Combining Outreach and Cross-sectional Research to Gather Children's Soil Values in Aotearoa New Zealand: Protocol for the Mixed Methods Soilsafe Kids Program

BACKGROUND

Soil underpins most terrestrial systems; hence, its degradation should concern everyone. In 2021, Soilsafe Aotearoa surveyed the adult population of New Zealand about how they value soil, particularly values related to how they care about and are concerned about soil. Pursuant to this study, Soilsafe Kids (the outreach branch of Soilsafe Aotearoa) developed a combined research and outreach program to collect a supplemental data set of children's soil values, so both adults' and children's voices can be considered when understanding the implications of different practices and how to care for presently "uncared for" or neglected soils in the future.

OBJECTIVE

The program not only asks primary school students about their soil values but also aims to teach them about soil from many disciplinary perspectives to enhance their understanding and awareness of soil, and, more broadly, for knowledge production.

METHODS

Here we describe the research protocol used in this Soilsafe Kids program. This program uses surveys (in the form of worksheets), focus groups (introduced as group discussions), and art projects to learn what children think about soil in Tāmaki Makaurau Auckland. We have received ethics approval from the University of Auckland's Human Participants Ethics Committee (reference number 23556) on March 25, 2022, for 3 years.

RESULTS

We have begun recruiting participants and delivering the Soilsafe Kids program in schools across Tāmaki Makaurau Auckland. Our data collection is ongoing with final student engagement in the first quarter of 2023. We expect to analyze data at the start of 2023 and to disseminate results later this year.

CONCLUSIONS

Once this study is complete, we will disseminate the final results to the research community, stakeholders, and the local community through conference presentations, journal articles, hui (meetings), on our website, and in art exhibits. We note that although Tāmaki Makaurau Auckland is home to the majority of people living in Aotearoa New Zealand, the Auckland region only represents a small portion of Aotearoa New Zealand's land, and findings are not generalizable to Aotearoa New Zealand as a whole.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/43390.

Mild cognitive impairment in middle-aged adults with coronary microvascular dysfunction

Introduction

Coronary microvascular dysfunction (CMD) may be a manifestation of systemic small vessel disease, including the brain. The prevalence of cognitive impairment in CMD patients is poorly understood.

Purpose

To assess the prevalence of cognitive impairment in patients with CMD.

Methods

Between April 2018-March 2020, we enrolled patients with chest discomfort who were admitted to a chest pain observation unit and underwent 3D cardiac positron emission tomography/computed tomography (PET/CT). Exclusions included myocardial infarction, hypertensive urgency, and heart failure. Patients were categorized as 1) Normal: coronary flow reserve (CFR) ≥2.5 without perfusion defect or calcification, 2) Possible CMD: CFR 2–2.5 without perfusion defects or calcification, 3) CMD: CFR <2 without perfusion defects or calcification and 4) coronary artery disease (CAD/CALC): any CFR with perfusion defects or calcifications. We assessed cognitive function with the Montreal Cognitive Assessment (MoCA) and used <23 as the cutoff for impaired cognition. We added 1 point to the total score for those with 12 years of education or less. Odds ratios of cognitive impairment in each group were calculated with the normal group as reference, adjusting for age, sex, and race.

Results

Of 111 patients consented, 109 patients had complete data for analysis. (Table 1) Mean age was 57 years (± 11), 68% were female, and 49% were non-White. All 11 patients with CMD were females, with a mean age of 59 years (±12). The majority (72%) of CMD patients had cognitive impairment on the MoCA compared to 25% of patients with normal flows (unadjusted OR: 8.00 [95% CI 1.70–37.67]), even after adjustment for age, sex, and race (OR: 37.23 (95% CI 2.01–677.05). MoCA scores did not differ significantly between the normal and the CAD/CALC group (unadjusted OR: 0.95 [95% CI 0.30–3.070]), or the possible CMD group (1.44 [95% CI 0.50–4.14]). Additionally, non-White patients were more likely to demonstrate cognitive impairment on MoCA than White patients (OR: 9.47 [95% CI 3.48–25.81]). There was no significant nonparametric correlation between CFR and the MoCA score (r=0.05, p=0.6).

Conclusion

Patients with CMD are more likely to have cognitive impairment, supporting the need to further investigate the heart-brain connection in systemic small vessel disease.

FUNDunding Acknowledgement

Type of funding sources: None.

Surgical treatments compared with early structured physiotherapy in secondary care for adults with primary frozen shoulder: the UK FROST three-arm RCT

BACKGROUND

Frozen shoulder causes pain and stiffness. It affects around 10% of people in their fifties and is slightly more common in women. Costly and invasive surgical interventions are used, without high-quality evidence that these are effective.

OBJECTIVES

To compare the clinical effectiveness and cost-effectiveness of three treatments in secondary care for adults with frozen shoulder; to qualitatively explore the acceptability of these treatments to patients and health-care professionals; and to update a systematic review to explore the trial findings in the context of existing evidence for the three treatments.

DESIGN

This was a pragmatic, parallel-group, multicentre, open-label, three-arm, randomised superiority trial with unequal allocation (2 : 2 : 1). An economic evaluation and a nested qualitative study were also carried out.

SETTING

The orthopaedic departments of 35 hospitals across the UK were recruited from April 2015, with final follow-up in December 2018.

PARTICIPANTS

Participants were adults (aged ≥ 18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation in the affected shoulder to < 50% of the opposite shoulder, and with plain radiographs excluding other pathology.

INTERVENTIONS

The inventions were early structured physiotherapy with a steroid injection, manipulation under anaesthesia with a steroid injection and arthroscopic capsular release followed by manipulation. Both of the surgical interventions were followed with post-procedural physiotherapy.

MAIN OUTCOME MEASURES

The primary outcome and end point was the Oxford Shoulder Score at 12 months post randomisation. A difference of 5 points between early structured physiotherapy and manipulation under anaesthesia or arthroscopic capsular release or of 4 points between manipulation under anaesthesia and arthroscopic capsular release was judged clinically important.

RESULTS

The mean age of the 503 participants was 54 years; 319 were female (63%) and 150 had diabetes (30%). The primary analyses comprised 473 participants (94%). At the primary end point of 12 months, participants randomised to arthroscopic capsular release had, on average, a statistically significantly higher (better) Oxford Shoulder Score than those randomised to manipulation under anaesthesia (2.01 points, 95% confidence interval 0.10 to 3.91 points; p = 0.04) or early structured physiotherapy (3.06 points, 95% confidence interval 0.71 to 5.41 points; p = 0.01). Manipulation under anaesthesia did not result in statistically significantly better Oxford Shoulder Score than early structured physiotherapy (1.05 points, 95% confidence interval -1.28 to 3.39 points; p = 0.38). No differences were deemed of clinical importance. Serious adverse events were rare but occurred in participants randomised to surgery (arthroscopic capsular release,n = 8; manipulation under anaesthesia,n = 2). There was, however, one serious adverse event in a participant who received non-trial physiotherapy. The base-case economic analysis showed that manipulation under anaesthesia was more expensive than early structured physiotherapy, with slightly better utilities. The incremental cost-effectiveness ratio for manipulation under anaesthesia was £6984 per additional quality-adjusted life-year, and this intervention was probably 86% cost-effective at the threshold of £20,000 per quality-adjusted life-year. Arthroscopic capsular release was more costly than early structured physiotherapy and manipulation under anaesthesia, with no statistically significant benefit in utilities. Participants in the qualitative study wanted early medical help and a quicker pathway to resolve their shoulder problem. Nine studies were identified from the updated systematic review, including UK FROST, of which only two could be pooled, and found that arthroscopic capsular release was more effective than physiotherapy in the long-term shoulder functioning of patients, but not to the clinically important magnitude used in UK FROST.

LIMITATIONS

Implementing physiotherapy to the trial standard in clinical practice might prove challenging but could avoid theatre use and post-procedural physiotherapy. There are potential confounding effects of waiting times in the trial.

CONCLUSIONS

None of the three interventions was clearly superior. Early structured physiotherapy with a steroid injection is an accessible and low-cost option. Manipulation under anaesthesia is the most cost-effective option. Arthroscopic capsular release carries higher risks and higher costs.

FUTURE WORK

Evaluation in a randomised controlled trial is recommended to address the increasing popularity of hydrodilatation despite the paucity of high-quality evidence.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN48804508.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 71. See the NIHR Journals Library website for further project information.

Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial

BACKGROUND

Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection.

METHODS

In this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508.

FINDINGS

Between April 1, 2015, and Dec 31, 2017, we screened 914 patients, of whom 503 (55%) were randomly assigned. At 12 months, OSS data were available for 189 (94%) of 201 participants assigned to manipulation (mean estimate 38·3 points, 95% CI 36·9 to 39·7), 191 (94%) of 203 participants assigned to capsular release (40·3 points, 38·9 to 41·7), and 93 (94%) of 99 participants assigned to physiotherapy (37·2 points, 35·3 to 39·2). The mean group differences were 2·01 points (0·10 to 3·91) between the capsular release and manipulation groups, 3·06 points (0·71 to 5·41) between capsular release and physiotherapy, and 1·05 points (-1·28 to 3·39) between manipulation and physiotherapy. Eight serious adverse events were reported with capsular release and two with manipulation. At a willingness-to-pay threshold of £20 000 per quality-adjusted life-year, manipulation under anaesthesia had the highest probability of being cost-effective (0·8632, compared with 0·1366 for physiotherapy and 0·0002 for capsular release).

INTERPRETATION

All mean differences on the assessment of shoulder pain and function (OSS) at the primary endpoint of 12 months were less than the target differences. Therefore, none of the three interventions were clinically superior. Arthoscopic capsular release carried higher risks, and manipulation under anaesthesia was the most cost-effective.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Sub-Kelvin cooling for two kilopixel bolometer arrays in the PIPER receiver

The Primordial Inflation Polarization Explorer (PIPER) is a balloon-borne telescope mission to search for inflationary gravitational waves from the early universe. PIPER employs two 32 × 40 arrays of superconducting transition-edge sensors, which operate at 100 mK. An open bucket Dewar of liquid helium maintains the receiver and telescope optics at 1.7 K. We describe the thermal design of the receiver and sub-Kelvin cooling with a continuous adiabatic demagnetization refrigerator (CADR). The CADR operates between 70 and 130 mK and provides ≈10 μW cooling power at 100 mK, nearly five times the loading of the two detector assemblies. We describe electronics and software to robustly control the CADR, overall CADR performance in flightlike integrated receiver testing, and practical considerations for implementation in the balloon float environment.

United Kingdom Frozen Shoulder Trial (UK FROST), multi-centre, randomised, 12 month, parallel group, superiority study to compare the clinical and cost-effectiveness of Early Structured Physiotherapy versus manipulation under anaesthesia versus arthroscopic capsular release for patients referred to secondary care with a primary frozen shoulder: study protocol for a randomised controlled trial

BACKGROUND

Frozen shoulder (also known as adhesive capsulitis) occurs when the capsule, or the soft tissue envelope around the ball and socket shoulder joint, becomes scarred and contracted, making the shoulder tight, painful and stiff. It affects around 1 in 12 men and 1 in 10 women of working age. Although this condition can settle with time (typically taking 1 to 3 years), for some people it causes severe symptoms and needs referral to hospital. Our aim is to evaluate the clinical and cost-effectiveness of two invasive and costly surgical interventions that are commonly used in secondary care in the National Health Service (NHS) compared with a non-surgical comparator of Early Structured Physiotherapy.

METHODS

We will conduct a randomised controlled trial (RCT) of 500 adult patients with a clinical diagnosis of frozen shoulder, and who have radiographs that exclude other pathology. Early Structured Physiotherapy with an intra-articular steroid injection will be compared with manipulation under anaesthesia with a steroid injection or arthroscopic (keyhole) capsular release followed by manipulation. Both surgical interventions will be followed with a programme of post-procedural physiotherapy. These treatments will be undertaken in NHS hospitals across the United Kingdom. The primary outcome and endpoint will be the Oxford Shoulder Score (a patient self-reported assessment of shoulder function) at 12 months. This will also be measured at baseline, 3 and 6 months after randomisation; and on the day that treatment starts and 6 months later. Secondary outcomes include the Disabilities of Arm Shoulder and Hand (QuickDASH) score, the EQ-5D-5 L score, pain, extent of recovery and complications. We will explore the acceptability of the different treatments to patients and health care professionals using qualitative methods.

DISCUSSION

The three treatments being compared are the most frequently used in secondary care in the NHS, but there is uncertainty about which one works best and at what cost. UK FROST is a rigorously designed and adequately powered study to inform clinical decisions for the treatment of this common condition in adults.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Register, ID: ISRCTN48804508 . Registered on 25 July 2014.

Polarisation of equine pregnancy outcome associated with a maternal MHC class I allele: Preliminary evidence

Identification of risk factors which are associated with severe clinical signs can assist in the management of disease outbreaks and indicate future research areas. Pregnancy loss during late gestation in the mare compromises welfare, reduces fecundity and has financial implications for horse owners. This retrospective study focussed on the identification of risk factors associated with pregnancy loss among 46 Thoroughbred mares on a single British stud farm, with some but not all losses involving equid herpesvirus-1 (EHV-1) infection. In a sub-group of 30 mares, association between pregnancy loss and the presence of five common Thoroughbred horse haplotypes of the equine Major Histocompatibility Complex (MHC) was assessed. This involved development of sequence specific, reverse transcriptase polymerase chain reactions and in several mares, measurement of cytotoxic T lymphocyte activity. Of the 46 mares, 10 suffered late gestation pregnancy loss or neonatal foal death, five of which were EHV-1 positive. Maternal factors including age, parity, number of EHV-1 specific vaccinations and the number of days between final vaccination and foaling or abortion were not significantly associated with pregnancy loss. In contrast, a statistically significant association between the presence of the MHC class I B2 allele and pregnancy loss was identified, regardless of the fetus/foal's EHV-1 status (p=0.002). In conclusion, this study demonstrated a significantly positive association between pregnancy loss in Thoroughbred mares and a specific MHC class I allele in the mother. This association requires independent validation and further investigation of the mechanism by which the mare's genetic background contributes to pregnancy outcome.

A case report on over-replacement of oral calcium supplements causing acute pancreatitis

A 42-year-old female teetotaller presented via the accident and emergency department with a 2-day history of vomiting and upper abdominal pain. She was diagnosed with acute pancreatitis. The aetiology of the pancreatitis was identified as hypercalcaemia secondary to oral calcium supplementation. The hypercalcaemia was corrected by stopping calcium supplements and aggressive fluid resuscitation. A thorough literature search did not show any case reports in which the aetiology of pancreatitis was oral calcium supplement over-replacement.

Monitoring agricultural rodenticide use and secondary exposure of raptors in Scotland

Despite the documented risk of secondary poisoning to non-target species by anticoagulant rodenticides there is no statutory post-approval monitoring of their use in the UK. This paper presents results from two Scottish monitoring schemes for the period 2000-2010; recording rodenticide use on arable farms and the presence of residues in raptor carcasses. More than three quarters of arable farms used anticoagulant rodenticides; predominately the second generation compounds difenacoum and bromadiolone. There was widespread exposure to anticoagulant rodenticides in liver tissues of the raptor species tested and the residues encountered generally reflected agricultural use patterns. As found in other studies, Red Kites (Milvus milvus) appeared to be particularly vulnerable to rodenticide exposure, 70 % of those sampled (n = 114) contained residues and 10 % died as a result of rodenticide ingestion. More unexpectedly, sparrowhawks (Accipiter nisus), which prey almost exclusively on birds, had similar exposure rates to species which prey on rodents. Although, with the exception of kites, confirmed mortality from rodenticides was low, the widespread exposure recorded is concerning. Particularly when coupled with a lack of data about the sub-lethal effects of these compounds. This raises questions regarding whether statutory monitoring of use is needed; both to address whether there are deficiencies in compliance with approval conditions or whether the recommended risk management procedures are themselves adequate to protect non-target wildlife.

Intussusception secondary to a solitary peritoneal lung metastasis

We report a 77-year-old woman, newly diagnosed with a malignant lung neoplasm of indeterminate nature who presented with profuse bilious vomiting without abdominal distension, pain or constipation. CT confirmed proximal small bowel obstruction. Laparotomy found a large area of intussusception from an intraluminal mass in the small bowel, which was resected and a primary anastomosis performed. Histology reported the mass as metastatic non-small-cell carcinoma and brought clarity to the primary tumour diagnosis. The patient made a good recovery from the operation, but unfortunately died a few months later from complications of her metastatic disease.

Risk factors for failure of outpatient parenteral antibiotic therapy (OPAT) in infective endocarditis

Objectives

To identify risk factors for failure of outpatient antibiotic therapy (OPAT) in infective endocarditis (IE).

Patients and methods

We identified IE cases managed at a single centre over 12 years from a prospectively maintained database. ‘OPAT failure’ was defined as unplanned readmission or antibiotic switch due to adverse drug reaction or antibiotic resistance. We analysed patient and disease-related risk factors for OPAT failure by univariate and multivariate logistic regression. We also retrospectively collected follow-up data on adverse disease outcome (defined as IE-related death or relapse) and performed Kaplan–Meier survival analysis up to 36 months following OPAT.

Results

We identified 80 episodes of OPAT in IE. Failure occurred in 25/80 episodes (31.3%). On multivariate analysis, cardiac or renal failure [pooled OR 7.39 (95% CI 1.84–29.66), P = 0.005] and teicoplanin therapy [OR 8.69 (95% CI 2.01–37.47), P = 0.004] were independently associated with increased OPAT failure. OPAT failure with teicoplanin occurred despite therapeutic plasma levels. OPAT failure predicted adverse disease outcome up to 36 months (P = 0.016 log-rank test).

Conclusions

These data caution against selecting patients with endocarditis for OPAT in the presence of cardiac or renal failure and suggest teicoplanin therapy may be associated with suboptimal OPAT outcomes. Alternative regimens to teicoplanin in the OPAT setting should be further investigated.

Comparison of coagulation performance and floc properties using a novel zirconium coagulant against traditional ferric and alum coagulants

Coagulation in drinking water treatment has relied upon iron (Fe) and aluminium (Al) salts throughout the last century to provide the bulk removal of contaminants from source waters containing natural organic matter (NOM). However, there is now a need for improved treatment of these waters as their quality deteriorates and water quality standards become more difficult to achieve. Alternative coagulant chemicals offer a simple and inexpensive way of doing this. In this work a novel zirconium (Zr) coagulant was compared against traditional Fe and Al coagulants. The Zr coagulant was able to provide between 46 and 150% lower dissolved organic carbon (DOC) residual in comparison to the best traditional coagulant (Fe). In addition floc properties were significantly improved with larger and stronger flocs forming when the Zr coagulant was used with the median floc sizes being 930 μm for Zr; 710 μm for Fe and 450 μm for Al. In pilot scale experiments, a similar improved NOM and particle removal was observed. The results show that when optimised for combined DOC removal and low residual turbidity, the Zr coagulant out-performed the other coagulants tested at both bench and pilot scale.

Induction of antibody responses to African horse sickness virus (AHSV) in ponies after vaccination with recombinant modified vaccinia Ankara (MVA)

Background

African horse sickness virus (AHSV) causes a non-contagious, infectious disease in equids, with mortality rates that can exceed 90% in susceptible horse populations. AHSV vaccines play a crucial role in the control of the disease; however, there are concerns over the use of polyvalent live attenuated vaccines particularly in areas where AHSV is not endemic. Therefore, it is important to consider alternative approaches for AHSV vaccine development. We have carried out a pilot study to investigate the ability of recombinant modified vaccinia Ankara (MVA) vaccines expressing VP2, VP7 or NS3 genes of AHSV to stimulate immune responses against AHSV antigens in the horse.

Methodology/Principal Findings

VP2, VP7 and NS3 genes from AHSV-4/Madrid87 were cloned into the vaccinia transfer vector pSC11 and recombinant MVA viruses generated. Antigen expression or transcription of the AHSV genes from cells infected with the recombinant viruses was confirmed. Pairs of ponies were vaccinated with MVAVP2, MVAVP7 or MVANS3 and both MVA vector and AHSV antigen-specific antibody responses were analysed. Vaccination with MVAVP2 induced a strong AHSV neutralising antibody response (VN titre up to a value of 2). MVAVP7 also induced AHSV antigen–specific responses, detected by western blotting. NS3 specific antibody responses were not detected.

Conclusions

This pilot study demonstrates the immunogenicity of recombinant MVA vectored AHSV vaccines, in particular MVAVP2, and indicates that further work to investigate whether these vaccines would confer protection from lethal AHSV challenge in the horse is justifiable.

Flocs through the looking glass

The paper describes the investigation of how the make up of raw water influences the physical properties of flocculated suspensions. The work focuses on the properties of four characteristic organic fractions separated as a function of their hydrophobicity. Mesoscale data indicates that the hydrophobic fractions dominate the make up of the water and are the most easily removed. Microscale and nanoscale data reveals that the fulvic acid fraction (FAF) generates statistically smaller and more compact flocs than those formed by the other fractions and the hydrophilic fractions form the most internally open and dendritic structures. The FAF fraction was also seen to dominate the zeta potential response of the raw water.

A quadricuspid pulmonic valve diagnosed in a live newborn by two-dimensional echocardiography

Quadricuspid pulmonic valve is a rare congenital anomaly which appears to occur in the absence of other cardiac or systemic anomalies. It predominates in males and tends to be clinically quiescent. The first case of quadricuspid pulmonic valve in a live newborn infant diagnosed by two-dimensional echocardiography is presented here with a review of the literature.

Construction of a high-affinity receptor site for dihydropyridine agonists and antagonists by single amino acid substitutions in a non-L-type Ca2+ channel

The activity of L-type Ca2+ channels is increased by dihydropyridine (DHP) agonists and inhibited by DHP antagonists, which are widely used in the therapy of cardiovascular disease. These drugs bind to the pore-forming alpha1 subunits of L-type Ca2+ channels. To define the minimal requirements for DHP binding and action, we constructed a high-affinity DHP receptor site by substituting a total of nine amino acid residues from DHP-sensitive L-type alpha1 subunits into the S5 and S6 transmembrane segments of domain III and the S6 transmembrane segment of domain IV of the DHP-insensitive P/Q-type alpha1A subunit. The resulting chimeric alpha1A/DHPS subunit bound DHP antagonists with high affinity in radioligand binding assays and was inhibited by DHP antagonists with high affinity in voltage clamp experiments. Substitution of these nine amino acid residues yielded 86% of the binding energy of the L-type alpha1C subunit and 92% of the binding energy of the L-type alpha1S subunit for the high-affinity DHP antagonist PN200-110. The activity of chimeric Ca2+ channels containing alpha1A/DHPS was increased 3.5 +/- 0.7-fold by the DHP agonist (-)Bay K8644. The effect of this agonist was stereoselective as in L-type Ca2+ channels since (+) Bay K8644 inhibited the activity of alpha1A/DHPS. The results show conclusively that DHP agonists and antagonists bind to a single receptor site at which they have opposite effects on Ca2+ channel activity. This site contains essential components from both domains III and IV, consistent with a domain interface model for binding and allosteric modulation of Ca2+ channel activity by DHPs.

Fine mapping of the autosomal recessive retinitis pigmentosa locus (RP12) on chromosome 1q; exclusion of the phosducin gene (PDC)

In a previous study on a large pedigree from a genetically isolated population in the Netherlands, we localized a gene for autosomal recessive retinitis pigmentosa with paraarteriolar preservation of the retinal pigment epithelium (PPRPE) on the long arm of chromosome 1. In this study, we present an integrated genetic map of the target region. The resulting genetic order of the markers was used to construct haplotypes and to screen for key-recombinants in the pedigree. The obligate RP12 region was reduced from 16 cM to 5 cM between the markers D1S533 and CACNL1A3. The CACNL1A3 and phosducin (PDC) genes were placed outside the candidate gene region, thereby excluding the involvement of these genes in retinitis pigmentosa with PPRPE. Our data result in the following order of the markers and genes in the region 1q31 --> q32.1: cen-D1S158-(D1S238-D1S422)/PDC- D1S533-RP12/(F13B-D1S413)-CACNL1A3-DIS4 77-D1S306-D1S53-tel.

Survival depends on effective partnerships with suppliers, management, and physicians

Partnering in health care materiel management circles is a concept that has been discussed for years. We, as materiel managers, have never accomplished effective partnering; but I propose that if we are to have a professional future, we should learn to establish effective partnership arrangements with our various customers--externally and internally.

Once bitten, twice shy

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Cancer biotherapy with interferon, interleukin-2 and tumor-derived activated cells (TDAC)

Interleukin-2 (Il-2) allows for the therapeutic augmentation of immunity in vivo and/or in vitro. In extensive studies in nearly 1000 patients with advanced cancer, we have demonstrated that Il-2 by continuous infusion, with cellular therapy (LAK or TDAC), is feasible, cost effective and useful in selected patients with melanoma and kidney cancer. Studies in patients with other tumor types are underway.

Stability of photorefractive spatial solitons

We present a theoretical analysis of the stability of photorefractive spatial solitons along with experimental results that show that the solitons are stable for small-scale perturbations but break down when the perturbations exhibit a transverse scale comparable with the soliton size (cross section).

Dimensionality and size of photorefractive spatial solitons

We study experimentally self-trapping of optical beams in photorefractive media and show that the trapping is inherently asymmetric with respect to the two (transverse) trapping dimensions. We also present experimental results that show how the sizes of the resultant photorefractive spatial solitons are independent (within their range of existence) of the amplitude of the externally applied electric field used to generate them.

A teaching tool for patients receiving continuous i.v. infusion recombinant interleukin-2 therapy

PURPOSE/OBJECTIVES

To present a tool developed to facilitate education of patients and families undergoing continuous i.v. therapy with interleukin-2 (IL-2).

DATA SOURCES

Published articles, book chapters, authors' clinical experience.

DATA SYNTHESIS

Topics covered in the teaching tool include development of IL-2, immune functioning, common side effects, side effect management, and when to contact healthcare providers.

CONCLUSIONS

Well-received by patients, families, and healthcare providers who reviewed the material.

IMPLICATIONS FOR NURSING PRACTICE

Use of a written patient education tool enables nurses to effectively teach patients with efficient use of nursing time.

Case management of the hospitalized patient receiving interleukin-2

Patients receiving intermediate-dose CI rIL-2 therapy require hospitalization for assessment and management of the potentially severe side effects, primarily those involved with cardiopulmonary and renal toxicities. Once the tolerable dose level has been identified for a particular patient, the severity of the side effects on subsequent cycles of therapy may decrease. During therapy, nursing management includes interventions to minimize distressing side effects such as fever, flu-like symptoms, fatigue, anorexia, and pruritus. Because the side effects of rIL-2 therapy are predictable, nurses can focus on early detection of these side effects and institute prompt interventions to reduce, minimize, or eliminate the symptoms. As oncology nurses prepare to care for hospitalized patients receiving rIL-2, a knowledge of the agent's side effect profile provides the foundation on which to base nursing practice.

Autosomal dominant retinitis pigmentosa: localization of a disease gene (RP6) to the short arm of chromosome 6

DNA from members of an Irish pedigree presenting with late onset autosomal dominant retinitis pigmentosa (ADRP) have been typed with a series of genetic markers from chromosome 6p. Positive two-point lod scores have been obtained with five markers (D6S89: theta = 0.10, Z = 3.338; D6S109: theta = 0.10, Z = 3.932; D6S105: theta = 0.00, Z = 6.081; HLA-DRA: theta = 0.00, Z = 4.364; and RDS: theta = 0.00, Z = 5.376). In a series of overlapping multipoint analyses a lod score of 6.6 was obtained, maximizing at HLA-DRA and hence localizing the ADRP gene (RP5) segregating in this pedigree to 6p. These data provide direct evidence for an additional autosomal dominant RP locus and strongly implicate the human equivalent of the mouse retinal degeneration slow (rds) gene, peripherin-rds, as a candidate for autosomal dominant retinitis pigmentosa.

Evaluation and clinical relevance of patient immune responses to intravenous therapy with murine monoclonal antibodies conjugated to adriamycin

A retrospective study was performed in order to examine the clinical relevance of human anti-murine antibodies (HAMA) to concurrent clinical events in 21 patients receiving intravenous therapy with cocktails of murine monoclonal antibodies conjugated to Adriamycin. In vivo tumor localization of the murine antibodies was also evaluated. Serum levels of HAMA, human-murine immune complexes (HMIC), and murine antibodies were measured using an automated fluorescence immunoassay. Immunohistochemical staining was performed on frozen sections of tumor biopsies from eight of the patients to examine the in vivo binding of the murine antibodies. The patients were divided into low, intermediate, and high antibody dose groups. The incidence of allergic symptoms (80%) and HAMA correlation (75%) were highest in the low dose group. Specific IgM HAMA was the most highly correlated with allergic reactions, being present in 61.5% of the allergic patients. Thirteen of the 21 patients studied (61.9%) developed allergic symptoms after one or more doses of the murine monoclonal antibody conjugates. The percentages of total antibody doses in the patients' sera at varying intervals post-infusion varied widely from patient to patient for any given time point and dose, suggesting complex factors in the distribution and clearance of the murine antibodies. All eight of the patients biopsied during or post-therapy exhibited tumor localization of the murine monoclonal antibodies. Six of the eight had concurrent HAMA in their sera. Thus, the presence of HAMA did not prevent in vivo localization of the murine antibodies in the target tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Recent advances in the management of biotherapy-related side effects: fatigue

Limited information about fatigue patterns in patients with cancer exists in the biotherapy literature. When fatigue is mentioned, it is usually to state whether or not it was a dose-limiting side effect. No further data are provided on how fatigue was measured; which patterns were noted and when; and which relationships were found between fatigue and demographic characteristics, type of biologic response modifier, route of administration, or cumulative dose. Thus, there is little available in the biotherapy literature to guide nursing practice in managing this side effect. Theory that guides practice, however, often emanates from the personal experiences of the patients and from the clinical observations and intuitive hunches of the nurses and physicians participating in clinical trials. These individuals have been most generous in sharing their insights and unpublished data with the authors. This paper presents a comprehensive view of current knowledge on fatigue to guide present nursing practice with patients receiving biotherapy and to provide direction for future nursing and clinical trial research.

Linkage analysis of human chromosome 4: exclusion of autosomal dominant retinitis pigmentosa (ADRP) and detection of new linkage groups

As part of our ongoing linkage studies of degenerative retinal diseases, we tested seven DNA markers and two classical genetic markers from chromosome 4 in two extended families with autosomal dominant retinitis pigmentosa (ADRP). Our goals were (1) to detect or exclude linkage of ADRP to markers spanning most of chromosome 4 and (2) to contribute useful new information regarding the linkage map of this chromosome. Our results exclude linkage of ADRP from more than 82% of chromosome 4. We detected four new linkage relationships: loose linkage of K082 (D4S10) and G1E5 (D4S21) at a distance of 21 cM; loose linkage of 4F2 (D4S18) and GC protein at a distance of 19 cM; tight linkage (i.e., no recombinants) between B3D (D4S44), B5A (D4S40), and the MNS blood group; and tight linkage between 4F2 and GDS5 (D4S23). These data, combined with previously reported data, exclude ADRP from approximately 35% of the human genome.

Glossal cysts in four infants

Cysts at the base of the tongue causing stridor may be fatal if they are not recognised and treated. Digital palpation along the surface of the tongue to the epiglottis is a useful diagnostic method. An operative technique that might avoid the need for tracheostomy is described.

An improved method for the generation of human lymphokine activated killer cells

In an effort to make interleukin-2/lymphokine-activated killer cell (IL-2/LAK) therapy safer for cancer patients, we examined the efficacy of using Fenwal PL732 bags as tissue culture flasks. These bags can be sterilly connected using tubing kits thus reducing the risk of contamination to the cells. Peripheral blood mononuclear cells were obtained from normal donors or cancer patients undergoing IL-2/LAK cell therapy. Following Ficoll-Hypaque purification, these cells were incubated in the presence of IL-2 in either PL732 plastic bags or standard tissue culture flasks. Our results showed that LAK cells could be generated from either normal donors or cancer patients in the bags as well as in the flasks. Comparisons were made of the LAK cell populations obtained from the two sources and showed that each was similar in terms of morphology as determined by Wright stain differentials. The populations of cells were also similar in regard to cell surface phenotype as determined by flow cytometric analysis. In addition, recoveries from either tissue culture vessel as well as cell viability of the LAK cells were comparable. Finally, the LAK cells obtained from both sources were assessed for cytolytic activity against the tumor cell lines K562 and Daudi. These results showed that the cytolytic activity of the LAK cells against these target cells was the same whether the cells were obtained from the flasks or the bags.