Corticosterone Contributes to Diet-Induced Reprogramming of Post-Metamorphic Behavior in Spadefoot Toads

Stressful experiences in early life can have phenotypic effects that persist into, or manifest during, adulthood. In vertebrates, such carryover effects can be driven by stress-induced secretion of glucocorticoid hormones, such as corticosterone, which can lead to developmental reprogramming of hypothalamic-pituitary-adrenal/interrenal axis activity and behavior. Nutritional stress in the form of early life nutrient restriction is well known to modify later life behaviors and stress activity through corticosterone-related mechanisms. However, it is not known whether corticosterone is also mechanistically involved in carryover effects induced by a different form of nutritional variation: the use of alternate or entirely novel types of dietary resources. The plains spadefoot (Spea bombifrons) presents an excellent system for testing this question, since larvae of this species have evolved to use 2 alternate diet types: an ancestral detritus-based diet and a more novel diet of live shrimp. While previous work has shown that feeding on the novel shrimp diet influences juvenile (i.e., post-metamorphic) behavior and corticosterone levels, it is unclear whether these diet-induced carryover effects are mediated by diet-induced corticosterone itself. To test for the mechanistic role of corticosterone in diet-induced carryover effects, we experimentally treated S. bombifrons larvae with exogenous corticosterone and measured subsequent effects on juvenile behavior and corticosterone levels. We found that while shrimp-fed larvae had elevated corticosterone levels, treatment of larvae with corticosterone itself had effects on juvenile behavior that partially resembled those carryover effects induced by the shrimp diet, such as altered food seeking and higher locomotor activity. However, unlike carryover effects caused by the shrimp diet, larval corticosterone exposure did not affect juvenile corticosterone levels. Overall, our study shows that corticosterone-related mechanisms are likely involved in carryover effects induced by a novel diet, yet such diet-induced carryover effects are not driven by corticosterone alone.

Clinical audit research and evaluation of motor neuron disease (CARE-MND): a national electronic platform for prospective, longitudinal monitoring of MND in Scotland

Objectives: Launched in 1989, the Scottish Motor Neuron Disease Register (SMNDR) has provided a resource for prospective clinical data collection. However, in 2015 we aimed to evolve a system to allow: i) A patient-centered approach to care based on recognized standards, ii) Harmonized data sharing between Scottish health professionals in "real-time", iii) Regular audit of care to facilitate timely improvements in service delivery, and iv) Patient participation in a diverse range of observational and interventional research studies including clinical trials. Methods: We developed a standardized national electronic data platform-Clinical Audit Research and Evaluation of MND (CARE-MND) which integrates clinical audit and research data fields. Data completion pre- and post-CARE-MND were compared, guided by recently published National Institute for Clinical Excellence (NICE) recommendations. Statistical difference in data capture between time periods was assessed using Z-test of proportions. Results: Data field completion for the historical 2011-2014 period ranged from 4 to 95%; median 50%. CARE-MND capture ranged from 32 to 98%; median 87%. 15/17 fields were significantly more complete post-CARE-MND (p < 0.001). All MND nurse/allied health specialists in Scotland use the CARE-MND platform. Management of MND in Scotland is now coordinated through a standardized template. Conclusions: Through CARE-MND, national audits of MND care and interventions have been possible, leading to protocols for harmonized service provision. Stratification of the MND population is facilitating participation in observational and interventional studies. CARE-MND can act as a template for other neurological disorders.

Dysregulation of follicle development in a mouse model of premature ovarian insufficiency

Premature ovarian insufficiency (POI) occurs in 1% of reproductive-age women. The ovarian manifestation ranges from the presence of a variable population of follicles (follicular) to the absence of follicles (afollicular), and in the majority of cases the cause is unknown. A transgenic mouse model of follicular POI, the Double Mutant (DM), arises from oocyte-specific deletion of Mgat1 and C1galt1 required for the generation of O- and N-glycans. DM females are subfertile at 6 weeks, infertile by 9 weeks and exhibit POI by 12 weeks of age. In this study we investigate the cause of the reduced fertility at 6 weeks and infertility at 9 weeks of DM females. Ovary sections were used to analyse follicle and corpora lutea (CL) numbers, apoptosis, and levels of laminin and 3β-hydroxysteroid dehydrogenase using immunohistochemistry. After POI, DM females unexpectedly remained sexually receptive. At both 6 and 9 weeks, DM ovaries contained more primary follicles, however, at 9 weeks DM follicles were proportionally healthier, revealed by TUNEL analysis compared with Controls. In 9 week DM ovaries (collected post-mating), secondary follicles had theca and basal lamina structure abnormalities, whilst preovulatory follicles failed to ovulate resulting in the presence of numerous luteinised unruptured follicles, indicative of ovulation failure. Finally, DM ovaries contained more regressing CL with decreased luteal cell apoptosis indicative of a defect in CL regression. Identifying these follicular modifications have provided insight into the aetiology of a model of POI and highlight targets to investigate with the hope of developing new fertility treatments.

Balancing the needs and preferences of humans against concerns for fishes: how to handle the emerging ethical discussions regarding capture fisheries?

How can stakeholders within the fisheries community engage in constructive ethical discussions? Drawing on experiences from previous debates surrounding the human use of animals, this paper presents a proactive approach whereby stakeholders can create a framework for ethical discussion of capture fisheries.

The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction

BACKGROUND

The project aims were to evaluate the benefit of transmucosal midazolam 0.2 mg/kg pre-medication on anxiety, induction behaviour and psychological morbidity in children undergoing general anaesthesia (GA) extractions.

METHOD

One hundred and seventy-nine children aged 5-10 years (mean 6.53 years) participated in this randomised, double blind, placebo-controlled trial. Ninety children had midazolam placed in the buccal pouch. Dental anxiety was recorded preoperatively and 48 hours later using a child reported MCDAS-FIS scale. Behaviour at anaesthetic induction was recorded and psychological morbidity was scored by the parent using the Rutter Scale preoperatively and again one week later. Subsequent dental attendance was recorded at one, three and six months after GA.

RESULTS

While levels of dental anxiety did not reduce overall, the most anxious patients demonstrated a reduction in anxiety after receiving midazolam premedication (p = 0.01). Neither induction behaviour nor psychological morbidity improved. Irrespective of group, parents reported less hyperactive (p = 0.002) and more pro-social behaviour (p = 0.002) after the procedure; older children improved most (p = 0.048). Post-GA dental attendance was poor and unaffected by premedication.

CONCLUSION

0.2 mg/kg buccal midazolam provided some evidence for reducing anxiety in the most dentally anxious patients. However, induction behaviour, psychological morbidity and subsequent dental attendance were not found to alter.

A randomised placebo-controlled trial of the effects of midazolam premedication on children's postoperative cognition

This randomised, placebo-controlled study assessed the effects of midazolam premedication on children's postoperative cognition and physical morbidity. In all, 179 children aged 5-10 years were randomly assigned to receive buccal midazolam (0.2 mg x kg(-1)) or placebo before sevoflurane-nitrous oxide anaesthesia for multiple dental extractions. They performed tests of choice reaction time, attention, psychomotor co-ordination and memory pre-operatively (baseline), before discharge and at 48 h. The reaction time of both groups was significantly slower before discharge compared to baseline, with the midazolam group being significantly slower than placebo. Psychomotor co-ordination was also significantly impaired postoperatively after midazolam. Performance on both tests had recovered to baseline by 48 h. Midazolam was also associated with significant anterograde amnesia, both postoperatively and at 48 h, for information presented in the interval between premedication and surgery. The results show significant short-term impairment of children's cognitive function and amnesia enduring for 48 h after low-dose midazolam premedication.

The effects of brief sevoflurane-nitrous oxide anaesthesia upon children's postoperative cognition and behaviour

This study assessed the effects of brief sevoflurane-nitrous oxide anaesthesia on children's postoperative cognition, behaviour and physical morbidity. Forty-eight children aged 5-10 years undergoing anaesthesia without premedication for multiple dental extractions, and 48 control children, performed tests of choice reaction time, attention, psychomotor co-ordination and memory pre-operatively (baseline), prior to discharge and at 48 h (anaesthesia group only). Physical and psychological morbidity were recorded at 1 week. Mean choice reaction time and psychomotor co-ordination were significantly impaired postoperatively but had recovered at 48 h. However, measures of performance variability suggested the presence of residual impairment. Profound retrograde amnesia affected postoperative and 48-h recall of pictorial stimuli presented prior to anaesthesia, but recognition memory was unimpaired. Attention-seeking, tantrums, crying and nightmares were occurring more frequently in some 8-20% of children 1 week after the procedure.

A partially blinded randomised controlled trial of patient-maintained propofol sedation and operator controlled midazolam sedation in third molar extractions

Patient-maintained sedation using propofol has recently been shown to be effective for dental surgery. We compared this new technique to the established technique of operator administered midazolam. The two groups were compared before, during and after sedation. The two primary outcomes were time until discharge and oxygen saturation. Vital signs, anxiety and psychomotor skills were also compared. State anxiety was reduced to a greater extent in the propofol group (mean difference 10 (SD 4) mm; p = 0.010. Propofol patients recovered quicker (mean difference 7 (SD 1.4) min; p = 0.001). Propofol patients had a smaller reduction in arterial oxygen saturation (mean difference 0.8 (SD 0.3)%; p = 0.030), and a reduced increase in heart rate (mean difference 9 (SD 2) beats.min(-1); p < 0.001). Both techniques were well tolerated and safe. Propofol sedation offered superior anxiolysis, quicker recovery, less amnesia and less depression of simple psychomotor function.

Patient maintained sedation for colonoscopy using a target controlled infusion of propofol

In this study, we evaluated safety and recovery using a patient maintained, target controlled infusion of propofol for sedation in 20 patients undergoing colonoscopy. Using a handset with a two-minute lockout interval, patients could make 0.2 micro g.ml(-1) increments to an initial target plasma concentration of 1 micro g.ml(-1) up to a maximum 4.5 micro g.ml(-1). Four patients became oversedated but required no airway or circulatory interventions. Subjects had a significant reduction in mean (SD) heart rate: 78.7 (15) vs. 69.8 (13.5) (p < 0.001) and in systolic blood pressure 121.1 (13.2) mmHg vs. 96.5 (8.6) mmHg (p < 0.001). Choice reaction time testing 15 min after colonoscopy showed a significant median (IQR [range]) rise of 162 (- 16, 383.3 [-199-859]) ms (p < 0.05). Six patients had faster reaction times postcolonoscopy. All patients denied unpleasant recall and were satisfied with the system. Although oversedation was a problem in this model, we conclude that patient maintained propofol sedation could be possible for colonoscopy.

Long term neuropsychological outcome after head injury: relation to APOE genotype

BACKGROUND

Existing evidence suggests that some patients who sustain a head injury suffer cognitive decline many years later, and that head injury and possession of the APOE epsilon 4 allele are each risk factors for Alzheimer's disease.

OBJECTIVE

To determine whether late cognitive decline after head injury is more prevalent among carriers of APOE epsilon 4.

METHODS

A database of head injured patients was used. Initial assessment was at the time of their injury, between 1968 and 1985, and outcome data at six months were available. Their ages at the time of injury ranged between 2 and 70 years. A cohort of 396 subjects was reassessed at a mean of 18 years later, with determination of APOE genotype and detailed neuropsychological testing.

RESULTS

Judging by the Glasgow outcome scale, twice as many patients had deteriorated as improved between six months after injury and the late assessment; 22.2% of APOE epsilon 4 carriers had a good late outcome compared with 30.5% of non-carriers (95% confidence interval for the difference, -0.7% to 17.2%; p = 0.084). There were no clear differences between epsilon 4 carriers and non-carriers in detailed neuropsychological assessments.

CONCLUSIONS

Although this study provides additional evidence that a late decline may occur after head injury, there was no clear relation to APOE genotype. Despite the follow up interval of 15 to 25 years, the cohort is still too young (mean age 42.1 years) to assess the risk of Alzheimer's disease.

Randomized clinical trial of no wound drains and early discharge in the treatment of women with breast cancer

BACKGROUND

Women undergoing surgery for primary breast cancer routinely have suction drains inserted deep to the wounds, which are removed approximately 6-8 days after operation, requiring a period of stay of that duration in hospital. The aim of this study was to perform a prospective randomized clinical trial to evaluate a new surgical technique of suturing flaps without wound drainage, combined with early discharge, in women undergoing surgery for breast cancer.

METHODS

A total of 375 patients undergoing surgery for breast cancer were randomized to conventional surgery or suturing of flaps with no drain. The main outcome measures were length of hospital stay, surgical morbidity, psychological morbidity and health economics.

RESULTS

Suturing of flaps and avoiding wound drainage in women undergoing surgery for breast cancer resulted in a significantly shorter hospital stay. Adopting this surgical technique with early discharge did not lead to any difference in surgical or psychological morbidity. Health economic benefits to the National Health Service resulted from saved bed days with no impact on community costs.

CONCLUSION

Wound drainage following surgery for breast cancer can be avoided, thereby facilitating early discharge with no associated increase in surgical or psychological morbidity.

Humic acid enhanced remediation of an emplaced diesel source in groundwater. 1. Laboratory-based pilot scale test

The enhanced solubility of petroleum-derived compounds in humic acid solutions is the basis for a new groundwater remediation technology. In this unique pilot-scale test, a stationary contaminant source consisting of diesel fuel was placed below the water table in a model sand aquifer (1.2 x 5.5 x 1.8-m deep) and flushed with water at a flow rate of 2 cm/h over 5 years. At 51 days, laboratory grade humic acid was added to the water and maintained at a level of approximately 0.8 g/l. The addition of humic acid had only a small impact on the aqueous transport of the BTEX components, which were rapidly dissolved from the diesel, but had a large effect on the flushing of PAHs, including methylated naphthalenes (MNs). Binding to aqueous humic acid enhanced the solubilization of MNs two- to tenfold. During aqueous transport, biodegradation of the BTEX and PAHs occurred, limiting the lateral and longitudinal extent of the diesel contaminant plume in the model aquifer. It appears that through enhanced solubilization, the overall biodegradation rate of the MNs was increased. As the various MNs were depleted from the diesel source, the MN plume shrank and then disappeared.

Humic acids enhanced removal of aromatic hydrocarbons from contaminated aquifers: developing a sustainable technology

Contamination by gasoline and diesel fuels is a threat to groundwater resources. Polynuclear aromatic hydrocarbons (PAHs) which can represent up to 60% of volume in diesel fuels are of particular concern because many of them are carcinogenic and they are persistent, especially in oxygen-limited environment. Despite the development of alternative approaches, pump and treat continues to be the leading technology for the remediation of groundwater contaminated by gasoline and diesel fuels. The efficiency of this technology is however limited by the low solubility of the aromatic hydrocarbons. The objective of this study was to investigate the influence of humic acids on the removal of aromatic hydrocarbons from petroleum products in groundwater aquifers and to evaluate the potential use of humic acids, as a cost effective additive, in groundwater and soil remediation. In order to prove the feasibility of using humic acid in the field, a pilot scale experiment was conducted in a model aquifer with a very dense monitoring network, providing controlled conditions only possible in a semi-artificial system. In addition, different sources of humic acids were compared with surfactants for their ability to bind PAHs.

Pre-existing cognitive impairment as a factor influencing outcome after cardiac surgery

Conventional methodology to investigate cognitive impairment after coronary artery bypass graft (CABG) surgery leaves unclear the potential for pre-existing cognitive deficits to influence outcome. Individuals with pre-existing deficits may be more vulnerable to the effects of CABG, hence biasing the results of a typical prospective trial if account is not taken of their state. The present study examined the effect of pre-existing cognitive impairment upon cognitive outcome in 81 patients undergoing CABG. Patients performed the Stroop Neuropsychological Screening Test and other psychometric assessments prior to and at 6 days and 6 months after CABG. Those with pre-existing cognitive deficits were significantly more likely to display impairment at 6-day and 6-month follow-ups than were those without pre-existing deficits. Greater age and lower pre-morbid intelligence were also significant predictors of post-CABG deficit, confirming earlier findings. The results imply both that pre-existing cognitive impairments may render patients more vulnerable to post-operative deficits and that, in the absence of such pre-existing impairments, CABG surgery does not inevitably lead to later deficits. The study also replicated previous findings showing a similar influence of pre-existing depression upon emotional state after CABG. Overall, the results confirm the importance both of a patient's pre-existing cognitive and emotional states, and the methodology to assess them, in influencing outcome after cardiac surgery and the conclusions to be drawn as to the supposed adverse effects of the procedure.

Blood alcohol concentration and psychomotor effects

This study assessed the effect of intravenous alcohol infusions on psychomotor impairment and compared it with that of alcohol administered orally. Comparisons were made between three European drink-driving limits of blood alcohol concentration (BAC) (20, 50 and 80 mg 100 ml-1) and an oral dose of alcohol 0.75 mg kg-1. Twelve volunteers, aged 22-34 yr, were recruited. At targets of 20, 50 and and 80 mg 100 ml-1, the mean (SD) BAC was 22.1 (3.7), 51.5 (3.3) and 80.5 (4.2) mg 100 ml-1, respectively. The peak BAC following an oral dose of alcohol 0.75 mg kg-1 ranged from 19 to 68 mg 100 ml-1. In psychomotor testing, choice reaction time deteriorated with increasing BAC and showed significant differences between baseline and the 50 (P < 0.05) and 80 mg 100 ml-1 (P < 0.01) conditions. Dual-task secondary reaction time deteriorated with increasing BAC and showed a statistically significant difference between all groups and baseline (oral and 20 mg groups, P < 0.05; 50 and 80 mg groups, P < 0.01). Dual-task tracking in the 50 and 80 mg groups was significantly different from baseline (P < 0.05 and P < 0.01, respectively). Oral dosing resulted in widely variable BACs, making it difficult to assess psychomotor impairment reliably. An intravenous infusion enables the BAC to be maintained within a narrow range. This allows precision when investigating the effects of alcohol on psychomotor performance.

Blood propofol concentration and psychomotor effects on driving skills

We studied psychomotor performance in 10 healthy volunteers during recovery after a target-controlled infusion of propofol. Choice reaction time, dual task tracking with secondary reaction time and a within-list recognition task were assessed at target blood propofol concentrations of 0.8, 0.4 and 0.2 microgram ml-1. Performance was impaired most at the highest blood propofol concentration (choice reaction time increased by a mean of 247 ms and secondary reaction time by a mean of 178 ms). Choice reaction time and dual task tracking with secondary reaction time were the most sensitive and reliable methods of assessment (significant difference from baseline (P < 0.05) at a propofol concentration of 0.2 microgram ml-1 with choice and secondary reaction time testing). Within-list recognition assessment of memory was not sufficiently sensitive at very low propofol concentrations. The impairment in choice and secondary reaction time with a blood propofol concentration of 0.2 microgram ml-1 was less than that observed with a blood alcohol concentration of 50 mg 100 ml-1 and no greater than that observed with a blood alcohol concentration of 20 mg 100 ml-1 in a previous study involving healthy volunteers.

Tissue plasminogen activator and its receptor in the human amnion, chorion, and decidua at preterm and term

The plasminogen activator system consists of two proteins: tissue plasminogen activator (tPA) and urokinase plasminogen activator (uPA), which act upon their specific receptors to generate plasmin from plasminogen located on the cell surface. Plasmin then acts directly and indirectly to degrade the components of the extracellular matrix (ECM). This process is likely to be important in the normal turnover of the ECM of fetal membranes and in its premature weakening in preterm premature rupture of the fetal membranes. Quantitative Northern analysis and in situ hybridization have shown that the decidua expresses mRNA for tPA. However, the immunolocalized tPA protein was most strongly associated with the amnion and chorion, as was its receptor annexin II, suggesting that the amnion and chorion are the targets for decidual tPA. At term, decidual tPA expression was unaffected by labor, and the tPA receptor was elevated both before and after labor. At preterm, the converse was found: decidual tPA expression was significantly (p < 0. 05) up-regulated by labor, but the tPA receptor was not. The results suggest that the generation of plasmin at term would be controlled by an increased concentration of the tPA receptor in the amnion and chorion, whereas at preterm a pathological increase in plasmin would be generated by an overexpression of tPA, initiated by labor.

Is residual impairment after alcohol an effect of repeated performance?

BACKGROUND

The study examines the residual impairment of performance due to alcohol on the descending limb of the blood alcohol curve. The occurrence of residual impairment at low or zero levels of blood alcohol is well established but its cause is uncertain. It is hypothesized that residual impairment may be due in part to the methodological procedure of repeated performance testing in the post-ingestion period.

METHODS

There were 80 volunteers randomly allocated to one of four treatment conditions: a) alcohol and repeated performance (A-R) where psychomotor tasks were performed at 20-min interval for 2 h post ingestion; b) alcohol and double performance (A-D) where tasks were performed only at 1 h and 2 h from ingestion; c) placebo and repeated performance (P-R); and d) placebo and double performance (P-D). Alcohol was administered as vodka to achieve a peak blood-alcohol concentration (BAC) of approximately 80 mg per 100 ml. Performance effects were assessed by a dual task of primary pursuit tracking and secondary visual reaction time, and a visual sustained attention task.

RESULTS

Alcohol caused significant impairment of secondary reaction time, the effect being greatest at peak BAC. Sustained attention was also impaired by alcohol but the effect just missed significance. Repeated performance conditions were associated with significantly greater impairment of secondary reaction time and sustained attention when compared with double performance conditions. The factor of performance condition did not, however, interact with that of alcohol.

CONCLUSIONS

The monotony and boredom that may be associated with repeated performance do not contribute to residual alcohol impairment.

Effects of meal composition on blood alcohol level, psychomotor performance and subjective state after ingestion of alcohol

Moderating effects of meal composition on psychomotor performance impairment and feelings after alcohol were examined in a between-subjects design. Fifty-one male volunteers fasted or received either a high carbohydrate (85% energy) or a high protein (94% energy) meal. Alcohol was administered at a dose to achieve a blood alcohol level (BAL) of 60 mg/100 ml, as a placebo. Subjects performed a dual task of primary tracking and secondary reaction time and a five-choice reaction time task. Feelings were also assessed by rating. The high carbohydrate meal reduced BAL at peak and 2 h after drinking, but a high protein meal had no significant effect. Although performance was impaired by alcohol, neither meal significantly reduced impairment and there was no effect of meal type on performance in the placebo condition. However, alcohol increased rated intoxication and the high carbohydrate meal reduced this effect. Subjects who had consumed high protein meals had more negative affect 2 h after alcohol than did subjects who had consumed high carbohydrate meals or fasted. It is concluded that there is only a weak relationship between BAL and performance impairment and food has only limited effects on impairment, although it reduces BAL.

Verbal expectancies and performance after alcohol

New verbal expectancies about the effects of alcohol were experimentally induced in subjects by suggesting in writing and verbally that food had positive, negative, or neutral effects on performance after alcohol. Subjects (n = 120, male) received this suggestion, food (fed or fasted), and alcohol (alcohol or placebo) in a between-subjects design. Alcohol impaired reaction time and tracking (with a secondary reaction-time task). Food reduced this impairment. The verbal expectancy manipulation had no effect on performance, although it had a marginally significant effect on rated ability to perform. It is concluded that verbal expectancy effects about alcohol influence verbal or social behaviours more easily than cognitive processes.

A system for psychomotor evaluation; design, implementation and practice effects in volunteers

This paper describes the design, implementation and assessment of PsychE, psychomotor evaluation system. Six standard tests are included: numeric vigilance, a dual task, probed memory recall, simple reaction time, choice reaction time and semantic long-term memory. The test presentations are described in detail. Practice effects were assessed in 10 healthy volunteers and were only evident in the performance measures for the simple reaction time test. For the remaining five tests, stable performance was reached within a single test session. The volunteers were healthy and most were regular users of computers. Therefore, the lack of practice effects cannot be assumed for the general population. A control group is essential for all studies using these tests. The system is implemented on an IBM-compatible personal computer and includes a database shell for the convenient collection, storage and analysis of performance data.

Category generation testing in the search for implicit memory during general anaesthesia

We gave auditory examples of two semantic categories through headphones to 100 surgical patients anaesthetized with propofol and enflurane. This presentation was made during certain stages of the procedure, potentially associated with arousal, and during steady-state anaesthesia. Postoperative review using category generation tests showed successful priming in a pre-induction group but no evidence of implicit memory in the anaesthetized groups. These results suggest that timing an auditory input to coincide with surgical stimulation does not increase the probability of retrieval of information by this type of testing.

Processing messages about disease detection and health promotion behaviors: the effects of anxiety

A study was conducted to examine the effects of anxiety on the processing of messages that encourage the performance of disease detection and health promotion behaviors. It was hypothesized that under high-anxiety conditions messages about health promotion behaviors would be processed more than messages about disease detection behaviors and that this effect would reverse under lower levels of anxiety. To test this hypothesis, the participants were required to read information designed either to increase or to decrease anxiety about health. Following the anxiety manipulation, participants received a strong or weak message promoting the performance of either health promotion or disease detection behaviors. Then participants were required to indicate their attitudes about the behavior, their cognitive responses to the message, and their recall of the message. The results support the hypothesis.

Music in theatre: not so harmonious. A survey of attitudes to music played in the operating theatre

Music played to staff in the operating theatre is thought to improve surgeons' concentration but its effects on other theatre staff are unknown. We surveyed 200 anaesthetists to determine the prevalence of music playing in the operating theatre and anaesthetists' attitudes to it. The response rate was 72% and of these 72% (104) worked in a theatre where music was played regularly. Around 26% of the sample felt that music reduced their vigilance and impaired their communication with other staff while 11.5% felt that music might distract their attention from alarms. Fifty-one per cent felt that music was distracting when a problem was encountered during the anaesthetic.

Some common characteristics of pregnant teen who choose childbirth

This non-experimental survey study identified some of the common characteristics of pregnant teen who choose childbirth. Respondents reported a history of physical abuse, sexual abuse, family violence, and substance abuse, as well as thoughts and attempts of suicide. These findings can assist nurses and others in developing programs to intervene with adolescents at risk for pregnancy.

The effects of anxiety on response times to disease detection and health promotion behaviors

It was hypothesized that increasing levels of anxiety about health issues would make response times to disease detections longer than response times to health promotion behaviors and that this effect would reverse when anxiety about health issues was decreased. In a laboratory study 82 participants recruited from undergraduates and the general community were randomly assigned to read information designed either to increase or to decrease anxiety about health. Following the anxiety manipulation participants were required to indicate their attitude about both disease detection and health promotion behaviors and response times to both types of behavior were recorded. Finally, the participants' attitudes toward all the health behaviors were measured using 9-point scales. The results supported the hypothesis.

Patient-controlled analgesia with morphine and droperidol following caesarean section under spinal anaesthesia

BACKGROUND

The addition of droperidol to morphine for patient-controlled analgesia reduces the incidence of nausea and vomiting, but may result in unwanted side effects.

METHOD

We studied 40 women randomised to receive morphine sulphate with or without added droperidol (10mg droperidol/60 mg morphine) by patient-controlled analgesia following elective caesarean section under spinal anaesthesia.

RESULTS

Median morphine demand in the 20 h after surgery was 74 mg with morphine alone, and 53 mg with added droperidol, the median consumption of which was 8.8 mg. The incidence of nausea was reduced from 80% to 38.8% (P < 0.01), and that of emesis from 55% to 16.7% (P < 0.05) by the addition of droperidol. Psychomotor function was significantly impaired to a similar degree in both groups and there was no significant difference in sedation scores or pain scores. Subjective drowsiness which resulted in withdrawal from the study occurred in two patients, both of whom were receiving droperidol, and though all patients who completed the study were satisfied with their analgesia overall, significantly more of those receiving unsupplemented morphine (11/19 compared with 4/18, P < 0.05) described it as excellent.

CONCLUSION

The addition of droperidol 10 mg to morphine 60 mg for PCA following caesarean section under spinal anaesthesia reduces the incidence of nausea and emesis, but may result in drowsiness, limiting the usefulness of the technique.

Cognitive failures after general anaesthesia for day-case surgery

Patients are normally thought to have recovered from general anaesthesia within a few hours after day-case surgery. Previous recovery studies using objective psychometric tests showed a return to baseline values within this period. Nevertheless, patients are advised about what activities they should not undertake in the subsequent 24 h because it is feared that the residual anaesthetic effects may impair their ability. These studies did not follow patients out of hospital and their relevance to the real world is not known. Using the cognitive failures questionnaire, a standard measure of performance of everyday tasks, 54 patients were asked to report their own performance after general anaesthesia for the 3 days after discharge from hospital: 30 local anaesthetic patients were studied for comparison. The general anaesthesia group reported a highly significant greater incidence of cognitive failures after anaesthesia compared with the local anaesthesia group. This suggests that the residual effects of anaesthesia persist beyond 24 h.

The effects of expectancy and alcohol on cognitive-motor performance

Previous studies have found equivocal evidence for expectancy effects on cognitive-motor performance. The effects of expectancy and alcohol on a dual tracking and reaction-time task analogous to some driving skills, and on choice reaction-time, were studied in a balanced-placebo design (n = 90). A dose of alcohol achieving 80 mg/100 ml (high dose) had large effects on both tasks, but a low dose (40 mg/100 ml) had no significant effects. Expecting alcohol led to subjects who received the high dose performing significantly better on the primary tracking task than subjects expecting placebo (but also receiving the high alcohol dose). By contrast, on a secondary reaction-time task, subjects who had received placebo performed worse 100-130 minutes after drinking, if they had expected alcohol. All groups felt more drunk than baseline and expecting alcohol made subjects feel more able to perform, whatever drink they had received. The implications of these findings for the nature of expectancy effects on performance and the relationship between expectations and strategy are discussed.

An in vivo model for screening peptidomimetic inhibitors of gelatinase A

Gelatinase A, a matrix metalloproteinase, is frequently associated with human solid tumors, and its secretion and activation in the tumor milieu is considered important in the process of angiogenesis, invasion, and metastasis. Consequently, metalloproteinase inhibitors may be of value in the therapy of cancer as well as other disease states involving tissue remodeling and release of biologically active peptide/protein by proteolytic cleavage. Here we describe the development of a rapid screening assay for in vivo activity of peptidomimetic inhibitors of gelatinase A that involves assessment of inhibition of an enzyme-substrate reaction in a circumscribed body compartment, the mouse pleural cavity. As examples of the utility of this assay, in vivo activity of the aryl sulfonamide, sulfamyl urea, morpholino and carboxylic acid functionality at the P3' position of a series of hydroxamic acid inhibitors was examined after administration both intraperitoneally (ip) (to approximate systemic administration) and orally. For up to 2 h after ip administration, all inhibitors tested showed marked activity (> 90% inhibition) at 17 mumol/kg (approximately 10 mg/kg). This activity declined in a dose-responsive manner to insignificant levels at 0.67 mumol/kg (approximately 0.4 mg/kg). Aryl sulfonamides showed significant inhibition (> 50%) for up to 7 h after administration. A higher dosage (136 mumol/kg, approximately 80 mg/kg) was required to reveal oral activity, which was observed only with morpholino compounds (> 50% inhibition). Thus, the model described may be of value in the identification of orally active gelatinase A inhibitors.

Negative affective consequences of thinking about disease detection behaviors

It was proposed that thinking about disease-detection behavior would lead to more negative moods than thinking about health-promotion behavior. Detection behaviors produce more negative moods because they can threaten perceptions of good health. In a laboratory study, the initial mood states of 121 participants recruited from undergraduates and the general community were measured using a neutral-words rating procedure. Then participants were randomly assigned to think about performing a disease-detection behavior or a health-promotion behavior. Subsequently, they wrote down their responses to the behavior and evaluated these as either positive, negative, or neutral. Finally, the participant's mood was remeasured using both a neutral words-rating procedure and a more traditional bipolar rating measure. Results indicated that thought about disease-detection behavior produced more negative affective responses and more negative mood change than did thought about health-promotion behavior.

Influence of ivermectin on cellular and humoral immune responses of lambs

In view of the extensive use of anthelmintics in sheep and the fact that their activity may in part depend upon the immune system, we were interested to determine if ivermectin had any influence on aspects of the sheep immune response. Ten parasite-free 6-month-old lambs were drenched with ivermectin and 1 day later were given intravenously human erythrocytes and subcutaneously ovalbumin. Ten other lambs with injected antigens were not drenched and served as controls. Both groups were bled at intervals for cells and serum. The procedure was repeated on day 28. Lymphocytes from the drenched lambs, cultured in vitro in RPMI plus 50% autologous serum collected up to 7 and 14 days after the first and second antigen injections respectively, had decreased blastogenic activity compared with lymphocytes from control lambs. Similar results were obtained with lymphocytes cultured in RPMI 1640 supplemented with 50% autologous serum plus concanavalin A (Con A) or phytohaemagglutinin (PHA). When washed, lymphocytes were cultured in RPMI 1640 supplemented with 5% foetal calf serum (FCS) or 5% FCS plus Con A or PHA, decreased blastogenesis was observed but blastogenesis depression was not as marked as that observed with autologous serum. Similar antibody responses were seen for the drenched and control groups in response to the two injections of both antigens except that after the second injection, there was a significant reduction in antibody response to ovalbumin in the ivermectin-treated lambs. There were no differences in serum complement or serum nitric oxide levels between the two groups at any stage, but insulin-like growth factor-1 levels were significantly reduced in serum of the ivermectin-treated group, 4 days after each drench. Growth hormone levels were consistently significantly higher 22 days after both drenchings. There was no difference in mean body weight increase between the groups during the experiment.

Assessment of preoperative anxiety: comparison of measures in patients awaiting surgery for breast cancer

We have compared three measurements of anxiety to determine their equivalence in assessing anxiety before surgery. Forty-four patients awaiting breast cancer surgery completed the state scale of the state-trait anxiety inventory (STAI), the hospital anxiety and depression scale (HAD) and a 100-mm visual analogue scale (VAS). Analysis restricted to correlations between the scales gave the misleading impression that VAS scores were inconsistent with those of the HAD and STAI. However, when scores were considered in relation to normative cut-off values to categorize anxiety levels, the three scales showed good agreement. We conclude that the scales were equivalent in their assessment of anxiety before surgery, but that reference to normative data was important in establishing such equivalence and in determining the patient's state.

Comparative biodistributions of indium-111-labelled macrocycle chimeric B72.3 antibody conjugates in tumour-bearing mice

A novel 111In ligand (a C-functionalised derivative of 1,4,7-triazacyclononanetriacetic acid), termed 9N3, was covalently attached to chimeric B72.3, labelled with 111In and compared with 111In-labelled chimeric B72.3 diethylenetriaminepentaacetic acid (DTPA) cyclic anhydride conjugate (cDTPA) and a C-linked derivative of DTPA (CT-DTPA) in athymic mice bearing human colon carcinoma xenografts. Significant differences in biodistribution were observed between 9N3 and cDTPA conjugates especially in the tumour uptake and blood, liver, femur and colon levels at 24, 48 and 144 h. Significantly higher tumour uptake was observed for 111In-cB72.3-9N3 compared with 111In-cB72.3-cDTPA at all time points. Radiolocalisation (RI) indices increased with time for the 9N3 conjugate but remained constant for the cDTPA conjugate. The biodistribution of 111In-labelled cB72.3-CT-DTPA was similar to that of 111In-labelled cB72.3-9N3 except for elevated kidney levels. A 12N4 macrocycle (a C-functionalised derivative of 1,4,7,10-tetraazacyclododecanetetraacetic acid) was also tested for its ability to chelate 111In and its biodistribution examined. Labelled conjugates with this macrocycle were more difficult to prepare in a stable form but gave a very similar biodistribution to the 9N3 macrocycle conjugate. Macrocycle-antibody conjugates of this type offer considerable promise for tumour imaging in patients.

Personality traits as predictors of anxiety prior to caesarean section under regional anaesthesia

One hundred and fifteen patients scheduled for elective Caesarean section under regional anaesthesia were questioned to determine their personality profiles and anxiety state. Positive correlations were found between neuroticism and anxiety scores (p < 0.05). Patients with tendencies towards both neuroticism and introversion had higher pre-operative anxiety scores than other personality types (p = 0.015). In general, previous experience did not reduce pre-operative anxiety and personality appeared to be a better predictor of anxiety prior to Caesarean section under regional anaesthesia. Some personality types might benefit from additional support to improve their ability to cope with this stressful event.

Efficacy of therapeutic suggestions presented during anaesthesia: re-analysis of conflicting results

Re-analysis has been made of two clinical studies which used similar methodologies but found different effects of so-called therapeutic suggestions presented to anaesthetized patients undergoing abdominal hysterectomy. The re-analysis suggested that when data from the two studies were examined jointly, it was uncertain if positive suggestions had a reliable influence upon the recovery measure of "days to discharge". The supposed positive effect reported in one of the studies may arise from a rather different distribution of data in the control group. It is proposed that the effect may be attributable to chance bias in allocation of patients to the control group, or to some other chance anomaly in the composition of the group as a result of relatively small sample size. The importance of sample size is discussed in relation to detection of effects when only a few patients may be in a state susceptible to intra-anaesthetic suggestions. The importance of presenting data distributions in addition to summary statistics is also emphasized.