Terahertz in vivo imaging of human skin: Toward detection of abnormal skin pathologies

Terahertz (THz) imaging has long held promise for skin cancer detection but has been hampered by the lack of practical technological implementation. In this article, we introduce a technique for discriminating several skin pathologies using a coherent THz confocal system based on a THz quantum cascade laser. High resolution in vivo THz images (with diffraction limited to the order of 100 μm) of several different lesion types were acquired and compared against one another using the amplitude and phase values. Our system successfully separated pathologies using a combination of phase and amplitude information and their respective surface textures. The large scan field (50 × 40 mm) of the system allows macroscopic visualization of several skin lesions in a single frame. Utilizing THz imaging for dermatological assessment of skin lesions offers substantial additional diagnostic value for clinicians. THz images contain information complementary to the information contained in the conventional digital images.

Safety of TCMCB07, a melanocortin-4 antagonist peptide, in dogs with naturally occurring cachexia

BACKGROUND

The melanocortin 4 antagonist TCMCB07 is safe and effective in reversing cachexia caused by sepsis or cancer in rodents. The safety and pharmacokinetics of TCMCB07 are demonstrated in healthy beagle dogs.

HYPOTHESIS/OBJECTIVES

The objectives of this study were to investigate the safety, peak plasma concentrations, and potential for efficacy of TCMCB07 in pet dogs with naturally occurring cachexia over a 4-week time period.

ANIMALS

Fourteen dogs with cachexia of any underlying cause, except cancer of the oral cavity or gastrointestinal tract, were eligible for enrollment with informed client consent.

METHODS

This study was a prospective, 1-armed open-label trial. Physical examination, complete blood count, chemistry panel, and owner-assessed quality of life surveys were checked at weeks 1, 2, and 4. Due to potential for bradycardia and hypotension, Holter monitoring and blood pressure evaluations were scheduled at pre-enrollment and week 4.

RESULTS

Fourteen dogs completed the trial. Significant changes detected included increased mean body weight (18.6-19.5 kg, P < .02), increased body condition score (median Tufts 5-point thin dog scale score P < .004 and WSAVA muscle condition score P < .02) and increased mean blood urea nitrogen (21.79-30.43 mg dL-1 , P < .004). On quality of life surveys, pet owners perceived their dog appeared to be panting less (P < .002) and that the general health improved (P < .03). Four dogs had a change in coat pigmentation. The peak plasma concentration of TCMCB07 in cachectic dogs was similar to that in healthy beagle dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

TCMCB07 was safe and has potential efficacy in pet dogs with cachexia.

'Odds Are: They Win': a disruptive messaging innovation for challenging harmful products and practices of the gambling industry

OBJECTIVE

This paper presents an evidence informed rationale for focussing on harmful gambling products and industry practices in public health messaging through the example of a recent innovation called 'Odds Are: They Win'.

METHODS

'Odds Are: They Win' was initially developed through coproduction involving public health professionals and people with lived experience of gambling harms and implemented across a city-region area. A review of relevant evidence was undertaken, upon which the research team reflected to draw out the implications of 'Odds Are: They Win' for gambling harms messaging.

RESULTS

Evidence is mounting that safer gambling campaigns framed in terms of individual responsibility are ineffective and can generate stigma. 'Odds Are: They Win' presents an alternative focus that is not anti-gambling but raises awareness of industry manipulation of the situational and structural context of gambling. This is in-keeping with historical lessons from the stop smoking field and emerging research in critical health literacy. The latter highlights the potential of education on the social and commercial determinants of health to stimulate behaviour change and collective action.

CONCLUSION

'Odds Are: They Win' is a potentially disruptive innovation for the gambling harms field. Research is required to robustly evaluate this intervention across diverse criteria, target audiences, and delivery settings.

Pedi-R-MAPP | the development, testing, validation, and refinement of a digital nutrition awareness tool

BACKGROUND & AIMS

The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments and provide practical guidance for nutritional care. R-MAPP was adapted into Pediatric Remote Malnutrition Application (Pedi-R-MAPP) using a modified Delphi consensus, with the goal of providing a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. The aim of this study was to develop and validate a digital version of Pedi-R-MAPP using the IDEAS framework (Integrate, Design, Assess and Share).

METHODS

A ten-step process was completed using the IDEAS framework. This involved the four concept processes; Stage-1, Integrate (Step 1-3) identify the problem, specify the goal, and use an evidence-based approach. Stage-2, (Step 4-7) design iteratively and rapidly with user feedback. Stage 3, (Step 8-9) Assess rigorously, and Stage 4 (Step 9-10) publish and launch of the tool.

RESULTS

Stage 1:Evidence-based development, Pedi-R-MAPP was developed using Delphi consensus methodology. Stage 2:Iteration & design, HCPs (n = 22) from UK, Europe, South Africa, and North America were involved four workshops to further develop a paper prototype of the tool and complete small-scale testing of a beta version of the tool which resulted in eight iterations. Stage 3:Assess rigorously, Small scale retrospective testing of the tool on children with congenital heart disease (n = 80) was completed by a single researcher, with iterative changes made to improve agreement with summary advice. Large scale testing amongst (n = 745) children in different settings was completed by specialist paediatric dietitians (n = 15) advice who recorded agreement with the summary advice compared with their own clinical assessment. Paediatric dietitians were in overall agreement with the summary advice in the tool 86% (n = 640), compared to their own clinical practice. The main reasons for disagreement were i) frequency of planned review 57.1% (n = 60/105), ii) need for ongoing dietetic review due to chronic condition 20.0% (n = 21/105), iii) disagreement with recommendation for discharge 16.2% (n = 17/105) and iv) concerns with faltering growth and/or need for condition specific growth charts 6.7% (7/105). Iterative changes were made to the algorithm, leading to an improvement in agreement of the summary advice on re-evaluation to 98% (p=<0.0001).

CONCLUSION

A digital version of the Pedi-R-MAPP nutrition awareness tool was developed using the IDEAS framework. The summary advice provided by the tool achieved a high level of agreement when compared to paediatric dietetic assessment, by providing a structured approach to completing a remote nutrition focused assessment, along with identifying the frequency of follow-up or an in-person assessment.

The MARS PETCARE BIOBANK protocol: establishing a longitudinal study of health and disease in dogs and cats

BACKGROUND

The veterinary care of cats and dogs is increasingly embracing innovations first applied to human health, including an increased emphasis on preventative care and precision medicine. Large scale human population biobanks have advanced research in these areas; however, few have been established in veterinary medicine. The MARS PETCARE BIOBANK™ (MPB) is a prospective study that aims to build a longitudinal bank of biological samples, with paired medical and lifestyle data, from 20,000 initially healthy cats and dogs (10,000 / species), recruited through veterinary hospitals over a ten-year period. Here, we describe the MPB protocol and discuss its potential as a platform to increase understanding of why and how diseases develop and how to advance personalised veterinary healthcare.

METHODS

At regular intervals, extensive diet, health and lifestyle information, electronic medical records, clinicopathology and activity data are collected, genotypes, whole genome sequences and faecal metagenomes analysed, and blood, plasma, serum, and faecal samples stored for future research.

DISCUSSION

Proposed areas for research include the early detection and progression of age-related disease, risk factors for common conditions, the influence of the microbiome on health and disease and, through genome wide association studies, the identification of candidate loci for disease associated genetic variants. Genomic data will be open access and research proposals for access to data and samples will be considered. Over the coming years, the MPB will provide the longitudinal data and systematically collected biological samples required to generate important insights into companion animal health, identifying biomarkers of disease, supporting earlier identification of risk, and enabling individually tailored interventions to manage disease.

Utility of the combined use of 3 serologic markers in the diagnosis and monitoring of chronic enteropathies in dogs

BACKGROUND

Dogs with chronic enteropathies (CE) displayed elevated IgA seropositivity against specific markers that can be used to develop a novel test.

OBJECTIVE

To assess a multivariate test to aid diagnosis of CE in dogs and to monitor treatment-related responses.

ANIMALS

One hundred fifty-seven dogs with CE/inflammatory bowel disease (IBD), 24 dogs non-IBD gastrointestinal disorders, and 33 normal dogs.

METHODS

Prospective, multicenter, clinical study that enrolled dogs with gastrointestinal disorders. Serum sample collected at enrollment and up to 3 months follow-up measuring OmpC (ACA), canine calprotectin (ACNA), and gliadin-derived peptides (AGA) by ELISA.

RESULTS

Seropositivity was higher in CE/IBD than normal dogs (66% vs 9% for ACA; 55% vs 15% for ACNA; and 75% vs 6% for AGA; P < .001). When comparing CE/IBD with non-IBD disease, ACA and ACNA displayed discriminating properties (66%, 55% vs 12.5%, 29% respectively) while AGA separated CE from normal cohorts (54% vs 6%). A 3-marker algorithm at cutoff of ACA > 15, ACNA > 6, AGA > 60 differentiates CE/IBD and normal dogs with 90% sensitivity and 96% specificity; and CE/IBD and non-IBD dogs with 80% sensitivity and 86% specificity. Titers decreased after treatment (47%-99% in ACA, 13%-88% in ACNA, and 30%-85% in AGA), changes that were concurrent with clinical improvements.

CONCLUSION AND CLINICAL IMPORTANCE

An assay based on combined measurements of ACA, ACNA, and AGA is useful as a noninvasive diagnostic test to distinguish dogs with CE/IBD. The test also has the potential to monitor response to treatment.

Lyophilized platelets versus cryopreserved platelets for management of bleeding in thrombocytopenic dogs: A multicenter randomized clinical trial

Background

Thrombocytopenia in dogs is common in critical care medicine, but availability of fresh platelet concentrates in veterinary medicine can be limiting. Lyophilized platelets have long shelf‐lives and can be easily transported, stored, and administered in various settings.

Objective

To evaluate the efficacy and safety of a novel trehalose‐stabilized canine lyophilized platelet product in thrombocytopenic dogs with clinically‐evident bleeding.

Animals

Eighty‐eight dogs with platelet counts <50 × 10³/μL and a standardized bleeding assessment tool (DOGiBAT) score ≥2.

Methods

Multicenter, randomized, non‐blinded, non‐inferiority clinical trial comparing dimethyl sulfoxide (DMSO)‐stabilized cryopreserved platelet concentrates (CPP) with trehalose‐stabilized lyophilized platelets (LP) for control of bleeding in thrombocytopenic dogs. Dogs were randomized to receive 3 × 10⁹ platelets/kg of LP or CPP. Primary outcome measures were change in DOGiBAT score, platelet count, need for additional red cell transfusion and all‐cause mortality.

Results

Fifty dogs received LP and 38 received CPP. Baseline demographics and clinical characteristics of both groups were comparable. At 1‐hour post‐transfusion, LP were superior for change in DOGiBAT score, and non‐inferior at 24‐hours post‐transfusion. The LP were non‐inferior to CPP for change in platelet count, need for additional red blood cell units, and survival to discharge. The LP were superior for change in hematocrit at 1‐hour post‐transfusion, and non‐inferior at 24‐hours. No adverse effects were noted in either group.

Conclusions and Clinical Importance

A novel trehalose‐stabilized canine LP product appears to be logistically superior and is clinically non‐inferior to DMSO‐stabilized canine CPP for management of bleeding in thrombocytopenic dogs.

Tuberculosis and diabetes mellitus: a dose-response relationship between the odds of tuberculosis and HbA1c

SETTING: The main hospital tuberculosis (TB) clinic in South Tarawa, the capital of the Republic of Kiribati, a Pacific nation located in the central Pacific Ocean.OBJECTIVE: To determine if higher levels of HbA1c were associated with greater odds of TB.DESIGN: A case-control study to assess the association between TB and diabetes (DM). We recruited 275 TB cases and 498 controls (persons without signs and symptoms of TB), aged 18 years and above. A standardised questionnaire was administered and HbA1c was measured in all participants.RESULTS: The median HbA1c among cases was 6.0%; among controls it was 5.6% (P < 0.001). Comparing cases to controls, the odds ratio for TB was 2.8 (95%CI 2.0-4.1). Adjusted odds ratios for TB associated with HbA1c groupings of 5.7-6.4%, 6.5-8.5% and >8.5% were 1.5, 2.7 and 4.3, respectively (P ≦ 0.001 for trend).CONCLUSIONS: The median HbA1c was higher among TB patients than controls. As the HbA1c rose so did the odds of TB. This demonstrates the importance of targeted TB screening of people with DM in TB-endemic settings. Optimal glycaemic control is also crucial as this reduces DM-related end organ damage and may also reduce TB risk.

Parents' and healthcare professionals' experiences of care after stillbirth in low- and middle-income countries: a systematic review and meta-summary

BACKGROUND

Stillbirth has a profound impact on women, families, and healthcare workers. The burden is highest in low- and middle-income countries (LMICs). There is need for respectful and supportive care for women, partners, and families after bereavement.

OBJECTIVE

To perform a qualitative meta-summary of parents' and healthcare professionals' experiences of care after stillbirth in LMICs.

SEARCH STRATEGY

Search terms were formulated by identifying all synonyms, thesaurus terms, and variations for stillbirth. Databases searched were AMED, EMBASE, MEDLINE, PsychINFO, BNI, CINAHL.

SELECTION CRITERIA

Qualitative, quantitative, and mixed method studies that addressed parents' or healthcare professionals' experience of care after stillbirth in LMICs.

DATA COLLECTION AND ANALYSIS

Studies were screened, and data extracted in duplicate. Data were analysed using the Sandelowski meta-summary technique that calculates frequency and intensity effect sizes (FES/IES).

MAIN RESULTS

In all, 118 full texts were screened, and 34 studies from 17 countries were included. FES range was 15-68%. Most studies had IES 1.5-4.5. Women experience a broad range of manifestations of grief following stillbirth, which may not be recognised by healthcare workers or in their communities. Lack of recognition exacerbates negative experiences of stigmatisation, blame, devaluation, and loss of social status. Adequately developed health systems, with trained and supported staff, are best equipped to provide the support and information that women want after stillbirth.

CONCLUSIONS

Basic interventions could have an immediate impact on the experiences of women and their families after stillbirth. Examples include public education to reduce stigma, promoting the respectful maternity care agenda, and investigating stillbirth appropriately.

TWEETABLE ABSTRACT

Reducing stigma, promoting respectful care and investigating stillbirth have a positive impact after stillbirth for women and families in LMICs.

Age and dose-limited PET-CT scan regime in lymphoma: between the devil and the deep blue sea?

In this study the authors speculate about hypothetical effective-dose (E) reduction through limiting post-chemotherapy PET-CT scanning to lymphoma sites previously identified on pre-treatment CT. E reductions/scan time savings are compared between post-treatment standard and theoretically limited PET-CT scans. The influence of patient age with E savings and associated clinical implication for 100 subjects are discussed. The greatest E theoretical savings of 52 and 32% for the CT contribution and combined PET-CT, respectively, were seen in patients <18 y old using limited scans in this study, with a potential mean time saving of 16 min per patient across the entire cohort. However, the limited PET-CT regime here missed a 1% rate of unexpected cancer that standard PET-CT recorded. The authors recommend performing larger scale multi-centre studies comparing PET-CT pre- and post-chemotherapy to establish full clinical efficacy of this method.

WE-E-211-01: Medical Physics in Federal and State Governments

In 2010, FDA's Center for Devices and Radiological Health (CDRH) launched an "Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging" and held a public meeting on "Device Improvements to Reduce Unnecessary Radiation Exposure from Medical Imaging" March 30- 31, 2010). In follow-up, FDA is pursuing efforts using its regulatory authority as it applies to imaging equipment and manufacturers and also partnering with professional organizations such as AAPM, industry and other governmental agencies to incorporate radiation protection principles into facility quality assurance, personnel credentialing, and training requirements.The current U.S. Federal guidance on medical x-rays was published in 1976 and addresses film imaging for radiographie and dental modalities. The Medical Workgroup of the Interagency Steering Committee on Radiation Standards (ISCORS) has modernized that document to address both diagnostic and interventional approaches, film and digital imaging, and the broad range of modalities that include radiography, computed tomography, interventional fluoroscopy, dentistry, bone densitometry, and veterinary practice. The current scope and status of the document will be presented.The Military Health System is committed to providing state-of- the-art care to its beneficiaries; both at home and abroad. Personnel constraints and the continuing wars oversees have created obstacles to this objective. In the past decade, tremendous advances have occurred in Electronic Health Records (EHR) and Teleradiology. Military Radiology seeks to leverage these advances as a means of surmounting many of the challenges it faces. In this talk, the current status of DoD teleradiology and EHR will be presented.

LEARNING OBJECTIVES

1. To provide a venue in which physicists working in the public sector can interface and discuss specific issues related to supporting the federal and state governments 2. To provide a venue for medical physicists to voice specific concerns with federal/state programs where medical physics should be involved in and/or more effective. 3. To educate audience on federal or state new or updated guidelines.

Demonstration of ignition radiation temperatures in indirect-drive inertial confinement fusion hohlraums

We demonstrate the hohlraum radiation temperature and symmetry required for ignition-scale inertial confinement fusion capsule implosions. Cryogenic gas-filled hohlraums with 2.2 mm-diameter capsules are heated with unprecedented laser energies of 1.2 MJ delivered by 192 ultraviolet laser beams on the National Ignition Facility. Laser backscatter measurements show that these hohlraums absorb 87% to 91% of the incident laser power resulting in peak radiation temperatures of T(RAD)=300 eV and a symmetric implosion to a 100 μm diameter hot core.

Prognostic utility of spontaneous erythroid colony formation and JAK2 mutational analysis for thrombotic events in essential thrombocythaemia

BACKGROUND

Thrombotic events in essential thrombocythaemia (ET) are difficult to predict with current risk stratification based on age and prior history of thrombosis.

AIMS

We aimed to assess the predictive value of the JAK2 V617F mutation (JAK2) and spontaneous erythroid colony (SEC) growth for the development of thrombotic events post diagnosis in patients with ET.

METHODS

Consecutive patients with ET were retrospectively identified, and clinical and laboratory correlates were evaluated. Thrombotic events were categorized according to their occurrence at or prior to diagnosis (prior thrombosis), and any time post diagnosis of ET (subsequent thrombosis). JAK2 analysis was performed by allele-specific PCR on whole blood or bone marrow.

RESULTS

A total of 62 patients was identified, median age 63 years; 67% (41/61) JAK2-positive and 47% (25/53) SEC-positive. Median follow-up was 33 months (range, 1 to 137). JAK2-positive patients showed a trend to increased prior thrombosis (27% vs 5%, P= 0.08), and a significant increase in the development of subsequent thrombosis (5-year event rate 31% vs 6%, P= 0.04), which persisted when stratified for a history of prior thrombosis (P= 0.04). Survival was not affected by JAK2 status. The SEC assay predicted an increased rate of baseline thrombosis (16% vs 0%, P= 0.04), but was not found to be predictive of any subsequent thrombotic events.

CONCLUSIONS

Patients with ET who are JAK2-positive by whole blood allele-specific PCR appear to be at increased risk of thrombotic complications, which is independent of a prior history of thrombosis.

Rapid dissection of a complex phenotype through genomic-scale mapping of fitness altering genes

The understanding and engineering of complex phenotypes is a critical issue in biotechnology. Conventional approaches for engineering such phenotypes are often resource intensive, marginally effective, and unable to generate the level of biological understanding desired. Here, we report a new approach for rapidly dissecting a complex phenotype that is based upon the combination of genome-scale growth phenotype data, precisely targeted growth selections, and informatic strategies for abstracting and summarizing data onto coherent biological processes. We measured at high resolution (125 NT) and for the entire genome the effect of increased gene copy number on overall biological fitness corresponding to the expression of a complex phenotype (tolerance to 3-hydroxypropionic acid (3-HP) in Escherichia coli). Genetic level fitness data were then mapped according to various definitions of gene-gene interaction in order to generate network-level fitness data. When metabolic pathways were used to define interactions, we observed that genes within the chorismate and threonine super-pathways were disproportionately enriched throughout selections for 3-HP tolerance. Biochemical and genetic studies demonstrated that alleviation of inhibition of either of these super-pathways was sufficient to mitigate 3-HP toxicity. These data enabled the design of combinatorial modifications that almost completely offset 3-HP toxicity in minimal medium resulting in a 20 g/L and 25-fold increase in tolerance and specific growth, respectively.

A stop codon mutation in SCN9A causes lack of pain sensation

The general lack of pain experience is a rare occurrence in humans, and the molecular causes for this phenotype are not well understood. Here we have studied a Canadian family from Newfoundland with members who exhibit a congenital inability to experience pain. We have mapped the locus to a 13.7 Mb region on chromosome 2q (2q24.3-2q31.1). Screening of candidate genes in this region identified a protein-truncating mutation in SCN9A, which encodes for the voltage-gated sodium channel Na(v)1.7. The mutation is a C-A transversion at nucleotide 984 transforming the codon for tyrosine 328 to a stop codon. The predicted product lacks all pore-forming regions of Na(v)1.7. Indeed, expression of this altered gene in a cell line did not produce functional responses, nor did it cause compensatory effects on endogenous voltage-gated sodium currents when expressed in ND7/23 cells. Because a homozygous knockout of Na(v)1.7 in mice has been shown to be lethal, we explored why a deficiency of Na(v)1.7 is non-lethal in humans. Expression studies in monkey, human, mouse and rat tissue indicated species-differences in the Na(v)1.7 expression profile. Whereas in rodents the channel was strongly expressed in hypothalamic nuclei, only weak mRNA levels were detected in this area in primates. Furthermore, primate pituitary and adrenal glands were devoid of signal, whereas these two glands were mRNA-positive in rodents. This species difference may explain the non-lethality of the observed mutation in humans. Our data further establish Na(v)1.7 as a critical element of peripheral nociception in humans.

Serious carbamazepine-induced hypersensitivity reactions associated with the HSP70 gene cluster

OBJECTIVES

The use of carbamazepine (CBZ), the most commonly prescribed antiepileptic drug, is hampered by the occurrence of severe, potentially lethal hypersensitivity reactions. The pathogenesis of hypersensitivity is not yet known, but immune mechanisms are involved. Predisposition to CBZ hypersensitivity is likely to be genetically determined, and genes within the major histocompatibility complex (MHC) have been implicated. The heat shock protein (HSP70) gene cluster is located in the MHC class III region.

METHODS

Using a case-control study design, we compared 61 patients with CBZ hypersensitivity (22 with a severe reaction) to 44 patients on CBZ with no signs of hypersensitivity and 172 healthy controls. The genotyping strategy involved identification of common and rare single nucleotide polymorphisms (SNPs) within the HSP70 gene cluster by sequencing, estimation of linkage disequilibrium (LD) and haplotype structure, and thereafter, analysis of SNP/haplotype frequencies in the cases and controls. Population substructure was evaluated by genotyping of 34 microsatellites.

RESULTS

Twenty-five SNPs were detected across the three HSP70 genes. Analyses revealed that alleles G, T and C at the SNPs HSPA1A +1911 C/G, HSPA1A +438 C/T and HSPA1L +2437 T/C, respectively, were associated with protection from serious hypersensitivity reactions to CBZ, with the associated alleles falling on a common haplotype. We were unable to detect the presence of population stratification in our patients and controls.

CONCLUSIONS

Our data show that HSP70 gene variants are associated with serious CBZ hypersensitivity reactions, but whether this is causal or reflects LD with another gene within the MHC requires further study.

Detection of submicron-sized raft-like domains in membranes by small-angle neutron scattering

Using coarse grained models of heterogeneous vesicles we demonstrate the potential for small-angle neutron scattering (SANS) to detect and distinguish between two different categories of lateral segregation: 1) unilamellar vesicles (ULV) containing a single domain and 2) the formation of several small domains or "clusters" (approximately 10 nm in radius) on a ULV. Exploiting the unique sensitivity of neutron scattering to differences between hydrogen and deuterium, we show that the liquid ordered (lo) DPPC-rich phase can be selectively labeled using chain deuterated dipalymitoyl phosphatidylcholine (dDPPC), which greatly facilitates the use of SANS to detect membrane domains. SANS experiments are then performed in order to detect and characterize, on nanometer length scales, lateral heterogeneities, or so-called "rafts", in approximately 30 nm radius low polydispersity ULV made up of ternary mixtures of phospholipids and cholesterol. For 1:1:1 DOPC:DPPC:cholesterol (DDC) ULV we find evidence for the formation of lateral heterogeneities on cooling below 30 degrees C. These heterogeneities do not appear when DOPC is replaced by SOPC. Fits to the experimental data using coarse grained models show that, at room temperature, DDC ULV each exhibit approximately 30 domains with average radii of approximately 10 nm.

Whole-genome scan, in a complex disease, using 11,245 single-nucleotide polymorphisms: comparison with microsatellites

Despite the theoretical evidence of the utility of single-nucleotide polymorphisms (SNPs) for linkage analysis, no whole-genome scans of a complex disease have yet been published to directly compare SNPs with microsatellites. Here, we describe a whole-genome screen of 157 families with multiple cases of rheumatoid arthritis (RA), performed using 11,245 genomewide SNPs. The results were compared with those from a 10-cM microsatellite scan in the same cohort. The SNP analysis detected HLA*DRB1, the major RA susceptibility locus (P=.00004), with a linkage interval of 31 cM, compared with a 50-cM linkage interval detected by the microsatellite scan. In addition, four loci were detected at a nominal significance level (P<.05) in the SNP linkage analysis; these were not observed in the microsatellite scan. We demonstrate that variation in information content was the main factor contributing to observed differences in the two scans, with the SNPs providing significantly higher information content than the microsatellites. Reducing the number of SNPs in the marker set to 3,300 (1-cM spacing) caused several loci to drop below nominal significance levels, suggesting that decreases in information content can have significant effects on linkage results. In contrast, differences in maps employed in the analysis, the low detectable rate of genotyping error, and the presence of moderate linkage disequilibrium between markers did not significantly affect the results. We have demonstrated the utility of a dense SNP map for performing linkage analysis in a late-age-at-onset disease, where DNA from parents is not always available. The high SNP density allows loci to be defined more precisely and provides a partial scaffold for association studies, substantially reducing the resource requirement for gene-mapping studies.

Oral daily ibandronate prevents bone loss in early postmenopausal women without osteoporosis

Oral daily ibandronate was investigated for the prevention of bone loss in postmenopausal women without osteoporosis (n = 653). BMD at the lumbar spine and hip were significantly increased (3.1% and 1.8%, respectively; p < or = 0.0001 versus placebo) with 2.5 mg ibandronate after 24 months. Oral ibandronate is a promising option for the prevention of postmenopausal bone loss.

INTRODUCTION

Further strategies to manage patients most at risk from developing postmenopausal osteoporosis are required. The objectives of this multicenter, double-blind, randomized, placebo-controlled study were to examine the efficacy, tolerability, and optimal dose of oral daily ibandronate in the prevention of bone loss in postmenopausal women.

MATERIALS AND METHODS

In total, 653 women (mean bone mineral density [BMD] T-score > -2.5 at the lumbar spine), who had been postmenopausal for at least 1 year, were allocated to one of four strata based on time since menopause and baseline lumbar spine BMD. Women were randomized to receive calcium (500 mg daily) plus either placebo (n = 162) or ibandronate 0.5 mg (n = 162), 1 mg (n = 166), or 2.5 mg (n = 163) as once-daily oral treatment for 2 years. The primary endpoint was the mean percent change in lumbar spine BMD with ibandronate versus placebo.

RESULTS AND CONCLUSIONS

After 2 years, oral daily ibandronate produced a dose-related and sustained maintenance or increase in BMD at the lumbar spine and hip (total hip, femoral neck, trochanter), together with a dose-related reduction in the rate of bone turnover. The greatest nominal increases in spinal and hip BMD were observed with the 2.5-mg dose, which produced statistically significant BMD gains compared with placebo at 6 months and all subsequent time-points at the spine and hip (3.1% and 1.8% increase in lumbar spine and total hip BMD, respectively, versus placebo; p < or = 0.0001 after 24 months). Oral daily ibandronate was well tolerated with an incidence of upper gastrointestinal adverse events similar to placebo. No safety concerns were identified. In summary, oral daily ibandronate 2.5 mg decreases bone turnover, preserves or increases BMD in the spine and proximal femur, and is well tolerated. Oral ibandronate provides a promising option for the prevention of bone loss in postmenopausal women.

Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations

BACKGROUND

Influenza causes lower respiratory tract complications (LRTCs), particularly bronchitis and pneumonia, in both otherwise healthy adults and those with underlying conditions. The aim of this study was to assess the effect of oseltamivir treatment on the incidence of LRTCs leading to antibiotic treatment and hospitalizations following influenza illness.

METHODS

We analyzed prospectively collected data on LRTCs and antibiotic use from 3564 subjects (age range, 13-97 years) with influenzalike illness enrolled in 10 placebo-controlled, double-blind trials of oseltamivir treatment.

RESULTS

In adults and adolescents with a proven influenza illness, oseltamivir treatment reduced overall antibiotic use for any reason by 26.7% (14.0% vs 19.1% with placebo; P<.001) and the incidence of influenza-related LRTCs resulting in antibiotic therapy by 55% (4.6% vs 10.3% with placebo; P<.001). In those subjects considered at increased risk of complications, 74 (18.5%) of 401 placebo recipients developed an LRTC leading to antibiotic use compared with 45 (12.2%) of 368 oseltamivir recipients (34.0% reduction; P =.02). Hospitalization for any cause occurred in 18 (1.7%) of 1063 placebo recipients compared with 9 (0.7%) of 1350 oseltamivir-treated patients (59% reduction; P =.02). In contrast, among subjects with an influenzalike illness but without a confirmed influenza infection, the incidence of LRTCs (6.7% vs 5.3%), overall antibiotic use (19.7% vs 19.3%), or hospitalizations (1.7% vs 1.9%) was similar between placebo and oseltamivir recipients, respectively.

CONCLUSION

Oseltamivir treatment of influenza illness reduces LRTCs, antibiotic use, and hospitalization in both healthy and "at-risk" adults.

Development and consumer validation of the Functional Evaluation in a Wheelchair (FEW) instrument

PURPOSE

The purpose of the study is to develop an outcome measurement tool to investigate functional performance of consumers using seating and wheelchair systems as their primary seating and mobility device. The instrument is undergoing systematic development in three phases. The results of Phase 1 will be reported.

METHOD

Manual and power wheelchair users were interviewed using a modified version of a client-centred outcome measure. An item bank was derived based on the interview data. Subjects were then asked to validate item categories of the new instrument, and finally to self-administer the first version of the instrument.

RESULTS

Subjects reported 154 self-care, productivity, and leisure occupational performance issues related to their current seating-mobility system. Based on their input, 10 categories (i.e. transfers, reach, accessing task surfaces, transportation-portability, human-machine interface, architectural barriers, transportation-accessibility, transportation-securement, natural barriers and accessories) were validated for inclusion in the new outcome measure, Functional Evaluation in a Wheelchair (FEW).

CONCLUSION

The items on the FEW focus on the interaction between the consumer, the technology, and the milieu. Consumers viewed the overall importance of FEW categories for seating-mobility system users differently than when they self-administered the FEW.

Frequency and relationship of reported symptomology in victims of intimate partner violence: the effect of multiple strangulation attacks

The objective of this study is to examine the correlation between the number of times a victim of intimate partner violence (IPV) has been strangled and symptom development subsequent to the attacks. One hundred and one female subjects responded to a series of questions regarding the history and characteristics of the strangulation and the development of specific medical symptoms. Multiple strangulation victims, individuals who had experienced more than one strangulation attack, on separate occasions, by the same abuser, reported neck and throat injuries, neurologic disorders, and psychological disorders with increased frequency. Despite the increased frequency of symptoms, only 39% of the multiple strangulation victims sought medical care. These observations strongly support the need for health care professionals to inquire about the incidence of strangulation, examine the victim closely for evidence of injuries caused by the attacks, and recommend immediate care in anticipation of the potentially long term medical needs.

Frequency and relationship of reported symptomology in victims of intimate partner violence: the effect of multiple strangulation attacks

The objective of this study is to examine the correlation between the number of times a victim of intimate partner violence (IPV) has been strangled and symptom development subsequent to the attacks. One hundred and one female subjects responded to a series of questions regarding the history and characteristics of the strangulation and the development of specific medical symptoms. Multiple strangulation victims, individuals who had experienced more than one strangulation attack, on separate occasions, by the same abuser, reported neck and throat injuries, neurologic disorders, and psychological disorders with increased frequency. Despite the increased frequency of symptoms, only 39% of the multiple strangulation victims sought medical care. These observations strongly support the need for health care professionals to inquire about the incidence of strangulation, examine the victim closely for evidence of injuries caused by the attacks, and recommend immediate care in anticipation of the potentially long term medical needs.

Comets and the formation of biochemical compounds on the primitive Earth--a review

Thirty years ago it was suggested that comets impacting on the primitive Earth may have represented a significant source of terrestrial volatiles, including some important precursors for prebiotic synthesis (Oró, 1961, Nature 190: 389). This possibility is strongly supported not only by models of the collisional history of the early Earth, but also by astronomical evidence that suggests that frequent collisions of comet-like bodies from the circumstellar disk around the star beta Pictoris are taking place. Although a significant fraction of the complex organic compounds that appear to be present in cometary nuclei were probably destroyed during impact, it is argued that cometary collisions with the primitive Earth represented an important source of both free-energy and volatiles, and may have created transient, gaseous environments in which prebiotic synthesis may have taken place.

Wireless endoscopy

BACKGROUND

Miniaturization of electronic components may allow the construction of new types of endoscopes that no longer require external wires, cables, or optical fibers. Our aim was to assess the feasibility of wireless endoscopy and to construct experimental prototypes using miniature charge-coupled device cameras, light sources, microwave transmitters, and batteries.

METHODS

Feasibility, dimensions of miniature components, and power requirements were assessed. Prototypes were constructed and tested using cameras, transmitters, and halogen lamps powered by small batteries; 10.6 and 0.187 GHz transmitters were used to transmit the video signal.

RESULTS

Moving television images were transmitted through models, post-mortem and live porcine stomachs, to the external receiver. Transmission of images through the abdomen was tested by placing the device in a microwave-impermeable box behind a volunteer's back and the receiver in front of his abdomen. In other experiments the endoscope was used inside the human mouth. The device was placed surgically in the stomachs of 150 kg pigs in vivo and good-quality color television image reception was achieved.

CONCLUSIONS

These experiments demonstrate the feasibility of constructing a new type of endoscope that can transmit moving color television images from the GI tract without requiring fiberoptic or electrical cables.

Risk assessment and suicide prevention in primary care

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.

Risk assessment and suicide prevention in primary care

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.

Effects of castration and testosterone replacement on veno-occlusion during penile erection in the rat

AIM

To determine if androgens directly regulate veno-occlusion or if androgens act indirectly to maintain the penile structures which control outflow.

METHODS

Using CASTRATE and TESTO rats, measurement was made of mean arterial pressure (MAP), intracavernosal pressure (CCP), and intracavernosal flow (CCF) during erection resulting from stimulation of the autonomic innervation of the penis. CCP and CCF were also measured during saline infusion into the cavernosal sinuses before and after treatment with sodium nitroprusside (SNP, a nitric oxide donor drug) to fully relax cavernosal smooth muscle. Penile tissue was also collected to measure the content of alpha actin and proline and hydroxyproline to determine if brief withdrawal of androgenic support led to changes in the number of smooth muscle cells or the collagen content of the tissue.

RESULTS

Infusion of saline into the cavernosal sinuses demonstrated that veno-occlusion was defective in CASTRATE rats while veno-occlusion was fully functional in TESTO animals. Furthermore, veno-occlusion could be induced in CASTRATE rats if they were first treated with SNP. This observation suggests that failure of veno-occlusion in the CASTRATE rats is due to a deficiency in the production of NO resulting in a reduction in the degree of relaxation of the penile smooth muscle. The measurements of smooth muscle a actin and proline and hydroxyproline content of collagen showed that both were unaffected by castration and that the basic structure of the penis did not degenerate after one week without androgenic support.

CONCLUSION

These results can be interpreted to mean that androgens control the veno-occlusive mechanism indirectly via a NO dependent mechanism and not by maintaining the structures of the penis which are essential to veno-occlusion.

Intravenous saline has no effect on blood ethanol clearance

For patients presenting to emergency departments with ethanol intoxication, intravenous (i.v.) fluids are initiated for varied reasons. This investigation determined the effect of i.v. fluid therapy on the rate of blood ethanol clearance in such patients. Volunteers received a predetermined dose of ethanol on two separate occasions. On the second occasion, volunteers rapidly received a liter of i.v. saline directly following ethanol ingestion. At intervals on both occasions, blood ethanol levels were estimated using a breath analyzer. Using linear regression analysis, no difference was found in rates of alcohol clearance with or without i.v. fluid intervention. The common rate of clearance between both groups was 15 mg/dL/h (95% CI 12 to 18). We conclude that i.v. fluid therapy does not accelerate ethanol clearance in intoxicated patients. While such therapy may be justified for other reasons, practitioners are cautioned against initiating fluids in such patients solely to expedite ethanol elimination.

Use of the NOSIE to predict assaults among acute psychiatric patients. Nurses' Observational Scale for Inpatient Evaluation

OBJECTIVE

The study evaluated the Nurses' Observational Scale for Inpatient Evaluation (NOSIE), the Brief Psychiatric Rating Scale (BPRS), the Mini Mental State Examination (MMSE), and other measures as predictors of assaults that occurred during psychiatric hospitalization.

METHODS

On admission, the MMSE was administered to 335 acutely ill psychiatric patients, and diagnostic and demographic data were recorded. Immediately after admission, patients were rated by nurses using the NOSIE and by psychologists using the BPRS. Patients who committed assaults during hospitalization (N = 47) and those who did not were compared, and relationships between several variables and assaults were evaluated by t tests, Mann-Whitney U tests, chi square tests, and analyses of variance.

RESULTS

A high score on the irritability factor of the NOSIE and failure to complete the MMSE correctly predicted the occurrence or nonoccurrence of assault 81 percent of the time. None of the other variables examined were significantly related to assaults, including total scores on the BPRS and MMSE, psychiatric diagnosis, and several demographic variables.

CONCLUSIONS

Scores on a test of distress level shortly after admission and failure to complete the MMSE on admission can help the clinician predict who will later engage in an assault.

Topical lidocaine adrenaline tetracaine (LAT gel) versus injectable buffered lidocaine for local anesthesia in laceration repair

The objective of the study was to compare topical lidocaine adrenaline tetracaine (LAT gel) with injectable buffered lidocaine with epinephrine regarding pain of application or injection and anesthesia effectiveness. The study was a randomized prospective comparison trial in an urban emergency department. Physicians and patients ranked the pain of application, injection, and suturing according to a 10-cm visual analog scale. Sixty-six patients were entered, 33 in the LAT gel group and 33 in the injectable buffered lidocaine group. Injection was found to be significantly more painful than application of gel (P < 0.001). For anesthesia effectiveness, there was no difference according to patients (P = 0.48) or physicians (P = 0.83) for topical vs injectable forms. The number of sutures causing pain was not statistically different in the two groups (P = 0.28). In conclusion, LAT gel compared favorably with injectable buffered lidocaine for local anesthesia effectiveness and was significantly less painful to apply. It may be the preferred local anesthetic for this reason.

Domestic violence in an inner-city ED

STUDY OBJECTIVE

To determine the prevalence of domestic violence (DV) for male and female ED patients and to determine the demographics of DV.

METHODS

The study design was a descriptive written survey of adults. We used the Index of Spouse Abuse (ISA), a previously validated survey tool. The study was set in an inner-city ED with approximately 75,000 patients annually, most of them indigent. Patients 18 years or older who were able to give consent were included. Patients were excluded if they had a language barrier, were a prisoner, or had never had a partner. All patients presenting during 31 randomly selected 4-hour shifts during July 1995 were considered for the study. DV was defined as either physical or nonphysical on the basis of ISA scoring. The prevalence was determined for present (in the preceding year) and past (more than 1 year ago) abuse. Four violence parameters were calculated for patients who had a partner at the time of presentation: present physical, present nonphysical, past physical, and past nonphysical. Only the "past" parameters were calculated for patients who had had a partner in the past but had no partner at the time of presentation. We used the chi2 test to determine individually significant predictors of the four parameters. Logistic-regression models were constructed to determine the significant predictors of DV. Associations among the present physical, present nonphysical, past physical, and past nonphysical abuse categories were determined with McNemar's test.

RESULTS

We enrolled 516 patients, 233 men and 283 women. On the basis of ISA scoring, 14% of men and 22% of women had experienced past nonphysical violence (P=.02, men versus women), and 28% of men and 33% of women had experienced past physical violence (P=.35). Of the 157 men and 207 women with partners at the time of presentation, 11% of men and 15% of women reported present nonphysical violence (P=.20), and 20% men and 19% of women reported present physical violence (P=.71). Using logistic-regression models, we determined that women experienced significantly more past and present nonphysical violence but not physical violence than men. For all four parameters, the victim's suicidal ideation and alcohol use were independently associated with DV. The victim's family history was strongly associated with past abuse. Using McNemar's test, we found that physical and nonphysical abuse were correlated in the past and present.

CONCLUSION

Using a validated scale, we found that the prevalences of physical DV for men and women are high and that they are not statistically different in this population. Using chi 2 testing, we found that women had experienced significantly more past nonphysical violence than men; using logistic regression we found that they experienced significantly more nonphysical violence (both past and present) than men. DV was frequently associated with suicidal ideation, alcohol use, and family history of violence.

Construction of a transcription map around the gene for ataxia telangiectasia: identification of at least four novel genes

We have constructed YAC, PAC, and cosmid contigs in the ataxia-telangiectasia gene region and used the assembled clones to isolate expressed sequences by exon trapping and hybridization selection. In the interval between D11S1819 and D11S2029, exons and cDNAs for potentially 13 different genes were identified. Three of these genes, F37, K28, and 6.82, are large novel genes expressed in a variety of different tissues. K28 shows sequence homology to the Rab GTP binding protein family and gene 6.82 homology to the rabbit vasopressin activated calcium mobilizing receptor, while gene F37 has no homology to any known sequence in the database. Three further clones, exon 6.41 and cDNAs K22 and E74, from the interval between D11S1819 and D11S2029, appear to be expressed endogenous retrovirus sequences. The fourth large novel genes, E14, together with two further possible novel genes, E13 and E3, was identified from exons and cDNAs in the more telomeric 300-kb interval between markers D11S2029 and D11S2179. These are in addition to the genes for mitochondrial acetoacetyl-CoA-acetyltransferase (ACAT) and the ATM gene in the same region. Genes E3, E13, and E14 do not show homology to any known genes. K28, 6.82, ACAT, and ATM all appear to have the same transcriptional orientation toward the telomere.