Occult tension pneumothorax discovered following imaging for adult trauma patients in the modern major trauma system: a multicentre observational study

BACKGROUND

Tension pneumothorax following trauma is a life-threatening emergency and radiological investigation is normally discouraged prior to treatment in traditional trauma doctrines such as ATLS. Some trauma patients may be physiologically stable enough for diagnostic imaging and occult tension pneumothorax is discovered radiologically. We assessed the outcomes of these patients and compared them with those with clinical diagnosis of tension pneumothorax prior to imaging.

METHODS

A multicentre civilian-military collaborative network of six major trauma centres in the UK collected observational data from adult patients who had a diagnosis of traumatic tension pneumothorax during a 33-month period. Patients were divided into 'radiological' (diagnosis following CT/CXR) or 'clinical' (no prior CT/CXR) groups. The effect of radiological diagnosis on survival was analysed using multivariable logistic regression that included the covariates of age, gender, comorbidities and Injury Severity Score.

RESULTS

There were 133 patients, with a median age of 41 (IQR 24-61); 108 (81%) were male. Survivors included 49 of 59 (83%) in the radiological group and 59 of 74 (80%) in the clinical group (p=0.487). Multivariable logistic regression showed no significant association between radiological diagnosis and survival (OR 2.40, 95% CI 0.80 to 7.95; p=0.130). There was no significant difference in mortality between the groups.

CONCLUSION

Radiological imaging may be appropriate for selected trauma patients at risk of tension pneumothorax if they are considered haemodynamically stable. Trauma patients may be physiologically stable enough for radiological imaging but have occult tension pneumothorax because they did not have the typical clinical presentation. The historical dogma of the 'forbidden scan' no longer applies to such patients.

Health disparities in aging: Improving dementia care for Black women

In the United States, 80% of surveyed Black patients report experiencing barriers to healthcare for Alzheimer's disease and related dementias (ADRD), delaying the time-sensitive treatment of a progressive neurodegenerative disease. According to the National Institute on Aging, Black study participants are 35% less likely to be given a diagnosis of ADRD than white participants, despite being twice as likely to suffer from ADRD than their white counterparts. Prior analysis of prevalence for sex, race, and ethnicity by the Centers for Disease Control indicated the highest incidence of ADRD in Black women. Older (≥65 years) Black women are at a disproportionately high risk for ADRD and yet these patients experience distinct inequities in obtaining clinical diagnosis and treatment for their condition. To that end, this perspective article will review a current understanding of biological and epidemiological factors that underlie the increased risk for ADRD in Black women. We will discuss the specific barriers Black women face in obtaining access to ADRD care, including healthcare prejudice, socioeconomic status, and other societal factors. This perspective also aims to evaluate the performance of intervention programs targeted toward this patient population and offer possible solutions to promote health equity.

Safety and tolerability of Pau d' Arco (Tabebuia avellanedae) for primary dysmenorrhea: A single-arm, open-label trial on adults ages 18-45

Objectives

To evaluate the safety and tolerability of encapsulated Tabebuia avellanedae in generally healthy women aged 18-45 with primary dysmenorrhea.

Methods

A single arm, open-label trial was conducted in which 1050 mg/day of encapsulated Tabebuia avellanedae (Pau d'Arco) was administered to twelve healthy women aged 18-45 for eight weeks. The primary outcome was safety and tolerability as measured by standardized adverse events scales and serial collection of laboratory markers to assess general health, prothrombin times, and the presence or absence of anemia. Secondary outcomes included pain intensity, quality of life, and pain interference measured by the Visual Analog Scale (VAS), the Patient-Reported Outcomes Measurement Information System (PROMIS) 29 survey, and the PROMIS Visual Sexual Function and Satisfaction: Interfering Factors survey, respectively. Exploratory outcomes included serum concentration of high-sensitivity C-reactive protein as a marker of systemic inflammation.

Results

Seventy-five percent of participants (n = 9/12) completed the study. Seventy-five percent of study participants (n = 9/12) reported an adverse event, most of which were characterized as mild, and none were determined to be a Food and Drug Administration (FDA) serious adverse event. Most laboratory markers stayed within normal limits throughout the study period with a few clinically mild abnormalities. There was a significant decrease in pain intensity compared to baseline after the first dose (p < .01), after 4 weeks of treatment (p < .01), and after 8 weeks of treatment (p < .01). Over the 8-week intervention period, pain interference, quality of life, and sexual function and satisfaction scores improved nonsignificantly and hs-CRP decreased nonsignificantly.

Conclusions

Tabebuia avellanedae supplementation of 1050 mg/day dose for eight weeks in generally healthy women aged 18-45 with primary dysmenorrhea was generally safe, associated with moderate tolerability, and associated with significant improvements in pain intensity scores. Future studies examining the safety and efficacy of Tabebuia avellanedae on primary dysmenorrhea are warranted.

Axion Dark Matter Experiment: Detailed design and operations

Axion dark matter experiment ultra-low noise haloscope technology has enabled the successful completion of two science runs (1A and 1B) that looked for dark matter axions in the 2.66-3.1 μeV mass range with Dine-Fischler-Srednicki-Zhitnisky sensitivity [Du et al., Phys. Rev. Lett. 120, 151301 (2018) and Braine et al., Phys. Rev. Lett. 124, 101303 (2020)]. Therefore, it is the most sensitive axion search experiment to date in this mass range. We discuss the technological advances made in the last several years to achieve this sensitivity, which includes the implementation of components, such as the state-of-the-art quantum-noise-limited amplifiers and a dilution refrigerator. Furthermore, we demonstrate the use of a frequency tunable microstrip superconducting quantum interference device amplifier in run 1A, and a Josephson parametric amplifier in run 1B, along with novel analysis tools that characterize the system noise temperature.

Extended Search for the Invisible Axion with the Axion Dark Matter Experiment

This Letter reports on a cavity haloscope search for dark matter axions in the Galactic halo in the mass range 2.81-3.31  μeV. This search utilizes the combination of a low-noise Josephson parametric amplifier and a large-cavity haloscope to achieve unprecedented sensitivity across this mass range. This search excludes the full range of axion-photon coupling values predicted in benchmark models of the invisible axion that solve the strong CP problem of quantum chromodynamics.

Enzymatic-Ultraviolet Method for Measuring Lactose in Milk: Collaborative Study

Collaborators in 8 dairy and food industry laboratories performed one lactose determination on each of 8 unknown samples of milk, lowfat milk, or skim milk, as 3 pairs of blind duplicates. Two known samples were provided to gain experience prior to analysis of the unknown samples. All of the above samples were also analyzed for lactose content by the official AOAC gravimetric method (16.507) by a commercial laboratory. From the overall mean of results on all samples, determinations by the enzymatic method averaged 0.49% lower than by the AOAC method. This difference was significant by the t-test (P = 0.05), which indicated a lack of agreement between the compared methods in determining lactose content. Standard deviations were similar for the 3 sets of blind duplicates which ranged between 3.67 and 4.55% lactose content. F-values revealed that variations between means obtained by laboratories differed significantly as compared with variations within laboratory means. The method has been adopted official first action.

Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics

BACKGROUND

Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA.

METHODS

Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes.

RESULTS

Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics.

CONCLUSIONS

Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.

Piezoelectrically Tuned Multimode Cavity Search for Axion Dark Matter

The μeV axion is a well-motivated extension to the standard model. The Axion Dark Matter eXperiment (ADMX) collaboration seeks to discover this particle by looking for the resonant conversion of dark-matter axions to microwave photons in a strong magnetic field. In this Letter, we report results from a pathfinder experiment, the ADMX "Sidecar," which is designed to pave the way for future, higher mass, searches. This testbed experiment lives inside of and operates in tandem with the main ADMX experiment. The Sidecar experiment excludes masses in three widely spaced frequency ranges (4202-4249, 5086-5799, and 7173-7203 MHz). In addition, Sidecar demonstrates the successful use of a piezoelectric actuator for cavity tuning. Finally, this publication is the first to report data measured using both the TM_{010} and TM_{020} modes.

Search for Invisible Axion Dark Matter with the Axion Dark Matter Experiment

This Letter reports the results from a haloscope search for dark matter axions with masses between 2.66 and 2.81  μeV. The search excludes the range of axion-photon couplings predicted by plausible models of the invisible axion. This unprecedented sensitivity is achieved by operating a large-volume haloscope at subkelvin temperatures, thereby reducing thermal noise as well as the excess noise from the ultralow-noise superconducting quantum interference device amplifier used for the signal power readout. Ongoing searches will provide nearly definitive tests of the invisible axion model over a wide range of axion masses.

Quantifying yield behaviour in metals by X-ray nanotomography

Nanoindentation of engineering materials is commonly used to study, at small length scales, the continuum mechanical properties of elastic modulus and yield strength. However, it is difficult to measure strain hardening via nanoindentation. Strain hardening, which describes the increase in strength with plastic deformation, affects fracture toughness and ductility, and is an important engineering material property. The problem is that the load-displacement data of a single nanoindentation do not provide a unique solution for the material’s plastic properties, which can be described by its stress-strain behaviour. Three-dimensional mapping of the displacement field beneath the indentation provides additional information that can overcome this difficulty. We have applied digital volume correlation of X-ray nano-tomographs of a nanoindentation to measure the sub-surface displacement field and so obtain the plastic properties of a nano-structured oxide dispersion strengthened steel. This steel has potential applications in advanced nuclear energy systems, and this novel method could characterise samples where proton irradiation of the surface simulates the effects of fast neutron damage, since facilities do not yet exist that can replicate this damage in bulk materials.

Low noise, 0.4-3 GHz cryogenic receiver for radio astronomy

We present the design and measurement of a radio telescope receiver front end cooled to 100 K physical temperature, and working over 400 MHz to 3 GHz frequency band. The system uses a frequency independent feed developed for operation as a feed for parabola using sinuous elements and integrated with an ultra-wideband low noise amplifier. The ambient temperature system is tested on the 43 m radio telescope in Green Bank, WV and the system verification results on the sky are presented. The cryogenic receiver is developed using a Stirling cycle, one stage cryocooler. The measured far field patterns and the system noise less than 80 K over a 5:1 bandwidth are presented.

Cotton-wool-like bioactive glasses for bone regeneration

Inorganic sol-gel solutions were electrospun to produce the first bioactive three-dimensional (3-D) scaffolds for bone tissue regeneration with a structure like cotton-wool (or cotton candy). This flexible 3-D fibrous structure is ideal for packing into complex defects. It also has large inter-fiber spaces to promote vascularization, penetration of cells and transport of nutrients throughout the scaffold. The 3-D fibrous structure was obtained by electrospinning, where the applied electric field and the instabilities exert tremendous force on the spinning jet, which is required to be viscoelastic to prevent jet break up. Previously, polymer binding agents were used with inorganic solutions to produce electrospun composite two-dimensional fibermats, requiring calcination to remove the polymer. This study presents novel reaction and processing conditions for producing a viscoelastic inorganic sol-gel solution that results in fibers by the entanglement of the intermolecularly overlapped nanosilica species in the solution, eliminating the need for a binder. Three-dimensional cotton-wool-like structures were only produced when solutions containing calcium nitrate were used, suggesting that the charge of the Ca(2+) ions had a significant effect. The resulting bioactive silica fibers had a narrow diameter range of 0.5-2μm and were nanoporous. A hydroxycarbonate apatite layer was formed on the fibers within the first 12h of soaking in simulated body fluid. MC3T3-E1 preosteoblast cells cultured on the fibers showed no adverse cytotoxic effect and they were observed to attach to and spread in the material.

Abstract S4-07: Effects of bisphosphonate treatment on recurrence and cause-specific mortality in women with early breast cancer: A meta-analysis of individual patient data from randomised trials

Background: Disseminated tumour cells can remain dormant in the bone marrow for years prior to subsequent activation and the development of overt metastases. Bisphosphonates (BP) have profound effects on bone physiology and could potentially modify the metastatic disease process. Variable outcomes in terms of disease recurrence have been reported, with efficacy apparently influenced by menopausal status.

Methods: We sought individual patient data for meta-analysis from 41 randomised trials that compared BP to no BP (placebo or open control). Primary outcomes were time to recurrence, time to first distant recurrence and breast cancer mortality. Predefined subgroup comparisons were of type of BP (amino-/non-amino), duration and schedule of BP treatment, menopausal status, age, ER status, concomitant chemotherapy and site of distant recurrence (bone/other).

Results: Data on 17,751 women (75% of 23,573 randomised in relevant trials) have so far been received, with around 3,300 breast cancer recurrences and 2,500 deaths. Effects on breast cancer mortality, recurrence and bone metastases for 17,016 women in the locked database and for 10,540 who were postmenopausal are shown below.

No. eventsRate Ratio (SE)10 year gain2p valueAll women (n = 17,016)Breast cancer mortality2,0490.91 (0.04)1.7%0.04Breast cancer recurrence3,2840.94 (0.04)1.0%0.13Distant recurrence2,7510.92 (0.04)1.3%0.05Bone recurrence8250.79 (0.07)1.4%0.002Other distant recurrence1,9260.99 (0.05)0.1%0.8Postmenopausal women (n = 10,540)Breast cancer mortality1,1070.83 (0.06)3.1%0.004Breast cancer recurrence1,8090.86 (0.05)3.0%0.002Distant recurrence1,5030.83 (0.05)3.3%0.0007Bone recurrence4450.65 (0.08)2.9%0.00001Other distant recurrence1,0580.93 (0.06)0.7%0.26

Reductions in bone recurrence for postmenopausal women were similar irrespective of bisphosphonate type, treatment schedule, ER status, nodal involvement or use of concomitant chemotherapy. There were no improvements in bone (RR = 1.00, 2p = 0.97) or other recurrence for premenopausal women. Adjuvant bisphosphonates also reduced bone fractures (RR = 0.83, 2p = 0.009).

Conclusion: Adjuvant bisphosphonates reduce bone recurrences and improve breast cancer survival in postmenopausal but not premenopausal women.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S4-07.

Abstract P2-16-23: The ENCHANT-1 trial (NCT01677455): An open label multicenter phase 2 proof of concept study evaluating first line ganetespib monotherapy in women with metastatic HER2 positive or triple negative breast cancer (TNBC)

Background: Hsp90 is a molecular chaperone protein required for the stabilization and activation of many proteins, referred to as Hsp90 ‘clients’, such as HER2, HIF1-a, EGFR, ER, PI3K, AKT, P53 and VEGFR. The drug candidate, ganetespib is a novel triazolone inhibitor of Hsp90, with over 700 patients treated to date. Ganetespib has shown activity in preclinical models of HER2+, ER+/PR+ and TNBC. Early clinical trials documented ganetespib single agent activity in heavily pretreated HER2+ and TNBC patients. Ganetespib has been well tolerated in clinical trials with a favorable safety profile. This efficacy-screening study is designed to provide further evidence of ganetespib activity and identify potentially predictive biomarkers in metastatic breast cancer (BC).

Methods: The ENCHANT-1 Trial is an international, first-line 2-cohort Phase 2 study in BC patients: Cohort A, HER2 amplified (n = 35), and Cohort B, TNBC (n = 35). Patients who present with previously untreated metastatic disease are eligible for treatment with ganetespib at 150 mg/m2 twice weekly on 3 out of 4 wks, for a total of up to 12 wks. Primary endpoint: ORR assessed using RECIST1.1 criteria. Key secondary endpoints include metabolic response as assessed by PET/CT at wk 3 utilizing modified EORTC criteria. Disease progression (PD) at wk 3 by PET imaging indicates discontinuation of study therapy, and is performed to quickly offer patients with metabolic PD a standard of care treatment.

The study is designed as Simon 2-stage requiring at least one OR in 15 patients for the respective cohort to expand to 35 patients. A Steering Committee is established to oversee the overall study and review the interim results.

Results: The study was initiated in 23 centers globally. At the time of submission, a total of 17 patients had been enrolled; TNBC (n = 15) and HER2 (n = 2). Here we report the interim analysis in the TNBC cohort. The median age was 54 years (range 30 -77) with ECOG PS 0 (n = 7/15). Most patients (n = 9) presented with de novo metastatic disease. 5 patients were not evaluable for PET assessment (3 had not yet reached wk 3 and 2 withdrawn before wk 3 for clinical progression), and 9 patients were not evaluable for objective response at wk 6 (3 withdrawn before or at wk 3 for clinical progression and 6 had not yet reached wk 6 evaluation). In the 10 patients with evaluable PET imaging, 9 patients achieved metabolic (m) response (2 mPR, 4 mSD with dominant tumor shrinkage and 3 SD) and one patient with mPD. In the 6 patients evaluable for OR at wk 6, one patient achieved PR, 2 SD and 3 PD. Treatment with ganetespib was well tolerated; the most common AEs were mild or moderate diarrhea (8/15, 53%), fatigue (5/15, 33%), decreased appetite (4/15, 27%), insomnia (4/15, 27%), and nausea (4/15, 27%).

Conclusion: Ganetespib single agent was generally well tolerated and showed anti-tumor activity TNBC patients as early as 3 weeks following treatment. PET seems to be a good tool to screen antitumor activity of new agents in early settings rather that in heavily pretreated patients. The TNBC cohort has met the protocol criteria for proceeding to stage 2.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-16-23.

Corrosion Behaviour of British Magnox Waste Glass in Pure Water

The corrosion behaviour of Magnox Waste (MW) glass in deionized water has been investigated under the aegis of the Japanese-Swedish-Swiss (JSS) project. The studies carried out at PSI and BNFL included static leaching and corrosion layer characterization. The results were used by HMI to derive the modelling parameters for the MW glass with the PHREEQE/GLASSOL codes. The silica concentration was found to strongly influence the corrosion rate of the glass. The MW glass selectively retains Cs due to the formation of a Cs-Mg-Al-Si-O-rich layer on its surface.

Search for hidden sector photons with the ADMX detector

Hidden U(1) gauge symmetries are common to many extensions of the standard model proposed to explain dark matter. The hidden gauge vector bosons of such extensions may mix kinetically with standard model photons, providing a means for electromagnetic power to pass through conducting barriers. The axion dark matter experiment detector was used to search for hidden vector bosons originating in an emitter cavity driven with microwave power. We exclude hidden vector bosons with kinetic couplings χ>3.48×10⁻⁸ for masses less than 3  μeV. This limit represents an improvement of more than 2 orders of magnitude in sensitivity relative to previous cavity experiments.

Polariton condensation in dynamic acoustic lattices

We demonstrate that the tunable potential introduced by a surface acoustic wave on a homogeneous polariton condensate leads to fragmentation of the condensate into an array of wires which move with the acoustic velocity. Reduction of the spatial coherence of the condensate emission along the surface acoustic wave direction is attributed to the suppression of coupling between the spatially modulated condensates. Interparticle interactions observed at high polariton densities screen the acoustic potential, partially reversing its effect on spatial coherence.

Search for chameleon scalar fields with the axion dark matter experiment

Scalar fields with a "chameleon" property, in which the effective particle mass is a function of its local environment, are common to many theories beyond the standard model and could be responsible for dark energy. If these fields couple weakly to the photon, they could be detectable through the afterglow effect of photon-chameleon-photon transitions. The ADMX experiment was used in the first chameleon search with a microwave cavity to set a new limit on scalar chameleon-photon coupling βγ excluding values between 2×10(9) and 5×10(14) for effective chameleon masses between 1.9510 and 1.9525  μeV.

Epidemiological features of the bovine spongiform encephalopathy epidemic in Japan

On 10 September 2001, the first case of bovine spongiform encephalopathy (BSE) in Japan was confirmed in a five-year-old dairy cow born in Hokkaido and raised in Chiba prefecture. Subsequently, BSE surveillance was enhanced. As a result, 35 additional cases were detected by the end of March 2009, with two to ten cases being detected each year up to the end of 2007. The epidemic appeared to peak in 2006. Cases are detected mostly in dairy cattle; in cattle born in 1996 and 2000; and in cattle born in Hokkaido. Two were atypical cases of BSE and the remainder classical cases. This paper describes and discusses the demographic structure of dairy and beef cattle, surveillance programmes in place and the epidemiological features of the BSE epidemic in Japan.

SQUID-based microwave cavity search for dark-matter axions

Axions in the microeV mass range are a plausible cold dark-matter candidate and may be detected by their conversion into microwave photons in a resonant cavity immersed in a static magnetic field. We report the first result from such an axion search using a superconducting first-stage amplifier (SQUID) replacing a conventional GaAs field-effect transistor amplifier. This experiment excludes KSVZ dark-matter axions with masses between 3.3 microeV and 3.53 microeV and sets the stage for a definitive axion search utilizing near quantum-limited SQUID amplifiers.

The induction and control of delayed type hypersensitivity reactions induced in chickens by infectious bronchitis virus

Infectious bronchitis virus (IBV) was shown to induce delayed type hypersensitivity (DTH) reactions in the wattle, or to inhibit migration in a macrophage migration inhibition test (MIT) in sensitised birds. The magnitude of the reactions was related to the sensitising dose of the virus. The optimal dose for the cold attenuated A3-IBV was 10(3 .5) EID50, higher doses giving lower responses. Birds given a similar dose of T-IBV had negative DTH reactions, but the spleen non-adherent lymphocytes from these unreactive birds, and also birds sensitised with 10(6.5) EID50 of A3 virus, on transfer to allogeneic birds sensitised with the optimal dose of A3 virus (10(3.5) EID50) suppressed their DTH response. Treatment of birds with dexamethasone, 6-mercaptopurine, or cyclophosphamide, before vaccination with the dose of A3 virus which suppressed the DTH reaction (10(6.5)EID50), abrogated the DTH unresponsiveness. Drug treatment before optimal sensitisation (10(3 .5) EID50) did not increase the magnitude of the DTH response, but prolonged the time over which the DTH response could be elicited. MIT results mirrored the DTH responses. The antigens elicitating the response, or the transferred cells suppressing the response, derived from chickens immunised with any of the three strains of IBV studied had similar effects on DTH and MIT responses in A3 virus sensitised birds.

Intrinsic decoherence mechanisms in the microcavity polariton condensate

The fundamental mechanisms which control the phase coherence of the polariton Bose-Einstein condensate (BEC) are determined. It is shown that the combination of number fluctuations and interactions leads to decoherence with a characteristic Gaussian decay of the first-order correlation function. This line shape, and the long decay times ( approximately 150 ps) of both first- and second-order correlation functions, are explained quantitatively by a quantum-optical model which takes into account interactions, fluctuations, and gain and loss in the system. Interaction limited coherence times of this type have been predicted for atomic BECs, but are yet to be observed experimentally.

The ecology of childhood overweight: a 12-year longitudinal analysis

OBJECTIVE

To investigate ecological correlates of the development of overweight in a multisite study sample of children followed from age 2 to 12.

DESIGN

Longitudinal examination of covariates of overweight status throughout childhood, with covariates drawn from three ecological levels: sociocultural or demographic, quality of the child's home environment, and proximal child experience that could directly affect the balance between energy intake and energy expenditure.

SUBJECTS

A total of 960 children participating in a long-term longitudinal study provided growth data at least once; 653 of the children had complete data on covariates.

MEASUREMENTS

Height and weight measured seven times between ages 2 and 12 were converted to a body mass index (BMI) and entered into a latent transition analysis to identify patterns of overweight across childhood. Ecological correlates measured longitudinally included demographic characteristics obtained by maternal report, home environment quality obtained by observation and maternal report, and proximal child experience factors obtained by observation, maternal report and child report.

RESULTS

Four patterns of overweight were found: never overweight, overweight beginning at preschool age, overweight beginning in elementary school, and return to normal weight after being overweight at preschool age. The weight status groups differed on home environment quality and proximal child experience factors but not on demographics. Children overweight at preschool had less sensitive mothers than never overweight children. Children overweight at school age had fewer opportunities for productive activity at home than did never overweight children. School-age overweight children also watched the most TV after school. Multivariate logistic regression analyses further indicated the significance to children's weight status of proximal child experience variables. Less physically active children and those who watched more television after school were more likely to become overweight. Results did not vary by child sex.

CONCLUSION

The results support the idea that childhood overweight is multiply determined. The one potentially important and changeable factor identified as a target for intervention centers on how children spend their time, especially their after-school time. Children who are more physically active and spend less time watching TV after school are less likely to become overweight by age 12.

Small intestinal lactase status, frequency distribution of enzyme activity and milk intake in a multi-ethnic population

The aims of the study were to investigate the prevalence of primary lactase deficiency, frequency distribution of lactase activity and the relationship between lactose intake and lactase activity in three ethnic groups resident in Birmingham. Seventy-two white, 103 Indian and 58 Afro-Caribbean adult dyspeptic patients had distal duodenal biopsies taken for disaccharidase assay at endoscopy. Ten percent of whites, 51% Indians and 81% Afro-Caribbeans had primary lactase deficiency (sucrase/lactase ratio > 4). There was a generalized unexplained depression of disaccharidase activities in the Indians. Frequency distribution of lactase activity for the whole population showed a negative skew without evidence of trimodality. Lactose intake and symptoms attributed to lactose were assessed in a subgroup of 20 whites, 20 Indians and 18 Afro-Caribbeans by questionnaire. Lactose intake did not differ between lactase persistent and deficient subjects both within each racial group and between the groups. Diarrhoea, bloating and cramps were not significantly more common in lactase deficient than lactase persistent individuals.

Relationships between stand composition and ectomycorrhizal community structure in boreal mixed-wood forests

We investigated the community structure of ectomycorrhizal fungi under varying overstory tree compositions in the southern mixed-wood boreal forest of Quebec. Sampling took place at two locations of differing postfire ages and nine 100-m2 plots were sampled per location. The dominant overstory tree species in the plots were trembling aspen (Populus tremuloides Michx.), white birch (Betula papyrifera Marsh.) or white spruce [Picea glauca (Moench) Voss], and balsam fir [Abies balsamea (L.) Mill.]. Mycorrhizae were analyzed using morphological as well as molecular methods, employing fungal-specific primers to amplify ribosomal DNA for subsequent cloning and sequencing. A total of 1800 mycorrhizal root tips collected from the 18 plots were morphologically classified into 26 morphotypes, with Cenococcum geophilum dominating (36% of root tips). A second set of root tips, selected from the same 18 samples on which the morphological analysis was based, were analyzed using molecular methods. From this analysis, 576 cloned polymerase chain reaction products were screened by restriction fragment length polymorphism analysis and a total of 207 unique types were found. No one type dominated the system and 159 occurred only once. Sequence analysis of the types that occurred more than once revealed that Piloderma sp., Russula sp., Cortinarius sp., and Lactarius sp. were the most common mycorrhizae. The ectomycorrhizal fungal community structure revealed by the rDNA analysis differed from that observed using morphological methods. Canonical correspondence analyses of the sequenced restriction types and % overstory composition indicate that the distributions of ectomycorrhizal fungi are influenced by the relative proportions of host tree species. The distinct fungal assemblages found in the different plots supported by the different combinations of host tree species provides further support for the need to conserve stand diversity in the southern boreal forest.

TSE risk assessment for starting materials used during, or in the manufacture of vaccines for human use--a consultant's view of the commercial approach

Vaccination is an essential tool to protect humans from many infectious diseases. Materials derived from bovine tissues are used in, or during the manufacture of, most vaccines. Following the occurrence of BSE in cattle in three continents since 1986, the need to ensure the TSE safety of vaccines is vital. Various actions have been taken to ensure safety targets are reached. This paper shows that selecting starting tissues used in vaccine manufacture on the basis of their inherent TSE risk is of prime importance and is more secure than using geography as the primary criterion of a safe origin. Other approaches can also contribute to safety assurance. These include avoiding, where possible, tissues from animals, risk tissues and tissues of unknown or uncertain provenance. It is essential to ensure tissues are collected and processed appropriately and detailed records are kept. The risk assessment approach, based on the main safety factors of Source, Process and Use, coupled with these additional features, combine to establish that the TSE safety of vaccines is ensured, despite the challenge resulting from the occurrence of BSE.