Educational pathways of childhood cancer survivors-a parental cohort

PURPOSE

Using the International Standard Classification of Education (ISCED), we examined the educational and vocational pathways of two comparable, parental cohorts: childhood cancer survivors (CCS) and their siblings. Both cohorts had previously entered parenthood. The aim of the study was to elucidate whether childhood cancer and treatment affect the educational pathways chosen by parents who are former patients.

METHODS

We analysed data that was collected from childhood cancer survivors and their siblings regarding their offspring's health within the FeCt Multicentre Offspring Study (conducted 2013-2016). We evaluated and compared the professional pathways of (i) all participating survivors and all participating siblings and those of (ii) survivors and their biological siblings.

RESULTS

Overall information on parental gender, age, and education were available from 1077 survivors and 246 siblings (group (i)). The majority of participants were female with a mean age of 35.2 (survivor) and 37.9 (sibling) years at time of survey. For subgroup (ii), analysis information was available on 191 survivors and 210 siblings. Fathers achieved university degrees significantly more often than mothers (p = 0.003 (i), p < 0.001 (ii)). The distribution of professional education was not significantly different between cancer survivors and siblings in either cohort (i) or (ii).

CONCLUSIONS

Regarding our research on the educational and vocational trajectory of CCS, patients can be reassured that family planning and vocational education are well compatible. Inequalities regarding gender-specific educational pathways remain to be addressed.

IMPLICATIONS FOR CANCER SURVIVORS

CCS should monitor their fertility status regularly and, if necessary, cryopreserve germ cells or tissue in order to optimize their family planning. Educational opportunities should be pursued as desired and with confidence. Local as well as European aftercare programs can assist with family planning and education.

Anatomic Biomarkers of Macular Edema Associated with Retinal Vein Occlusion

PURPOSE

To assess the relationship between best-corrected visual acuity (BCVA) and anatomic features in patients with macular edema (ME) related to retinal vein occlusion (RVO).

DESIGN

Post hoc analysis of 3 clinical trials, which included verified diagnoses, protocol refractions, and the assessment of OCT and fluorescein angiography (FA) images at a masked reading center.

PARTICIPANTS

Patients diagnosed with RVO-ME.

METHODS

Correlation analyses were performed to determine the correlation between BCVA and macular anatomy at baseline and at 12 and 24 weeks and between changes from baseline to 12 and 24 weeks.

MAIN OUTCOME MEASURES

The correlations between BCVA and central subfield thickness (CST), ellipsoid zone (EZ) integrity, intraretinal fluid (IRF), subretinal fluid, central leakage, and ischemia were assessed.

RESULTS

In a total of 828 eyes with RVO-ME, the mean age, BCVA, and CST at baseline was 64.7 years, 51.1 letters, and 656.9 μm, respectively. At baseline, a moderate negative correlation was observed between BCVA and CST (r = - 0.56, P < 0.001). At weeks 12 and 24, the mean BCVA of eyes with definitely abnormal (absent) EZ was statistically significantly worse than that of eyes with normal EZ. At week 12, a moderate negative correlation was observed between changes in BCVA and changes in CST (r = - 0.35, P < 0.001), with a similar degree of association noted at week 24 (r = - 0.35, P < 0.001). At weeks 12 and 24, eyes that showed any improvement in central IRF showed a greater improvement in BCVA than eyes that showed no improvement worsening (week 12: 463 eyes, 18.3 letters vs. 177 eyes, 13.0 letters, respectively, P < 0.001) and (week 24: 332 eyes, 20.2 letters vs. 131 eyes, 13.3 letters, respectively, P < 0.001). With respect to the correlation between baseline BCVA and fluorescein leakage or capillary nonperfusion, the Pearson correlation coefficients were - 0.41 (P < 0.001) and - 0.16 (P = 0.060), respectively.

CONCLUSIONS

In addition to CST, there are important clinically relevant relationships between BCVA and both OCT and FA anatomic features in patients with RVO-ME.

1107 Supplementing Orthopaedic Education outside of the Medical Curriculum: The Utility of a 1-Day Orthopaedic Revision Course for Medical Undergraduates

Introduction

Orthopaedic undergraduate education is both minimal and variable across UK medical schools. Furthermore, the clinical skills required to treat musculoskeletal injuries have been found inadequate by several studies assessing UK medical graduates.

Method

Orthopaedic revision courses organized by the student surgical society consisted of lectures and workshops covering clinical orthopaedic knowledge and skills required for university assessments. Five identical courses were run between December 2017 and December 2019 following the completion of fourth year’s musculoskeletal clinical block. Course tutors ranged from foundation year doctors (57%) to orthopaedic consultants and trainees (43%). An anonymous feedback form was handed out at each event and 5-point Likert scale questioning assessed participant perceptions prior to and following the course.

Results

This course led to a significant mean increase in students’ perceived knowledge levels with an average increase of 0.96 (19.2%) across all clinical examinations and lectures (p &lt; 0.01). Tutor grade did not affect mean participant self-reported value of station, with stations taught by consultants and surgical trainees showing similar results to stations taught by FY doctors (p = 0.776).

Conclusions

The feedback revealed significant increases in student self-reported knowledge levels while poor pre-course scores reported might suggest inadequate coverage of orthopaedics in the undergraduate curriculum. The similarity in results when assessing the quality of tutorship suggests that FY doctors can be equally as valuable teaching tools for such courses as surgical trainees and consultants. These results suggest 1-day orthopaedic revision courses of this format can be highly beneficial in supplementing the undergraduate curriculum.

Does caffeine enhance bowel recovery after elective colorectal resection? A prospective double-blinded randomized clinical trial

BACKGROUND

Postoperative ileus is a common condition following abdominal surgery. Previous studies have shown the positive effects of coffee on gastrointestinal motility. The aim of this study was to assess whether caffeine is the stimulatory agent in coffee that triggers bowel motility and thus may reduce the duration of postoperative ileus.

METHODS

This was a single-centered, prospective, randomized controlled, double-blinded clinical trial. Patients scheduled to undergo elective laparoscopic colectomy between November 2017 and March 2019 were randomly assigned to receive either oral caffeine (100 mg three times daily) or placebo following the procedure. Primary endpoints were time to first flatus and time to first bowel movement. Secondary endpoints were time to tolerate a solid, low-residue diet and length of hospital stay. Registration number: NCT03097900.

RESULTS

Seventy patients were included, [35 males, median age 56 years (range 19-79 years)]. After the exclusion of 12 patients, there were 30 patients in the caffeine group and 28 patients in the placebo group. The first passage of stool in the caffeine group occurred 18 h earlier than in the placebo group (p = 0.012); other endpoints did not reach statistical significance. No caffeine-related adverse events were observed.

CONCLUSION

Caffeine consumption following colectomy is safe, leads to a significantly shorter time to first bowel movement, and may thus potentially lead to a shorter postoperative hospital stay.

Causes of adult mortality in two populations of New Zealand sea lions (Phocarctos hookeri)

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Infectious disease, including tuberculosis, was the most common cause of death.

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Anthropogenic trauma caused 26% of deaths in mainland sea lions.

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Trauma inflicted by adult male conspecifics caused 24% of deaths.

The New Zealand sea lion is an endangered species endemic to New Zealand. While causes of death are well described for pups of this species, mortality in adults is poorly characterised. This study investigated causes of death in 136 New Zealand sea lions in two different populations: a major breeding site on remote, uninhabited Enderby Island in the sub-Antarctic, and a slowly increasing recolonising population on the inhabited mainland. For animals with at least a partial diagnostic investigation (n = 112), the most frequently diagnosed causes of mortality were infectious disease (41/112; 37%), particularly tuberculosis due to M. pinnipedii (20/112; 18%), and conspecific trauma (27/112; 24%). Anthropogenic trauma was an important cause of death in mainland sea lions (9/33; 26%). Deliberate anthropogenic mortality has previously been identified as the greatest potential threat to population recovery for mainland sea lions, and as human and pinniped populations increase, managing interactions between these species will become increasingly important.

Captive husbandry and veterinary care of seabirds during the MV Rena oil spill response

Abstract ContextSeabirds were the most common taxa captured alive as part of the oiled wildlife response to the grounding of the container vessel MV Rena in the Bay of Plenty, New Zealand. AimsTo describe the management of seabirds during the spill response, to outline the common problems encountered and to make recommendations for future responses. MethodsSeabirds were collected from 7 October 2011 to 14 January 2012. They were stabilised and underwent pretreatment, washing and rinsing procedures to remove oil, followed by swimming physiotherapy to restore waterproofing and long-term housing in outdoor aviaries. The birds were released in batches close to the original sites of capture once the wild habitat was cleaned. Key results428 live seabirds were admitted. There were two temporal peaks in admissions associated with the ship grounding and when the ship broke up. The majority of live birds were little penguins (Eudyptula minor; 394/428, 92%). Most seabirds admitted (393/428, 91.8%) were contaminated with heavy fuel oil, with the remainder (35/428, 8.2%) found unoiled but starving and/or exhausted or with injuries. Little penguins had lower mortality during rehabilitation (28/394, 7.1%) than other seabird species combined (27/34, 79.4%). Seabirds in poorer body condition on arrival had higher mortality, and unoiled birds were also more likely to die than oiled birds. In oiled little penguins, the degree of oiling on the plumage ranged from 1 to 100%, but mortality was not significantly associated with the degree of oiling (P=0.887). Pododermatitis affected 66% of little penguins. The most common causes of death (n=45) included weakness, anaemia and hypothermia in oiled seabirds (16/45, 35.6%), and starvation and weakness in unoiled seabirds (14/45, 31.1%). ConclusionsTotal survival to release was 87.1%, primarily influenced by the species involved and the body condition of the birds on arrival. Unoiled seabirds had higher mortality rates than oiled seabirds. ImplicationsOiled wildlife can be rehabilitated with good success, even when heavily oiled, or to a lesser extent, when found in poor body condition. More work is needed to refine species-specific rehabilitation protocols for seabirds, especially for those being admitted in emaciated body condition.

Frictional coefficient during flossing of teeth

OBJECTIVE

This in-vitro study aimed to develop a technique to measure the frictional forces and determine the frictional coefficient (μ) associated with the rubbing of dental floss against teeth. Incorrect flossing technique and the etiology of grooves at the cementoenamel junction (CEJ) of proximal area of teeth has long been a controversial topic. We hypothesized that the μ between teeth surfaces and dental floss is affected by contact angulation.

MATERIALS AND METHODS

Tests were conducted using two different types of dental floss (waxed and unwaxed nylon) on different surfaces (enamel, dentine, smooth and rough glass rods) under different moisture conditions (dry and wet). The μ generated by performing C-shape flossing was measured, using the Capstan equation, at constant load (100g) over different flossing contact sliding angulations. In addition, the surface characteristics of intact and used nylon flosses were compared using a scanning electron microscope (SEM).

RESULTS

The mean μ was highest with a smooth glass rod (0.42±0.11), followed by rough glass rods (0.30±0.07), dry enamel (0.27±0.08), wet enamel (0.23±0.06), then dentine (0.18±0.04). Moreover, higher μ was associated with waxed floss when used against dry enamel, smooth and rough glass rods (P<0.001). At different moisture conditions, waxed floss demonstrated greater μ with dry surfaces (P<0.03). No association was found between μ and dental floss contact angulation. Both floss types showed deterioration after usage; although waxed type exhibited markedly greater deterioration when used on dry surfaces. In conclusion, the magnitude of the μ was found to be influenced by surface roughness, moisture condition, and independent of the contact angulation area during sliding of dental floss.

SIGNIFICANCE

It is important to consider the potential side effects of frictional forces on both tooth surface and dental floss during clinical application.

The use of funnel plots with regression as a tool to visually compare HIV treatment outcomes between centres adjusting for patient characteristics and size: a UK Collaborative HIV Cohort study

Objectives

A measure used for assessing the effectiveness of HIV care and comparing clinical centres is the proportion of people starting antiretroviral therapy (ART) with viral suppression (VS) after 1 year. We propose a method that adjusts for patients’ demographic characteristics, and visually compares this measure between different sites accounting for centre size.

Methods

We analysed viral load measurements for UK Collaborative HIV Cohort (UK CHIC) patients starting ART between 2006 and 2013. We used logistic regression to estimate the proportion with VS after 1 year of ART adjusted for patient mix (in terms of age and a combined gender/ethnicity/acquisition mode variable) and calendar year. We compared outcomes between centres using funnel plots which account for centre size.

Results

The overall proportion of the cohort with VS 1 year after starting ART was 90% and increased from 83% to 93% between 2006 and 2013. VS was lower in younger individuals. White men who have sex with men (MSM) had the highest (94%), and black African (81%) and white (82%) heterosexual women the lowest proportions achieving VS. Comparing the unadjusted funnel plot with the adjusted, there were movements of some centres from outside to inside the 95% contour limits, which was largely explained by the patient mix of these centres.

Conclusions

VS 1 year after ART start was associated with demographic characteristics and centre size; therefore, to compare the performances of centres, adjustment for these factors is required. Adjusted funnel plot is an effective tool which accounts for both the demographic characteristics and the centre size. Social factors, rather than treatment decisions within the control of the centres, may drive differences in outcomes.

Self-amplified photo-induced gap quenching in a correlated electron material

Capturing the dynamic electronic band structure of a correlated material presents a powerful capability for uncovering the complex couplings between the electronic and structural degrees of freedom. When combined with ultrafast laser excitation, new phases of matter can result, since far-from-equilibrium excited states are instantaneously populated. Here, we elucidate a general relation between ultrafast non-equilibrium electron dynamics and the size of the characteristic energy gap in a correlated electron material. We show that carrier multiplication via impact ionization can be one of the most important processes in a gapped material, and that the speed of carrier multiplication critically depends on the size of the energy gap. In the case of the charge-density wave material 1T-TiSe₂, our data indicate that carrier multiplication and gap dynamics mutually amplify each other, which explains-on a microscopic level-the extremely fast response of this material to ultrafast optical excitation.

Ventral dermatitis in rowi (Apteryx rowi) due to cutaneous larval migrans

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Rowi on a crèche island showed loss of feathers and dermatitis.

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We identified cutaneous larval migrans, possibly due to Trichostrongylus.

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This is the first instance of cutaneous larval migrans to be recorded in birds.

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Fatal complications resulted in the death of eight birds from aspergillosis.

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Intensive conservation management can result in pathways for novel infections.

The rowi is a critically endangered species of kiwi. Young birds on a crèche island showed loss of feathers from the ventral abdomen and a scurfy dermatitis of the abdominal skin and vent margin. Histology of skin biopsies identified cutaneous larval migrans, which was shown by molecular sequencing to be possibly from a species of Trichostrongylus as a cause of ventral dermatitis and occasional ulcerative vent dermatitis. The predisposing factors that led to this disease are suspected to be the novel exposure of the rowi to parasites from seabirds or marine mammals due to the island crèche and the limited management of roost boxes. This is the first instance of cutaneous larval migrans to be recorded in birds. Severe and fatal complications of the investigation resulted in the death of eight birds of aspergillosis and pulmonary complications associated with the use of bark as a substrate in hospital. Another bird died of renal failure during the period of hospitalisation despite oral and intravenous fluid therapy. The initiating cause of the renal failure was not determined. These complications have the potential to undermine the working relationship between wildlife veterinarians and conservation managers. This case highlights that intensive conservation management can result in increased opportunities for novel routes of cross-species pathogen transmission.

Phospholipase D1 regulates autophagic flux and clearance of α-synuclein aggregates

Many neurodegenerative diseases, such as Alzheimer's disease and Parkinson's disease, are characterized by abnormal accumulations of aggregated proteins. Brains in these diseases also show accumulation of autophagic vesicles in the neuronal cytoplasm, suggesting impairment of the autophagic process. As autophagy involves de novo membrane production and vesicle fusion, extensive changes in lipid molecules are necessary. However, the involvement of signaling lipid-modifying enzymes in autophagy and their roles in neurodegenerative diseases are not clear. Using specific inhibitor, we show that loss of phospholipase D1 (PLD1) activity resulted in an accumulation of microtubule-associated protein light chain 3 (LC3), p62, and polyubiquitinated proteins, signs representing malfunction in autophagic flux. Fluorescence and electron microscopic analyses demonstrated impaired fusion of autophagosomes with lysosomes, resulting in accumulation of autophagosomes. Within the cells with impaired autophagic flux, α-synuclein aggregates accumulated in autophagosomes. Knockdown of PLD1 expression using small interfering RNA also resulted in impaired autophagic flux and accumulation of α-synuclein aggregates in autophagosomes. Neuronal toxicity caused by α-synuclein accumulation was rescued by overexpression of PLD1; however, expression of activity-deficient mutant, PLD1-KRM, showed reduced rescue effects. Finally, we demonstrated that both PLD activity and expression levels were reduced in brain tissues of dementia with Lewy bodies (DLB) patients, whereas the amounts of α-synuclein and p62 were increased in the same tissue samples. Collectively, these results suggest that insufficient PLD activity, and therefore, the changes in phospholipid compositions within membranes, might be an important contributor to impaired autophagic process and protein accumulation in Lewy body diseases.

Pro-inflammatory effects and oxidative stress in lung macrophages and epithelial cells induced by ambient particulate matter

The objective of this study was to compare the toxicological effects of different source-related ambient PM10 samples in regard to their chemical composition. In this context we investigated airborne PM from different sites in Aachen, Germany. For the toxicological investigation human alveolar epithelial cells (A549) and murine macrophages (RAW264.7) were exposed from 0 to 96 h to increasing PM concentrations (0-100 μg/ml) followed by analyses of cell viability, pro-inflammatory and oxidative stress responses. The chemical analysis of these particles indicated the presence of 21 elements, water-soluble ions and PAHs. The toxicological investigations of the PM10 samples demonstrated a concentration- and time-dependent decrease in cell viability and an increase in pro-inflammatory and oxidative stress markers.

Immunotherapy with FBTA05 (Bi20), a trifunctional bispecific anti-CD3 x anti-CD20 antibody and donor lymphocyte infusion (DLI) in relapsed or refractory B-cell lymphoma after allogeneic stem cell transplantation: study protocol of an investigator-driven, open-label, non-randomized, uncontrolled, dose-escalating Phase I/II-trial

Background

Patients with B cell malignancies refractory to allogeneic stem cell transplantation (SCT) can be treated by subsequent immunotherapy with donor lymphocyte infusions (DLI). But unlike myeloid leukemia, B cell leukemia and lymphoma are less sensitive to allogeneic adoptive immunotherapy. Moreover, the beneficial graft-versus-lymphoma (GVL) effect may be associated with moderate to severe graft-versus-host disease (GVHD). Thus, novel therapeutic approaches augmenting the anti-tumor efficacy of DLI and dissociating the GVL effect from GVHD are needed. The anti-CD20 x anti-CD3 trifunctional bispecific antibody (trAb) FBTA05 may improve the targeting of tumor cells by redirecting immune allogeneic effector cells while reducing the risk of undesirable reactivity against normal host cells. Hence, FBTA05 may maximize GVL effects by simultaneously decreasing the incidence and severity of GVHD.

Methods/Design

Based on this underlying treatment concept and on promising data taken from preclinical results and a small pilot study, an open-label, non-randomized, uncontrolled, dose-escalating phase I/II-study is conducted to evaluate safety and preliminary efficacy of the investigational antibody FBTA05 in combination with DLI for patients suffering from rituximab- and/or alemtuzumab-refractory, CD20-positive low- or high-grade lymphoma after allogeneic SCT. During the first trial phase with emphasis on dose escalation a maximum of 24 patients distributed into 4 cohorts will be enrolled. For the evaluation of preliminary efficacy data a maximum of 12 patients (6 patients with low-grade lymphoma and/or Chronic Lymphocytic Leukemia (CLL) / 6 patients with high-grade or aggressive lymphoma) will attend the second phase of this clinical trial.

Discussion

Promising data (e.g. induction of cellular immunity; GVL predominance over GVHD; achievement of partial or complete responses; prolongation of time-to-progression) obtained from this phase I/II trial would represent the first milestone in the clinical evaluation of a novel immunotherapeutic concept for treatment-resistant low- and high-grade lymphoma and NHL patients in relapse.

Trial registration

NCT01138579

"CITY 2020+": assessing climate change impacts for the city of Aachen related to demographic change and health – a progress report

Abstract. The research initiative CITY 2020+ assesses the risks and opportunities for residents in urban built environments under projected demographic and climate change for the year 2020 and beyond, using the city of Aachen as a case study. CITY 2020+ develops strategies, options and tools for planning and developing sustainable future city structures. The investigation focuses on how urban environment, political structure and residential behaviour can best be adapted, with attention to the interactions among structural, political, and sociological configurations and their impacts on human health. The interdisciplinary research is organized in three clusters. Within the first cluster, strategies of older people exposed to heat stress, and their networks as well as environmental health risks according to atmospheric conditions are examined. The second cluster addresses governance questions, urban planning and building technologies as well as spatial patterns of the urban heat island. The third cluster includes studies on air quality related to particulate matter and a historical perspective of city development concerning environmental issues and climate variability. However, it turns out that research topics that require an interdisciplinary approach are best addressed not by pre-structuring the work into related sub-projects but through combining them according to shared methodological approaches. Examples illustrating this rather practical approach within ongoing research are presented in this paper.

Is there a relationship between foetal position and both preferred lying posture after birth and pattern of subsequent postural deformity in non-ambulant people with cerebral palsy?

BACKGROUND

A pattern of postural deformity was observed in a previous study that included an association between direction of spinal curvature and direction of windsweeping with more windswept deformities occurring to the right and lateral spinal curvatures occurring convex to the left. The direction of this pattern was found to be associated with preferred lying posture in early life. The aim of this study was to test the association between foetal position and both the preferred lying posture after birth, and the direction of subsequent postural deformity in non-ambulant children with cerebral palsy (CP).

METHODS

A retrospective cohort study was carried out involving 60 participants at level five on the gross motor function classification for CP. Foetal position during the last month of pregnancy was taken from antenatal records and parents were interviewed to identify preferred lying posture in the first year of life. At the time of the physical assessment ages ranged from 1 year and 1 month to 19 years with a median age of 13 years and 1 month.

RESULTS

Foetal presentation was found to be associated with the preferred lying posture with participants carried in a left occipito-anterior/lateral position more likely to adopt a supine head right lying posture, and vice versa. An association was also observed between the foetal position and asymmetrical postural deformity occurring later in life with participants carried in a left occipito-anterior/lateral presentation more likely to have a convex left spinal curve, a lower left pelvic obliquity, and a windswept hip pattern to the right.

CONCLUSIONS

Clinicians should be aware of the association between foetal presentation, asymmetrical lying posture, and the direction of subsequent postural deformity for severely disabled children. A hypothesis is described that might help to explain these findings.

National Hand Hygiene Campaigns in Europe, 2000-2009

Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.

National hand hygiene campaigns in Europe, 2000-2009

Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.

Morphometric study of the human lumbar spine for operation-workspace specifications

STUDY DESIGN

The anatomy of the lumbar vertebrae of 55 patients was measured by use of data provided by computed tomography. On the basis of these measurements, the location of puncture points and the orientation of the surgical instruments for pedicle, vertebral body, and disc entry points were calculated for open as well as percutaneous surgery.

OBJECTIVE

Normal anatomic variations of the lumbar spine were investigated to define the workspace for several spinal procedures and to define the workspace of a robot designed to guide the physician during those procedures.

SUMMARY OF BACKGROUND

Several comprehensive studies of vertebrae dimensions have been conducted in the past, but they lack several dimensions that are needed to determine the exact location of the entry point and orientation of the tool, in particular when a computerized guidance system is used.

METHODS

Fifty-five spinal columns (L1-L5, total 250 vertebrae) were measured by computed tomography. These data provide geometric relations that determine entry points and tool orientations for different spinal interventions.

RESULTS

The workspace for spinal operations was defined on the basis of anatomic data taken from computed tomography scans. The data included 15 measurements for each vertebra that defined its shape. The processed data provided puncture points for several spinal procedures in both open and percutaneous surgery.

CONCLUSIONS

This study provides additional information on vertebral structure needed to calculate accurately the entry point and tool orientation in various spinal procedures. These statistical data are also valuable for model and implant designs and for workspace specifications for a robot-assisted surgery system.

Dynamic assays of inhibin B and oestradiol following buserelin acetate administration as predictors of ovarian response in IVF

The study was designed to examine whether dynamic measurements of inhibin B and oestradiol following single administration of buserelin acetate were correlated with the ovarian response to stimulation in IVF. A total of 37 patients undergoing IVF treatment was studied when the long protocol was started in the early follicular phase. Blood samples were taken twice: on day 2 of the menstrual cycle, before the first s.c. administration of buserelin acetate 0.5 mg and on day 3, 24 h later. Inhibin B and oestradiol concentrations were compared with the ovarian response to stimulation. The ovarian response was defined in two ways: 'number of oocytes/total recombinant (r) follicle stimulating hormone (FSH) dose'; and 'square-root (number of follicles/total rFSH dose)'. The following measurements were highly correlated with the ovarian response to stimulation: increase in oestradiol (day 3-day 2 oestradiol concentration) [correlation coefficient (r) = 0.68, P: < 0.0001] and sum of inhibin B (day 2 + day 3 inhibin B concentrations) (r = 0.6, P: < 0.0001). Age and basal concentrations of FSH and inhibin B were inferior to the above measurements in terms of correlation with the ovarian response. In conclusion, dynamic measurements of inhibin B and oestradiol following single administration of buserelin acetate were highly correlated with the ovarian response to stimulation for IVF treatment.

Current medicolegal and confidentiality issues in large, multicenter research programs

The convenience of fast computers and the Internet have encouraged large collaborative research efforts by allowing transfers of data from multiple sites to a single data repository; however, standards for managing data security are needed to protect the confidentiality of participants. Through Dartmouth Medical School, in 1996-1998, the authors conducted a medicolegal analysis of federal laws, state statutes, and institutional policies in eight states and three different types of health care settings, which are part of a breast cancer surveillance consortium contributing data electronically to a centralized data repository. They learned that a variety of state and federal laws are available to protect confidentiality of professional and lay research participants. The strongest protection available is the Federal Certificate of Confidentiality, which supersedes state statutory protection, has been tested in court, and extends protection from forced disclosure (in litigation) to health care providers as well as patients. This paper describes the careful planning necessary to ensure adequate legal protection and data security, which must include a comprehensive understanding of state and federal protections applicable to medical research. Researchers must also develop rules or guidelines to ensure appropriate collection, use, and sharing of data. Finally, systems for the storage of both paper and electronic records must be as secure as possible.

Renal amyloidosis as a first manifestation of Familial Mediterranean Fever

Amyloid nephropathy was the presenting symptom in a case of Familial Mediterranean Fever (FMF). As recent progress in molecular pathology permits the detection of asymptomatic FMF individuals, it is suggested that relevant cases of renal amyloidosis should be tested for FMF mutations.

LPN role advancement: from blueprints to ribbon cutting

The role of the Licensed Practical Nurse (LPN) in an acute care setting has been a point of debate for many years. Increasing LPN job responsibility has not been widely reported. In this article, the authors describe the process used to advance the LPN role. Emphasized here is the educators' contribution to the process from inception to implementation.

Improvement of intestinal peptide absorption by a synthetic bile acid derivative, cholylsarcosine

The potential of the nontoxic bile salt derivative, cholylsarcosine, to enhance the intestinal absorption of peptides was investigated in vitro and in situ. The permeation of the two model peptides octreotide and vasopressin-[arg(8)CT>/=CS, whereas ursodeoxycholic acid exhibited no absorption enhancement. Determination of the cytotoxic potential of the bile salts revealed the same rank order. In rats, octreotide and desmopressin were absorbed from the gastrointestinal-tract with moderate absorption efficiency. Coadministration of bile salts resulted in an increased absorption efficiency. The effect of CS was similar to that of CT. In conclusion, CS shows absorption enhancement properties and a relatively low cytotoxicity. It offers an alternative as absorption enhancer as compared to conventional bile acids which may have a potential cocarcinogenic risk.

Falls: a coordinated strategy

Falls are a common and serious health problem. Responses to the problem should address the individual, the individual's environment, the system of health or residential care used by the individual, and the local community. This article describes a response to the issue of falls in Ryde Hospital and its surrounding community. This response has multiple components which include patient and staff education and interventions with people who have fallen. These initiatives have been developed without additional resources and incorporated into existing systems of care provision.

Health outcomes as an organisation-wide quality initiative

Since the burgeoning of the 'health outcomes' movement there has been an ever-increasing body of literature on health outcomes policy debates, directions, frameworks and tools for implementing health outcome-directed initiatives. There is a significant gap in the literature, however, in regard to translating a comprehensive health outcomes policy into practice at a local level. This paper addresses that gap. It describes the local implementation of a comprehensive health outcomes approach which works across the continuum of care. It identifies those organisation-wide structures and processes that support successful progress, thereby providing a useful guide to other organisations wishing to institutionalise the health outcomes approach.

Suicidal ideation in Sudanese women

A literature review indicated that suicidal behavior in Sudan was very infrequent. However, an assessment of suicidal ideation in two Sudanese groups of women demonstrated high levels, particularly in women in a displaced-persons area. In addition, the recent establishment of a Befrienders International volunteer service allowed anecdotal evidence of substantial suicidal behavior to be collated. These findings highlight the need for further professional and volunteer assistance with continuing evaluation and research concerning programs for this vulnerable population.