Do comparative judgements affect the perceived relevance of mobile phone road safety campaigns?

OBJECTIVE

Given the prevalence of illegal mobile phone use while driving and reliance upon messaging campaigns in deterring the behavior, there is a need to explore to what extent comparative judgements may influence desired outcomes of such campaigns. This exploratory study investigated (a) the perceived relevance and influence of different mobile phone road safety campaigns within a sample of Queensland motorists who reported using their mobile phone while driving and (b) if these varied depending on whether participants believed that their crash risk whilst using a phone was higher (comparative pessimism), lower (comparative optimism) or similar to the same-age and sex driver.

METHODS

A total of 350 licensed drivers residing within Queensland (Australia) were included in this study, of which 200 reported using their hand-held phone on some occasion. Participation involved completing a 20-25 min online anonymous survey, which included viewing three mobile phone road safety campaigns (injury-based, sanction-based and humor) and responding to questions about the perceived relevance and impact of each campaign.

RESULTS

A total of 64 (32%) participants displayed comparative optimism, 50 displayed similar judgements (25%) and 86 (43%) exhibited comparative pessimism. First, it was found that the injury-based campaign was perceived to be significantly more relevant than the humor campaign. Second, whilst the relevance of each campaign did not vary as a function of group membership, the campaigns were significantly less relevant to those displaying comparative optimism relative to those with similar judgements and comparative pessimism. Finally, the injury-based campaign was perceived to be significantly more influential than the other campaigns. However, overall, participants displaying comparative optimism believed that they would be less influenced by the campaigns compared to those with comparative pessimism.

CONCLUSIONS

Although preliminary, these findings suggest that low perceptions of risk may dilute or extinguish the desired behavioral outcomes of mobile phone road safety campaigns. Nonetheless, experimental research is needed to examine these effects directly.

Psychological distress experienced by parents caring for an immunosuppressed child during the COVID-19 pandemic

The COVID-19 pandemic has proved unique in both its unpredictability and the extent to which it has continued to impact on daily life since March 2020. Among the immunosuppressed population the challenges of the COVID-19 pandemic are cumulative to the ever-present challenges of living with a long-term condition. This prospective longitudinal study explored patterns of concern experienced by 467 British parents caring for an immunosuppressed child during the first 2 years of the COVID-19 pandemic and related this to parental mental wellbeing. Most parents slowly adapted or were resilient to the ever-changing stressors of the COVID-19 pandemic. However, 12% experienced high levels of concern throughout the first 2 years of the pandemic. This group was also more likely to report emotional mental health problems towards the end of this period. The experience of emotional mental health problems among parents caring for an immunosuppressed child was related to low household income, single parenting, difficult access to greenspace, and higher level of exposure to COVID positive cases and COVID restrictions (North of England). Parents reported that optimism, reduction of isolation, and support promoted coping and management of the challenges of the COVID-19 pandemic. More reliable COVID information and periodic medical-condition-specific guidance would have been appreciated. These findings can increase clinical awareness of high-risk parental groups and make an important contribution to the planning of appropriate targeted psychological family interventions.

Parental concern for clinically vulnerable child during first 18 months of the COVID pandemic

BACKGROUND

The uncertainties surrounding the COVID-19 pandemic have been associated with increased parental concern. The aim of this study is to explore if this increased level of concern is associated with certain individual/household characteristics or if parents adapted to the ever-changing realities of the COVID-19 pandemic over time.

METHODS

This prospective study explored COVID-19 concern trajectories and associated family characteristics of 765 UK parents caring for an immunosuppressed child during the first 18 months of the pandemic using growth mixture modelling. Qualitative analysis was performed to examine in more detail the source of concern.

RESULTS

Four different trajectories of parental COVID-19 concern were identified. Ongoing very high concern was associated with caring for children with nephrotic or respiratory disease; having a child on an organ transplant waiting list; residency in the North of England; or parental vocational inactivity. Explicit concerns voiced by the parents generally followed national trends, but vulnerable status specific concerns were also reported.

CONCLUSION

Diagnosis and prescribed medication of the immunosuppressed child, geographical location, household composition, and employment status of parent were associated with the different concern trajectories. This information can be helpful in targeting psychological family care where it is most needed.

IMPACT

Many British parents caring for a clinically vulnerable child during the first 18 months of the COVID-19 pandemic showed high levels of concern with little sign of psychological adaptation. Consistent with findings from non-vulnerable populations, parents mentioned the impact of shielding and repeated isolation on their child's education, social life, and mental health. Unique to the clinically vulnerable population, parents were worried about child's health status, impact of delayed healthcare, and were confused by the contradictory information received from government, doctors, and media. Psychological family care can be targeted to those parents at greater risk for high levels of concern.

Feasibility and outcomes of a general practice and specialist alcohol and other drug collaborative care program in Sydney, Australia

Alcohol and other drug (AoD) use is an important health and community issue and may be positively affected by collaborative care programs between specialist AoD services and general practice. This paper describes the feasibility, model of care and patient outcomes of a pilot general practice and specialist AoD (GP-AoD) collaborative care program, in Sydney, Australia, based on usual care data, the minimum data set, service utilisation information and the Australian Treatment Outcome Profile (ATOP), a patient-reported outcome measure. There were 367 referrals to the collaborative care program. GPs referred 210 patients, whereas the AoD service referred 157 patients. Most GP referrals (91.9%) were for AoD problems, whereas nearly half the AoD service referrals were for other issues. The primary drugs of concern in the GP group were either opioids or non-opioids (mostly alcohol). The AoD service-referred patients were primarily using opioids. An ATOP was completed for 152 patients. At the time of referral, those in the GP-referred non-opioid group were significantly less likely to be abstinent, used their primary drug of concern more days and were more likely to be employed (all P < 0.001). A second ATOP was completed for 93 patients. These data showed a significant improvement in the number of days the primary drug of concern was used (P = 0.026) and trends towards abstinence, improved quality of life and physical and psychological well-being for patients in the program. There are few studies of GP-AoD collaborative care programs and nothing in the Australian context. This study suggests that GP-AoD collaborative care programs in Australia are feasible and improve drug use.

Immunocompromised children and young people are at no increased risk of severe COVID-19

OBJECTIVES

We aimed to prospectively describe the incidence and clinical spectrum of SARS-CoV-2 infection in immunocompromised paediatric patients in the UK.

METHODS

From March 2020 to 2021 weekly questionnaires were sent to immunocompromised paediatric patients or their parents. Information, including symptom presentation and SARS-CoV-2 PCR test results, was collected from 1527 participants from 46 hospitals. Cross-sectional serology was investigated in February and March 2021.

RESULTS

Until the end of September 2020, no cases were reported. From September 28th 2020 to March 2021 a total of 38 PCR-detected SARS-CoV-2 infections were reported. Of these, four children were admitted to hospital but none had acute severe COVID-19. Increasing age in association with immunodeficiency increased reporting of SARS-CoV-2 infection. Worsening of fever, cough, and sore throat were associated with participants reporting SARS-CoV-2 infection. Serology data included 452 unvaccinated participants. In those reporting prior positive SARS-CoV-2 PCR, there were detectable antibodies in 9 of 18 (50%). In those with no prior report of infection, antibodies were detected in 32 of 434 (7•4%).

CONCLUSIONS

This study shows SARS-CoV-2 infections have occurred in immunocompromised children and young people with no increased risk of severe disease. No children died.

Unilateral branch pulmonary artery stenting in tetralogy of fallot improves ventricular function

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR

Background

Pulmonary artery stenosis (PAS) occurs commonly in patients with tetralogy of fallot (ToF). Cardiac function and especially left ventricular longitudinal strain has been identified as an important prognostic factor for long term survival in ToF. The clinical relevance of unilateral PAS to long-term bi-ventricular function is poorly understood.

Purpose

We sought to evaluate the effect of resolving unilateral pulmonary artery obstruction on right and left ventricular performance.

Methods

We prospectively included 40 patients with TOF between 2016 and 2020, 20 who underwent unilateral PAS stenting and as comparison 20 who underwent surgical pulmonary valve replacement (PVR). MRI data was acquired during routine clinical care before and around 6-12 months after the procedure. 4 PAS patients attended additional research scans acquiring ventricular 4D flow MRI data. 4D flow MRI data was compared to the average kinetic energy curve of 10 age-matched healthy volunteers.

Results

Of the 20 patients undergoing PAS, 2 also underwent percutaneous PVR and were excluded from the comparison analysis. All patients in the PAs group showed an improvement in branch PA flow differential post procedure. Patients undergoing PAS were younger than those undergoing PVR (median 12 vs 19 years, p &lt; 0.001). Other baseline anatomical and functional parameters including right ventricular (RV) volume indexed to body surface are (RVEDV/BSA) were comparable (pre PAS median 151 [122,170] vs pre PVR 162 [140,191]; p = 0.217). While in the PVR group the right ventricular volumes reduced in both end-diastole and end-systole, in the PAS group RV function improved due to reduced end-systolic volume with largely stable end-diastolic volumes.

Changes in the left ventricle (LV) were even more interesting. In the PVR group ejection fraction improved due to an increase in end-diastolic volume with no improvement in ventricular longitudinal strain. In contrast, in the PAS group LV ejection fraction improved by a reduction in end-systolic volume and the PAS group showed a small but significant improvement in LV longitudinal strain. In addition, ¾ patients undergoing 4D flow MRI assessment showed LV kinetic energy curve more similar to the healthy volunteer averaged  LV kinetic energy curve after PAS. The 4th patient already had a near normal LV kinetic energy curve prior to PAS.

Conclusion

Unilateral PAS does not alter RV end-diastolic volumes but improves RV function. LV ejection fraction improvement is similar to that seen after PVR, but importantly PAS also improved LV longitudinal strain. This suggests that PAS might positively influence long term morbidity and mortality risk in ToF patients, but a larger multi-centre long term follow-up study is needed to confirm this.

COVID-19 symptom surveillance in immunocompromised children and young people in the UK: a prospective observational cohort study

OBJECTIVES

To describe the frequency of symptoms compatible with SARS-CoV-2 infection in immunocompromised children and young people in the UK during the SARS-CoV-2 pandemic. To describe patient/parent anxiety regarding SARS-CoV-2 infection in this cohort.

DESIGN

A prospective observational cohort study.

SETTING

46 centres across the UK between 16 March and 4 July 2020. A weekly online questionnaire based on the International Severe Acute Respiratory and emerging Infections Consortium-WHO Case Report Form was used to collect participant reported data on symptoms, test results, National Health Service attendance, hospital admission and impact on daily life.

PARTICIPANTS

1490 immunocompromised children, defined as those requiring an annual influenza vaccination due to their underlying condition or medication.

MAIN OUTCOME MEASURES

Incidence of SARS-CoV-2-like symptoms and patient/parent anxiety score.

RESULTS

Over 16 weeks during the first wave of the pandemic, no SARS-CoV-2 infection was diagnosed in this large immunocompromised paediatric cohort (median age 11 years, 54.4% female). 110 symptomatic participants underwent a test for SARS-CoV-2; all were negative. 922 (67.4%) participants reported at least one symptom consistent with suspected SARS-CoV-2 infection over the study period. 476 (34.8%) reported three or more symptoms. The most frequently reported symptoms included joint pain, fatigue, headache, nausea and muscle pain. SARS-CoV-2 testing during this period was performed on admitted patients only. 137 participants had their medication suspended or changed during the study period due to assumed COVID-19 disease risk. 62% reported high levels of anxiety (scores of 7-10 out of 10) at the start of the study, with anxiety levels remaining high throughout the study period.

CONCLUSIONS

Although symptoms related to SARS-CoV-2 infection in children were common, there were no positive tests in this large immunocompromised cohort. Symptom-based screening to facilitate early detection of SARS-CoV-2 infection may not be helpful in these individuals. Patient/parent anxiety about SARS-CoV-2 infection was high.

TRIAL REGISTRATION NUMBER

NCT04382508.

91 Can propylene glycol modulate insulin and insulin-like growth factor-1 in superovulated dairy heifers?

The aim of this study was to determine the effect of propylene glycol (PPG) on serum concentrations of insulin and insulin-like growth factor (IGF)-1 in superovulated dairy heifers. We hypothesised that administration of PPG would have a positive effect on superovulation results via increased insulin and IGF-1. A total of 20 clinically healthy Holstein heifers with an average age of 12 months were used for this experiment. Superovulation was performed using a standard protocol. Briefly, each heifer received 3mg of oestradiol-17β IM and an intravaginal progesterone-releasing insert (CIDR) containing 1.9g of progesterone at random stages of the oestrous cycle (designated Day 0). From Day 4 to 8, heifers received a total of 200mg of NIH-follicle-stimulating hormone-P1 administered intramuscularly through 9 injections of decreasing doses (from 50 to 10mg) at 12-h intervals. On Day 7, heifers received 2 injections of 500µg of cloprostenol, a PGF2α analogue, at ~6-h intervals, after which intravaginal inserts were removed. Artificial insemination was performed on Day 10, 12h after treatment with 100µg of gonadotropin-releasing hormone IM. Embryos were flushed from the uterus of donor heifers 6 days after AI. The method consisted of simultaneously using 1 catheter per uterine horn. Catheters were maintained in place to perform 2 flushes 1h apart. A total of 1L of flushing medium was used, 700 and 300mL for the first and the second flush, respectively. Embryos were assessed for viability immediately after collection using the IETS classification. Heifers were divided into 2 groups (PPG and control group). From Day 4 to 14 of the superovulation protocol, PPG group received a daily dose of 400mL of a 66.7% propylene glycol solution, whereas the control group received the same amount of water. Two months later, the same experiment was conducted by inverting the groups. At Day 4 and 14, four blood samples were collected to measure insulin and IGF-1 at 25-min intervals. The first sample (0) was taken before heifers received PPG or water. Insulin was analysed using an ELISA kit following manufacturer’s instructions, whereas IGF-1 was determined using a chemiluminescence immunoassay. Embryo associated data were analysed using t-test. Both IGF-1 and insulin data were analysed using a two-way ANOVA, followed by Bonferroni post-hoc test. Treatment with PPG had no effect on the number of transferable embryos (8±5.1v. 7±5.5), degenerated embryos (0.5±0.8v. 1.5±2.4), or unfertilized oocytes (0.3±0.7v. 0.7±1.2) recovered. There was also no effect of PPG on IGF-1 serum concentrations at the beginning (Day 4) or the end (Day 14) of the treatment regimen. However, PPG treatment enhanced (P = 0.02) serum insulin concentrations 50min after administration on Day 4 (10.69 v. 6.88 pmol/L), as well as at 25 (19.58 v. 9.64 pmol/L) and 50min (16.67v. 8.21 pmol/L) on Day 14. It has been suggested that PPG metabolism may stimulate insulin and IGF-1 secretion, which can promote embryo development. However, in the present study, there was no effect of oral doses of PPG on IGF-1. Although higher serum concentrations of insulin were observed after PPG treatment, there was no effect of PPG treatment on the number of transferable embryos recovered following superovulation.

90 Effects of treatment with the nonsteroidal anti-inflammatory drug Anafen prior to embryo recovery and the number of embryo flush procedures performed on prostaglandin levels in uterine fluid and pregnancy rate following embryo transfer

Some studies have shown that performing a second flush during embryo collection can increase the number of embryos recovered. However, this technique results in greater uterine manipulation that may increase PGF2α in the uterine fluid of donor cows and affect pregnancy rate in recipient females. Two experiments were conducted (1) to determine whether PGF2α concentration in uterine fluid was affected by treatment with a non-steroidal anti-inflammatory drug (NSAID) before embryo recovery and (2) to determine whether the percent of recipients becoming pregnant following embryo transfer (P/ET) was affected by flush number. In both experiments, lactating Holstein cows were used as donors (n=18 and 34, respectively) and subjected to a standard superovulation protocol (Baracaldo et al. 2000 Theriogenology 53, 1239-1250, DOI: 10.1016/S0093-691X(00)00268-5). Embryo recovery was performed using 2 catheters that were inserted simultaneously into the uterus, 1 into each horn. During the first flush, a volume of 300mL of flush medium was used in each horn. At the end of the first flush approximately 75mL of fluid was left and, after 1h, a second flush was performed to recover the remaining fluid. Samples were taken from each horn at the first and second flush to determine PGF2α concentration using a bovine PGFM ELISA kit. Data for PGF2α concentrations in uterine fluid were presented as the average of both uterine horns. In Exp. 1, donors were randomly assigned to be treated with or without 1.2g of the NSAID Anafen (ketoprofen) IM 20min before embryo recovery. In Exp. 2, recovered grade-1 embryos from the first and second flush procedures were frozen in ethylene glycol and subsequently transferred to synchronized Holstein heifers (n=106 and 49 for the first and second flushes, respectively). Pregnancy was diagnosed by rectal palpation at Day 60. All data were analysed using t-test. In Exp. 1, Anafen treatment 20min before embryo recovery reduced PGF2α in uterine fluid during the second flush procedure (105.9±11.4v. 43.6±5.7 pg/mL; P&lt;0.001), but not during the first (54.7±7.3v. 44.2±5.6 pg/mL; P=0.34). In Exp. 2, PGF2α in uterine fluid was greater for the second flush as compared to the first flush (95.9±7.4v. 56.3±5.5 pg/mL; P&lt;0.001). A total of 345 viable embryos were recovered from the 34 donors in Exp. 2 (n=276 and 69 for the first and second flushes, respectively). The P/ET at Day 60 was greater (P&lt;0.05) for recipients that received embryos from the first flush as compared to recipients that received embryos from the second flush (64.2v. 49.0%). Taken together, the results of the present study indicate that the second flush procedure results in greater PGF2α levels in uterine fluid and that embryos recovered during the second flush are less likely to establish pregnancy following transfer. Moreover, pretreatment of donors with the NSAID Anafen reduced PGF2α levels in uterine fluid during the second flush. Further research is needed to determine whether treatment of donors with NSAID can improve the P/ET achieved following the transfer of embryos recovered following a second flush procedure.

Early versus delayed surgery for paediatric supracondylar humeral fractures in the absence of vascular compromise: a systematic review and meta-analysis

AIMS

We set out to determine if there is a difference in perioperative outcomes between early and delayed surgery in paediatric supracondylar humeral fractures in the absence of vascular compromise through a systematic review and meta-analysis.

MATERIALS AND METHODS

A literature search was performed, with search outputs screened for studies meeting the inclusion criteria. The groups of early surgery (ES) and delayed surgery (DS) were classified by study authors. The primary outcome measure was open reduction requirement. Meta-analysis was performed in the presence of sufficient study homogeneity. Individual study risk of bias was assessed using the Risk of Bias in Non-Randomised Studies - of Interventions (ROBINS-I) criteria, with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria used to evaluate outcomes independently.

RESULTS

A total of 12 studies met the inclusion criteria (1735 fractures). Pooled mean time to surgery from injury was and 10.7 hours for ES and 91.8 hours for DS. On meta-analysis there was no significant difference between ES versus DS for the outcome of open reduction requirement. There was also no significant difference for the outcomes: Iatrogenic nerve injury, pin site infection, and re-operation. The quality of evidence for all the individual outcomes was low or very low.

CONCLUSIONS

There is no evidence that delaying supracondylar fracture surgery negatively influences outcomes in the absence of vascular compromise. There are, however, notable limitations to the existing available literature.

Population trends in prenatal detection of transposition of great arteries: impact of obstetric screening ultrasound guidelines

OBJECTIVES

Dextro-transposition of the great arteries (d-TGA) is one of the most common critical neonatal heart defects, with a low detection rate antenatally. We sought to evaluate trends in the prenatal detection of d-TGA with or without ventricular septal defect (VSD) in Alberta over the past 13 years, examining the potential impact of ultrasound guidelines incorporating screening of cardiac outflow tracts, updated in 2009-2010 and in 2013, and factors affecting detection of the condition.

METHODS

All fetuses and neonates with d-TGA, with or without VSD, encountered between 2003 and 2015 in the province of Alberta, were identified retrospectively. Clinical records including obstetric ultrasound reports were reviewed. Pregnancy outcome, common referral indications and associated maternal and fetal pathology in affected pregnancies were assessed.

RESULTS

From 2003 to 2015, 127 cases with d-TGA were encountered in Alberta, of which 47 (37%) were detected prenatally. Prenatal detection improved over the study period, from 14% in 2003-2010, to 50% in 2011-2013, and to 77% in 2014-2015. Of the 47 fetuses with a prenatal diagnosis of d-TGA, an indication for fetal echocardiography included abnormal or poorly visualized cardiac outflows with normal four-chamber view in 46 (98%). Comorbidities were identified in 12 mothers, only five of which represented an additional reason for fetal echocardiography referral, and four fetuses had extracardiac pathology.

CONCLUSION

Substantial improvement in the prenatal detection of d-TGA has been observed in Alberta over the past few years, owing to improved screening of cardiac outflow tracts on routine obstetric ultrasound examination in otherwise healthy pregnancies, and has been temporally associated with updated obstetric ultrasound guidelines suggesting that these contributed to optimized screening of affected pregnancies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Electrophilic Metal Homoenolates and Their Application in the Synthesis of Cyclopropylamines

Since their discovery, metal homoenolates have been widely explored as carbon-based nucleophiles for the β-functionalization of carbonyl derivatives. Only recently has it been reported that metal ­homoenolates can react as carbonyl electrophiles. In this context, we have recently discovered that cyclopropylamines can be prepared from cyclopropanols via zinc homoenolate intermediates. This Synpacts ­article will present an overview of the reactivity of homoenolates and our strategy to employ these intermediates for the synthesis of cyclopropylamines. Key mechanistic observations and their influence on reaction optimization will also be discussed.

1 Introduction

2 Homoenolates as Nucleophiles—Selected Reactivity

3 Homoenolates as Electrophilic Reagents

4 Conclusion

The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection

Objectives

A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion.

Methods

Causes of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed.

Results

A total of 31% of patients had a single attributable cause, 55% had two causes, 14% had three causes and 1% had all four. Of those (31%) with only a single attributable cause, half were due to a mechanical factor and a quarter had dead bone with a gap. Mechanical causation was found in 59% of all patients, dead bone and a gap was present in 47%, host factors in 43% and infection was a causative factor in 38% of patients.

In all, three of 58 patients (5%) thought to be aseptic and two of nine (22%) suspected of possible infection were found to be infected. A total of 100% of previously treated patients no longer considered to have ongoing infection, had multiple positive microbiology results.

Conclusion

Two thirds of patients had multiple contributing factors for their nonunion and 5% had entirely unexpected infection. This study highlights the importance of identifying all of the aetiological factors and routinely testing tissue for infection in treating nonunion. It raises key points regarding the inadequacy of a purely radiographic nonunion classification system and the variety of different definitions for atrophic nonunion in the current mainstream classifications used for nonunion.

Cite this article: L. Mills, J. Tsang, G. Hopper, G. Keenan, A. H. R. W. Simpson. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res 2016;5:512–519. DOI: 10.1302/2046-3758.510.BJR-2016-0138.

Positive, site-specific associations between bone mineral status, fitness, and time spent at high-impact activities in 16- to 18-year-old boys

The incidence of hip and forearm fracture in elderly men in the United Kingdom is a public health issue, but there is limited knowledge on lifestyle factors affecting male bone health. The aim of this cross-sectional study was to evaluate the relationships between whole body and regional bone mineral status and self-reported participation time in no-, low-, moderate-, and high-impact activities and fitness measurements in 16- to 18-year-old boys. One hundred twenty-eight boys underwent absorptiometry (DXA) measurements (Hologic QDR 1000W) of bone mineral content (BMC), bone area (BA), and bone mineral density (BMD) at the whole body, hip, spine, and forearm. They also completed the EPIC (European Prospective Investigation of Cancer) physical activity questionnaire, which allowed categorization of activities according to impact and aerobic intensity. Fitness and strength were assessed in each subject using estimated VO2 max, grip strength, and back strength. Significant positive relationships were found between BMC, BA, and BMD and the fitness and strength measurements and participation time in high-impact sports at most skeletal sites. The relationships were further examined after adjustment of BMC for height, weight, and bone area, thereby minimizing the influence of body and bone size on these relationships. VO2 max was a significant positive determinant of size-adjusted BMC at the whole body, the ultradistal and one-third radius, and all the hip sites, except the trochanter. Size-adjusted BMC at the forearm sites and trochanter was significantly positively associated with grip strength. Size-adjusted BMC at the whole body and all the hip sites was significantly positively associated with time spent at high-impact activities. Differences in size-adjusted BMC across thirds of time spent at high-impact activities were also examined. Boys in the highest third of high-impact activity had significantly greater size-adjusted whole body BMC and total hip BMC compared to subjects in the lowest third [+3.4 (1.2)% for whole body and +8.5 (2.2)% for hip, both P = 0.001]. Boys in the highest third of high-impact activity spent most activity time jogging, playing tennis, football and rugby, basketball, and exercising with weights. Back strength and lean mass were significantly greater in subjects in the highest third compared to those in the middle (P = 0.02) and lowest third (P = 0.03). No significant differences were found between subjects in each third of high-impact activity for potential confounders including TV viewing, calcium intake, body fat, and height. These findings indicate that participation of male adolescents in a range of high-impact activities for 1 h or more a day is associated with greater bone size and mineral content, especially at the hip.

An MMP-2/MMP-9 inhibitor, 5a, enhances apoptosis induced by ligands of the TNF receptor superfamily in cancer cells

Several studies have shown that matrix metalloproteases (MMPs) promote tumor growth, invasion, and metastasis. Consequently, MMP inhibitors have been developed as a new class of anticancer drugs, many of which are in clinical trials. The exact mechanism of the antineoplastic activity of MMP antagonists is unknown. To investigate the mechanism, we hypothesized that MMP inhibitors enhance the actions of apoptosis-inducing agents. To test this hypothesis, we treated breast, melanoma, leukemia, osteosarcoma, and normal breast epithelial cells with (2R)-2-[(4-biphenylsulfonyl)amino]-3-phenylproprionic acid (compound 5a), an organic inhibitor of MMP-2/MMP-9, alone or in combination with TNFalpha or other apoptotic agents. FACS analysis showed that 5a interacted synergistically with ligands of the TNF receptor superfamily, including TNFalpha and TNF receptor-like apoptosis-inducing ligand (TRAIL), and with a Fas-cross-linking antibody (CH11), UV, paclitaxel, thapsigargin, and staurosporin, to induce apoptosis in a cell-type-specific manner. Other MMP inhibitors did not synergize with TNFalpha. Compound 5a did not act directly on the mitochondrion or via changes in protein synthesis. Instead, the mechanism requires ligand-receptor interaction and caspase 8 activation. Investigation of the effect of 5a on tumor growth in vivo revealed that continuous treatment of subcutaneous melanoma with a combination of 5a plus TRAIL reduced tumor growth and angiogenesis in nude mice. Our data demonstrate that 5a possesses a novel proapoptotic function, thus providing an alternative mechanism for its antineoplastic action. These observations have important implications for combination cancer therapy.

Comparison of sampling methods for obtaining accurate coagulation values in hemodialysis patients with heparinized central venous catheters

Monitoring coagulation values in hemodialysis (HD) is integral to the care of patients with central venous catheters (CVCs) to maintain catheter patency. HD patients can have problems providing blood samples and may experience discomfort with venipuncture, but no consensus in the literature is available to identify a reliable and efficient method of obtaining an international normalization ratio (INR) value from a heparinized CVC line. This was a comparative study of three different methods of blood sampling for INR values. The INR samples were obtained from a peripheral venipuncture site, the CVC line, and the arterial bloodline sample port. The peripheral INR sample was used as the gold standard. The study occurred in a 60-station hemodialysis center in a 428-bed, urban, acute care hospital. The sample included 33 HD patients with patent dialysis CVC lines. Blood samples were drawn with a standardized protocol during one HD session from each of the three sites. The Pearson correlation coefficient for the peripheral sample versus the CVC line sample was 0.97 (p < 0.001) and was 0.99 (p < 0.001) between the peripheral sample and the arterial bloodline sample. Results revealed that both alternative methods are suitable for taking INR samples. As a result of this study, the arterial bloodline sample port method for INR sampling was introduced into the HD unit at this hospital. This method has proven to be simple, quick, accurate, and noninvasive to renal patients.

Sexual initiation: predictors and developmental trends

BACKGROUND

Early initiation of sexual intercourse is associated with increased risk for acquiring sexually transmitted diseases.

GOAL

To examine variables related to sexual initiation and developmental changes in the reasons why adolescent girls have sexual intercourse.

STUDY DESIGN

A longitudinal study of girls recruited from an adolescent medicine clinic was performed.

RESULTS

Logistic regression showed that girls who described their families as being expressive, having a moral-religious emphasis, providing supervision, and having greater maternal education, and who experienced menarche at an older age were older at sexual initiation. On the basis of contingency analyses, younger girls were less likely to report attraction or love, and more likely to report peers having sex as a reason for sexual intercourse at initiation. A generalized estimating equation analysis indicated that girls at younger ages are more likely to report curiosity, a grown-up feeling, partner pressure, and friends having sexual intercourse as reasons for intercourse. Girls at older ages are more likely to report a feeling of being in love, physical attraction, too excited to stop, drunk or high partner, and feeling romantic as reasons for having sexual intercourse.

CONCLUSIONS

Prevention programs should include a focus on familial characteristics and susceptibility to peer norms. They should be conducted with sensitivity to the developmental changes in intimate relationships that occur during adolescence.

Effect of 17beta-estradiol, o,p'-DDT, octylphenol and p,p'-DDE on gonadal development and liver and kidney pathology in juvenile male summer flounder (Paralichthys dentatus)

The intent of this study was to compare histopathologically the effect of 17beta-estradiol (E(2)), o,p'-DDT, octylphenol and p,p'-DDE on gonadal development and liver and kidney condition in sexually immature (juvenile) summer flounder (Paralichthys dentatus). The dorsal sinus of 2-year-old juvenile male summer flounder was injected with the appropriate amount of chemical incorporated in coconut oil. A second identical injection was administered 2 weeks later. Fish were sampled at 4, 6 and 8 weeks after the initial injection and observed histopathologically. In control fish, spermatogenesis was predominantly in mid to late maturation. In fish treated with 1.0 and 10.0 mg/kg E(2) spermatogenesis regressed to primary spermatogonia or an immature functional state. Testicular atrophy and spermatogonial proliferation was also observed. An eosin-positive, hyaline material was found in the gonad, liver and kidney. This eosinophilic material also stained positive with Periodic Acid Schiff (PAS) stain. Treatment of 30 or 60 mg/kg o,p'-DDT elicited altered gonadal development similar to that observed with E(2) treated fish. Octylphenol treatment of 100 mg/kg resulted in reduced testicular size, ducts full of sperm, numerous spermatogonia and PAS positive material in the testis with no developing sperm cysts. No effect on liver or gonad tissues was observed with p,p'-DDE at the concentrations tested. All chemicals tested, with exception of p,p'-DDE, altered gonadal development, whereas only E(2) caused histopathological changes in the liver and kidney. Estrogenic activity induced the liver to produce a vitellogenin (VtG)-like substance and inhibited testicular maturation. As a result, both the lack of target cells for VtG and a continuous supply of VtG from the liver allowed the hyaline material to accumulate in the liver, testis and kidney causing histopathological changes.

A preliminary examination of adolescent girls' perceptions of the parental knowledge of their boyfriends

STUDY OBJECTIVE

The purpose of this study was to describe adolescent girls' perceptions of their parents' contact with and knowledge of the girls' boyfriends. A second objective was to determine if knowledge was related to demographic characteristics of the girls or aspects of the relationship with their boyfriend.

DESIGN

Cross-sectional analysis of data from an interview with adolescent girls enrolled in a longitudinal study.

SETTING

Urban adolescent medicine clinic.

PARTICIPANTS

Adolescent girls (n = 109) with a mean age of 17.6 (range 14.9-19.3 yr). Eighty percent were African-American and 20% were Caucasian.

RESULTS

Most girls reported that their parents had some contact (either in person or on the phone) with their boyfriends. Thirteen girls reported that their parents did not know their boyfriends well, 40 reported that their parents knew their boyfriends somewhat, and 56 reported that their parents knew their boyfriends well. Age, race, and sexual experience were not related to how well the parents knew the boyfriend. Girls who had been involved with their boyfriends longer, believed that their relationship would last longer, were more satisfied, were more likely to tell their boyfriends private information and were more likely to describe their parents as knowing their boyfriends well.

CONCLUSIONS

These results provide an initial description of girls' perceptions of their parents' relationships with their boyfriends. It would be important to understand how to utilize the information regarding these parental-boyfriend relationships to further adolescent girls' development of healthy (both psychologically and physically) relationships.

Antibiotic use for the treatment of upper respiratory infections in a diverse community

BACKGROUND

Previous studies have not addressed whether cultural factors influence beliefs and practices related to the treatment of upper respiratory infections (URIs). The purpose of our project was to assess beliefs, care-seeking behavior, use of antibiotics, and means of obtaining antibiotics for the treatment of URIs among different ethnic groups in an urban community.

METHODS

A total of 192 adults completed a self-administered questionnaire indicating their likelihood of seeking care, the perceived effectiveness of treatment methods, and their usual use of treatment regimens for 2 scenarios consistent with uncomplicated URIs. Respondents were also asked about their use of antibiotics not prescribed by a physician for a URI.

RESULTS

A majority of subjects reported a belief in the effectiveness of antibiotics for URIs and indicated they are likely to seek care for URIs. Many (26%) had obtained antibiotics from sources other than a physician's prescription (e.g., directly from pharmacists or a supplier outside the United States). Many (31%) believed that antibiotics should be available over the counter. Individuals who reported using antibiotics for a URI were more likely than those who did not to obtain them without a prescription (35% vs. 11%, P = .001). Subjects with a cultural background from countries where antibiotics are available over the counter are more likely to use antibiotics not prescribed by a physician than those from countries with variably enforced regulations or the United States (40%, 30%, and 20%, respectively, P = .049).

CONCLUSIONS

Members of an ethnically diverse community believe antibiotics are effective for colds, are very likely to seek care for colds, and often obtain antibiotics without a prescription. The ease of antibiotic access worldwide may influence their use in some communities in the United States.

Massage therapy for patients undergoing autologous bone marrow transplantation

The purpose of the current study was to examine the impact of massage therapy on psychological, physical, and psychophysiological measures in patients undergoing autologous bone marrow transplantation (BMT). Patients scheduled to undergo BMT were randomly assigned to receive either (a) massage therapy, consisting of 20-minute sessions of shoulder, neck, head, and facial massage, or (b) standard treatment. Overall effects of massage therapy on anxiety, depression, and mood were assessed pretreatment, midtreatment, and prior to discharge using the State-Trait Anxiety Inventory, Beck Depression Inventory, and Brief Profile of Mood States, respectively. The immediate effects of massage were measured via the State Anxiety Inventory, Numerical Scales of Distress, Fatigue, Nausea, and Pain and indices of psychophysiological arousal (heart rate, blood pressure, and respiration rate), collected prior to and following patients' first, fifth, and final massage (on Days--7, midtreatment, and predischarge). Analysis of the data evaluating the immediate effects of massage showed that patients in the massage therapy group demonstrated significantly larger reductions in distress, fatigue, nausea, and State Anxiety than the standard treatment group at Day-7, in State Anxiety at midtreatment, and in fatigue at the predischarge assessment. The overall measures of psychological symptoms measured at pretreatment, midtreatment, and prior to discharge showed no overall group differences, although the massage group scored significantly lower on the State Anxiety Inventory than the standard care group at the midtreatment assessment. The two groups together showed significant declines through time on scores from the Profile of Mood States and State and Trait Anxiety Inventories.

Use of pulse field gel electrophoresis for the epidemiological characterisation of coagulase positive Staphylococcus isolated from meat workers and beef carcasses

Coagulase positive staphylococci isolated at an Australian abattoir, from beef carcasses, hands, and environmental samples, were typed by the DNA macrorestriction patterns obtained following PFGE of SmaI digests. The predominant PFGE pattern of isolates collected before evisceration was different from the dominant pattern of isolates collected after evisceration. PFGE patterns for isolates from workers' hands and from concordant carcasses were indistinguishable. PFGE types among isolates collected from non-evisceration abattoir personnel and clerical staff were distinct from patterns among isolates collected from the slaughter floor personnel. Twenty-nine (85%) of the 34 isolates collected from carcasses after evisceration exhibited PFGE patterns that were 93% homologous. During evisceration the carcasses were handled extensively and it is proposed that the hands of workers at this abattoir are the primary source of staphylococcal contamination of carcasses on the slaughter floor. This paper highlights the usefulness of PFGE as an epidemiological tool for determining the source of staphylococcal contamination in the food industry.

Incidence of coagulase positive Staphylococcus on beef carcasses in three Australian abattoirs

The contamination of beef carcasses with coagulase-positive staphylococci (CPS) was studied at three beef abattoirs (A, B and C). The incidence and the number of CPS were determined on cattle hides immediately after slaughter and on three carcass sites (brisket, flank and round) at different points during processing along the slaughter line. The incidence of CPS on cattle hides ranged from 20 to 68.6%. At abattoir A, 6.5% of the carcasses sampled before evisceration were contaminated with CPS, compared to 40% of the carcasses after evisceration. The incidence on carcasses changed little during further processing; however, after chilling for 72 h, the incidence increased to 83%. After evisceration, the brisket and flank areas were more often contaminated than the round. A similar pattern of contamination was observed at abattoir B. At abattoir C, 26.7% of the samples collected before evisceration were contaminated and this fell to 16.7% after evisceration. After chilling for 72 h, the incidence of carcass contamination with CPS increased to 46.7%. The average number of CPS on contaminated carcasses prior to and after overnight chilling was less than 50 colony-forming units (cfu)/cm2 and, after weekend chilling, increased to 64 and 112 cfu/cm2 in abattoirs A and B, respectively. Of the isolates tested, 71.4% produced staphylococcal enterotoxin and 21% could not be classified phenotypically. The hands of workers and environmental sites associated with the evisceration process were examined for CPS at abattoir A. Hands were heavily contaminated and were the likely source of CPS contamination at this abattoir.

Effect of nitric oxide on hemoprotein-catalyzed oxidative reactions

Hemoglobin or myoglobin-catalyzed oxidation reactions have been suggested to initiate and/or exacerbate tissue injury associated with a variety of pathological conditions including post-ischemic tissue injury, hemorrhagic disorders, and chronic inflammation. In the present study, we investigated what effect different fluxes of nitric oxide (NO) have on hemoprotein-catalyzed oxidation reactions in vitro. The hypoxanthine/xanthine oxidase system was used to generate both O2- and H2O2, whereas the spontaneous decomposition of the spermine/NO adduct was used to generate NO at a known and constant rate. We assessed the ability of myoglobin (Mb) or hemoglobin (Hb) to oxidize dihydrorhodamine (DHR) to rhodamine (RH) in the presence of O2-/H2O2 and/or NO. In the presence of a constant flux of O2- and H2O2 (1 nmol/min each), 500 nM MetMb (Fe3+) stimulated DHR oxidation from normally undetectable levels to approximately 35 microM. This oxidation reaction was inhibited by catalase but not SOD, suggesting the formation of the ferryl-hemoprotein adduct (Fe4+). Equimolar fluxes of O2-, H2O2, and NO increased further DHR oxidation to approximately 50 microM. The 15 microM increase in DHR oxidation was independent of heme concentration and was inhibited by SOD. This suggested that equal fluxes of O2- and NO interact to yield a potent oxidant such as peroxinitrite (OONO-) which together with Mb-Fe4+ oxidizes DHR. Further increases in NO fluxes significantly inhibited DHR oxidation (80%) via the NO-dependent inhibition of Mb-Fe4+ formation. Additional studies using methemoglobin (Hb-Fe3+)-catalyzed oxidative reactions yielded virtually identical results. We conclude that in the presence of a hemoprotein such as myoglobin or hemoglobin, NO may promote or inhibit oxidation reactions depending upon the relative fluxes of O2-, H2O2, and NO.

Smith-Lemli-Opitz syndrome: a variable clinical and biochemical phenotype

We have reviewed all known UK cases of Smith-Lemli-Opitz syndrome. Among 49 cases with proven 7-dehydrocholesterol reductase deficiency, half had been terminated or had died in infancy. The minimum incidence is 1 in 60,000. The frequent occurrence of hypospadias may account for 71% of recognised cases being male. Important common features which emerged include short thumbs, severe photosensitivity, aggressive behaviour, and atrioventricular septal defect. The typical facial appearance becomes less obvious with age and 20% of cases did not have 2/3 toe syndactyly. Biochemical measurements of serum 7-dehydrocholesterol did not correlate with clinical severity.

A PCR specific for Escherichia coli O157 based on the rfb locus encoding O157 lipopolysaccharide

A PCR was developed for the detection of Escherichia coli O157 based on the rfbE O-antigen synthesis genes. A 479-bp PCR product was amplified specifically from E. coli O157 in cell lysates containing 200 or 2 CFU following crude DNA extraction. The PCR detected < 1 CFU of E. coli O157 per ml in raw milk following enrichment.

Dose escalation of the hypoxic cell sensitizer etanidazole combined with ifosfamide, carboplatin, etoposide, and autologous hematopoietic stem cell support

Multiple mechanisms of drug resistance contribute to treatment failure. Although high-dose therapy attempts to overwhelm these defenses pharmacologically, this approach is only successful in a fraction of treated patients. Many drug resistance mechanisms are shared between malignant and normal cells, but the expression of various drug resistance mechanisms associated with hypoxia is largely confined to tumor tissue. Thus, reversal of this mechanism is likely to provide a therapeutic advantage to the host. This study was designed to define the dose-limiting toxicities and maximum tolerated dose of etanidazole when it is given concurrently with high-dose ifosfamide, carboplatin, and etoposide (ICE), with hematopoietic stem cell support. The maximum tolerated doses of high-dose ICE were administered concurrently with dose escalations of etanidazole, a hypoxic cell sensitizer. All agents were given by 96-h continuous i.v. infusion beginning on day -7. Mesna uroprotection was provided. Autologous marrow and cytokine mobilized peripheral blood progenitor cells were reinfused on day 0. Granulocyte colony-stimulating factor was administered following reinfusion until the granulocytes recovered to > 1000/microliter. Fifty-five adults with advanced malignancies were enrolled in cohorts of five to nine patients. Four dose levels of etanidazole between 3 and 5.5 g/m2/day (12, 16, 20, and 22 g/m2 total doses) and two doses of carboplatin (1600 and 1800 mg/m2 total doses) were evaluated. Seven patients died of organ toxicity (13%); two each from veno-occlusive disease of liver and sepsis; and one each from sudden death, renal failure, and refractory thrombocytopenic hemorrhage. Five deaths occurred at the top dose level. One additional patient suffered a witnessed cardiorespiratory arrest from ventricular fibrillation and was resuscitated. Dose-dependent and largely reversible peripheral neuropathy was observed consisting of two syndromes: severe cramping myalgic/neuralgic pain, predominantly in stocking glove distribution, occurring between day -3 and day 0, and a sensory peripheral neuropathy with similar distribution peaking around day +60. The maximal achievable dose of etanidazole (16 g/m2 dose level) resulted in a mean serum level of 38 micrograms/ml (25-55 micrograms/ml). Etanidazole significantly enhanced host toxicity of high-dose ICE. Effective modulatory doses of etanidazole could not be given with acceptable toxicity using this schedule.

Secondary myelodysplasia and acute leukemia in breast cancer patients after autologous bone marrow transplant

PURPOSE

To determine the incidence of myelodysplasia (MDS) and/or acute leukemia (AL) in breast cancer patients after high-dose chemotherapy (HDC) with a single conditioning regimen and autologous bone marrow transplant (ABMT), and analyze the cytogenetic abnormalities that arise after HDC.

PATIENTS AND METHODS

We retrospectively reviewed the records of 864 breast cancer patients who underwent ABMT at Duke University Medical Center, Durham, NC, from 1985 through 1996 who received the same preparative regimen of cyclophosphamide 1,875 mg/m2 for 3 days, cisplatin 55 mg/m2 for 3 days, and BCNU 600 mg/m2 for 1 day (CPB). Pretransplant cytogenetics were analyzed in all patients and posttransplant cytogenetics were evaluated in four of five patients who developed MDS/AL.

RESULTS

Five of 864 patients developed MDS/AL after HDC with CPB and ABMT. The crude cumulative incidence of MDS/AL was 0.58%. The Kaplan-Meier curve shows a 4-year probability of developing MDS/AL of 1.6%. Pretransplant cytogenetics performed on these five patients were all normal. Posttransplant cytogenetics were performed on four of five patients and they were abnormal in all four, although only one patient had the most common cytogenetic abnormality associated with secondary MDS/AL (chromosome 5 and/or 7 abnormality).

CONCLUSION

Whereas MDS/AL is a potential complication of HDC with CPB and ABMT, the incidence in this series of patients with breast cancer was relatively low compared with that reported in patients with non-Hodgkin's lymphoma who underwent ABMT. The cytogenetic abnormalities reported in this group of breast cancer patients were not typical of those seen in prior reports of secondary MDS/AL and appear to have occurred after HDC.