Falling short of a culture of health: Planning alcohol-permitted events at a U.S. university

The Healthy Campus movement in the United States aims to infuse health promotion into higher education operations. We examined the extent to which event planners employ a culture-of-health approach related to alcohol consumption when planning alcohol-permitted events in a large, public university in California. We interviewed 31 event planners to assess their strategies for ensuring health and safety at the events and accommodating people in recovery from substance use disorders. We focused on events that involved faculty, staff, and graduate students. Event planners were most concerned about avoiding legal liabilities at the events, were less concerned about promoting responsible drinking among drinkers, and often failed to consider the needs of non-drinkers at the events. Their actions were informed by problematic beliefs about alcohol (e.g., people need alcohol to relax), drinkers (e.g., only undergraduate students engage in risky consumption), and people in recovery (e.g., they lack self-control). Planners over-relied on informal control to shape attendees' behavior, failing to acknowledge how contextual factors can shape individual behavior. Planners need to be educated about how to shape the event context to promote healthy behaviors, avoid exclusively focusing on preventing unhealthy behaviors and informal control, and promote better inclusion of people who don't drink.

Key messages

There is fertile ground for infusing a culture of health into events in higher education. Event planners need expanded perspectives that consider context, inclusivity, and health promotion.

Stakeholder evaluations of risk interventions for non-potable recycled water schemes: A case study

Non-potable recycled water schemes can benefit sustainable urban water management through reducing demand for drinking water and mitigating environmental loadings through the provision of advanced wastewater treatment. However, scheme feasibility can be diminished by high capital and operating costs which can be elevated by perceptions of health risks and subsequently overly cautious risk reduction measures. Conversely, a failure to anticipate the risk management expectations of stakeholders can undermine scheme feasibility through insufficient demand for recycled water. The aim of this study was to explore how stakeholders' perceptions and preferences for risk management and recycled water end-uses might influence scheme design. Using a case study scheme in London, four risk management intervention scenarios and six alternative end uses were evaluated using a stochastic PROMETHEE-based method that incorporated quantitative microbial risk assessment and stakeholder criteria weights together with an attitudinal survey of stakeholders' risk perceptions. Through pair-wise criteria judgements, results showed that stakeholders prioritised health risk reductions which led to the more conservative management intervention of adding water treatment processes being ranked the highest. In contrast, responses to the attitudinal survey indicated that the stakeholders favoured maintaining the case study's existing levels of risk control but with more stakeholder engagement. The findings highlighted potential benefits of understanding risk perceptions associated with different design options and contrasting these with multi-criteria model results. Extrapolating from these findings, future research could explore potential challenges and benefits of providing flexibility in scheme designs to appeal to a wider range of stakeholder needs as well as being more adaptable to future social, environmental or economic challenges. The study concludes that contemporary risk management guidance would benefit from more explicitly outlining constructive ways to engage stakeholders in scheme evaluation.

Informing public attitudes to non-potable water reuse - The impact of message framing

Water reuse is of increasing relevance for water-stressed regions but is often considered a contentious option. Research has shown that providing the public with information about reuse options can impact positively on its acceptability, although such impacts can be confined to specific groups. In this context, there is growing interest in understanding the impact of different forms and mechanisms of communication with the public around reuse. This contribution has investigated the use of video animations to communicate the safety of non-potable recycled water schemes. The aim of this study was to evaluate how different ways of framing messages about the safety of recycled water might impact on public attitudes. Participants were recruited in London (n = 689), UK, and randomly allocated to test and control groups, with the former being exposed to one of four video animations that used different frames to convey messages about recycled water safety. Surveys collected pre- and post-video message responses for dependent variables including the general acceptance of diverse non-potable recycled water uses, risk perceptions and trust. The findings complement existing knowledge on the impacts of different types of messaging on public attitudes to reuse schemes with important evidence for the positive impact of water safety communications framed in terms of compliance with water quality requirements. Contrarily, a positive attitudinal impact was not evident for safety message framed in terms of the selection of water treatment technology to remove contaminants nor in terms of non-potable water risks relative to other every-day risks. The results are of value to water resource planners looking to develop communication resources, as part of more comprehensive public engagement strategies, for improving perceptions of water reuse. Importantly, the findings help isolate the effects of specific message frames, and inform the debate on whether an increased understanding of risk positively or negatively influences willingness to support water reuse schemes.

Exploring the potential duty of care in clinical genomics under UK law

Genome-wide sequencing technologies are beginning to be used in projects that have both clinical diagnostic and research components. The clinical application of this technology, which generates a huge amount of information of varying diagnostic certainty, involves addressing a number of challenges to establish appropriate standards. In this article, we explore the way that UK law may respond to three of these key challenges and could establish new legal duties in relation to feedback of findings that are unrelated to the presenting condition (secondary, additional or incidental findings); duties towards genetic relatives as well as the patient and duties on the part of researchers and professionals who do not have direct contact with patients. When considering these issues, the courts will take account of European and international comparisons, developing guidance and relevant ethical, social and policy factors. The UK courts will also be strongly influenced by precedent set in case law.

Histopathological assessment of intrinsic laryngeal musculature in horses with dynamic laryngeal collapse

REASONS FOR PERFORMING STUDY

The pathogenesis of bilateral dynamic laryngeal collapse associated with poll flexion (DLC) of horses is unknown but might be associated with intrinsic laryngeal muscle weakness.

OBJECTIVES

To investigate histopathological characteristics of the cricoarytenoideus dorsalis, the cricothyroid (CT) and the cricoarytenoideus lateralis muscles in DLC-affected horses and compare these with unaffected controls. Our hypotheses were that evidence of neurogenic atrophy of the CT or cricoarytenoideus dorsalis muscles would be found in DLC-affected horses and that observed changes would be symmetrically (left/right) distributed, or that muscle fibre diameter would be significantly reduced in DLC-affected horses compared to unaffected controls, reflecting an underlying paresis.

STUDY DESIGN

Case-control study.

METHODS

Five DLC horses and 8 controls were included. Muscle samples were harvested immediately following euthanasia. Fibre type proportions and size were evaluated by multiple immunofluorescence labelling of cryosections, and compared between sides (left/right) and groups (DLC-affected cases/ unaffected controls). Subjective and objective assessments of fibre type grouping were compared between sides and groups.

RESULTS

Fibre type proportions, fibre size and the subjective assessment of fibre type grouping did not reveal any statistically significant differences between the groups. Objective assessment of fibre type grouping revealed significantly more large clusters of T1 fibres within the left cricoarytenoideus lateralis muscle of DLC-affected cases versus controls, and within the right CT muscle of control horses compared to the DLC-cases.

CONCLUSIONS

The absence of bilateral symmetric fibre type grouping, fibre type loss and fibre atrophy in the DLC-affected cases do not support a neuromuscular component within the pathogenesis of DLC. The objective assessment of fibre type grouping revealed some statistical differences between the DLC-affected cases and the unaffected controls; however, these findings were inconsistent with regard to DLC. An alternative aetiology of DLC seems likely.

Peptides as therapeutics with enhanced bioactivity

The development of techniques for efficient peptide production renewed interest in peptides as therapeutics. Numerous modifications for improving stability, transport and affinity profiles now exist. Several new adjuvant and carrier systems have also been developed, enhancing the immunogenicity of peptides thus allowing their development as vaccines. This review describes the established and experimental approaches for manufacturing peptide drugs and highlights the techniques currently used for improving their drug like properties.

Interprofessional handover and patient safety in anaesthesia: observational study of handovers in the recovery room

BACKGROUND

We aimed to describe how anaesthetists hand over information and professional responsibility to nurses in the operating theatre recovery room.

METHODS

We carried out non-participant practice observation and in-depth interviews with practitioners working in the recovery room of an English hospital and used qualitative methods to analyse the resulting transcripts.

RESULTS

We observed 45 handovers taking place between 17 anaesthetists and 15 nurses in the recovery room of the operating theatre suite. These took place in an environment that is event-driven, time-pressured, and prone to concurrent distractions. Anaesthetists and nurses often had differing expectations of the content and timing of information transfer. The point at which transfer of responsibility for the patient occurred during the handover process was variable and depended not only on the condition of the patient but also on the professional relationship between the nurse and doctor concerned. Handover also provided an 'audit point' in care where the patient's intraoperative progress was reviewed and plans were made for further management. Here, as in the transfer of responsibility, we found evidence that nurses play a greater role in defining the limits of anaesthetists' practice than might be expected.

CONCLUSIONS

Patient handovers in the recovery room are largely informal, but nevertheless show many inherent tensions, both professional and organizational. Although formalized handover procedures are often advocated for the promotion of safety, we suggest that they are likely to work best when the informal elements, and the cultural factors underlying them, are acknowledged.

Responses of horses offered a choice between stables containing single or multiple forages

To investigate the choices of foraging location of horses, 10 to 12 horses were introduced for five minutes into each of two similar stables containing a single forage or six forages, in four replicated trials. The horses were then removed and released into the gangway between the stables, and allowed five minutes to choose between the stables. Their initial and final choices, mean duration in each stable and proportional frequency of change of location were compared. Most of the horses initially entered the closest stable on release (P<0.05); if the closest stable contained a single hay, most horses transferred to the stable containing multiple forages (P<0.001). The length of time spent by the horses in the two stables suggested that they preferred multiple forages in multiple locations (P<0.001). Eleven horses moved from one stable to the other on one or more occasions during trials when hay or a preferred forage was available in both stables, possibly indicating a motivation to move between foraging locations regardless of the palatability of the forages offered or the horses' preference for a forage.

What defines expertise in regional anaesthesia? An observational analysis of practice †

BACKGROUND

Published work on knowledge in regional anaesthesia has focused on competence, for instance by identifying numbers of procedures required to achieve competence, or by defining criteria for successful performance of blocks. We aimed to define expertise in regional anaesthesia and examine how it is acquired.

METHODS

We observed anaesthetists performing 15 regional anaesthetic blocks and analysed the resulting transcripts qualitatively and in detail.

RESULTS

Expertise in regional anaesthesia encompasses technical fluency but also includes non-cognitive skills such as handling of the patient (communicating, anticipating and minimizing discomfort) and recognizing the limits of safe practice (particularly deciding when to stop trying to insert a block). Such elements may be underplayed by the experts who possess them. Focusing on a small number of regional anaesthetic procedures in detail (as is standard with such qualitative analytical approaches) has also allowed us to develop a model for the acquisition of expertise. In this model, trainees learn how to balance theoretical and practical knowledge by reflection on their clinical experiences, an iterative process which leads to the embedding of knowledge in the expert's personal repertoire of individual techniques.

CONCLUSIONS

Expertise in regional anaesthesia extends beyond competence at technical performance; non-cognitive elements are also vital. Further work is needed to test our learning model, and the hypothesis that learning can be enhanced by deliberate promotion of the tacit elements of 'expertise' we have described.

Adverse events in anaesthetic practice: qualitative study of definition, discussion and reporting

BACKGROUND

This study aimed to explore how critical and acceptable practice are defined in anaesthesia and how this influences the discussion and reporting of adverse incidents. Method. We conducted workplace observations of, and interviews with, anaesthetists and anaesthetic staff. Transcripts were analysed qualitatively for recurrent themes and quantitatively for adverse events in anaesthetic process witnessed. We also observed departmental audit meetings and analysed meeting minutes and report forms.

RESULTS

The educational value of discussing events was well-recognized; 28 events were discussed at departmental meetings, of which 5 (18%) were presented as 'critical incidents'. However, only one incident was reported formally. Our observations of anaesthetic practice revealed 103 minor events during the course of over 50 anaesthetic procedures, but none were acknowledged as offering the potential to improve safety, although some were direct violations of 'acceptable' practice. Formal reporting appears to be constrained by changing boundaries of what might be considered 'critical', by concerns of loss of control over formally reported incidents and by the perception that reporting schemes outside anaesthesia have purposes other than education.

CONCLUSIONS

Despite clear official definitions of criticality in anaesthesia, there is ambiguity in how these are applied in practice. Many educationally useful events fall outside critical incident reporting schemes. Professional expertise in anaesthesia brings its own implicit safety culture but the reluctance to adopt a more explicit 'systems approach' to adverse events may impede further gains in patient safety in anaesthesia.

Making monitoring 'work': human-machine interaction and patient safety in anaesthesia

This study aimed to explore the use of electronic monitoring within the context of anaesthetic practice. We conducted workplace observation of, and interviews with, anaesthetists and other anaesthetic staff in two UK hospitals. Transcripts were analysed inductively for recurrent themes. Whilst formal sources of knowledge in anaesthesia deal with the issue of monitoring in terms of theoretical principles and performance specifications of devices, anaesthetists in practice often 'disbelieve' monitoring information. They call on and integrate other sources of knowledge about the patient, especially from their clinical assessment. The ability to distinguish 'normal' and 'abnormal' findings is vital. Confidence in electronic information varies with experience, as does the degree to which electronic information may be considered 'redundant'. We conclude that electronic monitoring brings new dimensions of understanding but also the potential for new ways of misunderstanding. The tacit knowledge underlying the safe use of monitoring deserves greater acknowledgement in training and practice.

Expertise in practice: an ethnographic study exploring acquisition and use of knowledge in anaesthesia

BACKGROUND

Expert professional practice in any field is known to rely on both explicit (formal) and tacit (personal) forms of knowledge. Current anaesthetic training programmes appear to favour explicit knowledge and measurable competencies. We aimed to describe and explore the way different types of knowledge are learned and used in anaesthetic practice.

METHOD

Qualitative approach using non-participant observation of, and semi-structured interviews with, anaesthetic staff in two English hospitals.

RESULTS

The development of expertise in anaesthesia rests on the ability to reconcile and interpret many sources of knowledge--clinical, social, electronic, and experiential--and formal theoretical learning. Experts have mastered technical skills but are also able to understand the dynamic and uncertain condition of the anaesthetized patient and respond to changes in it. This expertise is acquired by working with colleagues, and, importantly, by working independently, to develop personal routines. Routines mark the successful incorporation of new knowledge but also function as a defence against the inherent uncertainty of anaesthetic practice. The habits seen in experts' routines are preferred ways of working chosen from a larger repertoire of techniques which can also be mobilized as changing circumstances demand.

CONCLUSIONS

Opportunities for developing expertise are linked to the independent development of personal routines. Evidence-based approaches to professional practice may obscure the role played by the interpretation of knowledge. We suggest that the restriction of apprenticeship-style training threatens the acquisition of anaesthetic expertise as defined in this paper.

Foraging enrichment for stabled horses: effects on behaviour and selection

The restricted access to pasture experienced by many competition horses has been linked to the exhibition of stereotypic and redirected behaviour patterns. It has been suggested that racehorses provided with more than one source of forage are less likely to perform these patterns; however, the reasons for this are currently unclear. To investigate this in 4 replicated trials, up to 12 horses were introduced into each of 2 identical stables containing a single forage, or 6 forages for 5 min. To detect novelty effects, in the first and third trials the single forage was hay. In the second and fourth, it was the preferred forage from the preceding trial. Trials were videotaped and 12 mutually exclusive behaviour patterns compared. When hay was presented as the single forage (Trials 1 and 3), all recorded behaviour patterns were significantly different between stables; e.g. during Trial 3 in the 'Single' stable, horses looked over the stable door more frequently (P<0.001), moved for longer (P<0.001), foraged on straw bedding longer (P<0.001), and exhibited behaviour indicative of motivation to search for alternative resources (P<0.001) more frequently. When a previously preferred forage was presented as the single forage (Trials 2 and 4) behaviour was also significantly different between stables, e.g in Trial 4 horses looked out over the stable door more frequently (P<0.005) and foraged for longer in their straw bedding (P<0.005). Further study is required to determine whether these effects persist over longer periods. However, these trials indicate that enrichment of the stable environment through provision of multiple forages may have welfare benefits for horses, in reducing straw consumption and facilitating the expression of highly motivated foraging behaviour.

Management strategies and financial performance in rural and urban hospitals

This study identifies the difference in financial performance between rural and urban hospitals and examines whether or not that difference may be attributed to the emphasis of revenue enhancement over cost management strategies. Hospitals in Virginia were included in this study except for the two state university medical centers. Rural and urban hospitals were compared on 10 performance indicators grouped into four categories: revenues, costs, profits, and productivity. The results suggest that rural hospital profitability is dependent on cost management. Since rural hospitals achieved lower cost, better efficiency and productivity level than urban hospitals in Virginia, they demonstrate a significant higher level of profit.

Effects of treatment intensification with hydroxyurea in HIV-infected patients with virologic suppression

BACKGROUND

Virologic rebound can result from suboptimal antiviral potency in combination antiretroviral therapy.

DESIGN

Multicenter, partially blinded, prospective, randomized study of 202 HIV-infected subjects to determine whether therapy intensification improves long-term rates of virologic suppression.

METHODS

Subjects had plasma HIV RNA < 200 copies/ml, CD4 cell count of > 200 x 10(6) cells/l, and treatment with indinavir (IDV) + zidovudine (ZDV) + lamivudine (3TC) for at least 6 months before randomization to stay on this regimen or to receive IDV + didanosine (ddI) + stavudine (d4T) plus or minus hydroxyurea (HU) (600 mg twice daily). Treatment failure was defined as either confirmed rebound of HIV RNA level to > 200 copies/ml or a drug toxicity necessitating treatment discontinuation.

RESULTS

Treatment failure occurred more frequently in subjects randomized to the HU-containing arm (32.4%), than in those taking IDV + ddI + d4T (17.6%) or IDV + ZDV + 3TC (7.6%). The time to treatment failure was shorter for the HU-containing arm compared with the IDV + ZDV + 3TC (P < 0.0001) or IDV + ddI + d4T arms (P = 0.032). Dose-limiting toxicities rather than virologic rebound accounted for the differences between treatment failure among the study arms. Pancreatitis led to treatment discontinuation in 4% of subjects in treatment arms containing ddI + d4T. Three subjects with pancreatitis died, all randomized to the HU-containing arm.

CONCLUSIONS

Switching to IDV + ddI + d4T + HU in patients treated with IDV + ZDV + 3TC was associated with a worse outcome, principally because of drug toxicity.

Functional magnetic stimulation facilitates colonic transit in rats

OBJECTIVE

To investigate the effect of functional magnetic stimulation (FMS) on colonic transit in rats.

DESIGN

Experimental.

SETTING

Functional magnetic stimulation laboratory in a Veterans Administration health care system.

ANIMALS

Twenty-four female Wistar rats, divided into an experimental group and a control group.

INTERVENTIONS

All rats had technetium 99m (Tc 99m) infused through a cecal catheter to assess colonic transit times. FMS was performed over the cervical region; a figure of 8 magnetic coil was used in the experimental group. The colon was removed and sectioned into 10 segments, and a stool sample was taken in both groups.

MAIN OUTCOME MEASURES

Distribution of radioactivity within the large intestine and stool were measured.

RESULTS

Geometric center calculations showed significant differences (p <.001) between the control group and the experimental group when the distribution of radioactivity along the colon was measured. The percentage of Tc 99m recovered from the stool in the experimental group was significantly higher than the percentage recovered from the control group.

CONCLUSION

FMS facilitates colonic transit in a rat model.

Treatment of leg telangiectasia by using a long-pulse dye laser at 595 nm with and without dynamic cooling device

BACKGROUND AND OBJECTIVE

The long-pulse dye laser (PDL) at 595 nm and pulse duration of 1.5 msec has been shown to improve clearance of larger vessels such as those seen in leg telangiectasia. The objectives of this study are twofold. First, to determine the effect of the dynamic cooling device (DCD) in clearance of leg telangiectasia by using a long-pulse PDL at 595 nm. Next, to determine the effect of the DCD in reducing transient discomfort associated with treatment and in reducing epidermal damage (blistering, hyper/hypopigmentation, scarring) caused by the laser.

STUDY DESIGN/MATERIALS AND METHODS

Matched treatment sites were compared at energy densities of 20 and 24 J/cm(2) with and without the use of the cryogen spray in 18 patients. In areas treated without the DCD, the laser pulse was delivered through a single layer of Spenco Second Skin. Patients received two treatments 6 weeks apart. Discomfort ratings, clearance of leg telangiectasia, and complications were assessed at 6 weeks, 12 weeks, and 6 months.

RESULTS

A reduction in discomfort ratings was found in most patients using the DCD. Six-month follow-up data revealed at the 20 J/cm(2) treatment sites, with or without the DCD, 76.9% showed greater than 50% clearance. At the 24 J/cm(2) treatment sites, with or without the DCD, 84.6% showed greater than 50% clearance.

CONCLUSION

The long-pulse dye laser at 595 nm with a 1.5-msec pulse duration cleared leg telangiectasia an average of 67.5% with two treatments at 6 months. The major effect of the DCD was on pain reduction. There was no difference in clearance rates when using the DCD vs. cooled Second Skin. Further studies with longer cooling times with the DCD are needed to optimize treatment parameters.

Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging

PURPOSE

To evaluate posteromedial tibial plateau injuries of or about the semimembranous tendon insertion site and their association with anterior cruciate ligament (ACL) tears on magnetic resonance (MR) images.

MATERIALS AND METHODS

A retrospective study of MR images and conventional radiographs was performed in 10 patients with posteromedial tibial plateau injuries, including avulsion fractures of the semimembranous tendon insertion site. Associated abnormalities were analyzed, including ACL tears, medial meniscal tears, and other lateral femorotibial compartment injuries. Findings from the clinical history and physical examination were correlated with radiographic and MR imaging findings. Nine patients had arthroscopically or surgically documented ACL tears.

RESULTS

All 10 patients had ACL tears at MR imaging. Five patients had posteromedial tibial plateau fractures: Four had avulsion fractures of the tendon insertion site, and one had a fracture lateral to the site. Five patients had posteromedial tibial plateau bruises: Two had bruises at the tendon insertion site. Five patients had tears of the posterior horn of the medial meniscus. Two patients had posterior meniscocapsular separations. Three patients showed evidence of the O'Donoghue triad. Six patients had bruises of the lateral tibial plateau and of the lateral femoral condyle.

CONCLUSION

There appears to be an association between posteromedial tibial plateau injuries and ACL tears. Posteromedial tibial plateau injuries may be predictive of ACL status.

The importance of ethology in understanding the behaviour of the horse

Domestication has provided the horse with food, shelter, veterinary care and protection, allowing individuals an increased chance of survival. However, the restriction of movement, limited breeding opportunities and a requirement to expend energy, for the benefit of another species, conflict with the evolutionary processes which shaped the behaviour of its predecessors. The behaviour of the horse is defined by its niche as a social prey species but many of the traits which ensured the survival of its ancestors are difficult to accommodate in the domestic environment. There has been a long association between horses and man and many features of equine behaviour suggest a predisposition to interspecific cooperation. However, the importance of dominance in human understanding of social systems has tended to overemphasize its importance in the human-horse relationship. The evolving horse-human relationship from predation to companionship, has resulted in serial conflicts of interest for equine and human participants. Only by understanding the nature and origin of these conflicts can ethologists encourage equine management practices which minimise deleterious effects on the behaviour of the horse.

Determination of behavioural traits of pure-bred dogs using factor analysis and cluster analysis; a comparison of studies in the USA and UK

The questionnaire survey of Hart and Hart (1985, Journal of the American Veterinary Medical Association 186, 1811-1815) ranked the 56 most popular breeds of dog in the USA on 13 behavioural traits and is compared here with results of a similar survey conducted on the 49 most popular breeds in the UK. Of the 36 breeds in common between the studies, 24 were similar for the traits aggressivity, reactivity and ease of housetraining between the two countries. However, the characteristics of nine breeds (Airedale Terrier, Old English Sheepdog, Welsh Corgi, Irish Setter, Standard Poodle, Beagle, Samoyed, Boxer, Dalmatian) differed markedly between the two countries, and a further three (Chihuahua, Scottish Terrier, Standard Dachshund) showed smaller, but probably meaningful, shifts. These differences should be recognised when giving advice to prospective owners, and when treating unwanted behaviour in these breeds.

MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients

OBJECTIVE

We evaluated how well MR imaging revealed ligamentous and bony abnormalities in patients with injuries of Lisfranc's joint.

SUBJECTS AND METHODS

We evaluated the studies of 11 patients with plantar hyperflexion injuries of the foot who underwent MR imaging in all three planes using spinecho T1-weighted, fast spin-echo T2-weighted, and short inversion time inversion recovery sequences. In four of the 11 patients, a three-dimensional spoiled gradient-recalled acquisition in the steady-state volume sequence was performed in the coronal plane. For five of the 11 patients, radiographs were available for evaluation.

RESULTS

Radiographs revealed tarsometatarsal joint malalignment in all five patients for whom plain films were available, metatarsal fractures in four of these patients, and tarsal fractures in the same four patients. MR imaging showed joint malalignment in all 11 patients and disruption of the Lisfranc's ligament in eight of the 11 patients. In the remaining three patients, normal Lisfranc's ligaments were associated with avulsion fractures of the second metatarsal bases or the medial cuneiform bones. On MR imaging, fractures of the metatarsal bases were evident in 10 of 11 patients. Fractures of the tarsal bones were seen in the same 10 patients.

CONCLUSION

MR imaging allows the detection of disruption of the Lisfranc's ligament as well as tarsal and metatarsal fractures and therefore may be a valuable technique in assessing patients after trauma to the tarsometatarsal joints when results of routine radiographs are not conclusive.

Ventral sacroiliac ligament. Anatomic and pathologic considerations

RATIONALE AND OBJECTIVES

The ventral sacroiliac ligament (VSL), which bridges the sacroiliac (SI) joint anteriorly, has been described as an important stabilizing structure of the joint, but no data exist regarding its assessment with routine and advanced imaging methods. The authors determine the imaging appearance of the normal and abnormal VSL using close anatomic-histologic-imaging correlation.

METHODS

Eight and 10 cadaveric SI joints were examined with magnetic resonance imaging in axial and coronal planes, respectively; and in four computed tomography scanning in both planes was obtained. Anatomic sectioning with histologic correlation at levels corresponding to those of imaging planes was performed. Representative examples of diseases that produce abnormalities of the VSL and connective tissue about the SI joint were reviewed.

RESULTS

Magnetic resonance images showed the VSL-anterior capsular complex as a hypointense, linear, or minimally curved structure of approximately 2 mm thickness traversing the SI joint anteriorly. The VSL could not be separated from the anterior joint capsule by imaging studies, but such differentiation by histology could be determined based upon the orientation of its collagen fibers. Any disease process that affects the ligament or the site of ligamentous attachment to bone produces characteristic imaging alterations.

Food selection by the domestic cat, an obligate carnivore

The domestic cat Felis silvestris catus is the most accessible member of the family Felidae for the study of the relationship between food selection and nutrition. In contrast to pack-living animals such as the dog, and opportunistic omnivores such as the rat, the cat is generally able to maintain its normal body weight even when allowed ad libitum access to palatable food by taking small meals and adjusting intake according to the energy density of the food(s) available. The most extreme adaptations to carnivory discovered to date lie in the taste buds of the facial nerve, which are highly responsive to amino acids and unresponsive to many mono- and disaccharides. Preferences for particular foods can be modified by their relative abundance, their novelty, and by aversive consequences such as emesis: the mechanisms whereby these are brought about appear to be similar to those used by omnivorous mammals.

A survey of the behavioural characteristics of pure-bred dogs in the United Kingdom

One-hundred-and-twelve small animal veterinarians and 56 dog care professionals were asked to rate the behavioural characteristics of 49 breeds of dog, and to compare males and females by means of a 13-point questionnaire. From their replies, factor analysis was used to extract three underlying traits, labelled aggressivity, reactivity and immaturity. On the basis of these traits, eight groups of breeds were derived. Membership of these groups did not correspond exactly with any of the four existing breed classification systems (Mégnin, the Fédération Cynologique International, ancient breeds and Kennel Club of Great Britain), but significant differences between Kennel Club groups were found on all three traits. Male dogs were rated higher than females on both aggressivity and immaturity; the components of reactivity were also rated higher in males, apart from the demand for affection which was rated higher in females. Females were also considered easier to train than males.

MR arthrography of the hip: improved imaging of the acetabular labrum with histologic correlation in cadavers

OBJECTIVE

The objective of this study was to correlate findings on conventional MR imaging and MR arthrography of the hip with pathologic findings in cadavers with abnormal labra to determine (1) the efficacy of MR imaging in assessing labral degeneration, (2) whether delineation of the labrum from the joint capsule is possible, and (3) if the conspicuity of surface abnormalities of the labrum is improved by administering intraarticular contrast material.

MATERIALS AND METHODS

Twelve cadaveric hip joints were obtained from elderly cadavers. Each hip was examined using fat-suppressed three-dimensional spoiled GRASS (gradient-recalled acquisition in the steady state) (SPGR) imaging and T1-weighted spin-echo imaging before and after intraarticular injection of contrast material. Thirty-six labral sections (three from each hip joint) were evaluated histologically to determine the labral-capsular relationship, the presence of degeneration, and the configuration of the labral base. These findings were correlated with the results of a blinded MR evaluation of these sections.

RESULTS

Delineation of the labrum from the adjacent joint capsule was possible on SPGR and T1-weighted MR arthrographic images (34 of 36 and 33 of 36 specimens, respectively), but was not consistently possible on standard SPGR and T1-weighted MR images (7 of 36 and 4 of 36 specimens, respectively). The sensitivities and specificities of the various MR sequences in evaluating labral degeneration varied from 50% to 67%, and from 25% to 94%. Increased signal at the base was common in both the normal (n = 12) and the abnormal (n = 24) labrum.

CONCLUSION

Conspicuity of the acetabular labral complex is enhanced with the intraarticular administration of contrast material. Although MR arthrography did not improve our specificity for diagnosing labral degeneration, the detection of surface abnormalities, particularly those near the base, was significantly improved.

Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging

OBJECTIVE

Complete knee dislocation is a rare injury. The purpose of this study was to evaluate the spectrum of injuries that are depicted by MR imaging in patients with a dislocation of the knee and to determine if there is any predictive factor that might indicate those patients who may be at risk for popliteal nerve injury.

MATERIALS AND METHODS

A retrospective search for patients sustaining traumatic knee dislocations who had radiographs and an MR imaging examination of the knee as part of their initial evaluation was done at three level I trauma centers for the period between 1989 and 1993. Each MR examination was independently reviewed by three osteoradiologists for ligamentous, tendinous, meniscal, and osseous injuries. Equivocal diagnoses were decided by consensus. Only patients who underwent surgery were selected. MR imaging findings were confirmed at the time of surgery. Seventeen patients (15 men, two women; age range, 14-62 years; mean age, 29 years) were studied. Motor vehicle accident, fall from a height, a vehicle striking a pedestrian, and football injury were common mechanisms of injury. Posterior dislocation (seven patients) and anterior dislocation (five patients) were the most common injuries.

RESULTS

At the time of surgery, all patients had complete tears of the anterior cruciate ligament, 15 had complete tears of the posterior cruciate ligament, nine had complete tears of the medial collateral ligament, and 12 had tears of the fibular collateral ligament (nine tore both the fibular collateral ligament and the biceps femoris tendon). Popliteal tendon tears occurred in eight patients (six complete, two partial). Of the six patients with complete tears of the popliteal tendon, five occurred at the musculotendinous junction; all were the result of either posterior or posterolateral dislocations. Four patients had injuries to the peroneal nerve; three of the four also had tears of the popliteal tendon. On MR imaging, the integrity of the anterior cruciate and lateral collateral ligaments was correctly depicted in all 17 patients; evaluation of the posterior cruciate ligament resulted in one false-positive and one false-negative diagnosis of a tear; evaluation of the medial collateral ligament resulted in one false-positive diagnosis of a tear; and one false-positive diagnosis of a tear occurred with evaluation of the popliteal tendon.

CONCLUSION

Knee dislocations cause extensive disruption of the ligaments that stabilize the knee and the surrounding soft-tissue structures, including the popliteal artery. Nearly all will result in disruption of the cruciate ligments and, often, injury of the collateral ligaments. An injury to the popliteal tendon denotes a more severe injury. The mechanism of injury that results in a popliteal tendon tear may also increase the possibility of a peroneal nerve injury. Recognition of this pattern of injuries on MR imaging enables precautionary observation for ischemic changes of the foot to be instituted in patients that otherwise may not be considered at risk for acute vascular compromise.

Technetium-99m labeled monoclonal antibodies in the detection of metastatic melanoma

Twenty-six stage II/III malignant melanoma patients with 321 measurable metastatic lesions were imaged using Fab fragments of an IgG murine monoclonal antibody labeled specifically with 10-30 mCi Tc-99m with a bi-functional chelating method (NeoRx, Seattle, WA). There were no side effects or adverse reactions. Immunoscintigraphy demonstrated 66.6% of lesions larger than 1 cm and 92.5% of lesions larger than 3 cm. Most frequently detected metastases were in lymph nodes, subcutaneous areas, and bone. Of lesions less than 1 cm, 23.6% were detected if superficial cutaneous lesions were excluded. The smallest detectable lesion was 4 mm. Twenty-one additional clinically unsuspected sites were visualized in 12 of the 26 patients studied. Of these, 56% were confirmed as metastasis by other tests. There were apparent nonspecific localizations owing to other causes, including fracture, varicosities, skin abscess and pneumonitis. Increased experience in image analysis facilitates correct interpretation of these localizations. This study demonstrates that imaging with Tc-99m labeled antibody fragments detects melanoma lesions in organs routinely surveyed and in other areas not routinely assessed by other imaging techniques. The procedure is readily performed and safe. The principal advantage of the test is its ability to survey the entire body and all organs with a single test. Its principal limitation, in common with other diagnostic imaging procedures, is its poor sensitivity for detecting lesions less than 1 cm.

The clinical use of autologous marrow to improve osteogenic potential of bone grafts in pediatric orthopedics

The high osteogenic potential of living autologous marrow cells can be combined with foreign bone to enhance new bone formation. Xenogeneic bone was combined with autologous red marrow and used in 23 patients aged 5-17 years. Kiel bone was impregnated with marrow aspirated from the iliac crest and, apart from one case of lesion recurrence, gave excellent results in all patients under conditions covering a wide range of indications for bone grafting. Unlimited supplies of xenograft bone and other bone substitutes can be rendered osteogenic by a simple procedure. Combining fresh autologous red marrow with other types of bank bone allograft or xenograft, or even with biological or synthetic biocompatible material that favors the induction of new bone, may provide even better results.

Fenestration of tenosynovial capillaries

A proportion of superficial capillaries in joint synovium are known to be fenestrated. The specialized functions of these fenestrated capillaries are unknown. We report the finding of fenestrae in tenosynovial capillaries from rabbit peroneal tendon sheaths. Fenestrations occupied 0.66% of the endothelial surface. Fenestrated capillaries appear to be a general feature of synovium, rather than a specific feature of joint tissue.

Clarification and standardization of substance abuse terminology

A four-stage Delphi survey of substance abuse experts was conducted to help achieve greater clarity and uniformity in terminology associated with alcohol and other drug-related problems. This multidisciplinary group of experts was asked to reach a consensus on alcohol and other drug-related terms and definitions. Results produced a list of 50 substance abuse terms deemed important, along with the most agreed on definition for each term.

Recurrent abdominal pain in childhood. Relationship to psychological adjustment of children and families: a preliminary study

The study investigated the prevalence of emotional and behavioural problems in children with recurrent abdominal pain (RAP), the sensitivity of RAP children to a painful stimulus, and the attitudes shown by RAP mothers to issues of health and illness. Three groups of children were compared including two groups with RAP, one in which an organic cause for the pain was found, and one where no organic cause was identified. The third group consisted of pain-free children from the general community. No consistent patterns of differences was identified between the groups on the measures used. Possible reasons for the findings are discussed and recommendations made for further research in this area.

Problems associated with distinguishing between singlet oxygen and electron transfer photooxygenation reactions

In the introduction a review is given of the various methods available for probing the mechanism of photooxygenation reactions. To illustrate the methodology, some new results on the photooxygenation of alpha-ketocarboxylic acids and esters is given in which it is shown that these compounds sensitise singlet oxygen formation but are relatively unreactive to this oxidising species. Alternative mechanistic schemes are proposed.

Pharmacological, hematological, and physiological effects of a new thromboxane synthetase inhibitor (CGS-13080) during cardiopulmonary bypass in dogs

The hematological and pharmacological effects of a new thromboxane synthetase inhibitor, CGS-13080 (imidazo[1,5-alpha]pyridine-5-hexanoic acid), were investigated during cardiopulmonary bypass in a blinded, randomized manner in dogs. Compared with placebo, CGS-13080 suppressed thrombin-stimulated platelet thromboxane B2 production by 90% during cardiopulmonary bypass (p less than .001), an effect that persisted for two hours after stopping the infusion. In the CGS-13080-treated group, plasma 6-keto-prostaglandin F1 alpha levels significantly increased over time (p less than .03) and were somewhat higher when compared with those in the placebo-treated group. This observation suggests that an "endoperoxide shunt" may have occurred. In the control group, an inverse correlation between platelet count and level of thromboxane B2 per platelet following in vitro thrombin stimulation (r = .5, p less than .001) was apparent, but there was no correlation between these two variables (r = .18, p less than .10) in the CGS-13080-treated group. No adverse hemodynamic or other effects attributable to CGS-13080 occurred during or immediately following cardiopulmonary bypass. These results suggest that CGS-13080 is an effective inhibitor of thromboxane B2 production during cardiopulmonary bypass in dogs and has no adverse physiological effects.