A comparative analysis of movement and physical activity in early childhood teacher education policy in five Nordic countries

Introduction

The aim of this study is to investigate the integration of movement and physical activity (MoPA) within Early Childhood Teacher Education (ECTE) policies across Denmark, Finland, Iceland, Norway, and Sweden. This knowledge can inform the development of ECTE policies and practices that promote MoPA in Early Childhood Education and Care (ECEC) in Nordic countries and other countries worldwide.

Methods

In this study, a Nordic cross-national network of researchers collaborated in investigating policy documents at the national and university levels, which govern the education of ECEC teachers. This study was inspired by the Non-affirmative Theory of Education, which provides a framework for understanding the various influences on curricular development in higher education. Based on this, a four-step comparative analytical process of national and university documents across the Nordic countries was conducted. It included keyword search for MoPA related courses and a qualitative description of MoPA in ECTE. Thus, a combination of investigations of policy documents at the national and university level and expert knowledge set a solid foundation for international comparison.

Results

The comparative analysis of MoPA in ECTE reveals diverse approaches influenced by national and university policies. A central theme is the variability in MoPA integration across these nations. Finland and Norway prioritize MoPA with independent mandatory courses. In Iceland, compulsory MoPA courses exist at one of two universities, and in Sweden at three out of 19. All university colleges in Denmark offer an elective course. Furthermore, learning objectives related to MoPA are, to varying degrees, part of the internships in the countries, with Sweden being an exception. In the participating countries, the teachers decide the content of the MoPA courses with little guidance, support, and agreement on essential MoPA content within and across the ECTE's. Norway has established guidelines, and in Finland, there is a network of ECTE Physical Education (PE) educators, which, to some degree, increases the consistency and quality of MoPA in education.

Discussion

The Nordic countries present diverse MoPA integration approaches rooted in national policies and educational traditions. The findings emphasize the necessity of independent and mandatory MoPA courses, integration of MoPA into internships and promoting networks across the educational and academic sectors to equip future early childhood educators with competencies for fostering physical activity, motor development and children's well-being.

Relationship among cattle breed and anabolic implant protocol relative to feedlot performance: Growth, temperament, feeding behavior, carcass traits, and economic return

Recent research has suggested that different cattle breed types may respond differently to anabolic implant protocols of varying intensity. Therefore, the purpose of this research was to compare anabolic implant protocols in feedlot steers of 2 different breed types. Sixty steers were stratified by weight and breed in a 2 × 3 factorial design examining 2 different breeds: Angus (AN; n=38) or Santa Gertrudis influenced (SG; n=22), and 3 implant strategies: no implant (CON; n=20), a moderate intensity implant protocol (d0 implant: Revalor-G, d56 implant: Revalor-IS, d112 implant: Revalor-S; MI; n=20), or a high intensity implant protocol (d0 implant: Revalor-IS, d56 implant: Revalor-S, d112 implant: Revalor-200; HI; n=20). Steers were randomly placed into pens equipped with GrowSafe bunks to collect dry matter intake and feeding behavior. All animals were fed the same diet. Weight, chute score, exit velocity, serum, rectal temperature, hip height and 12th rib fat thickness were collected approximately every 28 d over a 196 d period. Serum urea nitrogen (SUN) was evaluated as well. Total average daily gain was increased (P < 0.0001) in both the HI and MI steers compared to the CON steers by 29.4% and 26%, respectively. A treatment × breed interaction was observed (P < 0.0001) for hip height, with AN-CON steers being shorter (P < 0.0007) than AN-HI, SG-CON, SG-MI, and SG-HI steers. A breed × treatment interaction was observed (P < 0.004) for chute score and rectal temperature, with SG-HI and SG-MI steers having increased chute scores (P < 0.001) when compared to AN-HI, AN-MI, AN-CON, and SG-CON throughout the course of the trial. Additionally, SG-HI and SG-MI steers had an increased rectal temperature (P < 0.004) compared to AN-HI, AN-MI, AN-CON, and SG-CON steers. A breed effect was observed (P = 0.002) for SUN with AN steers having increased (P = 0.002) SUN concentration compared to SG sired steers, in addition to a treatment effect (P < 0.0001), with CON steers having a higher (P < 0.0001) SUN concentration than MI and HI steers, regardless of breed. The MI implant protocol increased net return per head, on average, by $97.28, regardless of breed, while the HI implant protocol increased net return by only $80.84. Taken together, despite the cattle breed types responding differently to the different anabolic implant protocols at times, a moderate intensity anabolic implant protocol was optimal in this experiment for steers raised in a temperate climate.

P01-03 Movement and physical activity in early childhood education and care in the Nordic countries

Background

The World Health Organization (WHO) acknowledges the importance of preschool children taking part in comprehensive physical activities supporting, among other things, their motor development, and competencies. A growing number of children attend early childhood education and care (ECEC), and expectations that this will support the development and learning of the youngest children are high. ECEC are governed by different policies embodied in both laws and curricula, and the framework of a curriculum plays a key role in ensuring the quality of ECEC services. The documents represent the content society wants the ECEC institutions to disseminate, and set out the values, objectives, and content of the work of pre-school teachers and serve as a point of reference for ECEC teachers and schools. The purpose of this study was to examine the values of movement and physical activity (MoPA) using government policy documents ECEC from Denmark, Finland, Iceland, Norway, and Sweden.

Methods

This descriptive, comparative study was designed based on curriculum theory and used word count and content analyses to examine values of MoPA and to identify similarities and differences in the ECEC policies of Nordic countries.

Results

Seven terms were identified as MoPA related; body, motor, move, physical activity, physical education, coordination, idrott/liikunta. These terms occurred in various content contexts: development, environment, expression, health and well-being, learning and play, albeit sparsely and were referred to as both a goal in itself and as a mean of achieving other goals (e.g., learning or development in another area). Formulations dedicated to MoPA as a goal were present in the Danish and Finnish curricula and, to some extent, also in the Norwegian, while the Icelandic and Swedish curricula mentioned MoPA only as a mean.

Conclusion

Findings indicated that MoPA, which are important for children's development, health, and well-being, is a low-priority value, to varying degrees, in the ECEC policies enacted by the Nordic countries. Thus, the guidance provided to educators and stakeholders therein is inexplicit. The low priority of the MoPA domain in the ECEC policies might negatively affect the possibility for young children to be physically active in preschools.

Opioids for Treatment of Pre-hospital Acute Pain: A Systematic Review

INTRODUCTION

Acute pain is a frequent symptom among patients in the pre-hospital setting, and opioids are the most widely used class of drugs for the relief of pain in these patients. However, the evidence base for opioid use in this setting appears to be weak. The aim of this systematic review was to explore the efficacy and safety of opioid analgesics in the pre-hospital setting and to assess potential alternative therapies.

METHODS

The PubMed, EMBASE, Cochrane Library, Centre for Reviews and Dissemination, Scopus, and Epistemonikos databases were searched for studies investigating adult patients with acute pain prior to their arrival at hospital. Outcomes on efficacy and safety were assessed. Risk of bias for each included study was assessed according to the Cochrane approach, and confidence in the evidence was assessed using the GRADE method.

RESULTS

A total of 3453 papers were screened, of which the full text of 125 was assessed. Twelve studies were ultimately included in this systematic review. Meta-analysis was not undertaken due to substantial clinical heterogeneity among the included studies. Several studies had high risk of bias resulting in low or very low quality of evidence for most of the outcomes. No pre-hospital studies compared opioids with placebo, and no studies assessed the risk of opioid administration for subgroups of frail patients. The competency level of the attending healthcare provider did not seem to affect the efficacy or safety of opioids in two observational studies of very low quality. Intranasal opioids had a similar effect and safety profile as intravenous opioids. Moderate quality evidence supported a similar efficacy and safety of synthetic opioid compared to morphine.

CONCLUSIONS

Available evidence for pre-hospital opioid administration to relieve acute pain is scarce and the overall quality of evidence is low. Intravenous administration of synthetic, fast-acting opioids may be as effective and safe as intravenous administration of morphine. More controlled studies are needed on alternative routes for opioid administration and pre-hospital pain management for potentially more frail patient subgroups.

Movement and Physical Activity in Early Childhood Education and Care Policies of Five Nordic Countries

The purpose of this study was to examine the values of movement and physical activity (MoPA) using government policy documents (e.g., laws and curricula) on early childhood education and care (ECEC) from Denmark, Finland, Iceland, Norway, and Sweden. This descriptive, comparative study was designed based on curriculum theory and used word count and content analyses to identify similarities and differences in the occurrence of MoPA in the ECEC policies of Nordic countries. Seven terms were identified as MoPA-related in Nordic policy documents. These terms occurred in various content contexts: development, environment, expression, health and well-being, learning and play, albeit sparsely. MoPA was referred to as both a goal in and of itself and as a means of achieving other goals (e.g., learning or development in another area). Formulations specifically dedicated to MoPA as a goal were present in the Danish and Finnish curricula and, to some extent, also in the Norwegian curriculum, while the Icelandic and Swedish curricula mentioned MoPA mostly as a means. Findings indicated that MoPA, which is important for children’s development, health, and well-being, is a low-priority value, to varying degrees, in the ECEC policies enacted by Nordic countries and the guidance provided to educators and stakeholders therein is inexplicit.

Do Health Service staff support the implementation of Voluntary Assisted Dying at their workplace?

BACKGROUND

On 29 November 2017, the Victorian Parliament passed the Voluntary Assisted Dying (VAD) Act 2017, which came into effect from 19 June 2019.

AIM

To investigate whether staff from a large regional health service support the legalisation of Voluntary Assisted Dying (VAD) and the implementation of VAD at their workplace.

METHODS

Staff were invited to complete an anonymous online survey comprising both closed and open-ended questions.

RESULTS

38% of the workforce (n = 1624) responded to the survey. Most participants supported the legalisation of VAD (88%), the provision of eligibility assessment and/or the administration of VAD within the health service (80%). There were negligible differences in support for VAD by role, however, specialist doctors were significantly less supportive (65%). Approximately half of the respondents expressed concern about monitoring (49%) or implementation (53%) of VAD. Concerns were also raised about assessment of eligibility, support for staff involved in VAD and pressure on both patients and staff to participate. Nearly three quarters (71%) of participants agreed that if the health service offers VAD services, a special unit or facility should be available.

CONCLUSION

This study found that health workers have concerns about the implementation of VAD at their workplace but are generally supportive. This paper provides information for health services considering the implementation of VAD, about staff concerns and issues that need to be addressed for the successful introduction of VAD. This article is protected by copyright. All rights reserved.

Impact of hospital type on risk-adjusted, traffic-related 30-day mortality: a population-based registry study

Background

Traffic incidents are still a major contributor to hospital admissions and trauma-related mortality. The aim of this nationwide study was to examine risk-adjusted traffic injury mortality to determine whether hospital type was an independent survival factor.

Methods

Data on all patients admitted to Swedish hospitals with traffic-related injuries, based on International Classification of Diseases codes, between 2001 and 2011 were extracted from the Swedish inpatient and cause of death registries. Using the binary outcome measure of death or survival, data were analysed using logistic regression, adjusting for age, sex, comorbidity, severity of injury and hospital type. The severity of injury was established using the International Classification of Diseases Injury Severity Score (ICISS).

Results

The final study population consisted of 152,693 hospital admissions. Young individuals (0-25 years of age) were overrepresented, accounting for 41% of traffic-related injuries. Men were overrepresented in all age categories. Fatalities at university hospitals had the lowest mean (SD) ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, for fatal traffic incidents. The crude overall mortality in the study population was 1193, with a mean ICISS 0.72 (0.17). Fatalities at university hospitals had the lowest mean ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, for fatal traffic incidents.When regional and county hospitals were merged into one group and its risk-adjusted mortality compared with university hospitals, no significant difference was found. A comparison between hospital groups with the most severely injured patients (ICISS ≤0.85) also did not show a significant difference (odds ratio, 1.13; 95% confidence interval, 0.97-1.32).

Conclusions

This study shows that, in Sweden, the type of hospital does not influence risk adjusted traffic related mortality, where the most severely injured patients are transported to the university hospitals and centralization of treatment is common.

Direct Synthesis of Methyl Chlorosilanes from Pd-Mg-SiO2 Substrates Using Mechanochemistry

The direct reaction of methyl chloride with magnesium and palladium infused silica substrates to synthesize methyl chlorosilanes is reported. First, high energy ball milling on solid Mg-SiO₂ mixtures produces elemental silicon and MgO. When PdCl₂ is infused into the mixture, after additional ball milling and high-temperature reduction under H₂ , dipalladium silicide (Pd₂ Si) is produced. The silicon of the Pd₂ Si readily reacts with MeCl under Müller-Rochow reaction conditions, to produce methyl chlorosilanes at yield ratios analogous to those of the traditional process. The dominant product is Me₂ SiCl₂ (selectivity > 30%), followed by MeSiCl₃ and Me₃ SiCl, with minor amounts of the remaining chlorosilanes. Silicon conversion exceeds 20% for most of the substrates. The elemental palladium, which remains within the Pd-Mg-SiO₂ contact mass is re-converted to Pd₂ Si at the next H₂ /high-temperature treatment and reacts again with MeCl to repeat the methyl chlorosilane production. In principle, the resulting cycle of the mechanochemically induced formation of Pd₂ Si followed by the reaction with MeCl can be repeated until the starting SiO₂ converts completely to methyl chlorosilanes.

Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm

BACKGROUND

Few publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.

METHODS

A systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.

RESULTS

We included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δvisual analogue scale -0.4 (-0.8 to 0.0) and Δnumeric pain rating scale -3.0 (-3.86 to -2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.

CONCLUSIONS

This systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.

OTHER

Scandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors.

PROSPERO REGISTRATION NUMBER

CRD42018114399.

Femoral nerve blocks for the treatment of acute pre-hospital pain: A systematic review with meta-analysis

BACKGROUND

Pain management is one of the most important interventions in the emergency medical services. The femoral nerve block (FNB) is, among other things, indicated for pre- and post-operative pain management for patients with femoral fractures but its role in the pre-hospital setting has not been determined. The aim of this review was to assess the effect and safety of the FNB in comparison to other forms of analgesia (or no treatment) for managing acute lower extremity pain in adult patients in the pre-hospital setting.

METHODS

A systematic review (PROSPERO registration (CRD42018114399)) was conducted. The Cochrane and GRADE methods were used to assess outcomes. Two authors independently reviewed each study for eligibility, extracted the data and performed risk of bias assessments.

RESULTS

Four studies with a total of 252 patients were included. Two RCTs (114 patients) showed that FNB may reduce pain more effectively than metamizole (mean difference 32 mm on a 100 mm VAS (95% CI 24 to 40)). One RCT (48 patients) compared the FNB with lidocaine and magnesium sulphate to FNB with lidocaine alone and was only included here for information regarding adverse effects. One case series included 90 patients. Few adverse events were reported in the included studies. The certainty of evidence was very low. We found no studies comparing FNB to inhaled analgesics, opioids or ketamine.

CONCLUSIONS

Evidence regarding the effectiveness and adverse effects of pre-hospital FNB is limited. Studies comparing pre-hospital FNB to inhaled analgesics, opioids or ketamine are lacking.

1408. Treponema pallidum-Specific Antibody Testing in the Evaluation of Neurosyphilis, a Prospective Trial

Background

The therapeutic challenges of neurosyphilis are rooted in its diagnosis and management, with potential for complications arising from asymptomatic, unrecognized, or under-treated disease. Currently, the non-treponemal VDRL testing of cerebrospinal fluid (CSF) samples is used to predict those with CNS invasion by T. pallidum. However, more extensive evaluation of those at any stage of infection demonstrates both that the incidence of CNS invasion is much greater than predicted, and there exists a large proportion of false positives from VDRL testing alone.

Methods

Subjects with suspected neurosyphilis were recruited from the infectious disease clinic after referral to LAC+USC Hospital. Informed consent was obtained and subjects underwent clinical examination, including a standardized neurological and neurocognitive evaluation and CSF sampling. A CSF-specific VDRL, FTAabs, and a T. pallidum particle agglutination index were calculated:

A TPPA Index >2.0 was defined as positive and definitive evidence of neurosyphilis

Results

40 subjects were recruited, 8 were HIV-negative and 32 HIV positive, of which, 1 declined to continue after CSF sampling (Table 1). Employing the CSF TPPA index, 7/31 HIV positive (22.6%) and 1/8 HIV-negative individuals (12.5%) had neurosyphilis (Table 2). Discordant results with the CSF VDRL were common; 4/31 subjects (12.9%) with a positive CSF VDRL had a TPPA Index < 2.0 (0.227, 0.227, 0.315, and 0.400) and 4/31 subjects (12.9%) with a negative CSF VDRL had a positive TPPA index (2.234, 3.333, 3.797, and 4.548, Table 3). Neurocognitive and neurologic abnormalities were commonly encountered in this population both with and without documented neurosyphilis.

Conclusion

Our investigations demonstrate the value of CSF sampling in persons with any stage of syphilis and establish the utility of T. pallidum-specific antibody testing to greatly facilitate clinical decision-making. The diagnostic tools to evaluate the T. pallidum-specific immunological response of the CNS to syphilis are currently widely available, inexpensive, but woefully underutilized

Disclosures

All authors: No reported disclosures.

Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study

BACKGROUND

A female survival advantage after injury has been observed, and animal models of trauma have suggested either hormonal or genetic mechanisms as component causes. Our aim was to compare age and risk-adjusted sex-related mortality in hospital for the three most common mechanisms of injury in relation to hormonal effects as seen by age.

METHODS

All hospital admissions for injury in Sweden during the period 2001-2011 were retrieved from the National Patient Registry and linked to the Cause of Death Registry. The International Classification of Diseases Injury Severity Score (ICISS) was used to adjust for injury severity, and the Charlson Comorbidity Index to adjust for comorbidity. Age categories (0-14, 15-50, and ≥ 51 years) were used to represent pre-menarche, reproductive and post- menopausal women.

RESULTS

Women had overall a survival benefit (OR 0.51; 95% CI 0.50 to 0.53) after adjustment for injury severity and comorbidity. A similar pattern was seen across the age categories (0-14 years OR 0.56 (95% CI 0.25 to 1.25), 15-50 years OR 0.70 (95% CI 0.57 to 0.87), and ≥ 51 years OR 0.49 (95% CI 0.48 to 0.51)).

CONCLUSION

In this 11-year population-based study we found no support for an oestrogen-related mechanism to explain the survival advantage for females compared to males following hospitalisation for injury.

Reactions: Antibacterial and bioactive dental restorative materials: Do they really work?

PURPOSE

The study and development of antibacterial materials for use in dental applications is growing with the development of novel materials and procedures. Examination of the effects of such antibacterial materials on oral pathogens as well as on stability and longevity of dental restorations is of paramount importance to the field.

RESULTS

This review addressed the range of topics covered by the manuscripts presented at the Seoul symposium on antibacterial dental materials.

CLINICAL SIGNIFICANCE

Based on the presented works, it seems that the emerging antibacterial and bioactive mate-rials can potentially benefit restorative dentistry; however, like many other subjects in clinical dentistry, good quality evidence on their effectiveness under clinical situations is yet to be accumulated.

Decreased risk adjusted 30-day mortality for hospital admitted injuries: a multi-centre longitudinal study

Background

The interpretation of changes in injury-related mortality over time requires an understanding of changes in the incidence of the various types of injury, and adjustment for their severity. Our aim was to investigate changes over time in incidence of hospital admission for injuries caused by falls, traffic incidents, or assaults, and to assess the risk-adjusted short-term mortality for these patients.

Methods

All patients admitted to hospital with injuries caused by falls, traffic incidents, or assaults during the years 2001–11 in Sweden were identified from the nationwide population-based Patient Registry. The trend in mortality over time for each cause of injury was adjusted for age, sex, comorbidity and severity of injury as classified from the International Classification of diseases, version 10 Injury Severity Score (ICISS).

Results

Both the incidence of fall (689 to 636/100000 inhabitants: p = 0.047, coefficient − 4.71) and traffic related injuries (169 to 123/100000 inhabitants: p < 0.0001, coefficient − 5.37) decreased over time while incidence of assault related injuries remained essentially unchanged during the study period. There was an overall decrease in risk-adjusted 30-day mortality in all three groups (OR 1.00; CI95% 0.99–1.00). Decreases in traffic (OR 0.95; 95% CI 0.93 to 0.97) and assault (OR 0.93; 95% CI 0.87 to 0.99) related injuries was significant whereas falls were not during this 11-year period.

Discussion

Risk-adjustment is a good way to use big materials to find epidemiological changes. However after adjusting for age, year, sex and risk we find that a possible factor is left in the pre- and/or in-hospital care.

Conclusions

The decrease in risk-adjusted mortality may suggest changes over time in pre- and/or in-hospital care. A non-significantdecrease in risk-adjusted mortality was registered for falls, which may indicate that low-energy trauma has not benefited for the increased survivability as much as high-energy trauma, ie traffic- and assault related injuries.

Changes in circulating inflammatory markers following febrile non-haemolytic transfusion reactions to leucoreduced red cells

It would be desirable to be able to distinguish fever as a result of febrile non-haemolytic transfusion reactions (FNHTR) from other febrile conditions. To further characterize the inflammatory feature of FNHTR, we measured a large panel of inflammatory markers in pre- and posttransfusion plasma samples from patients with and without FNHTR following the transfusion of leucoreduced red blood cells. As FNHTR patients only displayed a significant increase in IL-6, we conclude that changes in plasma cytokine levels during FNHTR are unlikely to be used diagnostically. An incidental finding of a distinct cytokine pattern in pretransfusion samples from FNHTR patients warrants further investigations, as it might be used to characterize the nature of FNHTR and to predict the risk of these adverse events.

Deaths caused by injury among people of working age (18-64) are decreasing, while those among older people (64+) are increasing

Background

Injury is an important cause of death in all age groups worldwide, and contributes to many losses of human and economic resources. Currently, we know a few data about mortality from injury, particularly among the working population. The aim of the present study was to examine death from injury over a period of 14 years (1999–2012) using the Swedish Cause of Death Registry (CDR) and the National Patient Registry, which have complete national coverage.

Method

CDR was used to identify injury-related deaths among adults (18 years or over) during the years 1999–2012. ICD-10 diagnoses from V01 to X39 were included. The significance of changes over time was analyzed by linear regression.

Results

The incidence of prehospital death decreased significantly (coefficient −0.22, r² = 0.30; p = 0.041) during the study period, while that of deaths in hospital increased significantly (coefficient 0.20, r² = 0.75; p < 0.001). Mortality/100,000 person-years in the working age group (18–64 years) decreased significantly (coefficient −0.40, r² = 0.37; p = 0.020), mainly as a result of decrease in traffic-related deaths (coefficient −0.34, r² = 0.85; p < 0.001). The incidence of deaths from injury among elderly (65 years and older) patients increased because of the increase in falls (coefficient 1.71, r² = 0.84; p < 0.001) and poisoning (coefficient 0.13, r² = 0.69; p < 0.001).

Conclusion

The epidemiology of injury in Sweden has changed during recent years in that mortality from injury has declined in the working age group and increased among those people 64 years old and over.

Haemostatic function and biomarkers of endothelial damage before and after platelet transfusion in patients with acute myeloid leukaemia

OBJECTIVES

The beneficial effect of platelet transfusion on haemostasis is well established, but there is emerging evidence that platelet transfusion induces an inflammatory response in vascular endothelial cells.

BACKGROUND

We investigated haemostatic function and endothelial biomarkers before and after platelet transfusion in patients with acute myeloid leukaemia.

MATERIALS AND METHODS

Blood was sampled before, 1 and 24 h after platelet transfusion. Primary and secondary haemostasis was evaluated by whole blood aggregometry (Multiplate) and thromboelastography (TEG). Endothelial biomarkers (sICAM-1, syndecan-1, sThrombomodulin, sVE-Cadherin) and platelet activation biomarkers (sCD40L, TGF-beta) were investigated along with haematology/biochemistry analyses.

RESULTS

Twenty-two patients were included. Despite continued low platelet counts, platelet transfusion normalised the median values of most TEG parameters and slightly increased platelet aggregation (all P < 0·05). Endothelial biomarkers were not significantly affected by transfusion. The 1 h sCD40L level correlated positively with Syndecan-1 and soluble thrombomodulin delta values, biomarkers of endothelial damage (both P = 0·005).

CONCLUSION

Platelet transfusion improved haemostasis, whereas post-transfusion increases in sCD40L were associated with endothelial damage, indicating that transfused platelets and platelet-derived pro-inflammatory mediators may have opposite effects on the endothelium.

Heart ischaemia-reperfusion induces local up-regulation of vasoconstrictor endothelin ETB receptors in rat coronary arteries downstream of occlusion

BACKGROUND AND PURPOSE

Endothelins act via two receptor subtypes, ETA and ETB . Under physiological conditions in coronary arteries, ETA receptors expressed in smooth muscle cells mediate vasoconstriction whereas ETB receptors mainly found in endothelial cells mediate vasorelaxation. However, under pathophysiological conditions, ETB receptors may also be expressed in vascular smooth muscle cells mediating vasoconstriction. Here, we have investigated whether vasoconstrictor ETB receptors are up-regulated in coronary arteries after experimental myocardial ischaemia in rats.

EXPERIMENTAL APPROACH

Male Sprague-Dawley rats were subjected to either heart ischaemia-reperfusion (15 min ischaemia and 22 h reperfusion), permanent ischaemia (22 h) by ligation of the left anterior descending coronary artery, or sham operation. Using wire myography, the endothelin receptor subtypes mediating vasoconstriction were examined in isolated segments of the left anterior descending and the non-ligated septal coronary arteries. Endothelin receptor-mediated vasoconstriction was examined with cumulative administration of sarafotoxin 6c (ETB receptor agonist) and endothelin-1 (with or without ETA or ETB receptor blockade). The distribution of ETB receptors was localized with immunohistochemistry and quantified by Western blot.

KEY RESULTS

Endothelin ETB receptor-mediated vasoconstriction and receptor protein levels were significantly augmented in coronary arteries situated downstream of the occlusion after ischaemia-reperfusion compared with non-ischaemic arteries. In contrast, the ETA receptor-mediated vasoconstriction was unaltered in all groups.

CONCLUSIONS AND IMPLICATIONS

Ischaemia-reperfusion induced local up-regulation of ETB receptors in the smooth muscle cells of coronary arteries in the post-ischaemic area. In contrast, in non-ischaemic areas, ETB receptor function was unaltered.

Differential localization and characterization of functional calcitonin gene-related peptide receptors in human subcutaneous arteries

AIM

Calcitonin gene-related peptide (CGRP) and its receptor are widely distributed within the circulation and the mechanism behind its vasodilation not only differs from one animal species to another but is also dependent on the type and size of vessel. The present study examines the nature of CGRP-induced vasodilation, characteristics of the CGRP receptor antagonist telcagepant and localization of the key components calcitonin receptor-like receptor (CLR) and receptor activity modifying protein 1 (RAMP1) of the CGRP receptor in human subcutaneous arteries.

METHODS

CGRP-induced vasodilation and receptor localization in human subcutaneous arteries were studied by wire myograph in the presence and absence of the CGRP receptor antagonist telcagepant and immunohistochemistry respectively.

RESULTS

At concentrations of 1, 3, 5, 10 and 30 nm, telcagepant had a competitive antagonist-like behaviour characterized by a parallel rightwards shift in the log CGRP concentration-tension/calcium curve with no depression of the maximal relaxation. CGRP-induced vasodilation was not affected by mechanical removal of the endothelium or addition of L-NG-nitroarginine methyl ester and indomethacin, antagonists for synthesis of nitric oxide and prostaglandins, respectively. CLR and RAMP1 were localized in the vascular smooth muscle and endothelial cells.

CONCLUSION

The present results indicate that CGRP exerts its vasodilatory effect in human subcutaneous arteries by binding to its receptors located on the smooth muscle cells and is suggested to be endothelium-independent. In conclusion, these results underline the dynamic distribution of CGRP receptor components in the human circulation reflecting the important role of CGRP in fine tuning of the blood flow in resistance arteries.

Transfusion-associated anaphylaxis during anaesthesia and surgery--a retrospective study

BACKGROUND AND OBJECTIVES

Transfusion-associated anaphylaxis (TAA) is a severe adverse reaction reported to occur in 1:9000-90,000 transfusions. According to the Danish Registration of Transfusion Risks (DART), the frequency is 1:300,000 transfusions, which suggests insufficient reporting of TAA in Denmark. Our aims were to identify possible cases of TAA, to characterize their symptoms and tryptase levels and to investigate the reporting of TAA to the haemovigilance systems.

MATERIAL AND METHODS

We reviewed 245 patients with suspected allergic reactions during anaesthesia and surgery, investigated at the Danish Anaesthesia Allergy Centre (DAAC). Based on the outcome of this investigation, the patients were classified as DAAC positive (confirmed hypersensitivity to identified agent, n = 112), or DAAC negative (no confirmed hypersensitivity, n = 133). Data on case history, details of blood transfusion and results of laboratory and clinical investigations were collected. TAA cases were identified according to the recommendations of the International Society of Blood Transfusion (ISBT).

RESULTS

Ten possible TAA cases (30% of all transfused patients) were identified, all DAAC negative. The frequency of elevated serum tryptase, hypotension and male sex was significantly higher among these cases compared with the remaining DAAC negative (P < 0·05), but not different from the DAAC-positive patients. One case had been reported to the Blood Bank haemovigilance system and none to DART.

CONCLUSION

We identified unreported cases of possible TAA, which resembled the DAAC-positive patients with respect to elevated tryptase and symptoms. By applying the ISBT criteria of adverse transfusion reactions, we conclude that TAA during anaesthesia and surgery is likely to be underreported in Denmark.

Testosterone therapy decreases subcutaneous fat and adiponectin in aging men

OBJECTIVE

Testosterone therapy increases lean body mass and decreases total fat mass in aging men with low normal testosterone levels. The major challenge is, however, to determine whether the metabolic consequences of testosterone therapy are overall positive. We have previously reported that 6-month testosterone therapy did not improve insulin sensitivity. We investigated the effect of testosterone therapy on regional body fat distribution and on the levels of the insulin-sensitizing adipokine, adiponectin, in aging men with low normal bioavailable testosterone levels.

DESIGN

A randomized, double-blinded, placebo-controlled study on 6-month testosterone treatment (gel) in 38 men, aged 60-78 years, with bioavailable testosterone <7.3 nmol/l, and a waist circumference >94 cm.

METHODS

Central fat mass (CFM) and lower extremity fat mass (LEFM) were measured by dual X-ray absorptiometry. Subcutaneous abdominal adipose tissue (SAT), visceral adipose tissue (VAT), and thigh subcutaneous fat area (TFA) were measured by magnetic resonance imaging. Adiponectin levels were measured using an in-house immunofluorometric assay. Coefficients (b) represent the placebo-controlled mean effect of intervention.

RESULTS

LEFM was decreased (b = -0.47 kg, P = 0.07) while CFM did not change significantly (b = -0.66 kg, P = 0.10) during testosterone therapy. SAT (b = -3.0%, P = 0.018) and TFA (b = -3.0%, P < 0.001) decreased, while VAT (b = 1.0%, P = 0.54) remained unchanged. Adiponectin levels decreased during testosterone therapy (b = -1.3 mg/l, P = 0.001).

CONCLUSION

Testosterone therapy decreased subcutaneous fat on the abdomen and lower extremities, but visceral fat was unchanged. Moreover, adiponectin levels were significantly decreased during testosterone therapy.

Rapid Detection of Tobacco Rattle Tobravirus in Viruliferous Paratrichodorus allius from Greenhouse and Field Specimens

The stubby root nematode, Paratrichodorus allius, is important to the potato industry in the Pacific Northwest of USA, because it vectors Tobacco rattle virus (TRV), the causal agent of corky ringspot disease. The current method for determining if nematodes are viruliferous for TRV takes several weeks, requiring a glasshouse bioassay followed by a serological test. To overcome this drawback, a rapid and affordable molecular test was developed using reverse transcription polymerase chain reaction (RT-PCR) to identify viruliferous P. allius nematodes within 48 hours. Primers from the 16 kDa gene of TRV were used to detect TRV in both greenhouse-reared and field collected P. allius. TRV RNA can be detected consistently in nucleic acids equivalent to one quarter of a viruliferous adult nematode reared in the greenhouse. In order to reduce the time and expense of processing individual nematodes from field samples, viral RNA was consistently and affordably detected in extracts from 5 field-collected adult P. allius.

Search for Lorentz and CPT violation effects in Muon spin precession

The spin precession frequency of muons stored in the (g-2) storage ring has been analyzed for evidence of Lorentz and CPT violation. Two Lorentz and CPT violation signatures were searched for a nonzero delta omega a(=omega a mu+ - omega a mu-) and a sidereal variation of omega a mu+/-). No significant effect is found, and the following limits on the standard-model extension parameters are obtained: bZ = -(1.0+/-1.1) x 10(-23) GeV; (m mu dZ0 + HXY)=(1.8+/-6.0) x 10(-23) GeV; and the 95% confidence level limits b perpendicular mu+ <1.4 x 10(-24) GeV and b perpendicular mu- <2.6 x 10(-24) GeV.

A Randomized Controlled Trial of Therapeutic Drug Monitoring in Treatment-Naive and -Experienced HIV-1-Infected Patients

OBJECTIVE

To improve the utility of therapeutic drug monitoring (TDM) by defining the proportion of patients with and predictors of above or below target protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI) concentrations.

METHODS

This 48-week, multicenter, open-label clinical trial randomized patients to TDM versus standard of care (SOC). Serial pharmacokinetics, including a week-2 3-sample sparse collection, and expert committee TDM recommendations were given to TDM-arm patients' providers.

RESULTS

Seventy-four (39%) of 190 patients had week-2 concentrations outside of targets and 122 (64%) of 190 had nontarget exposure at least once over 48 weeks. Providers accepted 75% of TDM recommendations. Among patients with below-target concentrations, more TDM-arm than SOC-arm patients achieved targets (65% vs. 45%; P = 0.09). Increased body weight and efavirenz or lopinavir/ritonavir use were significant predictors of nontarget concentrations. Patients at target and patients who achieved targets after TDM-directed dose modifications trended toward greater viral load reductions at week 48 than patients with below-target exposures (HIV RNA reductions: 2.4, 2.3, and 1.9 log10 copies/mL, respectively; P = 0.09).

CONCLUSIONS

Most patients had nontarget PI and/or NNRTI concentrations over 48 weeks. TDM recommendations were well accepted and improved exposure. Patients below TDM targets trended toward worse virologic response.

The acceptability of a directly-administered antiretroviral therapy (DAART) intervention among patients in public HIV clinics in Los Angeles, California

Directly administered antiretroviral therapy (DAART) is an intensive adherence support strategy for highly active antiretroviral therapy (HAART) that requires patient acceptance to be effective. In one arm of a randomized adherence study, community workers (CW) delivered and observed ingestion of one HAART dose to participants five days a week for six months. We evaluated acceptability by study participation, retention, attendance and a satisfaction survey. Chi-square and nonparametric tests were used to examine differences between participants who did and did not complete DAART. Between November 2001 and March 2004, 416 eligible participants were identified; 250 were enrolled and 166 refused to participate (22 of these (13%) because of DAART specifically). Of the 82 randomized to DAART (70% Latino, 20% African American, 27% female and 69% foreign-born), 65 (79%) completed six months of DAART. Participants attended 6,953/7,390 (94%) appointments. Latinos were more likely to complete DAART compared to African Americans (OR=4.76, 95%CI=1.38, 16.44, p=0.01). In addition, foreign-born participants were more likely to complete DAART than US-born participants (OR=3.38, 95%CI=1.11-10.22, p=0.03). Participants completing DAART reported high rates of satisfaction. Retention, attendance and participant satisfaction suggest that DAART is an acceptable adherence support strategy in this public clinic population, particularly among Latino and foreign-born participants.

A practical synthesis of 2-((1H-pyrrolo[2,3-b]pyridine-4-yl)methylamino)-5- fluoronicotinic acid

A practical synthesis of a key pharmaceutical intermediate, 2-[(1H-pyrrolo[2,3-b]pyridine-4-yl)methylamino]-5-fluoronicotinic acid (1), is described. To introduce the aminomethyl moiety of 2 via a palladium-catalyzed cyanation/reduction sequence, a regioselective chlorination of 7-azaindole via the N-oxide was developed. A highly selective monodechlorination of 2,6-dichloro-5-fluoronicotinic acid was discovered to afford the nicotinic acid 3. The two building blocks 2 and 3 were then coupled to complete the preparation of 1.

Emerging fungal pathogens in pulmonary disease

PURPOSE OF REVIEW

Invasive fungal infections of the lung have been increasing due to the increase of the population most at risk. This review aims to describe some of the emerging fungal pathogens and their complex management.

RECENT FINDINGS

With the increase in immunosuppressed populations, physicians are increasingly encountering uncommon fungal pathogens that historically have been difficult to identify and treat. Many of these fungal infections present with similar clinical features and often show similar histopathological changes. Treatment options are more complex because of an increasing number of antifungals that have become available for clinical use. The correct usage of these antifungals in addressing emerging fungal infections is unclear, however. Drawing from in-vitro and in-vivo susceptibility testing and case reports, some deductions may be made for the best empirical treatment of these deadly diseases. In general, the newer triazoles (voriconazole and posiconazole) and the use of combination therapy have shown promise.

SUMMARY

Invasive fungal infections are on the increase and contribute significantly to overall mortality, particularly among transplant recipients. With the lack of well designed controlled clinical studies, physicians will need to draw from previously described cases and in-vitro susceptibility testing to optimize therapy.

Changes in circulating lymphocyte subpopulations following administration of the leucocyte function-associated antigen-3 (LFA-3)/IgG1 fusion protein alefacept

Alefacept, a recombinant leucocyte function-associated antigen-3 (LFA-3)/IgG1 fusion protein approved for the treatment of psoriasis, is reported to reduce selectively the numbers of circulating CD4(+) CD45RO(+) and CD8(+) CD45RO(+) T cells, while sparing the naive cells. The purpose of the present study was to elucidate further the effect of alefacept on various circulating lymphocyte subsets. Sixteen patients, 12 with chronic plaque psoriasis and four with pustular psoriasis, received alefacept 7.5 mg once weekly for 12 weeks. Blood samples collected at study entry and after 12 weeks of treatment were analysed by four-colour flow cytometry. There were statistically significant reductions in the total number of conventional memory (CD45RA(-) CD27(+)) and effector (CD45RA(-) CD27(-) or CD45RA(+) CD27(-)) T cells, including CD4(+) and CD8(+) T cells expressing CD161 and CD8(+) T cells expressing cutaneous lymphocyte-associated antigen (CLA). Natural killer (NK) T cells were also reduced significantly, while no statistically significant changes were seen in NK cells and CD4(+) CD25(high) cells. The affected subpopulations were all characterized by a high expression of CD2. However, CD4(+) CD25(low), and CD4(+) CLA(+) cells, which also expressed relative high levels of CD2, were not reduced significantly. Our results suggest a heterogeneous effect of alefacept on the circulating memory T cell population, indicating that high expression of CD2 may not, by itself, be sufficient to explain the reduction in cell count for a specific subpopulation.