Health disparities among older adults following tropical cyclone exposure in Florida

Tropical cyclones (TCs) pose a significant threat to human health, and research is needed to identify high-risk subpopulations. We investigated whether hospitalization risks from TCs in Florida (FL), United States, varied across individuals and communities. We modeled the associations between all storms in FL from 1999 to 2016 and over 3.5 million Medicare hospitalizations for respiratory (RD) and cardiovascular disease (CVD). We estimated the relative risk (RR), comparing hospitalizations during TC-periods (2 days before to 7 days after) to matched non-TC-periods. We then separately modeled the associations in relation to individual and community characteristics. TCs were associated with elevated risk of RD hospitalizations (RR: 4.37, 95% CI: 3.08, 6.19), but not CVD (RR: 1.04, 95% CI: 0.87, 1.24). There was limited evidence of modification by individual characteristics (age, sex, or Medicaid eligibility); however, risks were elevated in communities with higher poverty or lower homeownership (for CVD hospitalizations) and in denser or more urban communities (for RD hospitalizations). More research is needed to understand the potential mechanisms and causal pathways that might account for the observed differences in the association between tropical cyclones and hospitalizations across communities.

Prenatal exposure to ambient air pollution and adverse birth outcomes: An umbrella review of 36 systematic reviews and meta-analyses

Multiple systematic reviews and meta-analyses linked prenatal exposure to ambient air pollutants to adverse birth outcomes with mixed findings, including results indicating positive, negative, and null associations across the pregnancy periods. The objective of this study was to systematically summarise systematic reviews and meta-analyses on air pollutants and birth outcomes to assess the overall epidemiological evidence. Systematic reviews with/without meta-analyses on the association between air pollutants (NO₂, CO, O₃, SO₂, PM_2.5, and PM₁₀) and birth outcomes (preterm birth; stillbirth; spontaneous abortion; birth weight; low birth weight, LBW; small-for-gestational-age) up to March 30, 2022 were included. We searched PubMed, CINAHL, Scopus, Medline, Embase, and the Web of Science Core Collection, systematic reviews repositories, grey literature databases, internet search engines, and references of included studies. The consistency in the directions of the effect estimates was classified as more consistent positive or negative, less consistent positive or negative, unclear, and consistently null. Next, the confidence in the direction was rated as either convincing, probable, limited-suggestive, or limited non-conclusive evidence. Final synthesis included 36 systematic reviews (21 with and 15 without meta-analyses) that contained 295 distinct primary studies. PM_2.5 showed more consistent positive associations than other pollutants. The positive exposure-outcome associations based on the entire pregnancy period were more consistent than trimester-specific exposure averages. For whole pregnancy exposure, a more consistent positive association was found for PM_2.5 and birth weight reductions, particulate matter and spontaneous abortion, and SO₂ and LBW. Other exposure-outcome associations mostly showed less consistent positive associations and few unclear directions of associations. Almost all associations showed probable evidence. The available evidence indicates plausible causal effects of criteria air pollutants on birth outcomes. To strengthen the evidence, more high-quality studies are required, particularly from understudied settings, such as low-and-middle-income countries. However, the current evidence may warrant the adoption of the precautionary principle.

Title: Screening for cognitive symptoms among cancer patients during chemotherapy: sensitivity and specificity of a single item self-report cognitive change score

OBJECTIVES

Cognitive symptoms are commonly reported among cancer patients and survivors, yet guidance on when self-reported cognitive symptoms warrant follow-up is lacking. We sought to establish cut-off scores for identifying patients with perceived low cognitive functioning on widely used self-report measures of cognition and a novel single item Cognitive Change Score.

METHODS

Adult patients diagnosed with invasive cancer who had completed at least one cycle of chemotherapy completed a questionnaire containing the EORTC-Cognitive Function (CF) subscale, FACT-COG Perceived Cognitive Impairment (PCI) and our Cognitive Change Score (CCS). We used ROC analyses to establish the discriminative ability of these measures against the PAOFI as our reference standard. We chose cut-off scores on each measure that maximised both sensitivity and specificity for identifying patients with self-reported low cognitive function.

RESULTS

We recruited 294 participants (55.8% women, mean age 56.6 years) with mixed cancer diagnoses (25.5 months since diagnosis). On the CCS, 77.6% reported some cognitive change since starting chemotherapy. On the PAOFI 36% had low cognitive function. The following cut-off scores identified cases of low cognitive function: ≥28.5 on the CCS (75.5% sensitivity, 67.6% specificity); ≤75.0 on the EORTC-CF (90.9% sensitivity, 57.1% specificity); ≤55.1 on the FACT-COG PCI-18 (84.8% sensitivity, 76.2% specificity), and ≤59.5 on the FACT-COG PCI-20 (78.8% sensitivity, 84.1% specificity).

CONCLUSIONS

We found a single item question asking about cognitive change has acceptable discrimination between patients with self-reported normal and low cognitive function when compared to other more comprehensive self-report measures of cognitive symptoms. Further validation work is required. This article is protected by copyright. All rights reserved.

Displacement of Racially and Ethnically Minoritized Groups after the Installation of Stormwater Control Measures (i.e., Green Infrastructure): A Case Study of Washington, DC

Stormwater control measures (SCMs) (i.e., green infrastructure) are advantageous methods of stormwater management. However, studies suggest that urban greening may be associated with gentrification, displacing racially/ethnically minoritized groups due to increased housing costs and loss of feelings of belonging. We studied displacement of racially/ethnically minoritized groups after SCM installation in Washington, DC. We compared the change in percentage of persons in racial/ethnic groups at the Census block group level with varying levels of SCM installation (i.e., area-weighted SCM count at 300 m buffer). We stratified findings by SCM type, pre-installation income, and SCM size. DC installed a higher density of SCMs in areas with a higher percentage of Black and/or Hispanic/Latino residents. Nonetheless, findings suggest SCM installation is associated with displacement of Black residents. The percentage of residents who are Black decreased by 2.2% [95% Confidence Interval: 1.7, 2.7] and 4.1% [95% Confidence Interval: 3.4, 4.8] after low and high levels of SCM installation, respectively. In turn, the change in percentage of residents who are White increased with increasing levels of SCM installation. Compared to ecological studies on SCMs, studies about social impacts are scarce. This research intends to help optimize SCM installations so more residents can enjoy their health, economic, and ecological benefits.

Ambient Air Pollution, Extreme Temperatures and Birth Outcomes: A Protocol for an Umbrella Review, Systematic Review and Meta-Analysis

Prenatal exposure to ambient air pollution and extreme temperatures are among the major risk factors of adverse birth outcomes and with potential long-term effects during the life course. Although low- and middle-income countries (LMICs) are most vulnerable, there is limited synthesis of evidence in such settings. This document describes a protocol for both an umbrella review (Systematic Review 1) and a focused systematic review and meta-analysis of studies from LMICs (Systematic Review 2). We will search from start date of each database to present, six major academic databases (PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid and Web of Science Core Collection), systematic reviews repositories and references of eligible studies. Additional searches in grey literature will also be conducted. Eligibility criteria include studies of pregnant women exposed to ambient air pollutants and/or extreme temperatures during pregnancy with and without adverse birth outcomes. The umbrella review (Systematic Review 1) will include only previous systematic reviews while Systematic Review 2 will include quantitative observational studies in LMICs. Searches will be restricted to English language using comprehensive search terms to consecutively screen the titles, abstracts and full-texts to select eligible studies. Two independent authors will conduct the study screening and selection, risk of bias assessment and data extraction using JBI SUMARI web-based software. Narrative and semi-quantitative syntheses will be employed for the Systematic Review 1. For Systematic Review 2, we will perform meta-analysis with two alternative meta-analytical methods (quality effect and inverse variance heterogeneity) as well as the classic random effect model. If meta-analysis is infeasible, narrative synthesis will be presented. Confidence in cumulative evidence and the strength of the evidence will be assessed. This protocol is registered with PROSPERO (CRD42020200387).

Developing a geostatistical simulation method to inform the quantity and placement of new monitors for a follow-up air sampling campaign

Sampling campaign design is a crucial aspect of air pollution exposure studies. Selection of both monitor numbers and locations is important for maximizing measured information, while minimizing bias and costs. We developed a two-stage geostatistical-based method using pilot NO₂ samples from Lanzhou, China with the goal of improving sample design decision-making, including monitor numbers and spatial pattern. In the first step, we evaluate how additional monitors change prediction precision through minimized kriging variance. This was assessed in a Monte Carlo fashion by adding up to 50 new monitors to our existing sites with assigned concentrations based on conditionally simulated NO₂ surfaces. After identifying a number of additional sample sites, a second step evaluates their potential placement using a similar Monte Carlo scheme. Evaluations are based on prediction precision and accuracy. Costs are also considered in the analysis. It was determined that adding 28-locations to the existing Lanzhou NO₂ sampling campaign captured 73.5% of the total kriged variance improvement and resulted in predictions that were on average within 10.9 μg/m³ of measured values, while using 56% of the potential budget. Additional monitor sites improved kriging variance in a nonlinear fashion. This method development allows for informed sampling design by quantifying prediction improvement (accuracy and precision) against the costs of monitor deployment.

Behavioral and subjective health changes in US and Mexico border residing participants in two promotora-led chronic disease preventive interventions

Chronic diseases are the primary health burden among Mexican-origin populations and health promotion efforts have not been able to change negative population trends. This research presents behavioral and subjective health impacts of two related community health worker (CHW) interventions conducted in the US-Mexico border region. Pasos Adelante (United States) and Meta Salud (Mexico) are 12-13 week CHW-led preventive interventions implemented with Mexico-origin adults. Curricula include active learning modules to promote healthy dietary changes and increasing physical activity; they also incorporate strategies to promote social support, empowerment and group exercise components responsive to their communities. Questionnaire data at baseline (N = 347 for Pasos; 171 for Meta Salud), program completion and 3-month follow-up were analyzed. Results showed statistically significant improvements in multiple reported dietary, physical activity and subjective health indicators. Furthermore, at follow-up across both cohorts there were ≥10% improvements in participants' meeting recommended physical activity guidelines, consumption of whole milk, days of poor mental health and self-rated health. While this study identifies some robust health improvements and contributes to the evidence base for these interventions current dissemination, the lack of change observed for some targeted behaviors (e.g. time sitting) suggests they may have stronger overall impacts with curricula refinement.

Important differences and meaningful changes for the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog)

Background

We estimated clinically important, group-level differences in self-reported cognitive function for the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) instrument. We also investigated individual level change that could be considered meaningful for cancer survivors affected by cognitive impairment following chemotherapy, and that could be used for responder analyses. We used data from a multi-site randomized controlled trial in 242 participants that evaluated a web-based intervention for improving self-reported cognitive functioning in adult cancer survivors who reported cognitive impairment and who had adjuvant chemotherapy in the previous 6–60 months. We used anchor and distribution methods to estimate a range of clinically important differences (CIDs) and investigated meaningful change thresholds (MCTs) for the FACT-Cog and the Perceived Cognitive Impairments (PCI) subscale, post-intervention and at six-month follow-up with empirical cumulative distribution functions. Our primary anchor was the patient reported cognitive function subscale of the European Organization for Research and Treatment of Cancer Quality of Life-Cognitive Functioning Scale (EORTC-CF).

Results

Most participants were female (95%) breast cancer survivors (89%). Correlation of changes in the FACT-Cog and the EORTC-CF were 0.55 post-intervention and 0.61 at follow-up. Anchor-based CID estimates for the FACT-Cog using our primary anchor were 11.3 points (post) and 8.8 (follow-up), which corresponds to a standardized effect size of 0.49 and 0.38; 8.6% and 6.6% of the total scale’s range. Anchor-based CID estimates for the FACT-Cog PCI subscale were 7.4 (post) and 4.6 points (follow-up), which corresponds to a standardized effect size of 0.50 and 0.31; 10.3% and 6.4% of the PCI range). Empirical cumulative distribution functions of change in FACT-Cog demonstrating possible MCTs showed that anchor change of none, minimally better and much better were well separated.

Conclusions

The CID and MCT estimates from this manuscript can help in the design, analysis and interpretation of self-reported cognitive function in cancer patients and survivors.

Impact of physical activity on fatigue and quality of life in people with advanced lung cancer: a randomized controlled trial

Background

Physical activity (PA) improves fatigue and quality of life (QOL) in cancer survivors. Our aim was to assess whether a 2-month PA intervention improves fatigue and QOL for people with advanced lung cancer.

Methods

Participants with advanced lung cancer, Eastern Cooperative Oncology Group performance status (PS) ≤2, >6 months life expectancy, and ability to complete six-min walk test, were stratified (disease stage, PS 0-1 versus 2, centre) and randomized (1:1) in an open-label study to usual care (UC) (nutrition and PA education materials) or experimental intervention (EX): UC plus 2-month supervised weekly PA and behaviour change sessions. Assessments occurred at baseline, 2, 4, and 6 months. The primary endpoint was fatigue [Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire] at 2 months. The study was designed to detect a difference in mean FACT-F subscale score of 6. Analysis was intention-to-treat using linear mixed models.

Results

We recruited 112 patients: 56 (50.4%) were randomized to EX, 55(49.5%) to UC; 1 ineligible. Male 55%; median age 64 years (34-80); 106 (96%) non-small cell lung cancer; 106 (95.5%) stage IV. At 2, 4 and 6 months, 90, 73 and 62 participants were assessed, respectively, with no difference in attrition between groups. There were no significant differences in fatigue between the groups at 2, 4 or 6 months: mean scores at 2 months EX 37.5, UC 36.4 (difference 1.2, 95% CI - 3.5, 5.8, P = 0.62). There were no significant differences in QOL, symptoms, physical or functional status, or survival.

Conclusions

Adherence to the intervention was good but the intervention group did not increase their PA enough compared to the control group, and no difference was seen in fatigue or QOL.

Trial Registration

Australian New Zealand Clinical Trials Registry No. ACTRN12609000971235.

SMART: Stroke-Like Migraine Attacks After Radiation Therapy

We describe two adults with stroke-like migraine attacks after radiation therapy (SMART syndrome), propose revised diagnostic criteria, and review the previously reported patients. ‘SMART’ is an acronym for a newly recognized syndrome which occurs as a delayed consequence of cerebral irradiation and consists of prolonged, unilateral, migrainous neurological symptoms with transient, dramatic cortical gadolinium enhancement of the affected cerebral hemisphere and is sometimes punctuated by generalized seizures and ipsilateral EEG slowing. Although the neurological symptoms can last for weeks, full recovery occurs. An appropriate evaluation should exclude alternative explanations.

Predictors of unmet needs and psychological distress in adolescent and young adult siblings of people diagnosed with cancer

PURPOSE

Predictors of psychological distress and unmet needs amongst adolescents and young adults (AYAs) who have a brother or sister diagnosed with cancer were examined.

METHODS

There were 106 AYAs (12-24 years old) who completed questionnaires covering demographics, psychological distress (Kessler 10), unmet needs (Sibling Cancer Needs Instrument) and family relationships (Family Relationship Index; Adult Sibling Relationship Questionnaire; Sibling Perception Questionnaire (SPQ)). Three models were analysed (demographic variables, cancer-specific variables and family functioning variables) using multiple linear regression to determine the role of the variables in predicting psychological distress and unmet needs.

RESULTS

Unmet needs were higher for AYA siblings when treatment was current or a relapse had occurred. Higher scores on the SPQ-Interpersonal subscale indicating a perceived decrease in the quality of relationships with parents and others were associated with higher levels of distress and unmet needs. The age and gender of the AYA sibling, whether it was their brother or sister who was diagnosed with cancer, the age difference between them, the number of parents living with the AYA sibling, parental birth country, time since diagnosis, Family Relationship Index, Adult Sibling Relationship Questionnaire and the SPQ-Communication subscale did not significantly impact outcome variables.

CONCLUSIONS

These results highlight the variables that can assist in identifying AYA siblings of cancer patients who are at risk and have a greater need for psychosocial assistance. Variables that may be associated with increased distress and unmet needs are reported to assist with future research. The results are also useful in informing the development of targeted psychosocial support for AYA siblings of cancer patients.

Improving decision making about clinical trial participation - a randomised controlled trial of a decision aid for women considering participation in the IBIS-II breast cancer prevention trial

BACKGROUND

Decision aids may improve informed consent in clinical trial recruitment, but have not been evaluated in this context. This study investigated whether decision aids (DAs) can reduce decisional difficulties among women considering participation in the International Breast Cancer Intervention Study-II (IBIS-II) trial.

METHODS

The IBIS-II trial investigated breast cancer prevention with anastrazole in two cohorts: women with increased risk (Prevention), and women treated for ductal carcinoma in situ (DCIS). Australia, New Zealand and United Kingdom participants were randomised to receive a DA (DA group) or standard trial consent materials (control group). Questionnaires were completed after deciding about participation in IBIS-II (post decision) and 3 months later (follow-up).

RESULTS

Data from 112 Prevention and 34 DCIS participants were analysed post decision (73 DA; 73 control); 95 Prevention and 24 DCIS participants were analysed at follow-up (58 DA; 61 control). There was no effect on the primary outcome of decisional conflict. The DCIS-DA group had higher knowledge post decision, and the Prevention-DA group had lower decisional regret at follow-up.

CONCLUSIONS

This was the first study to evaluate a DA in the clinical trial setting. The results suggest DAs can potentially increase knowledge and reduce decisional regret about clinical trial participation.

Immigrants' perceptions of the quality of their cancer care: an Australian comparative study, identifying potentially modifiable factors

BACKGROUND

Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients.

PATIENTS AND METHODS

This was a hospital-based sample of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated.

RESULTS

Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in 'difficulty knowing who to see' (P = 0.0002), 'length of time to confirm diagnosis' (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001); being offered the opportunity to see a counselor (P < 0.0001); and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen; however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors.

CONCLUSIONS

This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals.

PM2.5 exposure and birth outcomes: use of satellite- and monitor-based data

BACKGROUND

Air pollution may be related to adverse birth outcomes. Exposure information from land-based monitoring stations often suffers from limited spatial coverage. Satellite data offer an alternative data source for exposure assessment.

METHODS

We used birth certificate data for births in Connecticut and Massachusetts, United States (2000-2006). Gestational exposure to PM2.5 was estimated from US Environmental Protection Agency monitoring data and from satellite data. Satellite data were processed and modeled by using two methods-denoted satellite (1) and satellite (2)-before exposure assessment. Regression models related PM2.5 exposure to birth outcomes while controlling for several confounders. Birth outcomes were mean birth weight at term birth, low birth weight at term (<2500 g), small for gestational age (SGA, <10th percentile for gestational age and sex), and preterm birth (<37 weeks).

RESULTS

Overall, the exposure assessment method modified the magnitude of the effect estimates of PM2.5 on birth outcomes. Change in birth weight per interquartile range (2.41 μg/m) increase in PM2.5 was -6 g (95% confidence interval = -8 to -5), -16 g (-21 to -11), and -19 g (-23 to -15), using the monitor, satellite (1), and satellite (2) methods, respectively. Adjusted odds ratios, based on the same three exposure methods, for term low birth weight were 1.01 (0.98-1.04), 1.06 (0.97-1.16), and 1.08 (1.01-1.16); for SGA, 1.03 (1.01-1.04), 1.06 (1.03-1.10), and 1.08 (1.04-1.11); and for preterm birth, 1.00 (0.99-1.02), 0.98 (0.94-1.03), and 0.99 (0.95-1.03).

CONCLUSIONS

Under exposure assessment methods, we found associations between PM2.5 exposure and adverse birth outcomes particularly for birth weight among term births and for SGA. These results add to the growing concerns that air pollution adversely affects infant health and suggest that analysis of health consequences based on satellite-based exposure assessment can provide additional useful information.

Psychometric evaluation of the Sibling Cancer Needs Instrument (SCNI): an instrument to assess the psychosocial unmet needs of young people who are siblings of cancer patients

PURPOSE

The current study sought to establish the psychometric properties of the revised Sibling Cancer Needs Instrument (SCNI) when completed by young people who have a brother or sister with cancer.

METHODS

The participants were 106 young people aged between 12 and 24 who had a living brother or sister diagnosed with any type or stage of cancer in the last 5 years. They were recruited from multiple settings. The initial step in determining the dimensional structure of the questionnaire was exploratory factor analysis and further assessment followed using Rasch analysis. Construct validity and test-retest reliability (n = 17) were also assessed.

RESULTS

The final SCNI has 45 items and seven domains: information; practical assistance; "time out" and recreation; feelings; support (friends and other young people); understanding from my family; and sibling relationship. There was a reasonable spread of responses across the scale for every item. Rasch analysis results suggested that overall, respondents used the scale consistently. Support for construct validity was provided by the correlations between psychological distress and the SCNI domains. The internal consistency was good to excellent; Cronbach's alphas ranged from 0.78 to 0.94. The test-retest reliability of the overall measure is 0.88.

CONCLUSIONS

The SCNI is the first measure of psychosocial unmet needs which has been developed for young people who have a brother or sister with cancer. The sound psychometric properties allow the instrument to be used with confidence. The measure will provide a substantial clinical benefit in highlighting the unmet needs of this population to assist with the prioritisation of targeted supportive care services and evaluating the impact of interventions targeted at siblings.

Psychological morbidity and stress but not social factors influence level of fear of cancer recurrence in young women with early breast cancer: results of a cross-sectional study

BACKGROUND

Fear of cancer recurrence (FCR) is a common problem amongst survivors. Past research has shown that young women with breast cancer are particularly vulnerable to FCR, yet few previous studies have specifically examined FCR in this subgroup.

AIMS

The aim of the study is to explore the relationship between FCR, psychological morbidity and social factors. A secondary aim was to explore the relationship between clinical levels of FCR and generalised anxiety disorder (GAD) and hypochondriasis.

METHOD

Two hundred eighteen breast cancer survivors (aged 18-45 years at diagnosis) diagnosed at least 1 year prior were recruited through seven metropolitan oncology clinics and two breast cancer consumer groups. Participants completed a web-based questionnaire, which assessed FCR, psychological functioning, generalised anxiety, hypochondriasis and items exploring past cancer-related experiences, attitudes to future childbearing, social support and correlates were identified using linear regression.

RESULTS

Psychological morbidity scales measuring anxiety and psychological functioning and stressful life events were significantly associated with FCR in adjusted and unadjusted models (p < 0.0001). Past cancer experiences, children, social support and attitudes to childrearing were not associated with FCR. Among those with clinical levels of FCR (n = 152), 43% met screening criteria for hypochondriasis, and 36% met screening criteria for GAD.

CONCLUSIONS

This study shows psychological morbidity is associated with FCR, but the majority of women with high levels of FCR do not also meet the criteria for a clinical level of GAD or hypochondriasis. Understanding the factors that make young women vulnerable to FCR is important to help guide the development of FCR-specific interventions for this subgroup.

Physical symptoms, coping styles and quality of life in recurrent ovarian cancer: a prospective population-based study over the last year of life

OBJECTIVE

The aim of this study was to describe the trajectory of physical symptoms, coping styles and quality of life (QoL) and the relationship between coping and QoL over the last year of life in women with recurrent ovarian cancer.

METHODS

The patient cohort were women recruited to the Australian Ovarian Cancer Study who subsequently experienced recurrent, invasive ovarian cancer and completed at least one psychosocial assessment (optimism, minimisation, hopelessness/helplessness, QoL) during the last year of life (n=217).

RESULTS

QoL declined sharply from six months before death. Lack of energy was the most prevalent symptom over three measurement periods (67-92%) and also the most severe. Anorexia (36-55%), abdominal swelling (33-58%), nausea (26-47%) and pain (26-43%) all increased in prevalence and severity towards the end of life. Higher optimism (p=0.009), higher minimisation (p=0.003) and lower helplessness/hopelessness (p=0.03) at baseline were significant predictors of subsequent higher QoL.

CONCLUSIONS

Progressive deterioration in quality of life may be an indicator of death within about six months and therefore should be an important consideration in decisions about subsequent treatment. Coping styles which independently predicted subsequent changes in QoL could potentially be targeted by interventions to minimise worsening QoL.

Fear of cancer recurrence in young early-stage breast cancer survivors: the role of metacognitive style and disease-related factors

OBJECTIVE

Fear of cancer recurrence (FCR) is a common challenge of cancer survivorship, particularly in younger survivors. Maladaptive metacognitions have been shown to be important to the development of a range of emotional disorders but have not previously been explored in the context of FCR.

AIMS

This study aimed to explore the relationship between FCR and a maladaptive metacognitions.

METHODS

This cross-sectional study included young women diagnosed with early-stage breast cancer at least 1 year prior to study entry. Participants completed a web-based questionnaire, which included the Fear of Cancer Recurrence Inventory (FCRI) and the brief Metacognitions Questionnaire-30 (MCQ-30). Linear regression was used to calculate unadjusted and adjusted slope estimates of the association of FCR with six metacognition variables, the total score of the MCQ-30 and the five subscales.

RESULTS

Two-hundred and eighteen women with a mean age of 39 years at diagnosis participated. All measures of metacognitive style were moderately correlated with FCRI scores (r=0.31-0.49) and significantly associated with FCRI in both unadjusted and adjusted models. Overall metacognitive style explained 36% of the variance in FCR scores in combination with disease and demographic factors. Negative metacognitions (R(2) =0.32) and need for control over cognition (R(2)=0.26) were the MCQ-30 subscales most associated with higher FCR.

CONCLUSIONS

Unhelpful metacognitions appear to play an important role in FCR in young women with early-stage breast cancer. Treatments that focus on changing unhelpful metacognitions may prove a useful approach for treating clinical FCR in cancer survivors in the future.

Can accelerometry be used to discriminate levels of activity?

The aims of this study were to investigate the associations between an activity logbook and the RT3 accelerometer and to assess whether the RT3 can discriminate activity levels in healthy adults. Ten participants completed two trials wearing an RT3 accelerometer over a 4-6 h period and completed a detailed activity log. Results showed a poor correlation between the RT3 in moderate activities (r = 0.22) in comparison to low (r = 0.52) and hard (r = 0.70) from the logbook. A significant difference was found in average RT3 vector magnitude (VM) counts/min in each activity level (p < 0.0001). Discriminant analysis demonstrated that an RT3VM counts/min value of approximately 500 was found to have high sensitivity (88%), and specificity (88%) for discriminating between low and moderate activity levels from the logbook. This study found that accelerometry has the potential to discriminate activity levels in free living. This study is the first to investigate whether tri-axial accelerometry can discriminate different levels of free-living activity recorded in an activity logbook. The RT3 accelerometer can discriminate between low and moderate physical activities and offers a methodology that may be applicable to future research in occupational settings.

The effect of sandstorms and air pollution on cause-specific hospital admissions in Taipei, Taiwan

OBJECTIVE

Relatively little research exists focusing on the impact of air pollution on hospital admissions in Asia compared to the extensive work conducted in the USA and Europe. The issue is of particular importance because of the frequency, intensity and health effects of Asian sandstorms. This work investigates the relation between cause-specific hospital admissions and sandstorms and air pollution in Taipei, Taiwan's capital.

METHODS

Time-series analyses of asthma, pneumonia, ischaemic heart disease and cerebrovascular disease hospital admissions were performed for Taipei. An eight-year time period (1995-2002) was considered for various indicators of sandstorms and the pollutants NO(2), CO, ozone, SO(2), PM(10), and PM(2.5). Pollution effects based on single-day lags of 0, 1, 2 and 3 days were explored, along with the average of the same day and previous three days (L03).

RESULTS

The risk of ischaemic heart disease admissions was associated with several sandstorm metrics, including indicators of high PM(10) levels in the Taipei area, indicators of high PM(10) at a monitor designed to measure background pollution, the PM coarse fraction, and the ratio of PM(10) to PM(2.5). However, the lag structure of effect was not consistent across sandstorm indicators. Hospital admissions for this disease were 16-21% higher on sandstorm days compared to other days. This cause was also associated with transportation-related pollutants, NO(2), CO and PM(2.5). Asthma admissions rose 4.48% (95% CI 0.71% to 8.38%) per 28 mug/m(3) increase in L03 PM(10) levels and 7.60% (95% CI 2.87% to 12.54%) per 10 ppb increase in L03 ozone. Cerebrovascular disease admissions were associated with PM(10) and CO, both at lag 3 days. SO(2) exhibited no relation with admissions.

CONCLUSIONS

Risk of hospital admissions in Taipei may be increased by air pollution and sandstorms. Additional research is needed to clarify the lag structure and magnitude of such effects.

Reduction of Landscape Pathogens in Florida by Soil Solarization

Two experiments were conducted during autumn 1997 and 1998 in west-central Florida to evaluate the effectiveness of soil solarization alone and in combination with the biological control agents Streptomyces lydicus (Actinovate) and Pseudomonas chlororaphis (syn. P. aureofasciens, AtEze) and the reduced-risk fungicide fludioxonil (Medallion) in managing soilborne pathogens of impatiens (Impatiens × wallerana, 'Accent Burgundy'). Naturally infested soil was solarized for 47 or 48 days during September and October using two layers of 25-μm clear, low-density polyethylene mulch, separated by an air space of up to 7.5 cm. Solarization decreased the final incidence and progress of Rhizoctonia crown rot and blight, incidence of Pythium spp. in roots, and root discoloration, and increased shoot biomass in both experiments. The technique also consistently reduced root-knot severity and population densities of Meloidogyne incognita, Dolichodorus heterocephalus, Paratrichodorus minor, and Criconemella spp. The incidence of Rhizoctonia crown rot and blight was reduced by fludioxonil, but not by the biological control agents.

Skeletal muscle adaptations in response to voluntary wheel running in myosin heavy chain null mice

10.1152/ japplphysiol.00832.2001.-To examine the effects of gene inactivation on the plasticity of skeletal muscle, mice null for a specific myosin heavy chain (MHC) isoform were subjected to a voluntary wheel-running paradigm. Despite reduced running performance compared with nontransgenic C57BL/6 mice (NTG), both MHC IIb and MHC IId/x null animals exhibited increased muscle fiber size and muscle oxidative capacity with wheel running. In the MHC IIb null animals, there was no significant change in the percentage of muscle fibers expressing a particular MHC isoform with voluntary wheel running at any time point. In MHC IId/x null mice, wheel running produced a significant increase in the percentage of fibers expressing MHC IIa and MHC I and a significant decrease in the percentage of fibers expressing MHC IIb. Muscle pathology was not affected by wheel running for either MHC null strain. In summary, despite their phenotypes, MHC null mice do engage in voluntary wheel running. Although this wheel-running activity is lessened compared with NTG, there is evidence of distinct patterns of muscle adaptation in both null strains.

Modular fluorescence sensors for saccharides

Modular and modular polymer supported fluorescence photoinduced electron transfer (PET) sensors 2 and 3 with two boronic acid receptor units, a pyren-1-yl fluorophore, and hexamethylene linker show selective saccharide binding in aqueous methanolic solution at pH 8.21.

Reassessment of the lethal London fog of 1952: novel indicators of acute and chronic consequences of acute exposure to air pollution

This article develops and assesses novel indicators of respiratory and other morbidity and mortality following London's lethal smog in the winter of 1952. Public health insurance claims, hospital admission rates for cardiac and respiratory disease, pneumonia cases, mortality records, influenza reports, temperature, and air pollutant concentrations are analyzed for December-February 1952-1953 and compared with those for the previous year or years. Mortality rates for the smog episode from December 1952 to February 1953 were 50-300% higher than the previous year. Claims that the smog only elevated health risks during and immediately following the peak fog 5-9 December 1952 and that an influenza epidemic accounted fully for persisting mortality increases in the first 2 months of 1953 are rejected. We estimate about 12,000 excess deaths occurred from December 1952 through February 1953 because of acute and persisting effects of the 1952 London smog. Pollution levels during the London smog were 5-19 times above current regulatory standards and guidelines and approximate current levels in some rapidly developing regions. Ambient pollution in many regions poses serious risks to public health.

Cardiac and skeletal muscle adaptations to voluntary wheel running in the mouse

In this paper, we describe the effects of voluntary cage wheel exercise on mouse cardiac and skeletal muscle. Inbred male C57/Bl6 mice (age 6-8 wk; n = 12) [corrected] ran an average of 4.3 h/24 h, for an average distance of 6.8 km/24 h, and at an average speed of 26.4 m/min. A significant increase in the ratio of heart mass to body mass (mg/g) was evident after 2 wk of voluntary exercise, and cardiac atrial natriuretic factor and brain natriuretic peptide mRNA levels were significantly increased in the ventricles after 4 wk of voluntary exercise. A significant increase in the percentage of fibers expressing myosin heavy chain (MHC) IIa was observed in both the gastrocnemius and the tibialis anterior (TA) by 2 wk, and a significant decrease in the percentage of fibers expressing IIb MHC was evident in both muscles after 4 wk of voluntary exercise. The TA muscle showed a greater increase in the percentage of IIa MHC-expressing fibers than did the gastrocnemius muscle (40 and 20%, respectively, compared with 10% for nonexercised). Finally, the number of oxidative fibers as revealed by NADH-tetrazolium reductase histochemical staining was increased in the TA but not the gastrocnemius after 4 wk of voluntary exercise. All results are relative to age-matched mice housed without access to running wheels. Together these data demonstrate that voluntary exercise in mice results in cardiac and skeletal muscle adaptations consistent with endurance exercise.

Occasional physical inactivity combined with a high-fat diet may be important in the development and maintenance of obesity in human subjects

BACKGROUND

A better understanding of the environmental factors that contribute to obesity is imperative if any therapeutic effect on the increasing prevalence of overweight and obesity in the United States is to be achieved.

OBJECTIVE

This study examined the effect of the interaction of diet composition and physical inactivity on energy and fat balances.

DESIGN

Thirty-five normal-weight and obese subjects were randomly assigned to either a 15-d isoenergetic high-carbohydrate (HC) or high-fat (HF) diet according to a crossover design. During the first 14 d, body weight and physical activity were maintained. On day 15, subjects spent 23 h in a whole-room indirect calorimeter and were fed a diet similar to that consumed during the previous 7 d while remaining physically inactive.

RESULTS

Energy intakes required to maintain body weight stability during the first 14 d were similar between diets. Normal-weight and obese subjects consuming both diets had a positive energy balance on the sedentary day (day 15), suggesting that subjects were less active in the calorimeter. There was no significant effect of diet composition on total energy balance and total protein-energy balance on day 15; however, carbohydrate balance was more positive with the HC (2497.8 +/- 301.2 kJ) than with the HF (1159 +/- 301.2 kJ) diet (P = 0.0032). Most importantly, fat balance was more positive with the HF (1790.8 +/- 510.4 kJ) than with the HC (-62.8 +/- 510.4 kJ) diet (P = 0.0011).

CONCLUSION

Chronic consumption of a high-carbohydrate diet could provide some protection against body fat accumulation in persons with a pattern of physical activity that includes frequent sedentary days.

The effect of a probiotic milk product on plasma cholesterol: a meta-analysis of short-term intervention studies

INTRODUCTION

Certain fermented dairy milk products may have beneficial effects on plasma cholesterol levels. However, a number of studies have produced conflicting results as to whether dietary supplementation by a probiotic dairy product containing the bacteria culture Causido(R) reduces plasma cholesterol.

OBJECTIVE

To conduct a meta-analysis of intervention studies to evaluate the effect of the Causido(R) culture on plasma total cholesterol and low-density lipoprotein (LDL)-cholesterol. THE PROBIOTIC MILK PRODUCT: The yoghurt product Gaio(R) is fermented with Causido(R), composed of one strain of Enterococcus faecium (human species) with the proposed cholesterol-lowering effect, and two strains of Streptococcus thermophilus. STUDY INCLUSION AND DATA EXTRACTION: Six studies were identified from a literature search and from the yoghurt producer. All studies met the inclusion criteria. Summary data for plasma concentrations of total cholesterol and LDL-cholesterol were extracted from the original publications or by personal request to the authors. Data from 4-8 weeks of treatment duration was used.

STATISTICAL ANALYSIS

We performed a traditional meta-analysis where mean differences between intervention and control of the pre-post changes in total cholesterol and LDL-cholesterol were calculated, as well as 95% confidence intervals (CIs).

RESULTS

In the six studies included in the meta-analysis, the Gaio(R) interventions produced changes in total cholesterol above those of the control groups ranging from -0.02 to -1.02 mmol/l and in LDL-cholesterol ranging from -0.02 to -1.15 mmol/l. After inclusion of an open-label study, the meta-analysis of the double-blind studies showed that Gaio(R) as compared to the control group changed total cholesterol by -0.22 mmol/l (95% CI: -0.35 to -0.08, P<0.01) and LDL-cholesterol by -0.20 mmol/l (95% CI: -0.33 to -0.06, P<0.005). The outcome was essentially the same if all studies were included.

CONCLUSIONS

The present meta-analysis of controlled short-term intervention studies shows that the fermented yoghurt product produced a 4% decrease in total cholesterol and a 5% decrease in LDL-cholesterol when the open-label study is excluded. To demonstrate sustained effects on blood lipids, long-term studies are required.

SPONSORSHIP

MD Foods A/S, Denmark.

Comparison of greenhouse screening materials for excluding whitefly (Homoptera: Aleyrodidae) and thrips (Thysanoptera: Thripidae)

Twenty-eight greenhouse screening materials, with predetermined airflow resistance values, were evaluated for exclusion of the silverleaf whitefly Bemisia argentifolii Perring & Bellows and thrips from a mixed-species population. Screens differed in exclusion efficacy, expressed as a percentage of the fiberglass window screen control and at an approach velocity of 92 m/min, from -35 to 94% for silverleaf whitefly and from -13 to 95% for thrips. Seventeen screens excluded more silverleaf whitefly than did the window screen control, whereas only seven excluded more thrips. One material differentially excluded whitefly over thrips; many more differentially excluded thrips over whitefly. Airflow resistance, indicative of mesh hole size, did not necessarily correspond with degree of exclusion. Not all materials characterized as highly resistant to airflow provided significant exclusion. Exclusion of both types of pests was attained with several moderate- and one low-resistance screen. Another low-resistance screen excluded silverleaf whitefly only.

Postoperative pain management in the non-Hispanic white and Mexican American older adult

The purpose of this study was to assess use of pain relief measures and satisfaction with postoperative pain management among non-Hispanic white and Mexican American older adults after abdominal surgery. Findings revealed interpatient and intraethnic diversity, endorsing the importance of careful patient assessment and examining patient satisfaction for quality assurance/improvement.

Postoperative pain management for the cognitively impaired older adult

Communication difficulties associated with cognitive impairment pose a serious threat to effective pain management. The purpose of this study was to describe how pain behaviors and the use of pain relief measures differ between postoperative cognitively impaired and cognitively intact older adults. Findings showed that cognitively impaired patients may be at greatest risk for undertreatment of pain during the initial postoperative period.

Recognizing RNs' cognitive style preferences

Each individual possesses preferences that characterize a cognitive style. A study examines the predominate cognitive style preferences of staff registered nurses. A cognitive map may help managers understand how to assist staff nurses to adapt to changes in the work environment.

Attitudes toward menopause among Mexican American women

An exploratory study was conducted to determine Mexican American women's attitudes toward menopause and the relationships between these attitudes and socioeconomic status, level of acculturation, menopausal status, symptoms, self-esteem, and social support. The sample included 130 Mexican American women who ranged in age from 28 to 75 years. Attitudes did not differ by socioeconomic status, menopausal status, or number and severity of symptoms. More positive attitudes were reported by less acculturated women and women with higher self-esteem. Menopause was perceived as a potentially disturbing transition, and irritability and depressive mood were expected. Findings support the need for more accessible information to decrease uncertainty and avert negative expectations.

Realities of developing community health orientation programs

The realities of developing an orientation program include recognizing the critical influence of organizational culture and management priorities on the final form of plans and projects. The step from theory to practice is illustrated in the experience of three of the authors as they began to implement competency-based orientation programs. The common experiences of these three very different agencies were that programs are affected by organizational readiness, evolution to meet organizational needs, and the administrative context.

Monoclonal antibodies specific for prothrombin fragment 1.2 and their use in a quantitative enzyme-linked immunosorbent assay

Prothrombin fragment 1.2 (F1.2) is an activation peptide generated during a critical event of blood coagulation, the conversion of prothrombin to thrombin. As a marker of thrombin generation, F1.2 has clinical potential in assessing thrombotic risk and monitoring anticoagulant therapy. In developing a highly specific, monoclonal antibody-based immunoassay of human plasma F1.2, we generated six murine anti-F1.2 monoclonal antibodies, using as immunogen a synthetic peptide (sequence: CGSD-RAIEGR) similar to the unique carboxyl terminus of F1.2. Each antibody bound F1.2 but not prothrombin. Epitope mapping studies with one antibody (5-3B) showed that optimum binding required six to eight amino acids plus a terminal arginine to emulate the F1.2 carboxyl terminus. A quantitative sandwich ELISA for human plasma F1.2 was configured with monoclonal antibody 5-3B as the capture antibody and peroxidase-labeled polyclonal antibodies to the F1.2 amino-terminal region as detector antibodies. Calibrators were prepared by adding purified F1.2, 0-10 nmol/L, to F1.2-depleted plasma. Assay characteristics included the following: mean (+/- SD) analytical recovery of 98% +/- 13%; no interference from lipemia, hemolysis, icterus, or thrombolytic agents; 0.08 nmol/L sensitivity; and mean intra- and interassay imprecision (three lots) &lt; 12% at both low and high concentrations of F1.2.

Monoclonal antibodies specific for prothrombin fragment 1.2 and their use in a quantitative enzyme-linked immunosorbent assay

Prothrombin fragment 1.2 (F1.2) is an activation peptide generated during a critical event of blood coagulation, the conversion of prothrombin to thrombin. As a marker of thrombin generation, F1.2 has clinical potential in assessing thrombotic risk and monitoring anticoagulant therapy. In developing a highly specific, monoclonal antibody-based immunoassay of human plasma F1.2, we generated six murine anti-F1.2 monoclonal antibodies, using as immunogen a synthetic peptide (sequence: CGSD-RAIEGR) similar to the unique carboxyl terminus of F1.2. Each antibody bound F1.2 but not prothrombin. Epitope mapping studies with one antibody (5-3B) showed that optimum binding required six to eight amino acids plus a terminal arginine to emulate the F1.2 carboxyl terminus. A quantitative sandwich ELISA for human plasma F1.2 was configured with monoclonal antibody 5-3B as the capture antibody and peroxidase-labeled polyclonal antibodies to the F1.2 amino-terminal region as detector antibodies. Calibrators were prepared by adding purified F1.2, 0-10 nmol/L, to F1.2-depleted plasma. Assay characteristics included the following: mean (+/- SD) analytical recovery of 98% +/- 13%; no interference from lipemia, hemolysis, icterus, or thrombolytic agents; 0.08 nmol/L sensitivity; and mean intra- and interassay imprecision (three lots) < 12% at both low and high concentrations of F1.2.

A model skills list for orienting nurses to community health agencies

Nurse managers in community health can streamline the orientation of new employees by building planning and evaluation on a list of nursing skills that meet requirements for beginning practice. A model list of skills required in public health nursing and home health care can guide individual agencies in tailoring orientation programs to their respective needs, streamlining the process, reducing overall costs, and producing long-term benefits for nurse managers and nursing staff.

The Use of Cognitive Style Mapping as a Predictor for Academic Success of First-Semester Diploma Nursing Students

This study determined the relationship between the components of the cognitive map and the diploma nursing student's successful academic completion of the first semester. This ex post facto study applied the Modified Hill Cognitive Style Model (MHCSM) instrument; the final grade, the dependent variable, was intercorrelated with the instrument's 28 mapping elements. Data analysis indicated three positively correlated predictors: a preference for finding meaning from written words, for independent problem-solving, and for a logical deductive approach in decision-making. Four negatively correlated predictors included a preference for finding meaning from the spoken word, for finding meaning from sight, for problem-solving with peers, and for categorical reasoning. Implications applicable to nursing education are included.

Making the fit: orienting new employees to community health nursing agencies

Community health nurse managers require tested orientation methods to fit new employees into the rapidly changing conditions of professional practice, increase nursing productivity, and reduce turnover. The clinical competencies for community health nursing provide a workable framework for applying orientation principles to the special demands of community health nursing.

Sources and control of error in industrial hygiene measurements

Many sources of error exist in industrial hygiene measurements. Errors may be systematic or random. Eliminating or controlling systematic and random error during measurement, analysis, and data interpretation is a matter of aggressive quality control/quality assurance and appropriate statistical treatment of data. The occupational health care professional should be aware of error sources in industrial hygiene measurements and be on the lookout for flawed exposure estimates.

Learning a Complex Nursing Skill: Student Anxiety and the Effect of Preclinical Skill Evaluation

The purpose of this study was to identify the anxiety profile of undergraduate nursing students when learning a complex psychomotor skill, and to determine the effect of preclinical skill evaluation on student anxiety and performance when applying the skill in a patient situation. Findings support preclinical skill evaluation as an effective strategy for reducing anxiety related to initial transfer of skill learning from a laboratory to a clinical setting and enhancing self-confidence.

Clinical competencies for community health nursing

Cost-containment strategies initiated in the early 1980s caused a major shift in site of care delivery for persons needing nursing care. Where once the majority of clients were cared for in the acute-care setting until they were self-sufficient, now most are discharged to the home environment still requiring acute-care nursing interventions as well as community health nursing skills. This rapid shift in practice sites has placed severe strain on community health nursing agencies. Not only are more nurses required to fill the increased demand for services, but the demand comes at a time when we are experiencing a severe nursing shortage. This has forced many agencies to hire acute care nurses who have little or no community health nursing experience. These nurses come to community health nursing expecting to use the same set of skills and knowledge base used in their acute-care practice; however, the skill levels and concepts required for community health nursing are quite different from the acute care setting. Educational preparation has not kept pace with this shift in practice. Consequently, many nurses are not adequately prepared to enter community health nursing. Preparation must include theoretical and experiential components that focus on assessment skills (of the community and individual), decision making, case management, health systems management, teaching, and leadership. Collaborative efforts between community health organizations and educational institutions would seem to be one solution that would ensure adequately prepared nurses for community health nursing. The establishment and maintenance of strong staff-development programs within community health nursing agencies are also required.

Diagnostic efficacy of a new enzyme immunoassay for creatine kinase MB isoenzyme

A new commercial enzyme immunoassay kit for quantification of creatine kinase-MB (CK-MB) isoenzyme was compared with its electrophoretic determination with respect to efficacy in diagnosis of acute myocardial infarction. Enzygnost CK-MB (Behring Diagnostics) is a solid-phase "sandwich"-type enzyme immunoassay with antibodies to the B-subunit coated on plastic tubes and peroxidase-conjugated antibodies to the M-subunit added after incubation with sample. This kit is designed to measure only CK-MB and not CK-MM, CK-BB, adenylate kinase, or atypical CK molecules. The linear-regression equation comparing the two methods was: Enzygnost = 0.98 . electrophoresis - 0.72, with a correlation coefficient of r = 0.967 (n = 143). For 51 patients admitted for diagnosis of possible acute myocardial infarction, the Enzygnost kit achieved 100% sensitivity, specificity, and efficiency in predicting the correct diagnosis. Corresponding values for the electrophoretic assay were: 95.5% sensitivity, 93.1% specificity, and 94.1% efficiency. We conclude that this kit method provides an excellent alternative to electrophoresis.

Diagnostic efficacy of a new enzyme immunoassay for creatine kinase MB isoenzyme

A new commercial enzyme immunoassay kit for quantification of creatine kinase-MB (CK-MB) isoenzyme was compared with its electrophoretic determination with respect to efficacy in diagnosis of acute myocardial infarction. Enzygnost CK-MB (Behring Diagnostics) is a solid-phase "sandwich"-type enzyme immunoassay with antibodies to the B-subunit coated on plastic tubes and peroxidase-conjugated antibodies to the M-subunit added after incubation with sample. This kit is designed to measure only CK-MB and not CK-MM, CK-BB, adenylate kinase, or atypical CK molecules. The linear-regression equation comparing the two methods was: Enzygnost = 0.98 . electrophoresis - 0.72, with a correlation coefficient of r = 0.967 (n = 143). For 51 patients admitted for diagnosis of possible acute myocardial infarction, the Enzygnost kit achieved 100% sensitivity, specificity, and efficiency in predicting the correct diagnosis. Corresponding values for the electrophoretic assay were: 95.5% sensitivity, 93.1% specificity, and 94.1% efficiency. We conclude that this kit method provides an excellent alternative to electrophoresis.

Nonhelical, fibronectin-binding basement-membrane collagen from endodermal cell culture

A novel method of affinity chromatography on insolubilized collagen-binding fragments of fibronectin was utilized to isolate a random-coil collagenous protein from culture media of mouse teratocarcinoma-derived endodermal cells. These cells also produced another collagenous protein, which did not bind to fibronectin but could be isolated by differential salt precipitation. The affinity-purified collagen differs from its conventionally isolated counterpart in that it is not triple-helical in structure, its polypeptides are not disulfide-crosslinked and it has affinity for fibronectin in its native state. Both collagens resemble previously characterized type IV basement-membrane collagens with respect to their amino acid composition, cyanogen bromide peptides, chain size, immunological reactivity and tissue localization. The random-coil collagen is directly active in promoting the attachment of some lines of cells, but for attachment of the endodermal cells addition of fibronectin is required. This suggests that the presence of nonhelical, fibronectin-binding collagen may have biological significance in the interaction of cells with the extracellular matrix.

Role of scalp reduction in the treatment of male pattern baldness

Scalp reduction applies the principle of staged excision to the alopecic area in male pattern baldness. Two to rarely five excisions are performed as outpatient office procedures under local anesthesia. The reduction greatly enhances the results obtainable by supplementary hair transplantation and may reduce or eliminate the need for it. A personal series of 30 patients is presented. Technique and expected results are illustrated. Complications and limitations of the method are discussed. Wider consideration of scalp reduction in the treatment of patients seeking hair restoration is encouraged.