutum and Karlodinium veneficum) and one raphidophyte (Heterosigma akashiwo) maintained in bubble column photobioreactors under outdoor culture conditions are described for the first time. The biomass production, lipid content and lipid productivity of these three species were determined and the results compared to those obtained when the strains were cultured indoors. Under the latter condition, the biotic values did not significantly differ among species, whereas under outdoor conditions, differences in both duplication time and fatty acids content were observed. Specifically, A. minutum had higher biomass productivity (0.35 g·L⁻¹ day⁻¹), lipid productivity (80.7 mg lipid·L⁻¹ day⁻¹) and lipid concentration (252 mg lipid·L⁻¹) at harvest time (stationary phase) in outdoor conditions. In all three strains, the growth rate and physiological response to the light and temperature fluctuations of outdoor conditions greatly impacted the production parameters. Nonetheless, the species could be successfully grown in an outdoor photobioreactor and were of sufficient robustness to enable the establishment of long-term cultures yielding consistent biomass and lipid production.

Improvement of lipid production in the marine strains Alexandrium minutum and Heterosigma akashiwo by utilizing abiotic parameters

Two different strains of microalgae, one raphidophyte and one dinoflagellate, were tested under different abiotic conditions with the goal of enhancing lipid production. Whereas aeration was crucial for biomass production, nitrogen deficiency and temperature were found to be the main abiotic parameters inducing the high-level cellular accumulation of neutral lipids. Net neutral lipid production and especially triacylglycerol (TAG) per cell were higher in microalgae (>200% in Alexandrium minutum, and 30% in Heterosigma akashiwo) under treatment conditions (25°C; 330 μM NaNO3) than under control conditions (20°C; 880 μM NaNO3). For both algal species, oil production (free fatty acids plus TAG fraction) was also higher under treatment conditions (57 mg L−1 in A. minutum and 323 mg L−1 in H. akashiwo). Despite the increased production and accumulation of lipids in microalgae, the different conditions did not significantly change the fatty acids profiles of the species analyzed. These profiles consisted of saturated fatty acids (SAFA) and polyunsaturated fatty acids (PUFA) in significant proportions. However, during the stationary phase, the concentrations per cell of some PUFAs, especially arachidonic acid (C20:4n6), were higher in treated than in control algae. These results suggest that the adjustment of abiotic parameters is a suitable and one of the cheapest alternatives to obtain sufficient quantities of microalgal biomass, with high oil content and minimal changes in the fatty acid profile of the strains under consideration.

Comparison of calibrated and uncalibrated bone mineral density by CT to DEXA in menopausal women

OBJECTIVES

Coronary artery disease and osteoporosis increase in women after menopause. Computed tomography (CT) scans of the heart used to evaluate coronary arterial calcification include images of the thoracic vertebrae. The utility of using these images to assess bone health in women remains to be defined. Analyses of thoracic spine volumetric bone mineral density (vBMD) from CT scans of the heart were performed to determine how specific calibration affects the ability to assess vBMD in recently menopausal women and to evaluate how vBMD relates to areal bone mineral density (aBMD) using dual-energy X-ray absorptiometry (DEXA).

METHODS

Women (n = 111) enrolled in the Kronos Early Estrogen Prevention Study (KEEPS) at Mayo Clinic underwent a CT scan of the heart that included calibration phantoms and a DEXA of the lumbar spine. The Spine Cancer Assessment program was used to determine vBMD of thoracic vertebrae with and without the calibration correction.

RESULTS

Trabecular bone vBMD at T8 averaged 163.57±28.58 and 157.94±27.55 mg/cc (mean±standard deviation, SD) for calibrated and uncalibrated values, respectively. The relationship between calibrated and uncalibrated measures approached unity (R = 0.98). Lumbar spine (L2-4) aBMD was 1.19±0.16 g/cm(2) (mean±SD). Both calibrated and uncalibrated thoracic vBMD correlated positively and significantly with lumbar aBMD, but the relationship was less than unity (R = 0.63).

CONCLUSION

Uncalibrated measures of thoracic spine vBMD obtained from CT scans of the heart may provide clinically relevant information about bone health and osteoporosis/osteopenia risk in recently menopausal women.

BARRUFETA BRAVENSIS GEN. NOV. SP. NOV. (DINOPHYCEAE): A NEW BLOOM-FORMING SPECIES FROM THE NORTHWEST MEDITERRANEAN SEA(1)

The present study describes a new dinoflagellate genus, Barrufeta N. Sampedro et S. Fraga gen. nov., with one new species, B. bravensis Sampedro et S. Fraga sp. nov., isolated from the Costa Brava (NW Mediterranean Sea). The dinoflagellate was characterized at the genus and species levels by LM and EM; LSU and internal transcribed spacer (ITS) rDNA sequences; and HPLC analyses of the pigments, fatty acids, and possible presence of toxins of several cultured strains. The new Barrufeta species is oval shaped (22-35 μm long and 16-25 μm wide) and dorsoventrally flattened. It possesses numerous small chloroplasts that radiate from two large equatorially located pyrenoids and is a typical peridinin-containing dinoflagellate. The nucleus is in the anterior part of the epicone. The apical groove has a characteristic "Smurf-cap" shape that runs counterclockwise on the epicone and terminates on its right posterior part. B. bravensis is similar to the previously described species Gyrodinium resplendens Hulburt in its external morphology, but the original report of the latter lacked a description of the complete shape of the apical groove. It is therefore likely that some of the G. resplendens species reported in the literature are Barrufeta since they possess a Barrufeta-type apical groove. Fatty acids of Barrufeta were more similar to those of Karenia brevis than those obtained from other unarmored analyzed species including three species of Gymnodinium and Akashiwo sanguinea.

Quantitative PCR coupled with melt curve analysis for detection of selected pseudo-nitzschia spp. (Bacillariophyceae) from the Northwestern Mediterranean sea

The frequency and intensity of Pseudo-nitzschia spp. blooms along the coast of Catalonia have been increasing over the past 20 years. As species from this genus that are documented as toxigenic have been found in local waters, with both toxic and nontoxic species cooccurring in the same bloom, there is a need to develop management tools for discriminating the difference. Currently, differentiation of toxic and nontoxic species requires time-consuming electron microscopy to distinguish taxonomic features that would allow identification as to species, and cryptic species can still remain misidentified. In this study, cells of Pseudo-nitzschia from clonal cultures isolated from seawater were characterized to their species identity using scanning electron microscopy, and subsamples of each culture were used to create an internal transcribed spacer 1 (ITS-1), 5.8S, and ITS-2 ribosomal DNA database for development of species-specific quantitative PCR (qPCR) assays. Once developed, these qPCR assays were applied to field samples collected over a 2-year period in Alfaques Bay in the northwestern Mediterranean Sea to evaluate the possibility of a comprehensive surveillance for all Pseudo-nitzschia spp. using molecular methods to supplement optical microscopy, which can discern taxonomy only to the genus level within this taxon. Total Pseudo-nitzschia cell density was determined by optical microscopy from water samples collected weekly and compared to results obtained from the sum of eight Pseudo-nitzschia species-specific qPCR assays using duplicate samples. Species-specific qPCR followed by melt curve analysis allowed differentiation of amplicons and identification of false positives, and results correlated well with the total Pseudo-nitzschia cell counts from optical microscopy.

Coronary arterial calcification and thoracic spine mineral density in early menopause

OBJECTIVES

Cardiovascular disease and osteoporosis increase in women after menopause. While aortic calcification is associated with bone loss in women, a similar relationship for coronary arterial calcification (CAC), a risk factor for coronary artery disease in women, is less clear. This study was designed to examine the relationship between CAC and volumetric bone mineral density (vBMD) in women (n=137) who were within a median of 18 months past their last menses at screening for the Kronos Early Estrogen Prevention Study (KEEPS).

METHODS

CAC was measured using 64-slice computed tomography; vBMD was measured from these images using the Spine Cancer Assessment program. Concentrations of osteocalcin, bone alkaline phosphatase, tartrate-resident acid phosphatase-5b and osteopontin as bone matrix protein in serum and plasma were evaluated by ELISA.

RESULTS

CAC scores ranged from 0 to 327.6 Agatston Units (AU); 113 women had a score of 0 AU, 20 had a CAC score between 0 and 50 AU, and four had a CAC score>50 AU. Although not statistically significant, there was a trend toward decreasing central density of thoracic T9 with increasing CAC. On average, levels of markers of bone turnover were within the normal range but did not correlate with age or with months past menopause.

CONCLUSIONS

Clinically significant CAC and spine vBMD are quantifiable from the same scans within the first 3 years of menopause. Additional work is needed to determine how these measurements change with increasing age or with estrogenic treatments.

Use of the dinoflagellate Karlodinium veneficum as a sustainable source of biodiesel production

Microalgae are microscopic heterotrophic-autotrophic photosynthesizing organisms with enormous potential as a source of biofuel. Dinoflagellates, a class of microalgae, contain large amounts of high-quality lipids, the principal component of fatty acid methyl esters. The biotic characteristics of the dinoflagellate species Karlodinium veneficum include a growth rate of 0.14 day(-1), a wet biomass of 16.4 g/L, a growth period of approximately 30 days, and an approximate 97% increase in fatty acid content during the transition from exponential phase to stationary phase. These parameters make K. veneficum a suitable choice as a bioresource for biodiesel production. Similarly, two other species were also determined to be appropriate for biodiesel production: the Dinophyceae Alexandrium andersoni and the Raphidophyte Heterosigma akashiwo.

HOMOTHALLIC AUXOSPORULATION IN PSEUDO-NITZSCHIA BRASILIANA (BACILLARIOPHYTA)(1)

Most pennate diatoms are allogamous, and various types of mating systems have been described. In Pseudo-nitzschia, reproductive stages have been identified in some species, and it is generally accepted that the genus is mainly heterothallic. Here we report homothallic auxosporulation of Pseudo-nitzschia brasiliana Lundholm, Hasle et G. A. Fryxell. To our knowledge, this is the first verified description of homothallic sexual reproduction in the genus. Auxospore formation was observed in all 16 subclones derived from three initial clonal cultures of P. brasiliana. Pairing was followed by production of two gametes per gametangium, which fused to give two zygotes. Each zygote (early auxospore) was initially spherical and adhered to one girdle band of the parental frustule. The two auxospores tended to expand parallel to each other and perpendicular to the parental frustule. Elongation was synchronous, slightly asynchronous, or totally asynchronous. The entire process of sexual reproduction, from gamete formation to the appearance of the initial vegetative cells, took 2-4 d. The occurrence of sex in a homothallic species seems an advantageous life strategy for this species in that any encounter between cells of the right size class is potentially sexual.

Phase II trial of pirfenidone in adults with neurofibromatosis type 1

We performed an open-label phase II trial of oral pirfenidone in 24 patients with neurofibromatosis type 1 (NF1). Tumors were monitored by three-dimensional MRI. At the end of treatment, four patients had a decrease in tumor volume by 15% or more, three had tumor progression, and 17 remained stable. Pirfenidone warrants further investigation in NF1, which has until now lacked an effective control therapy.

Noise exposure among construction electricians

Data-logging noise dosimetry was used to assess the exposure levels of electricians working for a major electrical subcontractor in Washington State at five sites using four types of construction methods. Subjects documented activities and work environment information throughout their work shift, resulting in an activity/exposure record for each of the 174 full-shift samples collected over the 4-month duration of the study. Over 24% of the TWA samples exceeded 85 dBA; 5.2% exceeded the federal Occupational Safety and Health Administration permissible exposure limit of 90 dBA. The National Institute for Occupational Safety and Health exposure metric, which specifies a 3-dB ER, was also utilized; using this metric, 67.8% of the samples exceeded 85 dBA and 27% exceeded 90 dBA. Subjects were directly observed for a subset of 4469 min during which more detailed activity and environmental information was recorded. Linear and logistic regression models using this subset were used to identify the determinants of average exposure, and exposure exceedences, respectively. These models demonstrated the importance of multiple variable modeling in interpreting exposure assessments, and the feasibility and utility of modeling exposure exceedences using logistic regression. The results further showed that presumably quiet trades such as electrician are at risk of exposure to potentially harmful noise exposures, and that other workers' activities and the general environment contribute substantially to that risk. These results indicate that noise control strategies will have to address the construction work environment as an integrated system.

The value of case management in the publicly funded substance abuse treatment system. The perspective of program directors, case managers and clients

The many purposes of this article is to understand the role and value of case management from the perspective of program directors, case managers and clients. A survey of program directors from publicly funded substance abuse treatment programs in Boston was administered, and in-depth interviews with a sample of program directors, case managers, and clients were conducted. Case management allowed programs to serve more complex clients and increased time available for counselors to focus on the clinical needs of clients. From the perspective of case managers and clients, much of the value of case management came from educating clients about steps they could take to meet their needs and then supporting them in their efforts as they took these steps. Successful steps taken to deal with these needs helped lay the foundation necessary to confront the challenges of treatment. Program directors, case managers, and clients considered case management a valuable enhancement to substance abuse treatment.

Serum hepatic biochemical activity in two populations of workers exposed to styrene

OBJECTIVE

To determine whether hepatic biochemical changes, as measured by routinely available tests indicative of hepatocellular necrosis, cholestasis, or altered hepatic clearance of bilirubin, occur in association with low to moderate exposure to styrene commonly experienced in industrial production.

METHODS

Two independent cross sectional studies were performed comparing serum hepatic transaminases (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)), cholestatic enzymes (alkaline phosphatase (AP) and gamma glutamyl transpeptidase (GGT)), and bilirubin in (a) 47 workers of fibreglass reinforced plastics who were exposed to styrene and (b) 21 boat and tank fabricators, with separate referent groups of unexposed workers. Exposure to styrene was assessed in air by dosimetry, and in venous blood by headspace analysis. Hepatic biochemical variables were assessed across strata of exposure to styrene defined as 25 ppm in air, or 0.275 mg/l in blood, adjusting for age, sex, body mass index, and ethanol consumption.

RESULTS

A consistent and significant linear trend for increasing direct bilirubin and direct/total bilirubin ratio was found in association with increasing exposure to styrene, by both air and blood monitoring, in both studies. Mean direct bilirubin concentrations increased from 0.05-0.08 mg% in referents to 0.12-0.19 in workers exposed above 25 ppm, with a significant exposure-response trend (p<0.005). Significantly increased direct/total bilirubin ratios, ranging from 0.22 to 0.35 were associated with exposure to styrene (p<0.001), indicating diminished hepatic clearance of conjugated bilirubin. Also, a significant linear association between the hepatic transaminases ALT and AST and exposure to styrene was found in pooled regression analyses, with an increase in AP of about 10 IU/ml in workers exposed above 25 ppm air or 0.275 mg/l blood styrene in pooled analyses from both studies.

CONCLUSIONS

The consistent finding of increased direct bilirubin and AP concentrations in these two independent studies provides evidence for diminished hepatic clearance of conjugated bilirubin with associated cholestasis in workers exposed to styrene. The finding of a significant linear association between hepatic transaminase concentrations and exposure to styrene in pooled analyses is consistent with mild hepatic injury and associated metabolic dysfunction.

Pain After Epithelial Removal by Ethanol-assisted Mechanical Versus Transepithelial Excimer Laser Debridement

PURPOSE

To compare subjective pain responses between two techniques of epithelial removal prior to photorefractive keratectomy (PRK) treatment: ethanol-soaked pledget with mechanical debridement of the epithelium versus excimer laser transepithelial ablation.

METHODS

Nine patients underwent bilateral PRK. Each had the epithelium in one eye debrided by placing a pledget soaked in 20% ethanol on the cornea for 2 minutes followed by gentle scraping with a blade. The epithelium in the other eye was removed by transepithelial phototherapeutic keratectomy (PTK) treatment. For each eye, PRK was initiated immediately after removal of the epithelium. On postoperative day one, each patient was asked to rate the level of pain suffered over the last 24 hours on a scale of 0 (minimal) to 10 (maximal). Data were analyzed in a masked fashion.

RESULTS

Postoperative day one average pain level in the ethanol-assisted mechanically debrided eyes was 3.0 +/- 2.5 and in the transepithelial PTK eyes was 6.8 +/- 1.8. The difference was statistically significant by Student's t-test (P < .01). All epithelial defects healed within 3 days with no clinically significant difference in healing time between the two techniques.

CONCLUSION

In preparation for PRK, ethanol-assisted mechanical debridement of the epithelium caused significantly less postoperative pain than epithelial removal using the excimer laser.

Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy

OBJECTIVE

The purpose of this study was to evaluate imaging-guided vacuum-assisted mammotome biopsy as a minimally invasive method of obtaining a satisfactory diagnosis and eliminating the bothersome symptoms in patients presenting with nipple discharge.

MATERIALS AND METHODS

Forty-nine women who presented with nipple discharge and who had final pathologic diagnoses of papillary lesions were retrospectively identified. Fifty-six lesions were biopsied in this group. The examinations included mammography, ductography, sonography, and, if possible, percutaneous biopsy. All lesions were centrally located and most were superficial. Of this study group, four patients with five lesions proceeded to sonographically guided automated core biopsy, and 38 patients with 44 intraductal lesions identified by sonography advanced to sonographically guided biopsy with an 11-gauge mammotome probe. One patient underwent stereotactic 11-gauge mammotome biopsy. Patients not advancing to sonographically guided biopsy were those with masses either in the nipple or nipple-areolar complex (five patients), one patient with no identifiable lesion at sonography, and one directly referred for open surgical biopsy.

RESULTS

In all biopsied patients, satisfactory tissue for diagnosis was obtained. In patients biopsied with the mammotome probe, follow-up at a mean time of 13 months revealed resolution of the presenting problematic discharge in 97.2% of patients. Complications were mild and infrequent. Only one of 50 percutaneously biopsied lesions was not benign and required subsequent surgery.

CONCLUSION

Papilloma excision with percutaneous biopsy allows safe and accurate tissue analysis and a high probability of terminating the symptomatic nipple discharge.

Hard metal exposures. Part 2: Prospective exposure assessment

Hard metal exposures may precipitate lung disease in exposed workers. This article reports on a project investigating the relationship between local exhaust hood air flow levels and workplace hard metal exposures. Airborne cobalt, chromium, and cadmium exposure concentrations, and ventilation system function were monitored for three consecutive days prior to installation of three new ventilation systems, and then were followed monthly for one year. Work activities included wet and dry grinding of saw blades, brazing, welding, and setup. Work task exposures were highly variable over the period of the study. Ventilation air flows failed to meet design goals due to low total air volume and poor distribution; however, worker exposures to metals were controlled in most cases. Hood design, worker acceptance, and use of the hoods were as important in controlling exposures as were exhaust hood air flow levels.

Determination and optimization of mode matching into optical cavities by heterodyne detection

We report on a novel high-sensitivity method to characterize and improve mode matching into optical cavities. This method is based on heterodyne detection of cylindrical transverse cavity modes. A specially designed annular-segmented photodiode is used to measure the amplitude of nonresonant modes reflected by the cavity. Our measurements allow us to optimize cavity mode matching to nearly 99.98% and will play an important diagnostic role in gravitational-wave detectors.

An assessment of occupational noise exposures in four construction trades

Three hundred thirty-eight noise exposure samples were collected from 133 construction workers employed in 4 construction trades: carpenters, laborers, ironworkers, and operating engineers. Four sites using a variety of construction techniques were sampled at least 12 times on a randomly chosen date over a 22-week period. Up to 10 volunteer workers were sampled for an entire work shift on each sampling day using datalogging noise dosimeters, which recorded both daily time-weighted averages (TWAs) and 1-min averages. Workers also completed a questionnaire throughout the workday detailing the tasks performed and tools used throughout the day. Regression models identified work characteristics associated with elevated exposure levels. Comparisons were made between exposures measured using the Occupational Safety and Health Administration (OSHA) exposure metric and the 1996 draft National Institute for Occupational Safety and Health/International Organization for Standardization (NIOSH/ISO) metric to examine the effects of differing exchange rates and instrument response times on construction noise exposures. The mean OSHA TWA for 338 samples was 82.8 dBA +/- 6.8 dBA, whereas the mean NIOSH/ISO TWA for 174 samples was 89.7 dBA +/- 6.0 dBA. Forty percent of OSHA TWAs exceeded 85 dBA, and 13% exceeded 90 dBA, the OSHA permissible exposure limit. The tasks and tools associated with the highest exposure levels were those involving pneumatically operated tools and heavy equipment. Trade was a poor predictor of noise exposure; construction method, stage of construction, and work tasks and tools used were found to be better exposure predictors. An internal validation substudy indicated excellent agreement between worker self-reporting and researcher observation. These data provide substantial documentation that construction workers in several key trades are frequently exposed to noise levels that have been associated with hearing loss, and demonstrate the need for targeted noise reduction efforts and comprehensive hearing conservation programs in the industry.

Farmworker exposure to organophosphorus pesticide residues during apple thinning in central Washington State

The purpose of this study was to characterize worker exposure to azinphos-methyl (Guthion) over an entire 4-6 week apple-thinning season. Twenty workers from three work sites in the Chelan-Douglas County region of Washington state were recruited for the study. Exposure potential was estimated by dislodgeable foliar residue measurements, and individual exposures were estimated by biological monitoring through urinary metabolites. Measureable azinphos-methyl residues were found on apple foliage at all sites throughout the six-week sampling period, indicating continuous exposure potential (median residue level of 0.5 microgram/cm2). Measurable levels of the urinary dialkylphosphate metabolite, DMTP, were found in virtually all urine samples (limit of detection = 0.04 microgram/mL). Mean DMTP concentrations differed significantly across sites (0.53, 0.29, and 0.90 microgram/mL for Sites 1-3, respectively; analysis of variance, p < .002), and intraindividual variability was much greater than interindividual differences. Group mean DMTP concentrations at each site fluctuated according to foliar residue levels. Measurable DMTP concentrations were found in 9% of reference workers, ranging from 0.04-0.18 microgram/mL. Cholinesterase activity levels monitored with a field test kit were not considered reliable due to temperature changes of the instrument.

Optical contamination screening of materials with a high-finesse Fabry-Perot cavity resonated continuously at 1.06- microm wavelength in vacuum

An optical-loss measurement system based on a resonant Fabry-Perot cavity at 1.06 microm in vacuum has been developed for independent monitoring of the cavity total loss and the optical absorption loss. Maintenance of cavity resonance over a one-month period allows the assessment of long-term degradation of the cavity optics in the presence of outgassing materials, with sensitivities of 5 ppm/yr for total cavity loss and 2 ppm/yr for cavity absorption loss. Test results for light-emitting diodes, Kapton-insulated cable assemblies, and Vac-seal epoxy adhesive are given. Scaling of these results to the optical performance requirements of LIGO is discussed.

Use and costs of incontinence pads in female study volunteers. Continence Program for Women Research Group

OBJECTIVES

We examined the use and cost of incontinence pads and the relationship to factors such as age, duration of incontinence, diurnal frequency, incontinence severity indices, urodynamic diagnosis, and quality of life.

SUBJECTS AND SETTING

Three hundred fifteen women with urinary incontinence who volunteered to participate in 1 of 3 incontinence studies (behavioral intervention, estrogen supplementation, or surgery) were analyzed. Subjects were community-dwelling women aged 45 years and older living in 3 cities in the southeastern United States.

METHODS

Pad use was recorded on a daily diary. The type of pads used was reported on the history. Average price of pad types was assessed at local stores and reported in 1995 dollars. Statistical comparisons used nonparametric methods.

MAIN OUTCOME MEASURES

The number of pads used per week and annual cost of pads in 1995 dollars.

RESULTS

Seventy-seven percent of subjects used pads at baseline. Median cost per year for the entire cohort was $46 (interquartile range $3-$138). For pad users, median annual cost was $76 (interquartile range $36-$177), with costs being greater for women with detrusor instability than those with pure genuine stress incontinence (median $135-$138 versus $63). This increased cost was likely associated with the greater use of special incontinence products among women with detrusor instability. For the entire cohort, cost and usage did not differ by urodynamic diagnosis. Cost and pad usage were significantly associated with number of incontinent episodes and quality of life, but not with age, pad weight, or duration of incontinence.

CONCLUSIONS

The majority of incontinent women who sought treatment used absorbent pads at least once per week, with menstrual pads being the most common type of pad. The annual cost of pad usage was not as high as in previous estimates.

Exposures to wood dust in U.S. industries and occupations, 1979 to 1997

BACKGROUND

We analyzed 1,632 measurements of airborne wood dust reported to OSHA's Integrated Management Information System in the period 1979 to 1997.

METHODS

The relationships between wood dust concentrations and various factors documented in the OSHA database were examined in a multiple regression model.

RESULTS

Exposures ranged from less than 0.03 to 604 mg/m3, with an arithmetic mean of 7.93 and a geometric mean of 1.86. Reported exposure levels decreased substantially over time (e.g., unadjusted geometric mean in 1979 = 4.59 mg/m3; in 1997 = 0.14 mg/m3). High exposure jobs included sanders in the transportation equipment industry (unadjusted geometric mean = 17.5 mg/m3), press operators in the wood products industry (12.3 mg/m3), lathe operators in the furniture industry (7.46 mg/m3), and sanders in the wood cabinet industry (5.83 mg/m3).

CONCLUSIONS

In the multiple regression model, year, state, job, and industry were found to be predictors of exposure. Year and state were likely surrogates for other factors which directly influence exposure, but which were not included in the IMIS database, such as the use of engineering control measures.

Erotomania after aneurysmal subarachnoid hemorrhage: case report and literature review

A woman developed the delusional syndrome of erotomania 4 years after subarachnoid hemorrhage from a ruptured basilar artery aneurysm. The authors review the literature on erotomania in association with neurologic and medical conditions. Although no cause-and-effect relationship can be established between the neurologic event and erotomania in this patient, the possible neuropsychiatric correlates of this syndrome highlight the need for careful attention to neurologic and medical factors in future cases. Available information suggests that diffuse brain dysfunction may contribute to erotomania, perhaps by interfering with the operations of cerebral regions subserving complex emotional function.

[Hypercalcemia as the first manifestation of bone marrow T-cell lymphoma]

The authors describe the case of a 20-year-old patient where the first leading symptom was hypercalcaemia. A similar case was not published so far in the Czech literature. The disease took a fulminant course and proved fatal nine days after the first symptoms of the disease. The correct diagnosis was established only by necropsy. The adverse course of the disease could not be influenced by repeated haemodialysis nor by the administration of disodium pamidronate (Aredia) and calcitonin. The authors discuss differential diagnostic problems of hypercalcaemias and the pathogenesis of hypercalcaemia in malignant diseases of the haematopoietic system.

[The demand for emergency medical care by the prison population]

BACKGROUND

Urgent medical claim from recluse population shows some special traits due to firstly, the reclusion situation itself and the high prevalence of certain diseases in this population, as the infections ones, such as HIV infection, hepatitis B and tuberculosis. Moreover, emergency rooms constitute for this patients, a common previous admission place. Thus, a high and a complex medical care claim must be expected from this population in hospital emergency rooms.

METHODS

Consultations from ill prisoners examined in emergency room of Hospital Clinic Internal Medicine department during 1993, were checked: Age, sex, date, time of visit, serology and HIV risk factor, stage infection among positive HIV subjects, cause of complaint. age o symptomatology, number and the kind of complementary examinations done, the consulting time, the diagnosis and its link to the HIV infections, the consulting recurrence, and its relation with the initial cause, and the patient final destiny.

RESULTS

394 patients, from 598 who consulted, were visited (1.8% total consultings). The mean age was 32.4 years and 92% were men. A 68% (268 patients) realized that had HIV infection, and among these, a 37% (99 patients) were AIDS. The most frequent cause of complaint were related to respiratory, digestive, neurologic and non foci fever, which caused the higher number of admissions. The tuberculosis diagnosis was done in 39 patients (9.9%). Sixty wine patients discharged from hospital on first examination came again one or more times to the emergency room because of the same complaint. The number of complementary examinations done was 1,370 (a mean of 2.4 per visit), and were significantly higher among the HIV patients than in negative or unknown (p < 0.001). The overall admissions average was 37%, which increased to 71% among patients visited repeatedly. The HIV recluse patients required admission in the 46.3% of visits, and the HIV negative ones, in the 20.6% (p < 0.001). The duration of the visit among the patients that were discharged was 4 hours and 54 minutes.

CONCLUSION

Recluse population generates an important urgent medical care claim. The number of admissions among this population is elevated and higher than the respective to the general one, related to the age. This high number of consulting, the increased number of admissions and the complex assistance (high number of complementary examinations that often requires high technology, and the repetitive urgent visits, etc.), are caused, mainly by the high prevalence of HIV infections among this population.

Solvents and color discrimination ability. Nonreplication of previous findings

Previous research has shown exposure-related increases in the prevalence of acquired color vision deficits among printers. We administered the Lanthony D-15 desaturated test of color vision to 82 print shop workers. Two tests of cognitive function, Trails A and B and the Symbol Digit Modalities Test, were also administered. Personal air sampling indicated that current exposure to organic solvents was highest among printers and lowest among bindery workers. In contrast to previous studies, the age-adjusted quantitative Lanthony D-15 desaturated test error scores did not differ significantly between exposure groups, and the proportion of subjects with > or = 1 error was greater in the lower-exposure, rather than higher-exposure, groups (P = .03). Of note, the proportion of subjects with > or = 2 errors did not differ significantly between groups (P = .24). Cognitive tests showed no significant association with exposure. These results are discussed in the context of methodological issues related to lighting sources, reliability of test results, and establishment of criteria for identifying deficits.

Comparison of inpatient and outpatient traction in developmental dislocation of the hip

We studied 83 hips in 72 children being treated for developmental hip dislocation to assess the influence of home traction upon the incidence and severity of avascular necrosis (AVN). We compared two types of traction prior to closed or open reduction: inpatient Bryant's skin traction (40 hips), and outpatient (home) Bryant's skin traction (43 hips). No routine in-traction radiographs were taken in either group. After traction, a stable closed reduction was achieved in 55 hips (66%). Open reduction was performed on 28 hips (34%). The rate of severe AVN involving growth disturbance and resultant deformity (Bucholz types II, III, and IV) was low in both traction groups (inpatient, three out of 40, outpatient, one out of 43). These results demonstrate that an outpatient traction program without attention to radiographic hip station is as safe as identically instituted inpatient programs, as well as those that emphasize achievement of a traction reduction or a predetermined hip station.

Alteration of Baumann's angle by humeral position: implications for treatment of supracondylar humerus fractures

To determine the effects of limb positioning on Baumann's angle, we made a controlled radiographic study of a 6-year-old cadaver upper extremity specimen. Radiographic measurement of Baumann's angle was obtained at 10 degrees increments of humeral rotation from 40 degrees of internal rotation to 40 degrees of external rotation. These measurements were obtained with the humerus parallel to the x-ray cassette and with the humerus flexed 30 degrees from the cassette. Measurement of Baumann's angle with radiographs obtained with the humerus parallel to the x-ray cassette was associated with less variation in the measured angle (6 degrees of change for every 10 degrees of rotation). The relevance of these findings in management of supracondylar fractures is discussed.

Heat stress: its effect and control

Heat cramps, heat exhaustion, and heat stroke are major disorders resulting from the body's reaction to overexposure to hot environments. Physiological and psychological adaptation to hot environments--acclimatization--can improve heat tolerance. A number of measures determine the environmental contributions to heat stress. The occupational health nurse can establish priorities for addressing the work related health needs of workers in hot environments.

Peripheral markers of neurochemical function among workers exposed to styrene

A cross sectional study of biological markers of neurochemical function in peripheral blood cells, and self reported nervous system symptoms, was conducted among 60 workers exposed to styrene in three reinforced plastics plants and 18 reference workers not exposed to styrene or other solvents. Concentrations of styrene in the air at the plants ranged from less than 1 to 160 ppm. Biomarkers of neurochemical function measured were: sigma receptor binding in lymphocytes, monoamine oxidase type B (MAO-B) activity in platelets, and serotonin uptake by platelets. Blood styrene concentration was used as the exposure index to take account of the use of protective equipment and dermal uptake. Four blood styrene exposure groups were defined as: non-exposed (reference) and exposed to less than 0.05, 0.05-0.19, and greater than or equal to 0.20 micrograms/ml. The prevalences of headache, dizziness, light headedness, fatigue, irritability, memory loss, and feeling "drunk" at work increased with increasing blood styrene concentration. No effect on sigma receptor binding was seen. A slight positive correlation was found for uptake of serotonin, which has been used as an exposure related effect indicator in previous studies of workers exposed to solvents. The MAO-B activity decreased with increasing blood styrene concentration; the mean (SE) MAO-B values for the four groups were 34.2 (3.0), 28.1 (5.3), 20.1 (4.8), and 16.9 (7.7) pmol/10(7) cells/min. The MAO-B activity also correlated negatively with the number of reported nervous system symptoms, whereas no associations were seen between prevalence of symptoms and either serotonin uptake or sigma receptor binding. The findings for MAO-B activity are consistent with previously reported experimental data, and suggest that MAO-B may be a useful marker of styrene neurotoxicity.