Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey

OBJECTIVES

This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections.

STUDY DESIGN

The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland.

METHODS

Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression.

RESULTS

Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043).

CONCLUSIONS

Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.

Spectral induced polarization signatures of smoldering remediation enhanced with colloidal activated carbon: An experimental study

Monitoring the remediation of soil and groundwater contaminated by organic compounds remains highly challenging. Thermal treatments, such as smoldering combustion, have become established remediation techniques for destroying contaminants. Smoldering combustion can now be supported by colloidal activated carbon (CAC), with CAC being able to both adsorb contaminants and supplement the fuel source for destroying them. Despite this potential, effective performance monitoring of smoldering remediation remains limited. The objective of this study is to investigate the potential of the spectral induced polarization (SIP) geoelectrical technique to assess the performance of smoldering remediation of soils supplemented with CAC. SIP column experiments were first conducted to assess the response of SIP (i.e., real and imaginary components of the complex electrical conductivity) to varying concentrations of CAC in imitated field soils that contain, or do not contain, organic matter (OM). Results demonstrate that increasing OM and CAC contents increase both the real and imaginary conductivities, with the imaginary conductivity also showing frequency dependence. Smoldering and SIP column experiments were then conducted to assess the effectiveness of SIP for detecting changes in soils of varying OM and CAC contents that have been remediated by smoldering. Examination of the soils before and after smoldering indicates that SIP can track the evolving real conductivity and imaginary conductivity (in particular) between different soil compositions and different stages of the remedial process. High resolution scanning electron microscopy imaging was performed on all samples to validate the SIP and smoldering experiments, confirming significant reductions in carbon after smoldering. Overall, this study suggests that SIP has potential to track changes associated with the addition of remedial fluids like CAC in the subsurface, and the destruction of contaminants adsorbed to CAC by smoldering combustion.

A-79 Flynn Effect Correction: Accuracy Base Rate for IQ/Ability Level

Objective

Flynn Effect (FE) is the observed rise in population psychometric intelligence quotient (IQ) scores over time, approximately three IQ points per decade. Sometimes in forensic evaluations, points are deducted from archival IQ scores to “correct” for FE. This study determined the accuracy of FE correction for three IQ ranges.

Method

Participants were 240 people (age: M = 52.7, SD = 24.4; 149 female) from the WAIS-IV standardization group who took the WAIS-III and WAIS-IV in counterbalanced order with an inter-test interval from 6-163 days. WAIS-IV Full Scale IQ (FSIQ) scores were subtracted from WAIS-III scores and differences were divided into two groups: 1.) > 2 IQ points – when applying FE correction to a WAIS-III score produced a more accurate estimate and 2.) < 1 IQ points – when applying FE correction produced a less accurate estimate. Accuracy base rates were tabulated for three WAIS-III FSIQ groups: below average < 89; average 90-109; and above average groups > 110.

Results

FE correction produced more accurate WAIS-IV FSIQ estimates for 70% of the below average group, 56% of the average group, and 65% of the above average group.

Conclusions

Applying an FE correction provides a more accurate WAIS-IV IQ estimate about half the time for average IQ scores and about two-thirds of the time for above and below average IQ scores. (Standardization data from the WAIS-III Copyright © 1997 NCS Pearson Inc. & WAIS-IV Copyright © 2008 NCS Pearson Inc. Used with permission. All rights reserved.)

Data Set for the Reporting of Malignant Odontogenic Tumors: Explanations and Recommendations of the Guidelines From the International Collaboration on Cancer Reporting

A data set has been developed for the reporting of excisional biopsies and resection specimens for malignant odontogenic tumors by members of an expert panel working on behalf of the International Collaboration on Cancer Reporting, an international organization established to unify and standardize reporting of cancers. Odontogenic tumors are rare, which limits evidence-based support for designing a scientifically sound data set for reporting them. Thus, the selection of reportable elements within the data set and considering them as either core or noncore is principally based on evidence from malignancies affecting other organ systems, limited case series, expert opinions, and/or anecdotal reports. Nevertheless, this data set serves as the initial step toward standardized reporting on malignant odontogenic tumors that should evolve over time as more evidence becomes available and functions as a prompt for further research to provide such evidence.

Specific polarizability of sand-clay mixtures with varying ethanol concentration

We utilise a concept of specific polarizability (c _s ), represented as the ratio of mineral-fluid interface polarization per pore-normalised surface area S _p , to demonstrate the influence of clay-organic interaction on complex conductivity measurements. Complex conductivity measurements were performed on kaolinite- and illite-sand mixtures as a function of varying ethanol (EtOH) concentration (10% and 20% v/v). The specific surface area of each clay type and Ottawa sand was determined by nitrogen-gas-adsorption Brunauer-Emmett-Teller method. We also calculated the porosity and saturation of each mixture based on weight loss of dried samples. Debye decomposition, a phenomenological model, was applied to the complex conductivity data to determine normalised chargeability (m _n ). Specific polarizability estimates from previous complex conductivity measurements for bentonite-sand mixtures were compared with our dataset. The c _s for all sand-clay mixtures decreased as the EtOH concentration increased from 0% to 10% to 20% v/v. We observe similar c _s responses to EtOH concentration for all sand-clay mixtures. Analysis of variance with a level of significance α = 0.05 suggests that the suppression in c _s responses with increasing EtOH concentration was statistically significant for all sand-clay mixtures. On the other hand, real conductivity showed only 10% to 20% v/v changes with increasing EtOH concentration. The c _s estimates reflect the sensitivity of complex conductivity measurements to alteration in surface chemistry at available surface adsorption sites for different clay types, likely resulting from ion exchange at the clay surface and associated with kinetic reactions in the electrical double layer of the clay-water-EtOH media. Our results indicate a much larger influence of specific surface area and ethanol concentration on clay-driven polarization relative to changes in clay mineralogy.

IgG, IgA and IgM by Formylated Rocket Immunoelectrophoresis

Formylated rocket electrophoresis has been investigated as a means of measuring the serum immunoglobulins IgG, IgA, and IgM. This procedure is simpler to carry out than carbamylation. Comparison of formylated rocket results with those from the automated immunoprecipitin (A.I.P.) system and single radial immunodiffusion (S.R.D.) gives correlation coefficients of 0.92 to 0.98 and reproducibility comparable with the A.I.P. system and better than S.R.D. The procedure is recommended for use in laboratories when the number of requests for immunoglobulins does not warrant a specific protein analyser.

Simplified Area Measurement in Two-Dimensional Immunoelectrophoresis

A simplified method of measuring two-dimensional immunoelectrophoresis slides is described. The correlation between measurements made by the simplified method and by a graphic digitiser is very good. It is suggested that this simpler, more rapid, and cheaper method of measurement may increase the clinical potential of the technique.

Imaging Pathways in Fractured Rock Using Three-Dimensional Electrical Resistivity Tomography

Major challenges exist in delineating bedrock fracture zones because these cause abrupt changes in geological and hydrogeological properties over small distances. Borehole observations cannot sufficiently capture heterogeneity in these systems. Geophysical techniques offer the potential to image properties and processes in between boreholes. We used three-dimensional cross borehole electrical resistivity tomography (ERT) in a 9 m (diameter) × 15 m well field to capture high-resolution flow and transport processes in a fractured mudstone contaminated by chlorinated solvents, primarily trichloroethylene. Conductive (sodium bromide) and resistive (deionized water) injections were monitored in seven boreholes. Electrode arrays with isolation packers and fluid sampling ports were designed to enable acquisition of ERT measurements during pulsed tracer injections. Fracture zone locations and hydraulic pathways inferred from hydraulic head drawdown data were compared with electrical conductivity distributions from ERT measurements. Static ERT imaging has limited resolution to decipher individual fractures; however, these images showed alternating conductive and resistive zones, consistent with alternating laminated and massive mudstone units at the site. Tracer evolution and migration was clearly revealed in time-lapse ERT images and supported by in situ borehole vertical apparent conductivity profiles collected during the pulsed tracer test. While water samples provided important local information at the extraction borehole, ERT delineated tracer migration over spatial scales capturing the primary hydrogeological heterogeneity controlling flow and transport. The fate of these tracer injections at this scale could not have been quantified using borehole logging and/or borehole sampling methods alone.

Spectral induced polarization (SIP) response of mine tailings

Mine tailings impoundments are a source of leachates known as acid mine drainage (AMD) which can pose a contamination risk for surrounding surface and groundwater. Methodologies which can help management of this environmental issue are needed. We carried out a laboratory study of the spectral induced polarization (SIP) response of tailings from the Haveri Au-Cu mine, SW Finland. The primary objectives were, (1) to determine possible correlations between SIP parameters and textural properties associated with oxidative-weathering mechanisms, mineralogical composition and metallic content, and (2) to evaluate the effects of the pore water chemistry on SIP parameters associated with redox-inactive and redox-active electrolytes varying in molar concentration, conductivity and pH. The Haveri tailings exhibit well defined relaxation spectra between 100 and 10,000Hz. The relaxation magnitudes are governed by the in-situ oxidative-weathering conditions on sulphide mineral surfaces contained in the tailings, and decrease with the oxidation degree. The oxidation-driven textural variation in the tailings results in changes to the frequency peak of the phase angle, the imaginary conductivity and chargeability, when plotted versus the pore water conductivity. In contrast, the real and the formation electrical conductivity components show a single linear dependence on the pore water conductivity. The increase of the pore water conductivity (dominated by the increase of ions concentration in solution) along with a transition to acidic conditions shifts the polarization peak towards higher frequencies. These findings show the unique sensitivity of the SIP method to potentially discriminate AMD discharges from reactive oxidation zones in tailings, suggesting a significant advantage for monitoring threatened aquifers.

Complex resistivity signatures of ethanol biodegradation in porous media

Numerous adverse effects are associated with the accidental release of ethanol (EtOH) and its persistence in the subsurface. Geophysical techniques may permit non-invasive, real time monitoring of microbial degradation of hydrocarbon. We performed complex resistivity (CR) measurements in conjunction with geochemical data analysis on three microbial-stimulated and two control columns to investigate changes in electrical properties during EtOH biodegradation processes in porous media. A Debye Decomposition approach was applied to determine the chargeability (m), normalized chargeability (m(n)) and time constant (τ) of the polarization magnitude and relaxation length scale as a function of time. The CR responses showed a clear distinction between the bioaugmented and control columns in terms of real (σ') and imaginary (σ″) conductivity, phase (ϕ) and apparent formation factor (F(app)). Unlike the control columns, a substantial decrease in σ' and increase in F(app) occurred at an early time (within 4 days) of the experiment for all three bioaugmented columns. The observed decrease in σ' is opposite to previous studies on hydrocarbon biodegradation. These columns also exhibited increases in ϕ (up to ~9 mrad) and σ″ (up to two order of magnitude higher) 5 weeks after microbial inoculation. Variations in m and m(n) were consistent with temporal changes in ϕ and σ″ responses, respectively. Temporal geochemical changes and high resolution scanning electron microscopy imaging corroborated the CR findings, thus indicating the sensitivity of CR measurements to EtOH biodegradation processes. Our results offer insight into the potential application of CR measurements for long-term monitoring of biogeochemical and mineralogical changes during intrinsic and induced EtOH biodegradation in the subsurface.

Complex resistivity signatures of ethanol in sand-clay mixtures

We performed complex resistivity (CR) measurements on laboratory columns to investigate changes in electrical properties as a result of varying ethanol (EtOH) concentration (0% to 30% v/v) in a sand-clay (bentonite) matrix. We applied Debye decomposition, a phenomenological model commonly used to fit CR data, to determine model parameters (time constant: τ, chargeability: m, and normalized chargeability: mn). The CR data showed a significant (P≤0.001) time-dependent variation in the clay driven polarization response (~12 mrad) for 0% EtOH concentration. This temporal variation probably results from the clay-water reaction kinetics trending towards equilibrium in the sand-clay-water system. The clay polarization is significantly suppressed (P≤0.001) for both measured phase (ϕ) and imaginary conductivity (σ″) with increasing EtOH concentration. Normalized chargeability consistently decreases (by up to a factor of ~2) as EtOH concentration increases from 0% to 10% and 10 to 20%, respectively. We propose that such suppression effects are associated with alterations in the electrical double layer (EDL) at the clay-fluid interface due to (a) strong EtOH adsorption on clay, and (b) complex intermolecular EtOH-water interactions and subsequent changes in ionic mobility on the surface in the EDL. Changes in the CR data following a change of the saturating fluid from EtOH 20% to plain water indicate strong hysteresis effects in the electrical response, which we attribute to persistent EtOH adsorption on clay. Our results demonstrate high sensitivity of CR measurements to clay-EtOH interactions in porous media, indicating the potential application of this technique for characterization and monitoring of ethanol contamination in sediments containing clays.

Laboratory SIP signatures associated with oxidation of disseminated metal sulfides

Oxidation of metal sulfide minerals is responsible for the generation of acidic waters rich in sulfate and metals. When associated with the oxidation of sulfide ore mine waste deposits the resulting pore water is called acid mine drainage (AMD); AMD is a known environmental problem that affects surface and ground waters. Characterization of oxidation processes in-situ is challenging, particularly at the field scale. Geophysical techniques, spectral induced polarization (SIP) in particular, may provide a means of such investigation. We performed laboratory experiments to assess the sensitivity of the SIP method to the oxidation mechanisms of common sulfide minerals found in mine waste deposits, i.e., pyrite and pyrrhotite, when the primary oxidant agent is dissolved oxygen. We found that SIP parameters, e.g., phase shift, the imaginary component of electrical conductivity and total chargeability, decrease as the time of exposure to oxidation and oxidation degree increase. This observation suggests that dissolution-depletion of the mineral surface reduces the capacitive properties and polarizability of the sulfide minerals. However, small increases in the phase shift and imaginary conductivity do occur during oxidation. These transient increases appear to correlate with increases of soluble oxidizing products, e.g., Fe(2+) and Fe(3+) in solution; precipitation of secondary minerals and the formation of a passivating layer to oxidation coating the mineral surface may also contribute to these increases. In contrast, the real component of electrical conductivity associated with electrolytic, electronic and interfacial conductance is sensitive to changes in the pore fluid chemistry as a result of the soluble oxidation products released (Fe(2+) and Fe(3+)), particularly for the case of pyrrhotite minerals.

Electrical signatures of ethanol-liquid mixtures: implications for monitoring biofuels migration in the subsurface

Ethanol (EtOH), an emerging contaminant with potential direct and indirect environmental effects, poses threats to water supplies when spilled in large volumes. A series of experiments was directed at understanding the electrical geophysical signatures arising from groundwater contamination by ethanol. Conductivity measurements were performed at the laboratory scale on EtOH-water mixtures (0 to 0.97 v/v EtOH) and EtOH-salt solution mixtures (0 to 0.99 v/v EtOH) with and without a sand matrix using a conductivity probe and a four-electrode electrical measurement over the low frequency range (1-1000 Hz). A Lichtenecker-Rother (L-R) type mixing model was used to simulate electrical conductivity as a function of EtOH concentration in the mixture. For all three experimental treatments increasing EtOH concentration resulted in a decrease in measured conductivity magnitude (|σ|). The applied L-R model fitted the experimental data at concentration ≤0.4v/v EtOH, presumably due to predominant and symmetric intermolecular (EtOH-water) interaction in the mixture. The deviation of the experimental |σ| data from the model prediction at higher EtOH concentrations may be associated with hydrophobic effects of EtOH-EtOH interactions in the mixture. The |σ| data presumably reflected changes in relative strength of the three types of interactions (water-water, EtOH-water, and EtOH-EtOH) occurring simultaneously in EtOH-water mixtures as the ratio of EtOH to water changed. No evidence of measurable polarization effects at the EtOH-water and EtOH-water-mineral interfaces over the investigated frequency range was found. Our results indicate the potential for using electrical measurements to characterize and monitor EtOH spills in the subsurface.

Spectral induced polarization signatures of hydroxide adsorption and mineral precipitation in porous media

The spectral induced polarization (SIP) technique is a promising approach for delineating subsurface physical and chemical property changes in a minimally invasive manner. To facilitate the understanding of position and chemical properties of reaction fronts that involve mineral precipitation in porous media, we investigated spatiotemporal variations in complex conductivity during evolution of urea hydrolysis and calcite precipitation reaction fronts within a silica gel column. The real and imaginary parts of complex conductivity were shown to be sensitive to changes in both solution chemistry and calcium carbonate precipitation. Distinct changes in imaginary conductivity coincided with increased hydroxide ion concentration during urea hydrolysis. In a separate experiment focused on the effect of hydroxide concentration on interfacial polarization of silica gel and well-sorted sand, we found a significant dependence of the polarization response on pH changes of the solution. We propose a conceptual model describing hydroxide ion adsorption behavior in silica gel and its control on interfacial polarizability. Our results demonstrate the utility of SIP for noninvasive monitoring of reaction fronts, and indicate its potential for quantifying geochemical processes that control the polarization responses of porous media at larger spatial scales in the natural environment.

Calcite precipitation dominates the electrical signatures of zero valent iron columns under simulated field conditions

Calcium carbonate is a secondary mineral precipitate influencing zero valent iron (ZVI) barrier reactivity and hydraulic performance. We conducted column experiments to investigate electrical signatures resulting from concurrent CaCO(3) and iron oxides precipitation under simulated field geochemical conditions. We identified CaCO(3) as a major mineral phase throughout the columns, with magnetite present primarily close to the influent based on XRD analysis. Electrical measurements revealed decreases in conductivity and polarization of both columns, suggesting that electrically insulating CaCO(3) dominates the electrical response despite the presence of electrically conductive iron oxides. SEM/EDX imaging suggests that the electrical signal reflects the geometrical arrangement of the mineral phases. CaCO(3) forms insulating films on ZVI/magnetite surfaces, restricting charge transfer between the pore electrolyte and ZVI particles, as well as across interconnected ZVI particles. As surface reactivity also depends on the ability of the surface to engage in redox reactions via charge transfer, electrical measurements may provide a minimally invasive technology for monitoring reactivity loss due to CaCO(3) precipitation. Comparison between laboratory and field data shows consistent changes in electrical signatures due to iron corrosion and secondary mineral precipitation.

A comparison of the low frequency electrical signatures of iron oxide versus calcite precipitation in granular zero valent iron columns

Geophysical methods have been proposed as technologies for non-invasively monitoring geochemical alteration in permeable reactive barriers (PRBs). We conducted column experiments to investigate the effect of mineralogy on the electrical signatures resulting from iron corrosion and mineral precipitation in Fe0 columns using (a) Na2SO4, and (b) NaHCO3 plus CaCl2 mixture, solutions. At the influent interface where the reactions were most severe, a contrasting time-lapse electrical response was observed between the two columns. Solid phase analysis confirmed the formation of corrosion halos and increased mineralogical complexity in the corroded sections of the columns compared to the minimal/non-corroded sections. We attribute the contrasting time-lapse signatures to the differences in the electrical properties of the mineral phases formed within the two columns. While newly precipitated/transformed polarizable and semi-conductive iron oxides (mostly magnetite and green rust) increase the polarization and conductivity of the sulfate column, the decrease of both parameters in the bicarbonate column is attributed to the precipitation of non-polarizable and non-conductive calcite. Our results show that precipitate mineralogy is an important factor influencing the electrical properties of the corroded iron cores and must be considered if electrical geophysical methods are to be developed to monitor PRB barrier corrosion processes in situ.

Evidence of cardiac autonomic neuropathy in dogs with diabetes mellitus

The NeuroScope, a specific and sensitive indicator of cardiac vagal tone, was used to look for differences in autonomic tone between 25 dogs with naturally occurring diabetes mellitus and 23 healthy control dogs, to determine whether there was any correlation between the dogs' cardiac vagal tone, the duration of diabetes and the adequacy of glycaemic control. The cardiac index of parasympathetic activity (cipa) was determined for each dog over a period of 2600 heartbeats. The mean, median and modal cipa values were significantly lower in the diabetic dogs than in the healthy dogs. There was no significant relationship between the cipa values and the duration of disease or the adequacy of recent glycaemic control in the diabetic dogs, but there was a significant inverse relationship between the cipa values and the bodyweight of the diabetic dogs that was not evident in the normal dogs. The conclusions were based on a 500-heartbeat interval selected from the 2600 heartbeats recorded.

Monitoring change in the vertebrate fauna of central Queensland, Australia, over a period of broad-scale vegetation clearance, 1973—2002

This study reports change in the bird, mammal and amphibian fauna of the Emerald district, central Queensland, as detected from comparison of an inventory study undertaken in 1973–76, with a resurvey undertaken in 2001–02. Over this period, the region was subjected to unusually high rates of vegetation clearance, with the extent of native vegetation declining from 87% to 41%. In Australia, and elsewhere, there are remarkably few such long-term longitudinal studies, and particularly so for those that sample the same sites using identical procedures, and for those undertaken in a region of such dramatic environmental change. The ability to detect change from this dataset is constrained by the relatively small number of survey sites (24–45 survey sites, depending upon the taxonomic group considered). The interpretation of change is also affected by very different climatic conditions between the baseline and resurvey. Higher rainfall in the baseline survey period contributed to the most evident change, a major reduction in the number of waterbirds. However, even with waterbirds excluded, there was a significant change in the bird assemblage across the set of survey sites between the two periods. There were significant increases for a number of typically grassland birds (e.g. red-backed fairy-wren (Malurus melanocephalus), brown quail (Coturnix ypsilophora)) and significant decreases for a range of typically forest or woodland birds (e.g. grey shrike-thrush (Colluricincla harmonica), spiny-cheeked honeyeater (Acanthagenys rufogularis), striped honeyeater (Plectorhyncha lanceolata), grey fantail (Rhipidura fuliginosa)). These changes were largely maintained even when the dataset was restricted to only those sites that remained uncleared: that is, changes were evident not only across the changing landscape as a whole but there were also significant (consequential) changes at uncleared sites. Most of the native mammal species that were recorded sufficiently often to test for change showed a pattern of decline. Again, for some species (pale field-rat (Rattus tunneyi), greater glider (Petauroides volans) and eastern grey kangaroo (Macropus giganteus)), this decline occurred even within uncleared woodland sites. The most notable change in the frog fauna was the major increase in the exotic cane toad (Bufo marinus), but there were also significant declines for two native frog species. These results suggest a general trajectory of decline in distinctive woodland species, and their broad-scale replacement by more commensal species (weedy generalists favoured by human modification of the landscape).

Enzyme immunoassay for the diagnosis of cat-scratch disease defined by polymerase chain reaction

Whole-cell immunofluorescent antibody (IFA) tests for detection of anti-Bartonella henselae immunoglobulin (Ig) G are commonly used to diagnose cat-scratch disease (CSD). The need to cultivate B. henselae in Vero cells for antigen preparation and the absence of routinely applied IFA assays for IgM constitute the major disadvantages of this form of test. We describe the results of an enzyme immunoassay (EIA) for IgM and IgG that used N-lauroyl-sarcosine-insoluble outer membrane antigens from agar-grown B. henselae performed in 84 patients with definite CSD (regional lymphadenitis, cat contact, and > or =1 confirmatory test: polymerase chain reaction, skin test, or B. henselae culture). Although this method has been used as a diagnostic tool in several case reports, it has not previously been evaluated in a large study of definitively proven CSD cases. Results of this study indicate that the EIA described herein can play an important role in the serodiagnosis of CSD, although improvement of the sensitivity, particularly that of the IgM, would be desirable.

Evaluating the quality of systematic reviews in the emergency medicine literature

STUDY OBJECTIVE

The objective of this study was to examine the scientific quality of systematic reviews published in 5 leading emergency medicine journals.

METHODS

MEDLINE and EMBASE databases were electronically searched to identify published systematic reviews. Searches were only conducted in emergency medicine journals during the past 10 years; 4 of the journals were also hand searched. Potential reviews were assessed independently by 2 reviewers for inclusion. Data regarding methods were extracted from each review independently by 2 reviewers. All systematic reviews were retrieved and rated for quality by using the 10 questions from the overview quality assessment questionnaire.

RESULTS

Twenty-nine reviews were identified from more than 100 citations. The overall scientific quality of the systematic reviews was low (mean score, 2.7; 95% confidence interval 2.1 to 3.2; maximum possible score, 7.0). Selection and publication biases were rarely addressed in this collection of reviews. For example, the search strategies were only identified in 9 (31%) reviews, whereas independent study selection (6 [21%]) and quality assessment of included studies (9 [31%]) were infrequently performed. Overall, the majority of reviews had extensive flaws, and only 3 (10%) had minimal flaws.

CONCLUSION

The results of the study indicate that many of the systematic reviews published in the emergency medicine literature contain major flaws; reviews with poor methodology may limit the validity of reported results. Further efforts should be made to improve the design, reporting, and publication of systematic reviews in emergency medicine.

Extracellular Bartonella henselae and artifactual intraerythrocytic pseudoinclusions in experimentally infected cats

Blood, spleen and liver of specific pathogen-free (SPF) cats and SPF cats experimentally infected with Bartonella henselae were examined. Using immunohistochemical labeling, no intracellular B. henselae were observed in tissues of any cats, but extracellular B. henselae were detected in tissues of infected cats. Pseudoinclusions were detected in erythrocytes of all cats using electron microscopy.

Immune response of neonatal specific pathogen-free cats to experimental infection with Bartonella henselae

The purpose of this study was to determine whether neonatal cats develop and maintain a persistent bacteremia for longer than do adult cats with a normal mature immune system, and whether neonatal cats are susceptible to infection with Bartonella henselae by oral inoculation. Neonatal specific pathogen-free (SPF) cats were inoculated with B. henselae intradermally (n = 4) or orally (n = 5) or with 0.9% NaCl (n = 2). Blood was collected periodically through 16 weeks post-inoculation (PI) for serology, bacteriology and complete blood count. Cats inoculated orally or intradermally at 3-5 days of age were bacteremic through 12-16 weeks PI, similar to what is documented for adult cats inoculated intradermally or intravenously. One cat inoculated at age 2 weeks was bacteremic through 10 weeks PI; the other was not bacteremic. Intradermally inoculated neonatal cats produced serum IgG antibodies to B. henselae but orally inoculated neonatal cats did not. Infected cats with and without serum IgG antibodies to B. henselae became blood-culture negative simultaneously, suggesting that IgG is not required to clear bacteremia.

Evaluating the outcomes of low vision rehabilitation

The requirement for those providing healthcare to measure outcomes raises the fundamental question of how these should be measured. Both the scale of the low vision population and the different models of care proposed make it a pressing need to determine outcomes using valid and reliable measures. In this study we describe the development and piloting of a questionnaire designed to meet this requirement. The questionnaire was piloted on 56 subjects with age-related macular degeneration (ARMD). Test-retest reliability of the questionnaire was estimated using a further sample of 28 subjects with ARMD. Pilot testing confirmed the feasibility of administering the questionnaire to an elderly population with ARMD. A total of 87% of the sample reported using an LVA (65% on a daily basis), predominantly for a reading task. The number of tasks an LVA was used for, its frequency of use, length of continuous use and ease of use are significantly associated with the rating of an LVA as important/less important (P < 0.0001), but the acuity achieved with the device is not significantly associated with rated importance (P = 0.11), reinforcing doubt about the validity of visual function outcomes. The limitations of this pilot study and earlier case series in describing the outcomes of low vision care are discussed and a randomised controlled trial using a broad range of outcomes is proposed in order to fully describe the effectiveness of low vision rehabilitation and inform the debate about models of care.

Experimental infection of young specific pathogen-free cats with Bartonella henselae

Eighteen 12-week-old specific pathogen-free cats, blood culture- and serum antibody-negative for Bartonella henselae, were randomly allocated to groups and were intravenously inoculated with 10(10) (group 1), 10(8) (group 2), or 10(6) (group 3) B. henselae or with saline (group 4) or were not inoculated (group 5). Cats were humanely killed at 2, 4, 8, 16, and 32 weeks after inoculation. All B. henselae-inoculated cats were bacteremic by 2 weeks after infection. Bacteremia persisted until 32 weeks after infection in 1 cat. Cats in groups 1 and 2 had fever (>39.7 degrees C) and partial anorexia by 2 weeks after infection that lasted 2-7 days. All infected cats had Bartonella-specific IgM and IgG serum antibodies and lymphocyte blastogenic responses. Histopathologic lesions were observed in multiple organs of infected cats through 8 weeks after infection. Cats were readily infected with B. henselae by intravenous inoculation, developed histopathologic lesions that apparently resolved, and developed B and T lymphocyte responses to infection.

Oral mucosal melanomas: the WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology

A workshop to discuss primary oral melanomas was convened at the annual Western Society of Teachers of Oral Pathology meeting in Bannf, Alberta, Canada. Fifty oral melanomas, identified from the files of the participants, were reviewed in order to better understand the clinical features, histologic spectrum, and natural history of these perplexing lesions. Results confirmed that oral melanomas occur in adults almost three times more frequently in men than women and have a decided predilection for the palate and gingiva. Some lesions exhibit a clinically detectable and prolonged in situ growth phase, whereas others seem to lack this property and exhibit only or predominantly invasive characteristics. Recurrences, metastases, and death from tumor were characteristic of the follow-up of a limited number of patients. Until definitive prospective data are collected that elucidate natural history, oral mucosal melanomas should be tracked separately from cutaneous lesions. All oral pigmented lesions that are not clinically diagnostic should be biopsied. Lesions with equivocal histopathologic features might be referred to as "atypical melanocytic proliferation" and should be excised. Recognition of lesions in an early in situ phase and aggressive treatment should have a favorable effect on prognosis. To enhance future or prospective study of these rare neoplasms, guidelines for reporting oral melanomas are suggested.