Administration of commercial Rhodococcus equi specific hyperimmune plasma results in variable amounts of IgG against pathogenic bacteria in foals

Rhodococcus equi is the most common cause of pneumonia in young foals. A vaccine is not available and the use of R equi-specific hyperimmune plasma (HIP) is common. Despite its widespread use, the efficacy of HIP in preventing disease remains controversial. The objectives of this study were (1) to evaluate the virulence associate protein A (VapA)-specific IgG and IgG subclasses in commercially available R equi HIP and (2) to evaluate serum VapA-specific IgG and IgG subclasses in foals following administration of commercial R equi HIP. Three different lots from four commercial R equi HIP were sampled. VapA-specific IgG and IgG subclasses were evaluated in all samples using an ELISA. Serum was collected from newborn foals either after commercial R equi HIP was administered (n=97) or not (n=70). Serum was also collected from each mare. Administration of HIP significantly (P<0.001) increased VapA-specific IgGs in recipient foals, however, there was a marked variation in VapA-specific IgGs in foals receiving the same product. VapA-specific IgGs were significantly different (P<0.001) between products and varied between lots, with coefficients of variation ranging from 17 to 123 per cent. These results may explain previously reported disparities in HIP efficacy.

Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review

BACKGROUND

There are ongoing questions about whether unemployment has causal effects on suicide as this relationship may be confounded by past experiences of mental illness. The present review quantified the effects of adjustment for mental health on the relationship between unemployment and suicide. Findings were used to develop and interpret likely causal models of unemployment, mental health and suicide.

METHOD

A random-effects meta-analysis was conducted on five population-based cohort studies where temporal relationships could be clearly ascertained.

RESULTS

Results of the meta-analysis showed that unemployment was associated with a significantly higher relative risk (RR) of suicide before adjustment for prior mental health [RR 1.58, 95% confidence interval (CI) 1.33-1.83]. After controlling for mental health, the RR of suicide following unemployment was reduced by approximately 37% (RR 1.15, 95% CI 1.00-1.30). Greater exposure to unemployment was associated with higher RR of suicide, and the pooled RR was higher for males than for females.

CONCLUSIONS

Plausible interpretations of likely pathways between unemployment and suicide are complex and difficult to validate given the poor delineation of associations over time and analytic rationale for confounder adjustment evident in the revised literature. Future research would be strengthened by explicit articulation of temporal relationships and causal assumptions. This would be complemented by longitudinal study designs suitable to assess potential confounders, mediators and effect modifiers influencing the relationship between unemployment and suicide.

Children with nephrotic syndrome have greater bone area but similar volumetric bone mineral density to healthy controls

BACKGROUND

Glucocorticoid use has been associated with an increased fracture risk and reduced bone mineral density (BMD), particularly in the trabecular compartment. However the contribution of the underlying inflammatory disease process to these outcomes is poorly understood. Childhood nephrotic syndrome (NS) typically follows a relapsing-remitting course often requiring recurrent courses of glucocorticoids, but with low systemic inflammation during remission. NS therefore represents a useful clinical model to investigate the effects of glucocorticoids on BMD and bone geometry in childhood.

METHODS

Children with NS were compared to age and sex matched healthy controls. Body composition and areal BMD (whole body, lumbar spine and hip) were assessed by DXA. Peripheral quantitative computed tomography (pQCT) scans were obtained at metaphyseal (4%) and diaphyseal (66%) sites of the tibia to determine volumetric BMD and bone cross-sectional geometry. Lifetime cumulative glucocorticoid exposure was calculated from medical records.

RESULTS

29 children with NS (55% male, age 10.7±3.1years) were compared to 29 healthy controls (55% male, age 11.0±3.0years). The children with NS were of similar height SDS to controls (p=0.28), but were heavier (0.65±1.28SDS vs -0.04±0.89SDS, p=0.022) and had greater body fat percentage SDS (0.31±1.01 vs -0.52±1.10, p=0.008). Tibial trabecular and cortical vBMD were similar between the two groups but bone cross-sectional area (CSA) was significantly greater in children with NS at both the metaphysis (954±234mm(2) vs 817±197mm(2), p=0.002) and diaphysis (534.9±162.7mm(2) vs 463.2±155.5mm(2), p=0.014). Endosteal and periosteal circumferences were greater in children with NS than controls (both p<0.01), resulting in reduced cortical thickness (2.4±0.7mm vs 2.8±0.7mm, p=0.018), but similar cortical CSA (p=0.22). The differences in cortical geometry were not statistically significant when weight was included as a confounding factor. There were no associations between cumulative steroid exposure, duration of NS or number of relapses and any bone parameter.

CONCLUSIONS

Tibial bone CSA is increased in children with NS. We speculate that this is a compensatory response to increased body weight. Defects in trabecular BMD were not identified in this cohort of children with NS.

The effect of leaving employment on mental health: testing 'adaptation' versus 'sensitisation' in a cohort of working-age Australians

OBJECTIVES

To investigate the 'adaptation' versus 'sensitisation' hypotheses in relation to mental health and labour market transitions out of employment to determine whether mental health stabilised (adaptation) or worsened (sensitisation) as people experienced one or more periods without work.

METHODS

The Household Income and Labour Dynamics of Australia (HILDA) longitudinal survey was used to investigate the relationship between the number of times a person had been unemployed or had periods out of the labour force (ie, spells without work) and the Mental Component Summary (MCS) of the Short Form 36 (SF-36). Demographic, health and employment related confounders were included in a series of multilevel regression models.

RESULTS

During 2001-2010, 3362 people shifted into unemployment and 1105 shifted from employment to not in the labour force. Compared with participants who did not shift, there was a 1.64-point decline (95% CI -2.05 to -1.23, p<0.001) in scores of the MCS SF-36 among those who had one spell of unemployment (excluding not in the labour force), and a 2.56-point decline (95% CI -3.93 to -1.19, p<0.001) among those who had two or more spells of unemployment after adjusting for other variables. Findings for shifts from employment to 'not in the labour force' were in the same direction; however, effect sizes were smaller.

CONCLUSIONS

These results indicate that multiple spells of unemployment are associated with continued, though small, declines in mental health. Those who leave employment for reasons other than unemployment experience a smaller reduction in mental health.

Directional limits on persistent gravitational waves using LIGO S5 science data

The gravitational-wave (GW) sky may include nearby pointlike sources as well as stochastic backgrounds. We perform two directional searches for persistent GWs using data from the LIGO S5 science run: one optimized for pointlike sources and one for arbitrary extended sources. Finding no evidence to support the detection of GWs, we present 90% confidence level (C.L.) upper-limit maps of GW strain power with typical values between 2-20×10(-50)  strain(2) Hz(-1) and 5-35×10(-49)  strain(2) Hz(-1) sr(-1) for pointlike and extended sources, respectively. The latter result is the first of its kind. We also set 90% C.L. limits on the narrow-band root-mean-square GW strain from interesting targets including Sco X-1, SN 1987A and the Galactic center as low as ≈7×10(-25) in the most sensitive frequency range near 160 Hz.

Kunjin virus replicon-based vaccines expressing Ebola virus glycoprotein GP protect the guinea pig against lethal Ebola virus infection

Pre- or postexposure treatments against the filoviral hemorrhagic fevers are currently not available for human use. We evaluated, in a guinea pig model, the immunogenic potential of Kunjin virus (KUN)-derived replicons as a vaccine candidate against Ebola virus (EBOV). Virus like particles (VLPs) containing KUN replicons expressing EBOV wild-type glycoprotein GP, membrane anchor-truncated GP (GP/Ctr), and mutated GP (D637L) with enhanced shedding capacity were generated and assayed for their protective efficacy. Immunization with KUN VLPs expressing full-length wild-type and D637L-mutated GPs but not membrane anchor-truncated GP induced dose-dependent protection against a challenge of a lethal dose of recombinant guinea pig-adapted EBOV. The surviving animals showed complete clearance of the virus. Our results demonstrate the potential for KUN replicon vectors as vaccine candidates against EBOV infection.

Suicide in paradise: aftermath of the Bali bombings

BACKGROUND

The relationship between the Bali (Indonesia) bombings of October 2002 and suicide has not previously been investigated, despite anecdotal evidence of the economic and psychological consequences of these attacks.

METHOD

Suicide rates were calculated over the period 1994-2006 in three Bali regencies to determine whether suicide increased in the period following the first Bali bombings. Poisson regression and time-series models were used to assess the change in suicide rates by sex, age and area in the periods before and after October 2002.

RESULTS

Suicide rates (age-adjusted) increased in males from an average of 2.84 (per 100 000) in the period pre-2002 to 8.10 in the period post-2002, and for females from 1.51 to 3.68. The greatest increases in suicide in the post-2002 period were in the age groups 20-29 and 60 years, for both males and females. Tourist arrivals fell significantly after the bombings, and addition of tourism to models reduced relative risk estimates of suicide, suggesting that some of the increase may be attributable to the socio-economic effects of declines in tourism.

CONCLUSIONS

There was an almost fourfold increase in male suicide risk and a threefold increase in female suicide risk in the period following the 2002 bombings in Bali. Trends in tourism did not account for most of the observed increases. Other factors such as indirect socio-economic effects and Balinese notions of collective guilt and anxieties relating to ritual neglect are important in understanding the rise in suicide in the post-2002 period.

Behavioural and social correlates of sedentary time in young people

OBJECTIVE

In this study, behavioural and social correlates of objectively measured sedentary time in young people were identified.

DESIGN

Cross-sectional analysis of data from the European Youth Heart Study (EYHS).

SETTING

Schools in Denmark, Estonia, Portugal and Norway.

PARTICIPANTS

Respondents were invited using a twostage cluster sampling procedure. Analyses include 2107 children (9-10 years old) and adolescents (14-15 years old). ASSESSMENT OF INDEPENDENT VARIABLES: Seven behavioural and 15 social variables assessed by parental and computerised child questionnaires.

MAIN OUTCOME MEASURE

Sedentary activity as assessed by accelerometry (10 min blocks at <200 counts/min). Analyses were stratified by country, and interactions with grade and sex were investigated.

RESULTS

Adolescents were more sedentary than children (335.4 (90.4 min/day) vs 217.2 (75.6 min/day), p<0.001). Patterns of associations differed across countries. High computer use and no television viewing before school in Norway, and being sedentary during school breaks in Estonia were positively associated with sedentary time. No behavioural variables were associated with sedentary time in the Danish and Portuguese models. Socioeconomic position was positively associated with sedentary time in Portugal and Estonia, father's body mass index negatively in the Estonian model. Norwegian participants with a game console at home and Portuguese participants with a television in their bedroom were more sedentary.

CONCLUSIONS

A single strategy aimed at reducing sedentary behaviour is unlikely to be effective across Europe as the target populations and behaviours of focus differ between countries. Targeting high socioeconomic groups in Portugal and Estonia or focusing on reducing computer use in Norway might be effective intervention strategies to reduce overall sedentary time.

Effect of marker cluster design on the accuracy of human movement analysis using stereophotogrammetry

This paper presents a new, simple model to evaluate the instrumental random errors in kinematic analysis of human movements using stereophotogrammetry. By means of equations analogous to that relate linear or angular momentum with linear or angular velocities, a direct measurement of instantaneous motion can be made without previous finite displacement analysis. Single explicit expressions can be obtained to evaluate the influence of instrumental random errors in the accuracy of the kinematic variables. From these expressions, some conclusions about the effect of marker cluster design on the experimental errors are obtained. An experiment has been carried out in order to validate the proposed technique and to assess the experimental errors in linear and angular velocity measurement and its influence in instantaneous helical axis determination.

Normalizing temporal patterns to analyze sit-to-stand movements by using registration of functional data

Functional data analysis techniques provide an alternative way of representing movement and movement variability as a function of time. In particular, the registration of functional data provides a local normalization of time functions. This normalization transforms a set of curves, records of repeated trials, yielding a new set of curves that only vary in terms of amplitude. Therefore, main events occur at the "same time" for all transformed curves and interesting features of individual recordings remain after averaging processes. This paper presents an application of the registration process to the analysis of the vertical forces exerted on the ground by both feet during the sit-to-stand movement. This movement is particularly interesting in functional evaluations related to balance control, lower extremity dysfunction or low-back pain.

Physical activity patterns in nonobese and obese children assessed using minute-by-minute accelerometry

OBJECTIVE

To determine the levels and patterns of physical activity in a sample of obese (> or =99th percentile body mass index (BMI)) and nonobese (<99th percentile BMI) children.

DESIGN

Cross-sectional study.

SETTING

Children were recruited from schools in Bristol and from the childhood obesity clinic, Bristol Royal Hospital for Children. Children were instructed in the use of the accelerometer either while at school or in the clinic, and wore the instrument while carrying out their normal daily activities for 7 days.

PARTICIPANTS

A total of 133 children (mean age 10.5+/-0.8 y). In all 11 (16.9%) of the 65 girls and 14 (20.6%) of the 68 boys were classified as obese (above the 99th percentile for BMI and corresponding to projected adult BMI of 30).

MAIN OUTCOME MEASURES

Objectively measured physical activity volume, intensity and pattern.

RESULTS

Obese children were significantly less physically active overall than their nonobese counterparts (31,844+/-13,200 vs 41,844+/-10,430 counts/h; 95% confidence interval 4407 to 15592; P=0.001). Similarly the obese children spent less time in physical activity of moderate or greater intensity than the nonobese children (9.9+/-3.9 vs 12.9+/-4.2 min/h; 95% confidence interval 1.15 to 4.80; P=0.002). Hourly patterns of activity indicated a tendency in obese children to be less active than nonobese children at times when activity was more likely to be determined by free choice, particularly outside of school time.

CONCLUSIONS

Obese children demonstrated patterns of physical activity that may have contributed to and are likely to sustain their obesity. Minute-by-minute accelerometry is a valuable tool to investigate physical activity patterns in obese children. It can identify periods when intervention to increase activity may be most appropriate and provide an evidence base for specific exercise prescription in primary and secondary care.

Age-specific interval breast cancers in New South Wales and meta-analysis of studies of women aged 40-49 years

OBJECTIVE

To compare interval cancers in the 40-49 year age group with other age groups in New South Wales and with published trials and service studies.

SETTING

New South Wales data were derived from the population-based biennial mammography screening program, which achieved state-wide coverage in 1995. Women aged 40-49 years screened during 1995-1998 were included.

METHODS

Bilateral two-view mammography with reading by two radiologists was employed for biennial screening examinations. Interval cancers were detected by the screening program and by linkage with the state-wide cancer registry. Incidence of interval cancer based on the date of diagnosis was estimated as a proportion of the expected underlying breast cancer incidence for first- and second-year interval cancers. Sensitivity estimates were also calculated. Comparative data for the 40-49 year age group were derived from the published literature for meta-analyses of trial and service studies.

RESULTS

Interval cancer rates for New South Wales decreased with increasing age, with the highest proportional incidence in the 40-49 year age group for first year (56%, 95% confidence interval [CI] 50-62%) and second-year (86%, 95% CI 82-90%) interval cancers. Proportional incidence for women aged 50-69 years for first- and second-year interval cancers was 31% (95%CI 29-33%) and 50% (95% CI 47-52%) respectively. Sensitivity estimates for the program increased significantly with age, with lowest sensitivity estimates evident for women 40-49 years. In women aged 40-49 years the meta-analysed proportional incidence rate for randomised trials of screening for first- and second-year interval cancers was 42% (95% CI 21-62%) and 63% (95% CI 55-71%) respectively, while for service studies it was 44% (95% CI 31-58%) and 72% (95% CI 51-92%). Proportional incidence in the New South Wales program for women aged 40-49 years was not significantly different to the meta-analysed proportional incidences for trial and service studies in the first year, or for service studies in the second year.

CONCLUSION

Proportional incidence of interval cancer was significantly higher in women aged 40-49 years in New South Wales relative to older age groups, but did not differ significantly from service studies of women in a similar age group. The effectiveness of mammography screening for this age group needs to be examined in view of the comparatively high rate of interval cancers.

Pain in femoral arteriography. A double-blind, randomized, clinical study comparing safety and efficacy of the iso-osmolar iodixanol 270 mgI/ml and the low-osmolar iomeprol 300 mgI/ml in 9 European centers

PURPOSE

To compare the injection-associated pain and heat sensation after administration of the iso-osmolar contrast medium (IOCM) iodixanol (Visipaque trade mark 270 mg I/ml) and the low osmolar contrast medium (LOCM) iomeprol (Iomeron trade mark 300 mg I/ml) in femoral arteriography.

MATERIAL AND METHODS

352 patients received iodixanol or iomeprol in a prospective, double-blind, randomized, parallel-group clinical trial. The first injection during femoral arteriography (DSA with automated stepping) was standardized. Injection-associated pain and heat sensation, efficacy and safety up to 72 h were evaluated.

RESULTS

The iodixanol group reported significant less injection-associated pain than the iomeprol group after the first injection (7.4% vs. 17.6%; p = 0.007), and after all injections (11% vs. 19.4%; p = 0.045). Iodixanol caused less heat sensation after the first injection (p = 0.007) and after all injections (p = 0.029). Heat sensations in the iodixanol group were less intense after all injections (p < 0.0001). No difference was found between the groups regarding the frequency of patients having adverse reactions (5.1% vs. 4%).

CONCLUSION

The IOCM iodixanol caused significantly less frequent injection-associated pain and heat sensation than the LOCM iomeprol during femoral arteriography.