Australian student radiographers' experiences and perspectives in general paediatric medical imaging examinations

INTRODUCTION

Paediatric patients differ from adult patients with respect to anatomy, examination factors, behaviour, and intellectual development, requiring dedicated specialised knowledge and expertise. In the absence of a formal dedicated paediatric medical imaging subspecialty, this study undertook to understand student radiographers' experiences and perspectives on paediatric medical imaging.

METHODS

The study entailed a descriptive cross-sectional survey design entailed a 51-item closed and open-ended response questionnaire using a total sampling method. Data were collected from both under- and postgraduate student radiographers who undertook clinical placement. Data interpretation and analysis involved statistical analysis of close-ended questions and thematic analysis of open-ended questions.

RESULTS

The overall response rate was 70%. Most participants acknowledged the importance of dedicated paediatric content as well as the theory content covered. The shortcoming in pre-placement practical component was overcome through varied approaches like observations and attempting through supervision whilst experiencing uncertainty, anxiety and felt unfair to risk the patient. As reported in literature like their qualified counterparts expressed similar challenges in technique adaptation, styles of interactions in gaining cooperation from both the children and parents. They also felt paediatric content and the practicals should be embedded throughout the course offering to not compromise the day-to-day service delivery.

CONCLUSIONS

The study findings iterate the importance paediatric imaging in the service delivery context. The importance of undertaking these examinations reliant on experiential learning is insufficient to bridge the gap of preparation prior to placement.

IMPLICATIONS FOR PRACTICE

Collaborative academic and clinical radiography education will ensure that radiography students' dedicated specialised paediatric imaging knowledge and experience are enhanced.

Effectiveness of Autogenic Relaxation Technique on Depression Among Menopausal Women in SMCH

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. Menopause means permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity.It is the point of time when last and final menstruation oocurs.Autogenic relaxation technique also known as relaxation training is any method, process, or activity that helps a person relax. The aim of the study to evaluate the effectiveness of autogenic relaxation technique on depression among menopausal women admitted to saveetha medical college and hospital. A quantitative approach with experimental research design was adopted for the present study. 60 samples were selected by using simple random sampling techniques. A self structured questionnaire method was used to collect the demographic data. Among 60 participants 30 in the experimental group and 30 in the control group of menopausal women.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Forgetting to take HIV antiretroviral therapy: a qualitative exploration of medication adherence in the third decade of the HIV epidemic in the United States

Optimal adherence to HIV antiretroviral therapy (ART) is challenging, and racial/ethnic disparities in adherence rates are substantial. The most common reason persons living with HIV (PLWH) give for missed ART doses is forgetting. We took a qualitative exploratory approach to describe, from the perspectives of African American/Black and Hispanic/Latino PLWH, what it means to forget to take ART and factors that influence forgetting. Participants (N = 18) were purposively sampled for maximum variability and engaged in semi-structured/in-depth interviews on HIV/ART management. The analysis took a directed content analysis approach. Participants were mostly male (56%) and African American/Black (79%), between 50 and 69 years old, and had lived with HIV for an average of 21 years. Findings were organised into six inter-related themes: (1) forgetting to take ART was a shorthand description of a complex phenomenon, but rarely a simple lapse of memory; (2) ‘forgetting’ was means of managing negative emotions associated with HIV; (3) life events triggered mental health distress/substance use which disrupted adherence; (4) historical traumatic events (including AZT monotherapy) and recent trauma/loss contributed to forgetting; (5) patient-provider interactions could support or impede adherence; and (6) intrinsic motivation was fundamental. Implications for HIV social service and health care settings are described.

Development and implementation of a clinical information system-based protocol to improve nurse satisfaction of end-of-life care in a single intensive care unit

BACKGROUND

Patients treated in Australian intensive care units (ICUs) have an overall mortality rate of 5.05%. This is due to the critical nature of their disease, the increasing proportion of patients with multiple comorbidities, and advanced age. This has made treating patients during the end of life an integral part of intensive care practice and requires a high quality of care. With the increased use of electronic clinical information systems, a standardised protocol encompassing end-of-life care may provide an efficient method for documentation, communication, and timely delivery of comfort care.

OBJECTIVE

The aim of the study was to determine if an electronic clinical information system-based end-of-life care protocol improved nurses' satisfaction with the practice of end-of-life care for patients in the ICU.

DESIGN

This is a prospective single-centre observational study.

SETTING

The study was carried out at a 20-bed cardiothoracic and general ICU between 2015 and 2017.

PARTICIPANTS

The study participants were ICU nurses.

INTERVENTION

Electronic clinical information-based end-of-life care protocol was used in the study.

OUTCOME

The primary outcome was nurse satisfaction obtained by a survey.

RESULTS

The number of respondents for the before survey and after survey was 58 (29%) and 64 (32%), respectively. There was a significant difference between the before survey and the after survey with regard to feeling comfortable in transitioning from curative treatment (median = 2 [interquartile range {IQR} = 2, 3] vs 3 [IQR = 2, 3], p = 0.03), feeling involved in the decision to move from curative treatment to end-of-life care (median = 2 [IQR = 2, 2] vs 2 [IQR 2, 3], p = 0.049), and feeling religious beliefs/rituals should be respected during the end-of-life process (median = 4 [IQR = 3, 4] vs. 4 [IQR = 4, 4], p = 0.02). There were some practices that had a low satisfaction rate on both the before survey and after survey. However, a high proportion of nurses were satisfied with many of the end-of-life care practices.

CONCLUSION

The nurses were highly satisfied with many aspects of end-of-life care practices in this unit. The use of an electronic clinical information system-based protocol improved nurse satisfaction and perception of quality of end-of-life care practices for three survey questions.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

THU0408 EFFECT OF NEW-ONSET GOUT ON KIDNEY TRANSPLANT OUTCOMES: A RETROSPECTIVE COHORT ANALYSIS OF THE UNITED STATES RENAL DATA SYSTEM

Background:

Gout is a frequent comorbidity in kidney transplant (KT) recipients. However, assessing the independent effect of gout on KT outcomes is difficult because of multiple confounders (e.g., temporal changes in estimated glomerular filtration rate [eGFR], cyclosporine or tacrolimus dose, urate-lowering medication use) that obscure a clear picture of gout’s potential impact.

Objectives:

This investigation assessed if the development of new-onset gout after KT was an independent risk factor for loss of graft function, as assessed by the need for maintenance hemodialysis following KT.

Methods:

This retrospective cohort study analyzed data on patients in the United States Renal Data System (USRDS) who received a primary KT between 1/1/2008 and 12/31/2015. The date of transplantation was the ‘index’ date. Eligible patients were required to have ≥24 months of Medicare coverage and no prior history of gout, defined as ≥1 claim with a gout diagnosis code in the 24 months prior to the index date. All patients were also required to have ≥12 months of coverage post index. Patients who died, experienced graft failure, or returned to dialysis <12 months post index were excluded. Because the first year following transplant is associated with the highest frequency of rejections, we evaluated subjects beginning 1 year after transplant. The exposure of interest was new-onset gout, defined as the presence of ≥2 claims for gout post index, and the primary endpoint was return to dialysis >12 months post index. Baseline time-invariant confounders included recipient and donor demographics and clinical characteristics at index. Time-varying confounders included body mass index (BMI) adjusted tacrolimus and cyclosporine dose, eGFR, and urate-lowering medication use post index. Patients who died or lost Medicare coverage >12 months post index were censored; all patients remaining at the end of the study period (12/31/2016) were also censored. A marginal structural model (MSM) was fitted to determine the relative risk of new-onset gout on return to dialysis, while controlling for both time-invariant and time-varying confounders.

Results:

18,525 of 466,589 KT recipients in the USRDS met study eligibility. Within the observation period, 1,399 (7.6%) developed new-onset gout and 1,420 (7.7%) returned to dialysis >12 months post index. Median time from index to new-onset gout and from index to return to dialysis was 16.2 months (IQR: 33.4) and 32.8 months (IQR: 28.4), respectively. Adjusting for baseline time-invariant and time-varying confounders via the MSM showed new-onset gout was associated with a 51% increased risk of return to dialysis >12 months post index (RR: 1.51, 95% CI: 1.03, 2.20).

Conclusion:

New-onset gout was independently associated with a 51% increased risk of return to dialysis >12 months after primary KT compared to a control cohort without gout. To our knowledge, this is the first observation of this outcome in an appropriately controlled cohort study of KT recipients with gout. Results from this analysis may have important implications for the monitoring and management of new-onset gout in the kidney transplant population.

References:

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Disclosure of Interests: :

Justin Li: None declared, David Yin: None declared, Zheng Wang: None declared, Mark Brigham: None declared, Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Jeffrey Kent Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Megan Francis-Sedlak Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Richard Johnson Shareholder of: Colorado Research Partners LLC, XORTX Therapeutics, Consultant of: Horizon Therapeutics, Eli Lilly, Speakers bureau: Horizon Therapeutics, Nandini Hadker: None declared, Kevin Francis: None declared, Herman Sanchez: None declared, Gavin Miyasato: None declared

Evaluation of a Diagnostic Method to Quantify Aflatoxins B1 and M1 in Animal Liver by High-Performance Liquid Chromatography with Fluorescence Detection

Background: Aflatoxins (AFs) are secondary metabolites of fungi and are one of the causes of toxin-related pet food recalls. An intralaboratory method was previously developed to quantify aflatoxin B1 (AFB1) and aflatoxin M1 (AFM1) in animal liver by HPLC with fluorescence detection. Objective: The aim of this study was to extensively evaluate the method performance with a single-laboratory blinded method test (BMT-S) and a multilaboratory blinded method test (BMT-M). Methods: Blinded tissue samples were prepared by a third-party laboratory and sent out to participating laboratories for both BMT-S and BMT-M. Results: In both tests, participants analyzed blinded samples prepared by an independent laboratory. In the BMT-S, accuracy ranged between 111 and 154% for AFB1 and 113 and 159% for AFM1 within the quantitation range of 0.1–0.5 ng/g. The HorRat values for repeatability ranged between 0.1 and 0.3 for AFB1 and 0.3 and 0.6 for AFM1. In the BMT-M, the interlaboratory accuracy ranged between 77 and 81% for AFB1 and 83 and 85% for AFM1 within the quantitation range of 0.2–10 ng/g. The HorRat values for reproducibility ranged between 0.4 and 0.7 for AFB1 and 0.4 and 0.9 for AFM1. Both recovery and reproducibility were acceptable. Conclusions: BMT-M evaluation demonstrated that the method was suitable for quantitation of aflatoxins B1 and M1 in animal liver between laboratories. Highlights: The BMT-S and BMT-M results demonstrated that the method is rugged and reproducible among the participating laboratories.

Evaluation of a Diagnostic Method to Quantify Aflatoxins B1 and M1 in Animal Liver by High-Performance Liquid Chromatography with Fluorescence Detection

Background: Aflatoxins (AFs) are secondary metabolites of fungi and are one of the causes of toxin-related pet food recalls. An intralaboratory method was previously developed to quantify aflatoxin B₁ (AFB₁) and aflatoxin M₁ (AFM₁) in animal liver by HPLC with fluorescence detection. Objective: The aim of this study was to extensively evaluate the method performance with a single-laboratory blinded method test (BMT-S) and a multilaboratory blinded method test (BMT-M). Methods: Blinded tissue samples were prepared by a third-party laboratory and sent out to participating laboratories for both BMT-S and BMT-M. Results: In both tests, participants analyzed blinded samples prepared by an independent laboratory. In the BMT-S, accuracy ranged between 111 and 154% for AFB₁ and 113 and 159% for AFM₁ within the quantitation range of 0.1-0.5 ng/g. The HorRat values for repeatability ranged between 0.1 and 0.3 for AFB₁ and 0.3 and 0.6 for AFM₁. In the BMT-M, the interlaboratory accuracy ranged between 77 and 81% for AFB₁ and 83 and 85% for AFM₁ within the quantitation range of 0.2-10 ng/g. The HorRat values for reproducibility ranged between 0.4 and 0.7 for AFB₁ and 0.4 and 0.9 for AFM₁. Both recovery and reproducibility were acceptable. Conclusions: BMT-M evaluation demonstrated that the method was suitable for quantitation of aflatoxins B₁ and M₁ in animal liver between laboratories. Highlights: The BMT-S and BMT-M results demonstrated that the method is rugged and reproducible among the participating laboratories.

Utilizing a Global Cancer Center Network for Tobacco Control: Baseline Survey of MD Anderson´s Global Academic Program´s Sister Institution

Background: Globally, tobacco can be attributed to more than 7 million deaths each year. To address this potentially avoidable mortality, The University of Texas MD Anderson Cancer Center has engaged its Global Academic Program´s (GAP) sister institutions (SI) by conducting an inaugural tobacco control assessment survey. A similar survey was done with our University of Texas academic and health science center affiliates that led to improved adoption of tobacco control policies as well as prevention and cessation services on all campuses. The baseline data collected will serve as a mechanism to develop a tobacco prevention and control strategy within a global cancer center network. Aim: To assess SI laws and policies regarding tobacco use, existing screening and cessation services. Strategy/Tactics: Qualtrics was used to administer a 27-item survey to our GAP SI from April-October 2017. Survey questions focused on key areas of tobacco prevention and control: policy, tobacco use screening, and cessation services. A survey link was emailed to 34 institutions in 23 countries. Program/Policy process: Survey GAP SI to determine current tobacco prevention and control measures being implemented. Convene GAP SI in May 2018 to share tobacco control best practices across the network and identify resources and supports to strengthen tobacco control efforts at each institution. Build collaborations aimed at progressive actions in tobacco control policies, educational programs and cessation services culturally appropriate to the needs and resources of the GAP network. Outcomes: Of the 34 GAP SI, 26 responded to the survey (76% response rate). Key findings among the 26 responding institutions: policy - 96% are located in cities with laws regulating the sale and/or use of tobacco products by minors and 77% of the cities have laws regulating the use of tobacco in the workplace; 42% of the campuses have designated smoking areas; tobacco use screening - 65% screen for and document patients´ tobacco status, however only 27% screen “all the time”; cessation services - 19% offer telephone counseling as a cessation service; 38% offer cessation services to the community; 46% offer cessation services to employees. What was learned: The baseline assessment identified areas of institutional needs: cessation services and campus policies. Further discussion with the SI will help engage them in further efforts to address gaps in tobacco control. Collectively, we aim to develop action steps to collaborate and enhance existing services by creating a global platform in which tobacco control best practices and resources can be shared.

Abstract A17: NUAK1 acts as a growth suppressor in epithelial ovarian cancer

Epithelial ovarian cancer (EOC) cells form multicellular aggregates, or spheroids, and enter a dormant state during intraperitoneal metastasis. Dormant spheroids reduce anabolic metabolism and cell proliferation, which are linked to chemo-resistance. Liver kinase B1 (LKB1), encoded by the STK11 gene, is a critical regulator of stress metabolic signaling; LKB1 phosphorylates the downstream substrates AMP-activated protein kinase (AMPK) and AMPK-related kinases (ARKs) to mediate stress signaling. We have demonstrated that LKB1 expression and activity is required for EOC spheroid cell survival, yet knockdown of AMPKα1/α2 has no effect on viability. In addition, we have preliminary data demonstrating that phosphorylated AMPK is still maintained in EOC spheroids generated from CRISPR-mediated STK11-deleted cells, which completely lack LKB1 expression. Taken together, these results implicate the importance of other AMPK-independent effectors of LKB1 signaling in spheroid cell viability. Therefore, to identify critical downstream targets of LKB1-mediated signaling in EOC spheroids, we employed multiplex inhibitor beads/mass spectrometry (MIB/MS) using OVCAR8 STK11-knockout cells and OVCAR8 control cells grown in adherent and spheroid culture conditions. Using this proteomic approach, we identified NUAK1 as the sole ARK out of 12 different family members that is negatively affected by LKB1 loss. In fact, both phosphorylated and total NUAK1 protein expression are decreased in STK11-knockout cells and spheroids. NUAK1 can negatively control cell growth and proliferation by direct regulation of cell cycle checkpoint proteins in several cell systems; however, it has been relatively understudied in EOC. In analysis of the serous ovarian carcinoma data from TCGA, NUAK1 is infrequently altered (&lt;2% of tumors) and it has the highest mean mRNA expression level as compared with the other 11 ARK genes. However, using immunoblot analysis, we show that NUAK1 protein is largely underexpressed in many established (n=15) and new ascites-derived EOC cell lines (n=22). In fact, further NUAK1 knockdown increased spheroid cell viability, size, and reattachment capability, whereas knockdown of its closely-related family member NUAK2 had no effect compared with the non-targeting siRNA control. Likewise, treatment with the pharmacologic NUAK1/2 inhibitor WZ4003 increased EOC cell growth and clonogenicity. Conversely, ectopic overexpression of NUAK1 reduced EOC cell growth and clonogenicity. Collectively, our data indicate that NUAK1 acts as a newly identified growth suppressor downstream of LKB1 metabolic stress signaling in EOC. We are currently investigating mechanisms regulating NUAK1 protein stability and activity in EOC cells, and whether activated LKB1-NUAK1 signaling promotes stress metabolic signaling during tumor dormancy in the context of EOC metastasis.

Citation Format: Parima Saxena, Olga Collins, Yudith Ramos Valdes, Adrian Buensuceso, Kyle Francis, Kevin Brown, Karen Colwill, Anne-Claude Gingras, Robert Rottapel, Gabriel E. DiMattia, Trevor G. Shepherd. NUAK1 acts as a growth suppressor in epithelial ovarian cancer. [abstract]. In: Proceedings of the AACR Conference: Addressing Critical Questions in Ovarian Cancer Research and Treatment; Oct 1-4, 2017; Pittsburgh, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(15_Suppl):Abstract nr A17.

Abstract IA27: Functional genetic architecture of serous ovarian cancer

The degree of genetic aberrations characteristic of high-grade serous ovarian cancer (HGSC) makes identification of the molecular features that drive tumor progression difficult. Here, we perform genome-wide RNAi screens and whole-kinome proteomics to identify genes that are critical to their survival. We report that the tetraspanin CD151 contributes to survival of a subset of HGSC cell lines associated with a ZEB transcriptional program and supports the growth of HGSC tumors. Moreover, we show that high CD151 expression is prognostic of poor clinical outcome. We have identified essential kinases that manage biosynthetic stress indicative of the ovarian cancer transformed state. These data suggest that targeting pathways that underlie adaptation to cellular stress states rather than driver oncogenes may provide new therapeutic avenues for treating HGSC.

Citation Format: Kyle Francis, Helen Burston, Daphna Mokady, Melany Wagner, Mauricio Medrano, Robert Rottapel. Functional genetic architecture of serous ovarian cancer. [abstract]. In: Proceedings of the AACR Conference: Addressing Critical Questions in Ovarian Cancer Research and Treatment; Oct 1-4, 2017; Pittsburgh, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(15_Suppl):Abstract nr IA27.

Brain-derived neurotrophic factor (BDNF) in children with ASD and their parents: a 3-year follow-up

OBJECTIVE

Several lines of evidence point to a probable relationship between brain-derived neurotrophic factor (BDNF) and autism spectrum disorder (ASD), but studies have yielded inconsistent findings on the BDNF serum level in ASD. The study aimed to assess those levels in children with ASD and their families.

METHOD

BDNF serum levels were measured in 45 ASD children without intellectual disability (ID) and allergies, age 30-42 months and age-matched normal controls. BDNF serum levels in the parents of the ASD subjects were compared to normal controls. BDNF serum levels in the ASD subjects were followed up for 3 years and correlated with adaptive functioning changes.

RESULTS

BDNF serum levels were measured to be lower in children with ASD and independent of all the major baseline characteristics of the subjects. Having a child with ASD raises the BDNF levels in parents comparing to controls. Prospectively, no correlation between the change of BDNF variables in time and the change of the Vineland scores was found.

CONCLUSIONS

Our results contradict those from recent published meta-analyses with the age, the presence of ID and allergies being possible contributing factors. The parents' data indeed point to a role of BDNF in the pathophysiology of ASD.

Closing the gap in Indigenous health inequity - Is it making a difference?

AIM

This paper will review progress towards the identified targets within the Australian government policy document commonly known as 'Closing the Gap' and examine the role of nurses in supporting its implementation.

BACKGROUND

Australia is not alone in seeking to address the health inequity between Indigenous and non-Indigenous people. Globally such health inequities are similar and require interventions supported by governments in conjunction with health and education systems to affect desired change. For this reason, it is timely to undertake a review of progress on the impact of the Closing the Gap initiative.

SOURCES OF EVIDENCE

The Australian national partnership agreement and subsequent annual performance reports issued between 2010 and 2017.

DISCUSSION

Targets set within the Australian government national partnership agreement have had a range of success. Those targets not on track require significant long-term investment to ensure their success. Nurses as a large professional group are powerful advocates to speak up and support policy change that affects disempowered social groups.

CONCLUSION

Long-term social change takes time, yet without the commitment of Australian Governments through effective policy and economic support, the inequity in the health of Indigenous people will continue both now and in the future.

IMPLICATIONS FOR HEALTH AND SOCIAL POLICY

Nurses, as the largest health professional group, are uniquely placed to support and implement social change at all levels of health care (primary, secondary and tertiary) and to lobby government to amend policy alongside those who are disempowered.

IMPLICATIONS FOR NURSING PRACTICE

Health promotion and education programmes that are led by nurses can make an impact to health disparities within groups who are most at risk.

Syphilis screening in pregnancy in the United Kingdom, 2010-2011: a national surveillance study

OBJECTIVE

To evaluate the national antenatal syphilis screening programme and provide evidence for improving screening and management strategies.

DESIGN

National population-based surveillance.

SETTING

United Kingdom (UK).

POPULATION

All pregnant women screening positive for syphilis, 2010-2011.

METHODS

Demographic, laboratory and treatment details for each pregnancy were collected from UK antenatal units (~210), along with follow-up information on all infants born to women requiring syphilis treatment in pregnancy.

MAIN OUTCOME MEASURES

Proportion of women with newly or previously diagnosed syphilis among those with positive screening tests in pregnancy; proportion requiring treatment.

RESULTS

Overall, 77% (1425/1840) of reported pregnancies were confirmed syphilis screen-positive. Of these, 71% (1010/1425) were in women with previously diagnosed syphilis (155 requiring treatment), 26% (374/1425) with newly diagnosed syphilis (all requiring treatment) and 3% (41/1425) required treatment but the reason for treatment was unclear. Thus 40% (570/1425) required treatment overall; of these, 96% (516/537) were treated (missing data: 33/570), although for 18% (83/456), this was not until the third trimester (missing data: 60/537). Follow up of infants born to treated women was poor, with at least a third not followed. Six infants were diagnosed with congenital syphilis; two mothers were untreated, three had delayed treatment and one had incomplete treatment (first trimester).

CONCLUSION

Over 2 years, among pregnant women with confirmed positive syphilis screening results in the UK, a quarter had newly diagnosed infections and 40% required treatment. Despite high uptake of treatment, antenatal syphilis management could be improved by earlier detection, earlier treatment, and stronger links between healthcare teams.

TWEETABLE ABSTRACT

25% of pregnant women screening positive for syphilis in the UK were newly diagnosed and 40% needed treatment.

Children with autism spectrum disorders, who improved with a luteolin-containing dietary formulation, show reduced serum levels of TNF and IL-6

Autism spectrum disorders (ASDs) have been associated with brain inflammation as indicated by microglia activation, as well as brain expression and increased plasma levels of interleukin-6 (IL-6) and tumor necrosis factor (TNF). Here we report that serum levels of IL-6 and TNF were elevated (61.95 ± 94.76 pg ml(-1) and 313.8 ± 444.3 pg ml(-1), respectively) in the same cohort of patients with elevated serum levels of corticotropin-releasing hormone (CRH) and neurotensin (NT), while IL-9, IL-31 and IL-33 were not different from controls. The elevated CRH and NT levels did not change after treatment with a luteolin-containing dietary formulation. However, the mean serum IL-6 and TNF levels decreased significantly (P=0.036 and P=0.015, respectively) at the end of the treatment period (26 weeks) as compared with levels at the beginning; these decreases were strongly associated with children whose behavior improved the most after luteolin formulation treatment. Our results indicate that there are distinct subgroups of children within the ASDs that may be identifiable through serum levels of IL-6 and TNF and that these cytokines may constitute distinct prognostic markers for at least the beneficial effect of luteolin formulation.

Duration of ruptured membranes and mother-to-child HIV transmission: a prospective population-based surveillance study

OBJECTIVE

To investigate the association between duration of rupture of membranes (ROM) and mother-to-child HIV transmission (MTCT) rates in the era of combination antiretroviral therapy (cART).

DESIGN

The National Study of HIV in Pregnancy and Childhood (NSHPC) undertakes comprehensive population-based surveillance of HIV in pregnant women and children.

SETTING

UK and Ireland.

POPULATION

A cohort of 2398 singleton pregnancies delivered vaginally, or by emergency caesarean section, in women on cART in pregnancy during the period 2007-2012 with information on duration of ROM; HIV infection status was available for 1898 infants.

METHODS

Descriptive analysis of NSHPC data.

MAIN OUTCOME MEASURES

Rates of MTCT.

RESULTS

In 2116 pregnancies delivered at term, the median duration of ROM was 3 hours 30 minutes (interquartile range, IQR 1-8 hours). The overall MTCT rate for women delivering at term with duration of ROM ≥4 hours was 0.64% compared with 0.34% for ROM <4 hours, with no significant difference between the groups (OR 1.90, 95% CI 0.45-7.97). In women delivering at term with a viral load of <50 copies/ml, there was no evidence of a difference in MTCT rates with duration of ROM ≥4 hours, compared with <4 hours (0.14% for ≥4 hours versus 0.12% for <4 hour; OR 1.14, 95% CI 0.07-18.27). Among infants born preterm with infection status available, there were no transmissions in 163 deliveries where the maternal viral load was <50 copies/ml.

CONCLUSIONS

No association was found between duration of ROM and MTCT in women taking cART.

TWEETABLE ABSTRACT

Rupture of membranes of more than 4 hours is not associated with MTCT of HIV in women on effective ART delivering at term.

Elevated serum neurotensin and CRH levels in children with autistic spectrum disorders and tail-chasing Bull Terriers with a phenotype similar to autism

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by defects in communication and social interactions, as well as stereotypic behaviors. Symptoms typically worsen with anxiety and stress. ASD occur in early childhood, often present with regression and have a prevalence of 1 out of 68 children. The lack of distinct pathogenesis or any objective biomarkers or reliable animal models hampers our understanding and treatment of ASD. Neurotensin (NT) and corticotropin-releasing hormone (CRH) are secreted under stress in various tissues, and have proinflammatory actions. We had previously shown that NT augments the ability of CRH to increase mast cell (MC)-dependent skin vascular permeability in rodents. CRH also induced NT receptor gene and protein expression in MCs, which have been implicated in ASD. Here we report that serum of ASD children (4-10 years old) has significantly higher NT and CRH levels as compared with normotypic controls. Moreover, there is a statistically significant correlation between the number of children with gastrointestinal symptoms and high serum NT levels. In Bull Terriers that exhibit a behavioral phenotype similar to the clinical presentation of ASD, NT and CRH levels are also significantly elevated, as compared with unaffected dogs of the same breed. Further investigation of serum NT and CRH, as well as characterization of this putative canine breed could provide useful insights into the pathogenesis, diagnosis and treatment of ASD.

Evaluation of patients' attitudes towards stroke prevention and bleeding risk in atrial fibrillation

Patient's values and preferences regarding the relative importance of preventing strokes and avoiding bleeding are now recognised to be of great importance in deciding on therapy for the prevention of stroke due to atrial fibrillation (SPAF). We used an iPad questionnaire to determine the minimal clinically important difference (Treatment Threshold) and the maximum number of major bleeding events that a patient would be willing to endure in order to prevent one stroke (Bleeding Ratio) for the initiation of antithrombotic therapy in 172 hospital in-patients with documented non-valvular atrial fibrillation in whom anticoagulant therapy was being considered. Patients expressed strong opinions regarding SPAF. We found that 12% of patients were "medication averse" and were not willing to consider antithrombotic therapy; even if it was 100% effective in preventing strokes. Of those patients who were willing to consider antithrombotic therapy, 42% were identified as "risk averse" and 15% were "risk tolerant". Patients required at least a 0.8% (NNT=125) annual absolute risk reduction and 15% relative risk reduction in the risk of stroke in order to agree to initiate antithrombotic therapy, and patients were willing to endure 4.4 major bleeds in order to prevent one stroke. In conclusion, there was a substantial amount of inter-patient variability, and often extreme differences in opinion regarding tolerance of bleeding risk in the context of stroke prevention in atrial fibrillation. These findings highlight the importance of considering patient preferences when deciding on SPAF therapy.

[The projection of autism spectrum disorders in adult life]

Autism Spectrum Disorders (ASDs) consist a group of neurodevelopmental disorders that are usually diagnosed in early childhood but they persist throughout life, although significant changes can happen. The prevalence of the ASDs is estimated to be 1-1.2%. Subjects with the more severe form of the disorder that are usually characterised by the absence of a communicative language and learning difficulties of various severity, are often referred as persons with lower functioning. In the other end of the spectrum we can find subjects with less severe symptomatology, communicative language and at least of normal intelligence that are referred as high functioning autistic people or -in case of an absence of a language delay- as suffering from Asperger syndrome. The lower functioning adults can be referred to an adult psychiatrist mainly due to their behavioral problems and disruptive behaviors. Their inability to express their difficulties, due to their language restrictions and empathy deficits, can lead these people to behavioural deviances (often self- or hetero-destructive) that challenge their personal environment ending up in the pursuit of psychiatric help. In most cases, although not always justified, psychotropic medications will be prescribed in an attempt to control their maladaptive behaviors. Special attention should be paid to the catatonic exacerbation of ASD, which can be exhibited after adolescence. The catatonic features presented shouldn't be perceived as a possible comorbidity with another disorder, such as schizophrenia, but rather as an extreme form anxiety within the context of an ASD. High Functioning adults with ASDs are more difficult to be detected, but they may also need psychiatric consultation. These subjects may have never been diagnosed with an ASD, but they could have in their history a variety of diagnostic categorizations. Their accurate diagnosis could be further hampered in cases where they are exhibiting remarkable abilities, professional success or even an adequate social adaptation, such as marriage and family. Very often their symptoms will be confused with those of other disorders and they will be also prescribed psychotropic medication with very few, if any, results. In the current paper, we will point out the symptoms and situations that should alert the psychiatrist for the presence of an ASD in an adult with a normal intelligence and adequate functioning that is referred to him for bizarre ideas or behaviors. The designated diagnostic procedure for the ascertainment of the ASD in this case is similar to the one followed for children and adolescents and comprises of a detailed developmental history and a relevant observation and interview. Finally, we will discuss the most common difficulties in the differential diagnosis of the high functioning adults with an ASD from those suffering from Obsessive Compulsive Disorder, Schizoid Personality Disorder, Schizophrenia and Psychosis, and we will provide key issues that can be of an assistance in the more accurate assessment and categorization of the presented symptoms.

The crusade--a metaphorical explication of the journey made by mature female undergraduate nursing students

INTRODUCTION

Mature students now account for a significant percentage of undergraduate nursing students. For most mature students, application for access to a university course and subsequent enrollment will generate changes that can have long-term effects on their and their family's lives. Commencing university study is a major transition in the mature student's life, producing increased stress and lifestyle adjustment and changes. The mature age student participating in tertiary study has undergone, and continues to experience, transition, resulting in new social networks, new behaviours and a new sense of self. Little has been written about this rite of passage and the journey these students take as they negotiate learning to nurse.

METHODS

The constructivist grounded theory utilised is an interpretive research method that uses the constant comparative method to reduce data and develop categories and codes. Data collection and data analysis occurs concurrently but also cyclically. Ten participants were interviewed from two rural Australian universities for this study.

RESULTS

The mature students in this study identified five discrete yet overlapping stages in their university journey, expressed as: (1) initiating the crusade; (2) engaging the force; (3) retreating and regrouping; (4) soldiering on; and (5) the victory march. Initiating the crusade involves mature students preparing for university, while engaging the force examines the beginning of the university journey whereby participants identify new skills needed to learn to navigate their student role. Retreating and regrouping occurs when students' emotional integrity is threatened and involves students harnessing emotional strength through support from peers that allows them to soldier on or to keep going despite crisis and conflicting role demands. Finally, students spoke of a victory march, that is the day they have successfully completed their degree and the feelings of self-actualisation and pride they experience at that time.

CONCLUSION

The findings from this study indicate that the rurality factors that impact significantly on mature female nursing undergraduates are lack of resources, minimal formal support structures, and long travel time and associated costs.

Funding regimes and the implications for delivering quality palliative care nursing within residential aged care units in Australia

BACKGROUND

Funding to Australian residential aged care units has undergone recent reforms. Parallel with these fiscal developments, the Australian Government commissioned the Guidelines for a Palliative Approach in Residential Aged Care that addressed the inequities of service associated with dying in residential aged care.

AIMS

This literature review describes the variances in funding between Australian residential aged care facilities (RACFs), and multi-purpose services (MPSs) and, in doing so, exposes the impact that funding variances have on the delivery of end-of-life and palliative care to residents in aged care units.

FINDINGS

Government funding policy allowed RACFs an opportunity to adopt and implement the guidelines and standards, through funding individual resident identified healthcare needs. By comparison, MPSs are funded through an agreed (government and organisation) number of beds to provide nursing care to residents. This funding allocation forms MPSs' general consolidated revenue for service delivery.

KEY ISSUES

RACFs identify nursing care needs of residents through a residential classification scale, while management of MPSs allocates funding to service provision.

CONCLUSIONS

The significant factor of funding beds (MPS) not the delivery of nursing care required by residents (RACFs) does impact on the implementation of a palliative approach for residents and, hence, the delivery of quality nursing care. Nursing management should consider funding implications when allocating resources to services in MPSs.

Laparoscopic colon surgery: unreliability of end-tidal CO2 monitoring

BACKGROUND

The relatively good haemodynamic and respiratory tolerance to abdominal CO(2) insufflation has mostly been observed in healthy patients during short-lasting laparoscopic procedures. End-tidal CO(2) pressure (PetCO(2)) has been shown to be a reliable method to assess arterial CO(2) (PaCO(2)) in the absence of cardio-respiratory disease in this setting. However, no study has investigated whether PetCO(2) is accurately related to PaCO(2) during laparoscopic colon surgery. Indeed, these procedures last longer, prolonging the pneumoperitoneum and requiring a Trendelenburg position. The aim of the present study was to measure the PaCO(2)-PetCO(2) difference over time in patients undergoing laparoscopic colon surgery and to determine whether PaCO(2) is reliably assessed by PetCO(2).

METHODS

Forty consecutive patients (ASA I and II) scheduled for laparoscopic colon surgery were anaesthetized and ventilated to obtain a PetCO(2) between 4.0 and 5.5 kPa. After initiation of CO(2) insufflation, PaCO(2) and PetCO(2) were recorded every 30 min during surgery.

RESULTS

No complication was observed during anaesthesia. The mean arterial pressure increased significantly after CO(2) insufflation and remained steady up to the end of pneumoperitoneum. The heart rate remained stable over time. The relation between PaCO(2) and PetCO(2) was not constant among patients and increased over time within the same patients. The R(2) values fluctuated and did not show a constant correlation between PaCO(2) and PetCO(2).

CONCLUSION

The correlation between PaCO(2) and PetCO(2) during laparoscopic colon surgery is inconsistent mainly due to inter- and intra-individual variability.

The accidental mentor: Australian rural nurses developing supportive relationships in the workplace

INTRODUCTION

Like the fictional 'Accidental Tourist', an author who does not plan to write about travel, the accidental mentor is an experienced rural nurse who does not plan to be a mentor, and yet assumes that role with new or novice rural nurses as a result of them encountering a critical incident. Accidental mentoring is a short-term relationship that provides support for the new or novice nurse in managing the incident, while maintaining their level of confidence. This article describes the findings from a constructivist grounded theory study that examined Australian rural nurses' experiences of mentoring, including evidence for a new concept of mentoring - accidental mentoring.

METHODS

Constructivist grounded theory is a research methodology that focuses on issues of importance for participants around an area of common interest - in this case Australian rural nurse mentoring. In this study, seven participants were interviewed, generating nine transcripts. These were analysed using a process of concurrent data generation and analysis. In addition, the literature regarding rural nurse workforce and mentoring was incorporated as a source of data, using collective frame analysis.

RESULTS

Rural nurses live their work, which predisposes them to developing supportive relationships with new or novice rural nurses. Supportive relationships range from preceptoring, to accidental mentoring, mentoring and deep friendship, depending on the level of trust and engagement that is established between the partners and the amount of time they spend together. Accidental mentoring is a short-term relationship that is prompted by experienced rural nurses observing a new or novice rural nurse experiencing a critical incident.

CONCLUSIONS

Findings are presented that illustrate a new concept of accidental mentoring not present in the current literature around nurse mentoring. A series of recommendations are included that suggest strategies for improved rural nurse retention as an outcome of recognising and developing such supportive relationships in the workplace. Strategies include: performance review and development processes that account for all forms of supportive relationships conducted in the workplace; recognising the importance of developing supportive relationships and allocating time for these; and continuing professional development designed to meet local needs for developing a culture of support in the workplace.

Feasibility of group follow-up visit for breast cancer survivors

19603

Background: The ASCO 2006 guidelines specify that regularly scheduled follow-up care of breast cancer survivors should be the standard. Follow up care is a “teachable moment” to train survivors in positive habits. A group visit model at the Cleveland Clinic proved feasible and improved patient satisfaction for other diseases. Our objectives include assessing the feasibility of an adapted group follow-up visit for the care of breast cancer patients and patient satisfaction. Methods: A feasibility study targeting breast cancer patients who completed primary therapy and were scheduled for a routine appointment. We mailed letters inviting patients to a follow-up group visit. Patients were divided into 3 groups, each scheduled for a separate (90–120 minute). During the first half of the visit, participants were divided into three groups; 5-minute physician exam, nurse review of medications and vital signs, and instruction by a social worker. Groups were rotated. During the second half the doctor, nurse, and social worker met with all participants in one room starting with an educational presentation about fatigue and exercise. Each participant was subsequently interviewed by the physician in the presence of their peers. Shared complaints were investigated first. Patients rated their satisfaction with the different parts of the visit on a scale of 1–5. Participants were surveyed pre- and post- education session and asked if they would participate again. Participants were allowed to bring a family member or friend. Results: 29 (29.6 %) out of 98 consented and 22 (22.5%) attended;10 in first visit, 5 in second visit and 7 in last visit. Average age 61±8, ranged from 46–72 years. Most participants were satisfied with all parts of the group visit, except two in the first group were less satisfied with the check in process and moving between rooms. Comparing the pre- vs. post- educational session surveys showed an improved understanding of the importance of fatigue or exercise. 17 (77%) out of 22 participants agreed to participate in another group visit. Conclusion: Group visit format is feasible and provides patient satisfaction.

No significant financial relationships to disclose.

Older people's views of advice about falls prevention: a qualitative study

The aim of this study was to gain an understanding of older people's perceptions of falls prevention advice, and how best to design communications that will encourage older people to take action to prevent falls. Focus groups and interviews were carried out with 66 people aged 61-94 years recruited from a variety of settings, using falls prevention messages to stimulate discussion. Thematic analysis revealed that participants interpreted 'falls prevention' principally as meaning hazard reduction, use of aids and restriction of activity. Only one participant was aware that falls risk could be reduced by carrying out exercises to improve strength and balance. Falls prevention advice was typically regarded as useful in principle but not personally relevant or appropriate. Advice about falling was often depicted as common sense, only necessary for older or more disabled individuals, and potentially patronizing and distressing. Our findings suggest that older people do not reject falls prevention advice because of ignorance of their risk of falling, but because they see it as a potential threat to their identity and autonomy. Messages that focus on the positive benefits of improving balance may be more acceptable and effective than advice on falls prevention.

Quantification of manual force control and tremor

Isometric impulse frequencies associated with active tremor and force regulation were examined in 10 patients with idiopathic Parkinson's disease (PD) and in 10 older adults (OAs) who performed an isometric tracing task. The authors decoupled and analyzed the data to determine whether PD-related tremor in the thumb and in the index finger during isometric force control are related and whether PD impairs the performance of volitional force control beyond the errors contributed by tremor. After decoupling, there were clear and robust differences in PD patients' control of isometric force that could not be attributed to action-tremor error. Those errors, which occurred in the absence of movement, suggest impairment in coordinated recruitment and derecruitment of motor units during a fine-motor task.

Autism interventions: a critical update

As yet, there is no aetiology-based intervention for autistic spectrum disorders (ASD); despite this, parents and professionals still need to make informed decisions regarding treatment options for children with ASD. This paper seeks to evaluate widely used interventions according to specific research criteria. Interventions presented are grouped into psychoeducational/behavioural approaches, psychopharmacological interventions, and the less traditional or complementary approaches. The conclusions are less than favourable: while some interventions do have empirical support, others have been proven to have no positive effects, and furthermore, there are no robust data favouring one approach over the others. Nevertheless, several criteria for choosing between treatment options are briefly discussed.

Experience with laparoscopic adjustable gastric banding (la-band system) up to 8 years

Morbid obesity occurs in 2-5% of the population in Western countries. Laparoscopic adjustable silicone gastric banding is a minimally invasive, adjustable and reversible procedure for the treatment of morbid obesity. The lap-band system was evaluated retrospectively in a series of 222 patients. Postoperative outcome and weight loss patterns at up to 8 years follow-up are presented. The most frequent late complications were a leak between the port and the catheter, which occurred in 21 patients (9.4%) and total and irreversible food intolerance due to pouch dilation and/or slippage, which occurred in 13 patients (5.8%). The postoperative BMI reductions are successful and stable after a follow-up of up to 96 months. The lap-band system seems an effective procedure for achieving appreciable and stable weight loss up to 8 years of follow-up and the complications and re-operation rates are acceptable. In 81% of the cases also, the patient is very satisfied with the results of the operation. From the 47.3% who found their quality of life before the operation bad or even devastating, 93% envoy life after the operation like never before.

The Possible Prognostic Significance of Immunophenotype in Feline Alimentary Lymphoma: a Pilot Study

Twenty-three retrospective biopsy specimens from feline intra-abdominal lymphomas including tumours affecting the gastrointestinal tract, mesenteric lymph nodes, liver and spleen were immunohistochemically labelled with monoclonal antibodies to CD79a (B-cell phenotype) and CD3 (T-cell phenotype). Positive labelling occurred in 15 (65%) and 6 (26%) of the tumours, respectively. No statistically significant relationship was found between tumour cell immunophenotype and age, breed, or gender. There was no significant difference in survival time between the two immunophenotypes, based on the 16 cats for which this information was available.

Loss of ACTH expression in cultured human corticotroph macroadenoma cells is consistent with loss of the POMC gene signal sequence

The proopiomelanocortin (POMC) gene is highly expressed in the pituitary gland where the resulting mRNA of 1200 base pairs (bp) gives rise to a full-length protein sequence. In peripheral tissues however both shorter and longer POMC variants have been described, these include for example placental tissue which contain 800 (truncated at the 5' end) and 1500 as well as the 1200 bp transcripts. The importance of the 800 bp transcript is unclear as the lack of a signal sequence renders the molecule to be non-functional. This transcript has not been previously demonstrated in the pituitary gland. In this report we show evidence of a 5' truncated POMC gene in human pituitary corticotroph macroadenoma cells (JE) maintained in primary culture for >1 year. The original tumour tissue and the derived cells during early passage (up to passage 4-5) immunostained for ACTH and in situ hybridisation confirmed the presence of the POMC gene in the cultured cells. These cells also secreted 15-40 pg/10(5) cells/24 h ACTH. In addition, as expected RT-PCR demonstrated the presence of all three POMC gene exons and is thus indicative of a full-length POMC gene. In late culture passages (passages 8-15) JE cells ceased to express ACTH and cell growth became very slow due presumably to cells reaching their Hayflick limit. ACTH immunostaining in these cells was undetectable and ACTH secretion was also at the detection limits of the assay and no greater than 10 pg/10(5) cells/24 h. ACTH precursor molecules were also undetectable. RT-PCR for the POMC gene in these late passage cells showed that only exon 3 was detectable, in contrast to early passage cells where all three exons were present. In summary we isolated in culture, human pituitary cells that possessed initially all three exons of the POMC gene and immunostained for ACTH. On further passaging these cells showed a loss of exons 1 and 2 in the POMC gene and a loss of ACTH immunostaining and secretion. We would like to suggest that the loss of ACTH peptide expression in these late passage cells is in part due to the loss of the POMC signal sequence. An alternative explanation for our findings is that there were originally two populations of corticotrophs in the cultures, one of which possessed the full-length POMC gene and the other only the 5' truncated POMC transcript and it is these latter cells which survived in culture. In either scenario this is the first report of the 5' truncated POMC gene occurring in pituitary cells.

Bioproductivity and nutrient cycling in bamboo and acacia plantation forests

This study mainly aimed to investigate the bioproductivity and nutrient cycling processes in plantation forests of bamboo and acacia. In India, multipurpose tree (MPT) species are extensively planted to meet the increasing demand for fuel and industrial wood. The bioproductivity studies of bamboo showed that the total biomass increased with age (2.2 t/ha/year 1) up to six years (297.8 t/ha/year 6) and then decreased (15.6 t/ha/year 10). With acacia, the total biomass increased from 1.8 t/ha/(year 1) to 5.0 t/ha/ (year 3) and 10.9 t/ha/(year 5). In general the biomass increased with increase of diameter and height. Nutrient cycling in the plantation on an annual basis was worked out. A complete harvest of bamboo in 6 years removes 2341 kg/ha of nitrogen, 22 kg/ha of phosphorus, 2,653 kg/ha, of potassium, 1,211 kg/ha of calcium and 1,356 kg/ha of magnesium. A total harvest of above ground biomass of acacia in 3 years removes (kg/ha) 91.74 N, 2.53 P, 73.41 K, 110.45 Ca, 14.06 Mg, and in 4 years removes (kg/ha) 227.47 N, 7.34 P, 181.04 K, 284.15 Ca, and 38.89 Mg.

Service to the poor: the foundations of community nursing in England, Ireland and New South Wales

This paper describes the foundations of community nursing in England, Ireland and New South Wales. It is guided by Foucault's work on power, discourse and knowledge, and argues that the common discourse of poverty coupled with the influence of socially advantaged women in the nineteenth century was the impetus for the development of community nursing in England, Ireland and New South Wales. Throughout the nineteenth century in Great Britain, economic and industrial development, coupled with an unprecedented growth in the population (particularly among the poor) inspired socially advantaged women to extend traditional gender-specific roles to address the needs of the poor. Protestant women in England advanced professional nursing as a career for women and in Ireland and New South Wales; Catholic women pioneered professional nursing, targeting the poor as the focus of their practice. These women used prevailing social conditions to enhance their life options within the limits prescribed by social norms.

Evaluation of United States-licensed human immunodeficiency virus immunoassays for detection of group M viral variants

Six Food and Drug Administration (FDA)-licensed human immunodeficiency virus type 1 (HIV-1) and HIV-1/2 immunoassays, including five enzyme immunoassays and one rapid test, were challenged with up to 250 serum samples collected from various global sites. The serum samples were from individuals known to be infected with variants of HIV-1 including group M subtypes A, B, B', C, D, E, F, and G and group O. All immunoassays detected the vast majority of samples tested. Three samples produced low signal over cutoff values in one or more tests: a clade B sample, an untypeable sample with a low antibody titer, and a group O sample. It is concluded that HIV-1 immunoassays used in the United States are capable of detecting most HIV-1 group M variants.

The standardization of Achenbach's Youth Self-Report in Greece in a national sample of high school students

Achenbach's Youth Self Report (YSR) questionnaire is accepted worldwide for the assessment of adolescent competencies and behaviour problems. As with any similar instrument, it is liable to cultural influences, hence requires standardization for the culture in which it is to be used. This study reports on the standardization of the YSR in Greece, in a national school-based sample of 1456 high school students, 11-18 years of age. Responses at the item level seem to follow the culturally expected gender behaviour. Behaviour problem scale scores were not affected by degree of urbanization, reflecting a high degree of cultural homogeneity between urban and rural areas in Greece. Sex effects were important, with girls showing a greater tendency towards Internalizing and boys towards Externalizing Problems. Age effects were also statistically significant (older adolescents showing more problems, especially of the delinquent type), but numerically small. There was considerable correlation between Internalizing and Externalizing problems, with an odds ratio of 6.9 (95% confidence interval, 4.6-10.4) for exceeding both cut-offs. The analysis showed that Greek adolescents obtained significantly higher mean scores than their American counterparts on all scales. Cut-off points based on the 90th and 98th percentile developed from this sample are presented for the competencies and the problem scales.