Design, protocol and baseline data of Nurturing Healthy Teachers, a cluster non-randomized controlled trial to improve the health, well-being, and food security of preschool and elementary school teachers in Houston, Texas

Background

We present the conceptual framework, design, and study measures of Nurturing Healthy Teachers, a quasi-experimental study to examine the short- and long-term effectiveness of the Nurturing Healthy Teachers (NHT) nutrition intervention on food insecurity, dietary behaviors, mental health and cardiometabolic health among preschool and elementary school teachers.

Methods

A convenience sample of 28 elementary schools with pre-kindergarten and elementary classrooms were recruited in Houston, Texas. Nurturing Healthy Teacher intervention includes Brighter Bites, an evidence-based coordinated school health program that combines access to fresh produce and nutrition education, and Create Healthy Futures, a web-based nutrition education program that targets nutrition knowledge, self-efficacy, mindfulness, and social support to create healthy habits among teachers. The primary outcome is food insecurity. Secondary outcomes include diet quality, mental health, and cardiometabolic health. Metabolic markers and skin carotenoid levels were assessed using in-person assessments, while all other measures were obtained via questionnaire.

Results

At baseline, most of the participants were female, 63 % identified as Hispanic, were highly educated, and had a mean age of 42.6 years. Overall, 50 % of teachers were classified as being obese and 20 % had high cholesterol. At baseline teachers had a mean HbA1c (%) of 5.6 %. Moderate to severe depression was experienced by 18 % of teachers and 23 % of teachers experienced moderate to severe anxiety.

Conclusions

The results of this study will inform next steps towards future implementation and evaluation of teacher-focused interventions.

PEP reward reactivity moderates the effects of RSA reactivity on antisocial behavior and substance use

Integrating Polyvagal Theory and Reinforcement Sensitivity Theory (RST), we examined pre-ejection period (PEP) reward reactivity, which was suggested to index trait impulsivity, as a moderator between respiratory sinus arrhythmia (RSA) reactivity and antisocial behavior (ASB), and substance use in an urban male, adult sample. To understand the inconsistent findings between RSA reactivity and externalizing problems, we proposed to study both negatively and positively valenced tasks for RSA reactivity and to include PEP reward reactivity as a moderator for the RSA-behavior link. Data were collected from an urban sample of 131 male adults (active offenders, demographic controls, and college students). ICG (impedance cardiography) and ECG (electrocardiogram) were recorded, computing PEP (sympathetic nervous system activity marker) and RSA (parasympathetic nervous system activity marker), while participants completed the modified Trier Social Stress Test and a simple reward task. Reactivity was calculated by subtracting the baseline from the task activity. Consistent with prior studies, more RSA withdrawal to stress and less PEP shortening to reward predicted the most ASB and substance use. Less RSA withdrawal to reward and more PEP shortening to reward predicted the most ASB and substance use. We incorporated autonomic space, RST, and Polyvagal Theory to discuss our findings, and specifically highlight how clarifying what each reactivity captures based on the task demand (e.g., presence of social threat, need for vagal-mediated social affiliative behavior) can illuminate our understanding of the result patterns.

LGBTQI content on obstetrics and gynecology residency websites

BACKGROUND

In the United States (US), many obstetrics & gynecology (OB-GYN) trainees feel unprepared to care for lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) individuals, but interest in this topic is rising. Residency program websites are one way that directors can advertise whether this training is offered within their program. We aimed to describe the extent to which LGBTQI content is currently featured on OB-GYN residency websites across the country.

METHODS

We identified all OB-GYN residency programs in the United States using a publicly available database. We systematically searched for select LGBTQI keywords on program websites. We collected data on mentions of LGBTQI didactics and rotations. We also searched whether LGTBQI keywords were included in diversity, equity, and inclusion (DEI) statements. We used multivariable logistic regression to compare the characteristics of programs that do and do not include this content. We used STATA SE Version 16.0 for all analyses and set the level of significance at 5%.

RESULTS

We included 287/295 US OB-GYN residency programs in our analysis (97.3%) and excluded 8 that did not have websites. We identified any LGBTQI content on 50 program websites (17.4%), and specific mention of didactics or rotations on 8 websites (2.8%). On multivariable analysis, programs in the West were more likely to include any LGBTQI content compared to programs in the South (OR 2.81, 95%CI 1.04-7.63), as were programs with 1 or 2 fellowships (OR 3.41, 95%CI 1.43-8.14) or 3 or more fellowships (OR 4.85, 95%CI 2.03-11.57) compared to those without fellowships. Programs in departments led by female chairs were also more likely to include LBTQI content (OR 3.18, 95%CI 1.55-6.51).

CONCLUSIONS

Academic programs, West Coast programs, and those with departments led by female chairs are more likely to mention LGBTQI keywords on their websites. Given the increasing interest in LGBTQI education for OB-GYN trainees, program directors should consider providing training opportunities and including this content on their websites.

The role of death-related advertisements in cell phone use while driving

Approximately 25% of accidents in the United States are caused by texting while driving, prompting the creation of several media campaigns to reduce such risky behavior. The current research examined whether death-related advertisements increase cell phone use while driving. Studies 1-3 found that individuals engaged in greater distracted driving in the presence of a mortality-themed texting advertisement. Study 2 demonstrated that participants were more likely to text on their cell phone using a driving simulator, leading to more swerving and collisions after viewing a death-related (vs. neutral) poster. Finally, using eye-tracking, Study 3 showed that participants who viewed a death advertisement looked away from the road and texted more as compared to persons in the control condition. Implications and future directions are discussed.

There's an App for it: A systematic review of mobile apps providing information about abortion using a revised MARS scale

Mobile applications (apps) are increasingly being used to access health-related information, but it may be challenging for consumers to identify accurate and reliable platforms. We conducted a systematic review of applications that provide information about abortion. We searched the iTunes and Google Play stores and queried professional networks to identify relevant apps. To evaluate the apps, we used the validated Mobile App Rating Scale (MARS) and added relevant abortion-specific elements. Two reviewers independently rated each app, and we report mean scores on a 5-point scale across the domains of engagement, functionality, esthetics, and information. We also rated app characteristics (including target population and reach), and number of desirable abortion-specific features. We defined recommended apps as those that achieved a score of 4.0 or above for the question: "would you recommend this app to people who may benefit from it?" Our search initially yielded 282 apps and we identified two additional apps through professional mailing lists. Most were irrelevant or not abortion-specific. We excluded 37 apps that sought to discourage users from seeking abortion. Only 10 apps met inclusion criteria for this review. The Euki app had the highest overall score (4.0). Half of the apps achieved a score of 3.0 or greater. Most of the apps had few desirable design features. Some apps provided significant information but had poor functionality. Only four apps met criteria for being recommended: Euki, Safe Abortion by Hesperian, Ipas Mexico, and Marie Stopes Mexico. In conclusion, we found few apps that provide unbiased information about abortion, and their quality varied greatly. App developers and abortion experts should consider designing additional apps that are clinically accurate, unbiased and well-functioning. We registered this review in the PROSPERO database (Registration # CRD42020195802).

The effects of spring versus summer heat events on two arid zone plant species under field conditions

Heatwaves are increasingly occurring out-of-season, which may affect plants not primed for the event. Further, heat stress often coincides with water and/or nutrient stress, impairing short-term physiological function and potentially causing downstream effects on reproductive fitness. We investigated the response of water-stressed arid-zone Solanum oligacanthum and Solanum orbiculatum to spring vs summer heat stress under differing nutrient conditions. Heat stress events were imposed in open-topped chambers under in situ desert conditions. To assess short-term impacts, we measured leaf photosystem responses (F v /F m ) and membrane stability; long-term effects were compared via biomass allocation, visible damage, flowering and fruiting. Plants generally fared more poorly following summer than spring heat stress, with the exception of F v /F m . Summer heat stress caused greater membrane damage, reduced growth and survival compared with spring. Nutrient availability had a strong influence on downstream effects of heat stress, including species-specific outcomes for reproductive fitness. Overall, high temperatures during spring posed a lower threat to fitness than in severe arid summer conditions of high temperature and low water availability, which were more detrimental to plants in both the short and longer term. Our study highlights the importance of considering ecologically relevant, multiple-stressor events to understand different species responses to extreme heat.

The culturable seed mycobiome of two Banksia species is dominated by latent saprotrophic and multi-trophic fungi

Seed fungal endophytes play an important beneficial role in the formation of the seedling mycobiome and contribute to plant establishment, but can also occur as latent pathogens and saprotrophs. Current knowledge on the function and diversity of seed fungal endophytes has been gained through studies in agricultural systems whilst knowledge from natural systems is relatively less. We used two co-occurring species from the genus Banksia from four sites in Australia's Sydney Basin Bioregion to investigate the abundance and diversity of seed fungal endophyte communities present in natural ecosystem hosts. Based on results from culturing and DNA sequence analysis of multiple loci, we found that Banksia seeds house a diverse range of fungal endophyte species, that when assigned to functional guilds belonged to multiple trophic modes. Thirty-one of the fungal taxa identified had not been previously reported as endophytes. Amongst the 58 Operational Taxonomic Units identified, Leotiomycetes and Sordariomycetes were the dominant classes and Banksiamyces (Leotiomycetes) and Penicillium (Sordariomycetes) the dominant genera, with many of the species isolated recorded in the literature as having a limited distribution. The two Banksias shared few fungal endophyte species, which were not always present across all study sites. We revealed a 'hidden diversity' within seeds of Banksia from natural ecosystems and provided insights into the influence host species can have on the seed mycobiome.

A113 ANNUAL COLONOSCOPY VOLUME IS NOT PREDICTIVE OF COLONOSCOPY QUALITY - FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

Background

Performing a minimum number of colonoscopies annually has been proposed by some jurisdictions as a requirement for maintaining privileges. However, this practice is supported by limited evidence.

Aims

The objective of this study was to determine if annual colonoscopy volume was associated with colonoscopy quality metrics.

Methods

A population-based study was performed using the Southwest Ontario Colonoscopy cohort, which consists of all adult patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 academic and community hospitals within the health region. Data were collected through a mandatory quality assurance form completed after each procedure and pathology reports were manually reviewed. Physician annualized colonoscopy volumes were compared by correlation analysis to each quality-related outcome, by means of the area under the receiver operating characteristics curve (AUROC), and logistic regression. The prognostic value of colonoscopy volume was also adjusted for case-mix and potential confounders in separate regression analyses for each outcome. The primary outcome was ADR. Secondary outcomes were polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and cecal intubation.

Results

A total of 47,195 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others). There were no clear relationships between annual colonoscopy volumes and study outcomes. Colonoscopy volume was not associated with ADR (OR 1.03, 95% CI 0.96–1.10, p=0.48) and corresponded to an AUROC not significantly different from the null (AUROC 0.52, 95% CI 0.43–0.61, p=0.65). Multi-variable regression adjusting for case-mix also demonstrated no predictive value of annual colonoscopy volume for the primary outcome (OR 1.03, 95% CI 0.94–1.12, p=0.55). Similarly, analyses of secondary outcomes failed to find an association between colonoscopy volume and PDR, SSPDR, or cecal intubation (Table 1).

Conclusions

Annual colonoscopy volumes do not predict ADR, PDR, SSPDR, or cecal intubation rate.

Results of unconditional and conditional approaches for examining the predictive value of annual colonoscopy volume for quality related outcomes.

Funding Agencies

None

A117 PROPOFOL SEDATION DOES NOT IMPROVE MEASURES OF COLONOSCOPY QUALITY – FINDINGS FROM THE SOUTHWEST ONTARIO COLONOSCOPY COHORT

Background

The use of propofol during colonoscopy has gained increased popularity due to deeper anesthesia compared to conscious sedation. Prior studies examining the use of propofol sedation during colonoscopy have primarily focused on anesthesia outcomes. Whether propofol sedation is associated with improvements in colonoscopy outcomes is uncertain.

Aims

The primary outcome was adenoma detection rate (ADR). Secondary outcomes were the detection of any adenoma (conventional adenoma, sessile serrated polyp, and traditional serrated adenoma), sessile serrated polyp detection rate, polyp detection rate, cecal intubation rate, and perforation rate.

Methods

The Southwest Ontario Colonoscopy cohort consists of all patients who underwent colonoscopy between April 2017 and Oct 2018 at 21 hospitals serving a large geographic area in Southwest Ontario. Procedures performed in patients less than 18 years of age or by endoscopist who perform <50 colonoscopies/year were excluded. Data were collected through a mandatory quality assurance form that was completed by the endoscopist after each procedure. Pathology reports were manually reviewed.

Results

A total of 46,634 colonoscopies were performed by 75 physicians (37.5% by gastroenterologists, 60% by general surgeons, 2.5% others) of which 16,408 (35.2%) received propofol and 30,226 (64.8%) received conscious sedation (e.g. combination of a benzodiazepine and a narcotic). Patients who received propofol were likely to have a screening indication (49.2% vs 45.5%, p<0.0001), not have a trainee endoscopist present and be performed at a non-academic centre (32.2% vs 44.6%, p<0.0001). Compared to conscious sedation, use of propofol was associated with a lower ADR (24.6% vs. 27.0%, p<0.0001) and detection of any adenoma (27.7% vs. 29.8%, p<0.0001); no difference was observed in the detection ofsessile serrated polyps (5.0% vs. 4.7%, p=0.26), polyp detection rate (41.2% vs 41.2%, p=0.978), cecal intubation rate (97.1% vs. 96.8%, p=0.15) or perforation rate (0.04% vs. 0.06%,p=0.45). On multi-variable analysis, the use of propofol was not significantly associated with any improvement in ADR (RR=0.90, 95% CI 0.74–1.10, p=0.30), detection of any adenoma (RR=0.93, 95% CI 0.75–1.14, p=0.47), sessile serrated polyp detection rate (RR=1.20, 95%CI 0.90–1.60, p=0.22), polyp detection rate (RR=1.00, 95% CI 0.90–1.11, p=0.99), or cecal intubation rate (RR=1.00, 95%CI 0.80–1.26, p=0.99).

Conclusions

The use of propofol sedation does not improve colonoscopy quality metrics.

Funding Agencies

None

A Quality Improvement Initiative To Improve Postdischarge Antimicrobial Adherence

OBJECTIVES

Bedside delivery of discharge medications improves caregiver understanding and experience. Less is known about its impact on medication adherence. We aimed to improve antimicrobial adherence by increasing on-time first home doses for patients discharged from the pediatric hospital medicine service from 33% to 80% over 1 year via creation of a discharge medication delivery and counseling "Meds to Beds" (M2B) program.

METHODS

Using sequential plan-do-study-act cycles, an interprofessional workgroup implemented M2B on select pediatric hospital medicine units at our quaternary children's hospital from October 2017 through December 2018. Scripted telephone surveys were conducted with caregivers of patients prescribed antimicrobial agents at discharge. The primary outcome measure was on-time administration of the first home antimicrobial dose, defined as a dose given within the time of the inpatient dose equivalent plus 25%. Process measures primarily assessed caregiver report of barriers to adherence. Run charts, statistical process control charts, and inferential statistics were used for data analysis.

RESULTS

Caregiver survey response rate was 35% (207 of 585). Median on-time first home antimicrobial doses increased from 33% to 67% (P < .001). Forty percent of M2B prescriptions were adjusted before discharge because of financial or insurance barriers. M2B participants reported significantly less difficulty in obtaining medications compared with nonparticipants (1% vs 17%, P < .001).

CONCLUSIONS

The M2B program successfully increased parental report of timely administration of first home antimicrobial doses, a component of overall adherence. The program enabled providers to identify and resolve prescription problems before discharge. Importantly, caregivers reported reduced barriers to medication adherence.

Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea

BACKGROUND

The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking.

AIM

To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards.

METHODS

A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively.

FINDINGS

Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset.

CONCLUSION

HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.

Reviewing research priorities in weed ecology, evolution and management: a horizon scan

Weedy plants pose a major threat to food security, biodiversity, ecosystem services and consequently to human health and wellbeing. However, many currently used weed management approaches are increasingly unsustainable. To address this knowledge and practice gap, in June 2014, 35 weed and invasion ecologists, weed scientists, evolutionary biologists and social scientists convened a workshop to explore current and future perspectives and approaches in weed ecology and management. A horizon scanning exercise ranked a list of 124 pre-submitted questions to identify a priority list of 30 questions. These questions are discussed under seven themed headings that represent areas for renewed and emerging focus for the disciplines of weed research and practice. The themed areas considered the need for transdisciplinarity, increased adoption of integrated weed management and agroecological approaches, better understanding of weed evolution, climate change, weed invasiveness and finally, disciplinary challenges for weed science. Almost all the challenges identified rested on the need for continued efforts to diversify and integrate agroecological, socio-economic and technological approaches in weed management. These challenges are not newly conceived, though their continued prominence as research priorities highlights an ongoing intransigence that must be addressed through a more system-oriented and transdisciplinary research agenda that seeks an embedded integration of public and private research approaches. This horizon scanning exercise thus set out the building blocks needed for future weed management research and practice; however, the challenge ahead is to identify effective ways in which sufficient research and implementation efforts can be directed towards these needs.

Emerging investigator series: a 14-year depositional ice record of perfluoroalkyl substances in the High Arctic

To improve understanding of long-range transport of perfluoroalkyl substances to the High Arctic, samples were collected from a snow pit on the Devon Ice Cap in spring 2008. Snow was analyzed for perfluoroalkyl acids (PFAAs), including perfluoroalkyl carboxylic acids (PFCAs) and perfluoroalkyl sulfonic acids (PFSAs), as well as perfluorooctane sulfonamide (FOSA). PFAAs were detected in all samples dated from 1993 to 2007. PFAA fluxes ranged from <1 to hundreds of ng per m² per year. Flux ratios of even-odd PFCA homologues were mostly between 0.5 and 2, corresponding to molar ratios expected from atmospheric oxidation of fluorotelomer compounds. Concentrations of perfluorobutanoic acid (PFBA) were much higher than other PFCAs, suggesting PFBA loading on the Devon Ice Cap is influenced by additional sources, such as the oxidation of heat transfer fluids. All PFCA fluxes increased with time, while PFSA fluxes generally decreased with time. No correlations were observed between PFAAs and the marine aerosol tracer, sodium. Perfluoro-4-ethylcyclohexanesulfonate (PFECHS) was detected for the first time in an atmospherically - derived sample, and its presence may be attributed to aircraft hydraulic system leakage. Observations of PFAAs from these samples provide further evidence that atmospheric oxidation of volatile precursors is an important source of PFAAs to the Arctic environment.

'The end of my world'

New research from Parkinson's UK reveals that 37% of people with the condition have felt the need to lie about having it or to hide their symptoms.

Food-entrained rhythmic expression of PER2 and BMAL1 in murine megakaryocytes does not correlate with circadian rhythms in megakaryopoiesis

BACKGROUND

Circadian rhythms control a vast array of biological processes in a broad spectrum of organisms. The contribution of circadian rhythms to the development of megakaryocytes and the regulation of platelet biology has not been defined.

OBJECTIVES

This study tested the hypothesis that murine megakaryocytes exhibit hallmarks of circadian control.

METHODS

Mice expressing a PER2::LUCIFERASE circadian reporter protein and C57BI/6 mice were used to establish if megakaryocytes expressed circadian genes in vitro and in vivo. Mice were also subjected to 3 weeks on a restricted feeding regime to separate food-entrained from light-entrained circadian rhythms. Quantitative real time polymerase chain reaction (PCR), flow cytometry and imunohistochemistry were employed to analyse gene expression, DNA content and cell-cycle behavior in megakaryocytes collected from mice over a 24-h period.

RESULTS

Megakaryocytes exhibited rhythmic expression of the clock genes mPer2 and mBmal1 and circadian rhythms in megakaryopoiesis. mPer2 and mBmal1 expression phase advanced 8 h to coincide with the availability of food; however, food availability had a more complex effect on megakaryopoiesis, leading to a significant overall increase in megakaryocyte ploidy levels and cell-cycle activity.

CONCLUSIONS

Normal megakaryopoiesis requires synchrony between food- and light-entrained circadian oscillators.

High D-dimer levels at presentation in patients with venous thromboembolism is a marker of adverse clinical outcomes

Qualitative D-dimer results, together with clinical probability scores, are well established in the diagnosis of venous thromboembolism (VTE). The predictive value of quantitative D-dimer levels for various clinical outcomes in VTE patients is not fully understood. D-dimer levels obtained at presentation were analysed in 699 (360 men; 339 women) VTE patients for survival and occurrence of malignancy. Patients were followed for a median of 23 months. 17.2% patients had a D-dimer level >8000 ng FEU/mlat presentation, which was associated with decreased overall survival (OS) (P < 0.001) and event-free survival (EFS) (P < 0.001). 25.4% patients had malignancy and 4% subsequently developed malignancy following VTE. 29.9% of patients with VTE and malignancy had a D-dimer level >8 mg/l when compared with 13.4% of patients with VTE without malignancy (P < 0.001). 50% of patients who developed subsequent malignancy following VTE had a presentation D-dimer >8000 ng FEU/mlas compared with 13.3% of patients with VTE with out malignancy (P = 0.009). In conclusion, D-dimer >8000 ng FEU/ml at presentation in patients with VTE is a marker of poor OS, EFS and underlying malignancy. Consideration of screening for malignancy is recommended in patients with VTE with a presentation D-dimer >8000 ng FEU/ml and age >60 years.

Chapter 21: Modelling the impact of HPV vaccines on cervical cancer and screening programmes

The impact of human papillomavirus (HPV)-16/18 vaccination on the incidence of infection and disease can be explored in a range of different models. Here we explore the epidemiological and economic impact of vaccination where screening is absent and where it is well established. The importance for epidemiology of assumptions about naturally-acquired immunity and heterogeneity in risk behaviours are highlighted, as are the importance for health economic outcomes of vaccine costs and the ability to modify screening strategies. To date, model results are consistent in predicting a useful role for vaccine, but further epidemiological data are required to help test the validity of models.

Simulations of the HIV epidemic in sub-Saharan Africa: sexual transmission versus transmission through unsafe medical injections

OBJECTIVES

Heterosexual transmission has long been considered the predominant route of transmission of HIV-1 in sub-Saharan Africa. However, some have argued that unsafe medical injections account for the majority of transmission in this region.

GOAL

The goal of this study was to compare the HIV-1 epidemics associated with different transmission routes.

STUDY

An age-structured deterministic compartmental model of HIV-1 transmission through both sexual contact and unsafe injections was developed and simulations of sexual transmission and iatrogenic transmission were compared with observed prevalence.

RESULTS

Iatrogenic transmission probabilities and numbers of unsafe injections required to generate observed prevalence are unfeasibly high. Simulations of sexually transmitted HIV-1 generate observed prevalence using transmission probabilities and average partner change rates that are within plausible bounds.

CONCLUSIONS

Heterosexual transmission seems a more likely route of transmission in the region. However, heterogeneity in contact patterns is of key importance. Further information on groups who are likely to receive more injections is required.

Comparison of foraging behaviour of small, urban-sensitive insectivores in continuous woodland and woodland remnants in a suburban landscape

Small patches of remnant vegetation are often considered to have low conservation value. In urban landscapes their value may potentially be higher than in other landscapes because they can be the only representatives of original native vegetation. Despite this potential, many small insectivorous birds that rely on native vegetation demonstrate sensitivities within urban landscapes through reduced numbers or total absence. One reason for this sensitivity may be that remnants are of suboptimal quality, which may be reflected in behavioural changes. Using five insectivorous species that were present (in low numbers) in remnants surrounded by high-density housing, foraging behaviour was examined in relation to vegetation. The proportion of time birds spent on different foraging substrates and plant species was compared with that of conspecifics in continuous vegetation. Canopy and shrub foragers showed minimal behavioural changes. Ground foragers in remnants tended to forage at lower heights than those in continuous vegetation; however, these changes did not appear to reflect a negative effect. These changes were partially explained by structural differences between vegetation in remnants and continuous sites. The number of times a bird attacked prey items was significantly higher in continuous habitat for only two species. Overall, the foraging behaviour of small insectivorous birds in remnants surrounded by high-density housing was not adversely affected by urbanisation and it appears that remnants have potential value as habitat and foraging sources in an urban landscape. Despite this, small insectivores are still sensitive to urbanisation, suggesting that other factors, probably in the matrix, are important.

Environmental weed control policy in Australia: current approaches, policy limitations and future directions

Plant invasions of natural systems threaten biodiversity and ecosystem processes across many biomes. Historically most plant invasions have been facilitated by human activities such as industry, transport and landscape modification. Consequently, both causes and management of weed invasion are dependent on human behaviour and management advice provided by ecologists needs to take account of this fact. This paper assesses current environmental weed control policy in Australia and asks: are government, land managers and the scientific community using available social levers to achieve optimal weed management? We do this by comparing aspects of weed policy with a generalized natural resource policy framework. Adequacy of issue characterization and policy framing are discussed with particular reference to public perceptions of the weed problem, policy scaling and defining policy principles and goals. The implementation of policy Instruments, including regulation, VOluntary incentives, education, Information, motivational instruments, property-right instruments and pricing mechanisms are reviewed. Limitations of current instruments and potential options to improve instrument effectiveness are discussed. Funding arrangements for environmental weed control are also reported: environmental weed invasion generally represents an external cost to economic markets which has resulted in relatively low funding levels for control operations. Finally, review and monitoring procedures in weed programmes and policy are addressed. Rigorous monitoring systems are important in effective, adaptive weed management where control techniques are continually refined to improve ecological outcomes. The utility of maintaining links between project outcomes and policy inputs along with methods of implementing appropriate monitoring are discussed.

Pharmacokinetics and metabolic effects of triamcinolone acetonide and their possible relationships to glucocorticoid-induced laminitis in horses

Experiments were performed to establish the pharmacokinetics of triamcinolone acetonide and the effects of the glucocorticoid on glucose metabolism in horses. The pharmacokinetics after intravenous (i.v.) dosing was best described by a three-compartment open model. There was rapid distribution from the central compartment followed by two phases of elimination. The half-life of the rapid elimination phase was 83.5 min and of the slower phase was 12 h. The term (Vss/Vc)-1was 12.3 indicating extensive distribution into the tissues. Triamcinolone acetonide given i.v. or intramuscularly (i.m. ) induced a prolonged period of hyperglycaemia, hyperinsulinaemia and hypertriglyceridaemia. Significant changes in plasma glucagon and serum non-esterified fatty acids were not observed. These observations suggest that the hyperglycaemia was a result of decreased glucose utilization by tissues and increased gluconeogenesis. The effects on glucose metabolism persisted for 3-4 days after triamcinolone was given i.m. at 0.05 mg/kg, the upper limit of the recommended dose range, and for 8 days when given at 0. 2 mg/kg. These observations, together with recent evidence implicating inhibition of glucose metabolism in the pathogenesis of equine laminitis, indicated that triamcinolone-induced laminitis may be associated with the long duration of action of the glucocorticoid when higher than recommended doses or when repeated doses are given.

Appropriately trained nurses are competent at inserting intrauterine devices: an audit of clinical practice

OBJECTIVE

Very few nurses in the UK insert intrauterine devices (IUDs). Within King's Healthcare, nurses with the advanced family planning qualification (ENB AO8), who have also undertaken further training in IUD insertion, have done so for many years. This is a controversial issue and our aim was to evaluate whether women who had IUDs inserted by specialist nurses had significantly more problems compared with those inserted by doctors.

STUDY DESIGN

This was a prospective, ongoing, cohort study of all IUD insertions in hospital-based family planning clinics over a 3-month period. A medical, gynecological, obstetric and contraceptive history was taken, paying particular regard to the reason for requesting an IUD. Clinical assessment, bimanual examination findings and any difficulties with insertion were noted at the time. Any postinsertion problems were noted at the follow-up visit.

RESULTS

Fifty IUDs were inserted, 28 by doctors and 22 by nurses. Sixteen were for postcoital contraception and five were routine reinsertions alter removal of an existing IUD. Eleven nulliparous women had insertions (six by doctors and five by nurses). The specialist nurses did not have to consult the doctor with any problems or difficulties with insertion. Twenty-nine clients attended for their follow-up appointment at 6 weeks. Three IUDs required early removal due to unacceptable bleeding and pain--all three had been inserted by doctors. Two postcoital IUDs were removed following menstruation. Of the remaining patients, eight were noted to have minor problems (divided equally between doctor and nurse insertions).

CONCLUSION

This study provides favorable evidence that adequately trained nurses are proficient and safe at IUD insertions, regardless of the woman's parity. IUDs inserted by nurses are also likely to have additional benefits of cost-effectiveness and increased client and nurse satisfaction. Follow-up is ongoing.

Changing ventilator tubing circuits every seven days versus every 72 hours: proposed practice based on literature review

The changing of ventilator circuitry is a costly, time-consuming exercise. The current practise of changing circuits every 72 hours is not supported by research and is therefore being challenged. This literature review supports a change in practice from changing circuits every 72 hours to every 7 days or between patients, whichever occurs first. Previous research studying the time interval between circuit changes is reviewed. Contributing factors such as the contamination of tubing by various means are discussed and finally research-based proposals for future practice will be made.

Aerosol delivery of a beta-galactosidase adenoviral vector to the lungs of rodents

Aerosol delivery of adenoviral vectors is of particular interest in regard to gene therapy for cystic fibrosis (CF), with potential advantages of more uniform respiratory delivery, a less invasive approach, and ease of repetition. The AdHCMVsp1LacZ (AdLacZ) adenoviral vector was used to evaluate the feasibility of aerosol delivery to the respiratory epithelium in rodents. The adenoviral vector tolerated aerosol generation as measured by recovery in an all-glass impinger. Using an Andersen sampler to mimic the human respiratory tract, aerosol particles were found to have an average mass mean aerodynamic diameter of 1.6 microns and a geometric standard deviation of 1.7 microns. Cotton rats and mice exposed to viral aerosols demonstrated beta-galactosidase expression in up to 10-30% of the epithelial surface of the small and large airways, whereas expression in Sprague Dawley rats was largely limited to the alveolar epithelium. Transgene expression was distributed uniformly through both lungs in animals treated by aerosol. The variables for aerosol delivery are complex and include viral titer, aerosol device, duration of exposure, species of recipient, and respiratory behavior among other factors. Species differences in expression in airways as compared to alveolar epithelium have important implications for clinical application.

Consultations for breast disease in general practice and hospital referral patterns

As part of the evaluation of a health education campaign about breast disease, consultations for breast problems were monitored in five general practices over an 18-month period in Edinburgh. No increase was found as a result of the campaign, nor was there any increase in the number of biopsies performed. On average, each GP saw 13 women with breast problems each year, a rate of 1.6 per cent; 29 per cent were referred to hospital, regardless of their age. The most common presenting symptom was pain (47 per cent), with 35 per cent complaining of a lump. The reasons for hospital referral are discussed. It is suggested that GPs may refer too many young women to a specialist clinic, although this may be inevitable.

Edinburgh breast education campaign on breast cancer and breast self-examination: was it worth while?

A health education campaign was carried out at the start of a large trial of screening for breast cancer in Edinburgh. After preliminary studies the campaign concentrated on talks to small groups of women by specially trained health visitors. Over a year, 12,000 women attended. Systematic evaluation after 12 months showed that selected women who heard the talks were more knowledgeable about breast cancer, and a random sample of women in Edinburgh had a small but significant improvement in knowledge compared with women in Aberdeen. However, the random sample did not report an increase in the practice of breast self-examination (BSE) and there was no increase in workload for general practitioners. It is suggested that BSE is more likely to be accepted if combined with a physical examination.

Psychiatric morbidity after screening for breast cancer

One hundred and thirty two women with normal breast screening results were interviewed six months after their attendance at the Edinburgh Breast Screening Clinic. Eight percent of women said screening had made them more anxious about developing breast cancer. Thirty eight percent said they were more aware of the disease since screening but they regarded this as advantageous. Seventy percent of the women were still practising breast self-examination. There was no difference in the psychiatric morbidity of the screened sample when compared with a matched random sample community control group. Neither was there any difference in the General Health Questionnaire case rates before and after screening. Screening does not appear to increase the prevalence of psychiatric morbidity. Twenty nine percent of the interview sample were examining their breasts more than once a month--21% once a week or more. However, these frequent self-examiners did not have a greater prevalence of psychiatric morbidity than their matched controls.

Breast cancer and breast self-examination: what do Scottish women know?

To aid the design of a health education campaign centred around a breast screening programme, a survey of knowledge about breast cancer and breast self-examination was carried out in 810 women selected randomly from the electoral registers in Edinburgh and Aberdeen. On the whole, the level of knowledge was poor, but was strongly related to age, social class, previous experience of breast problems and preventive health behaviour. Very few women knew of signs to look for other than a lump or of any treatments other than mastectomy or radiotherapy. Although 57% had tried or were practising self-examination, only a small minority knew of the correct technique and when to do it. There may be several reasons for our findings, including previous lack of appropriate information from professional sources, avoidance due to fear and anxiety about breast cancer or lack of motivation because this disease is not seen as an important single threat. These results will be compared with a later survey as part of the evaluation of our health education campaign.

Attendance at a breast screening clinic: a problem of administration or attitudes

In a study of why a sample of women, aged 45-64 and registered with a group practice in Edinburgh, attended or did not attend the Edinburgh Breast Screening Clinic demographic, aetiological, social, and perceptual characteristics of attenders and non-attenders were compared. Similar proportions of attenders and non-attenders knew the chance of a breast lump being cancer and were aware of the benefits of early diagnosis and treatment. The study, however, suggests that non-attenders saw the screening clinic as a place of risk while the attenders saw screening in a positive light: 79% of non-attenders as compared with 36% of attenders said that they were afraid of cancer being found, and most women attended either to reassure themselves that they had not got breast cancer or to receive early treatment if they had. Furthermore, 72% of non-attenders as compared with 13% of attenders were anxious that their lives would be disrupted if cancer were found at the screening clinic. There may well be an important irreducible element to non-attendance due to attitudinal factors; the ethical implications of attempting to eliminate this require careful consideration.

Research ethical committees in Scotland

A questionnaire was sent to 41 ethical committees in Scotland requesting information about their constitution and supervision of clinical research. Thirty-four (83%) replies were received. Committees varied in size from one to 73 members, most of whom were medical. Ten had no nurse members and only three had lay members without direct NHS connections. Sixteen saw their role as advisory rather than supervisory. Thirteen had not met in the past year whereas two had held 10 or more meetings. Limited use (12) was made of standard protocols, and only six had formal procedures for monitoring research in progress. Only seven of 370 proposals were rejected outright. Risk/benefit dilemmas and difficulties relating to informed consent were the commonest problems encountered. The committees provide only limited safeguards for patients and research workers, and more effective, standardised procedures are indicated.

Temperature-dependent Changes in the Polysomal Population of Senescent (Ripening) Pear Fruit

A loss and recovery of polysomes coincident with the temperature-dependent interruption and resumption of pear fruit (Pyrus communis, L.) senescence establishes a close correlation between the presence of protein-synthesizing machinery and the progression of senescence and ripening.

Biracial study of arterial pressures in the first and second decades of life

The blood pressures of young Black and White American schoolchildren were measured and compared with those of Nigerian children of similar ages. Both diastolic and systolic pressures were consistently higher in the Nigerian children than in the Americans, both Black and White. The White children had the lowest pressures at each age. The mean weights and heights at each age were not significantly different in the three groups. Although the blood pressure of African children was higher than that of Black Americans, mean adult pressures are known to be similar in both groups. This suggests that the difference in childhood pressures must be due more to environmental factors than to genetic ones.