Reliability of a combined 3-min constant load and performance cycling test

Most fitness assessments either use a constant load to exhaustion (exercise capacity test) or an "all-out" effort (performance test). The purpose of this study was to determine the reliability of a high-intensity assessment that combined a constant load element with a performance test. Ten moderately trained male cyclists completed a ramp test to voluntary exhaustion in order to measure maximum minute power output (mean +/- s, 349.3 w +/- 55.0 w). On two other occasions subjects cycled at a constant load at maximum minute power output for 2-min immediately followed by a 1-min performance test. All tests were conducted on the subjects' own bicycles using a Kingcycle trade mark test rig. Power output was measured each second using SRM trade mark Power Cranks. The data were analysed by measuring the reliability of each 30 s of the 3-min test together with the peak power and the peak cadence achieved in the performance element of the test. There was no systematic bias in the data from trial 1 to trial 2 for any of the 6, 30 s blocks of the test, the peak power (mean, 95 % CI, 413.8 w, 357.8 - 469.7 w and 403.8 w, 339.9 - 467.6 w, trial 1 and trial 2, respectively) or peak cadence (95.0 rev x min(-1), 89.5 - 100.5 rev x min(-1) and 95.1 rev x min(-1), 90.0 - 100.1 rev x min(-1), trial 1 and trial 2, respectively). Mean (+/- s) total distance over the 3-min was 2.23 +/- 0.23 km and 2.26 +/- 0.26 km for trial 1 and trial 2 respectively (p > 0.05). The coefficients of variation ranged from 0.9 - 5.4 % and the intraclass correlation coefficients ranged from 0.96 - 0.99. It is concluded that in moderately trained subjects, the 3-min combination test provides reliable data and could therefore be used for short-term, high-intensity cycling intervention studies.

A case of plague successfully treated with ciprofloxacin and sympathetic blockade for treatment of gangrene

A critically ill patient with septicemic plague and peripheral gangrene was treated successfully with ciprofloxacin. There are no previous reports of plague being successfully treated with ciprofloxacin. Peripheral gangrene of this patient's feet was managed with use of sympathetic blockade; the patient's toes appear to have been saved by this approach.

Linkage disequilibrium mapping provides further evidence of a gene for reading disability on chromosome 6p21.3-22

Linkage disequilibrium (LD) mapping was used to follow up reports of linkage between reading disability (RD) and an 18 cM region of chromosome 6p21.3-22. Using a two-stage approach, we tested for association between RD and 22 microsatellite markers in two independent samples of 101 (Stage 1) and 77 (Stage 2) parent/proband trios in which RD was rigorously defined. The most significant replicated associations were observed between combinations of markers D6S109/422/1665 (Stage 1, P=0.002 (adjusted for multiple testing); Stage 2, P=0.0001) and D6S506/1029/1660 (Stage 1, P=0.02 (adjusted), Stage 2, P=0.0001). The only two-marker association observed in both samples was with D6S422/1665 (P=0.01, 0.04). No single marker showed replicated association but D6S506 produced values of P=0.01 and 0.08 which were significant when combined (P=0.02). We observed weaker and less consistent evidence of association in a region of confirmed linkage to RD in previous studies. The most consistently significant haplotypic association D6S109/422/1665, showed association with single-word reading, spelling, phonological awareness, phonological decoding, orthographic accuracy and random automised naming, but not with vocabulary or Attention Deficit Hyperactivity Disorder. Our findings strongly support the presence of a gene contributing to RD in a region of chromosome 6 between markers D6S109 and D6S1260, but do not rule out the presence of a gene between D6S1556 and MOG.

Traceless, self-cleaving solid- and solution-phase parallel synthesis of 3,4,7-trisubstituted 3,4-dihydroquinoxalin-2-ones

This article describes a new methodology for the parallel synthesis of 3,4-dihydroquinoxalin-2-ones containing three points of diversity. The synthesis begins with commercially available resin-bound alpha-amino acids as the source of the first diversity element and employs a combination of solid- and solution-phase chemistry to introduce the other two. The key step is an intramolecular cyclization and simultaneous traceless cleavage from the solid support to give a disubstituted 3,4-dihydroquinoxalin-2-one. The third substituent is introduced in solution by N-alkylation of the aniline nitrogen using a scavenger resin to dispose of excess reagent. All the reactions in the sequence take place at room temperature without the need to use strong acids or to maintain an inert atmosphere, thereby preserving the chiral integrity of the starting alpha-amino acid and facilitating the generation of libraries in a high-throughput parallel format.

Program directors' opinions in regard to Didactic Program in Dietetics graduates' failure to secure placement in Supervised Practice Programs

This study investigated program directors' perspectives on Didactic Program in Dietetics graduates' inability to secure positions in Supervised Practice Programs. The sample included all 229 program directors listed in the Directory of Dietetics Programs 1997-98. Directors contacted by electronic mail or fax completed a 4-part survey instrument including 3 Likert scale sections exploring the effects of the situation and strategies suggested to lessen them. The fourth part reported current practices. Response rate was 56%. Graduates' failure to secure Supervised Practice Program positions was found to be a significant or somewhat significant problem regardless of program size or affiliation. Strategies to increase the likelihood of Supervised Practice Program acceptance included work experience, application coaching, graduate coursework, and reapplication. We found that program directors have a high level of concern about their graduates' futures and are frustrated by their limited ability to improve the situation. Helping graduates who do not secure Supervised Practice Program assignments identify career options is essential.

Evaluation of diets for the development and reproduction of Franklinothrips orizabensis (Thysanoptera: Aeolothripidae)

The suitability of ten diets for the development and reproduction of Franklinothrips orizabensis Johansen, the key natural enemy of Scirtothrips perseae Nakahara, a pest of California grown avocados, was determined in the laboratory. The experimental diets evaluated were: (i) irradiated Ephestia kuehniella Zeller eggs; (ii) irradiated E. kuehniella eggs and avocado pollen; (iii) Tetranychus pacificus McGregor eggs; (iv) T. pacificus eggs and avocado pollen; (v) irradiated E. kuehniella eggs and T. pacificus eggs; (vi) irradiated E. kuehniella eggs, T. pacificus eggs and avocado pollen; (vii) Scirtothrips perseae; (viii) Heliothrips haemorrhoidalis (Bouchè); (ix) avocado pollen; and (x) a young avocado leaf. Franklinothrips orizabensis larvae were unable to develop to adulthood on diets 9 and 10. The remaining eight diets supported complete development of F. orizabensis, but only diets 1, 2, 5, 6, 7 and 8 produced fecund females. On diet 5, F. orizabensis exhibited high larval to adult survivorship (90%), mated females exhibited highest daily and lifetime fecundity, and the progeny of mated females were female biased (53%). Analysis of jackknife estimates of net reproduction (Ro), intrinsic rate of increase (rm), and finite rate of increase (lambda) were all significantly greater for F. orizabensis reared on irradiated E. kuehniella eggs and T. pacificus eggs (i.e. diet 5) than corresponding values for other diets on which female F. orizabensis were able to complete development and reproduce. Incorporation of avocado pollen into diets had an adverse effect on demographic statistics for F. orizabensis, and low quality diets resulted in male biased sex ratios for this predator.

Near-infrared spectroscopy versus compartment pressure for the diagnosis of lower extremity compartmental syndrome using electromyography-determined measurements of neuromuscular function

BACKGROUND

Compartmental syndrome (CS) is difficult to diagnose in intensive care unit patients. Compartment perfusion pressure (CPP) is an invasive, indirect measure of ischemia. Near-infrared spectroscopy is noninvasive, and directly measures ischemia by transmitting light through tissues at wavelengths that react with hemoglobin to provide percent tissue oxygen saturation (Sto(2)). Animal studies demonstrate that Sto(2) is superior to CPP for detecting CS. However, there are no studies in humans comparing Sto(2) with CPP. We hypothesized that Sto(2) can reliably detect CS, and is superior to CPP.

METHODS

CS was induced in 15 human volunteers using a standard calf compression model. At 30-minute intervals, compression was increased to reduce Sto(2) from baseline (86% +/- 4%) to 60%, 40%, 20%, and < 10%, with simultaneous recording of CPP. Outcome variables included deep peroneal nerve conduction assessed by electromyography, cutaneous peroneal nerve sensitivity using Semmes-Weinstein monofilaments, and pain (visual analog scale).

RESULTS

Both Sto(2) and CPP significantly correlated with all ischemia outcome variables (p < 0.001). Receiver operating characteristic curves of deep peroneal nerve conduction demonstrated that Sto(2) had higher sensitivity than CPP for detecting > 50% block. For example, when specificity was 83% for Sto(2) and 84% for CPP, sensitivity was 85% versus 56%, respectively (p = 0.02). When specificity for both was 72%, sensitivity was 94% for Sto(2) versus 76% for CPP (p = 0.04).

CONCLUSION

In intensive care unit patients who cannot alert physicians to symptoms, near-infrared spectroscopy may help clinicians to avoid delayed or unnecessary prophylactic fasciotomy, and provides the benefits of a continuous, noninvasive monitoring technique.

The management of constipation in people with advanced cancer

Constipation represents a significant problem for people with advanced cancer. It ranks in the top three most uncomfortable symptoms experienced, causing pain and anorexia that ultimately result in misery. The negative impact upon the quality of life of the patient and their carers is significant. The key to the provision of effective care lies in the informed application of the nursing process, underpinned by a sound knowledge base in relation to the management of constipation. Theoretical knowledge enables appropriate preventative interventions to be planned in collaboration with other members of the multidisciplinary team. When preventative measures are not applied or are unsuccessful, informed assessment and care planning enables appropriate interventions to be applied in order to resolve constipation. This article will discuss the causes and management of constipation. The discussion focuses on assessment, setting goals with the patient and their carers, planning appropriate nursing interventions to support medical interventions and evaluating clinical outcomes.

Visual discrimination learning in the water maze: a novel test for visual acuity

Learning about space, the environment and specific objects comprising three-dimensional arrangements requires processing of visual information. As learning and memory experiments in mammals rely heavily on normal processing of visual cues, drug-induced disruption of acquisition learning or memory formation necessitates the important control for visual acuity. A popular task used frequently for rats is the Morris water maze. However, previously used visual tasks in the water maze only control for gross visual disturbances. Here we describe a new training procedure enabling visual acuity to be tested in the water maze. Animals were trained to discriminate between two cue cards containing a pattern of vertical black and white stripes. Cards were presented in two adjacent quadrants separated by a barrier with the escape platform located in front of the smaller stripes (1 cm wide). Once 80% correct responses were attained, the wider cue card (normally 5 cm wide stripes) was randomly changed to gratings of 1,2,3,4,5, and 10 cm width. Animals learned the discrimination with acuity of 1.5 c/deg. A detailed analysis of the swim patterns further suggests that, independent of the grating used, animals make a choice immediately after release and swim along the walls towards the cue. In a further acuity test taken a few weeks later when animals were given saline infusions, performance was better than in the first test suggesting an effect of learning. This novel test may prove useful in determining subtle drug-induced deficits in visual acuity that may contribute to disruption of spatial performance in the water maze.

Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province

OBJECTIVES

This study determined the characteristics of fetal alcohol syndrome in a South African community, and methodology was designed for the multidisciplinary study of fetal alcohol syndrome in developing societies.

METHODS

An active case ascertainment, 2-tier methodology was used among 992 first-grade pupils. A case-control design, using measures of growth, development, dysmorphology, and maternal risk, delineated characteristics of children with fetal alcohol syndrome.

RESULTS

A high rate of fetal alcohol syndrome was found in the schools--40.5 to 46.4 per 1000 children aged 5 to 9 years--and age-specific community rates (ages 6-7) were 39.2 to 42.9. These rates are 18 to 141 times greater than in the United States. Rural residents had significantly more fetal alcohol syndrome. After control for ethnic variation, children with fetal alcohol syndrome had traits similar to those elsewhere: poor growth and development, congruent dysmorphology, and lower intellectual functioning.

CONCLUSIONS

This study documented the highest fetal alcohol syndrome rate to date in an overall community population. Fetal alcohol syndrome initiatives that incorporate innovative sampling and active case ascertainment methods can be used to obtain timely and accurate data among developing populations.

A specialist toxicity database (TRACE) is more effective than its larger, commercially available counterparts

The retrieval precision and recall of a specialist bibliographic toxicity database (TRACE) and a range of widely available bibliographic databases used to identify toxicity papers were compared. The analysis indicated that the larger size and resources of the major bibliographic databases did not, for a series of test queries, assure superior retrieval of relevant papers. The specialist database, in which document selection and indexing is undertaken by the same expert toxicologists who use the database in their day-to-day work, achieved markedly better retrieval, using simpler search strategies, than the other databases. Specialist databases may offer a valuable alternative to the existing major bibliographic databases. The concept of relevance, as used to determine the effectiveness of bibliographic databases, is discussed.

A novel dicentric deleted chromosome 21 arising from tandem translocation

We present a 26-year-old patient with myelodysplastic syndrome (MDS). Initial bone marrow cytogenetics with G-banding showed a rearranged chromosome 21, which was dicentric and bisatellited on CBG- and NOR-banding. Fluorescence in situ hybridization helped to characterize the structure, using a whole chromosome 21 paint and the locus specific AML1 gene probe. The rearranged 21 consisted solely of chromosome 21 material, contained only one copy of AML1, and was not a trisomy, but a deleted tandem translocation. The MDS transformed to acute myeloid leukemia (AML), and the patient died almost 12 months post-diagnosis. Cytogenetics was performed three times during the course of the disease, and the dicentric chromosome 21 was present throughout. Although there are a number of published rearrangements of chromosome 21 in MDS and AML, most are isodicentrics. We could not find another case of an abnormal chromosome 21 with the same structure as reported here.

Accuracy of leveling hemodynamic transducer systems

Critically ill patients frequently have invasive catheters placed to monitor hemodynamic pressures and to calculate hemodynamic indices. Correct leveling to the appropriate anatomical structure is critical as the pressure readings guide management of fluids, drug administration, and other interventions. The authors of this study investigated the accuracy with which registered nurses and respiratory technologists were able to level hemodynamic transducers to the phlebostatic axis using visual checks, a carpenter's level, and a laser leveling device. The results indicate that both groups were unable to accurately level transducers with visual checks alone. Use of a leveling tool improved accuracy. The laser level was superior for accuracy and speed and preferred for dexterity required, ease of use and patient safety. The data supports the need for a tool to accurately level hemodynamic transducer systems and suggests that the laser leveling device is the tool of choice.

Use of and attitudes about alternative and complementary therapies among outpatients and physicians at a municipal hospital

OBJECTIVES

To survey outpatients and physicians about their use of, knowledge of, and interest in alternative therapies.

DESIGN

Anonymous self-administered survey.

SETTINGS/LOCATION

Outpatient clinics at a major municipal medical center.

SUBJECTS

Outpatients visiting clinics and staff physicians.

INTERVENTIONS

Patient survey about overall use of 7 categories and 19 types of alternative therapies, and their desire to have specific therapies offered at the institution. Survey to physicians about whether their patients used the same categories and types of alternative therapies, whether they provided or recommended their use, and their interest in having them available at the institution.

OUTCOME MEASURES

Frequency of use of different alternative therapies by gender and race. Frequency of patient use of alternative therapies according to their physicians and frequency of physicians who provide or recommend alternative therapies.

RESULTS

A total of 567 outpatients completed questionnaires during the survey week. When given a list of alternative therapies, 85% of patients acknowledged use of one or more alternative therapies. When Diet/Nutrition was excluded, 42% reported use of alternative therapies. No differences in overall use were seen by age, sex, or race; but when Diet/Nutrition was excluded, women were more likely to use alternative therapies, and use of Manual Healing and Herbal Medicine differed by race. Of the 85 responding physicians, 86% reported that their ambulatory patients used alternative therapies. Similar proportions (35%-38%) of patients and physicians wanted Manual Healing and Mind/Body Control therapies to be available.

CONCLUSIONS

Frequency of use of alternative therapies was high, and similar according to patients and physicians. Overall use did not differ by gender and race, except when Diet/Nutrition was excluded. Patients and physicians had similar interests in having alternative therapies provided, and both were hampered by lack of information about many therapies.

Family-based association mapping provides evidence for a gene for reading disability on chromosome 15q

Family-based association mapping was used to follow up reports of linkage between reading disability (RD) and a genomic region on chromosome 15q. Using a two-stage approach, we ascertained 101 (stage 1) and 77 (stage 2) parent-proband trios, in which RD was characterized rigorously. In stage 1, a set of eight microsatellite markers spanning the region of putative linkage was used and a highly significant association was detected between RD and a three-marker haplotype (D15S994/D15S214/D15S146: P and empirical P < 0.001). A significant association with the same three-marker haplotype was also observed in the second-stage sample (P = 0.009, empirical P = 0.006). Our data therefore provide strong evidence for one or more genes contributing to RD being located in the vicinity of the region including D15S146 and D15S994. In addition, our results provide support for association analysis being a useful method to map susceptibility loci for complex disorders.

Computerized test development software. A comparative review updated

This article provides a comparative review of nine commercially available software programs: A+ Test Manager and Test Taker, CATSoftware, Diploma 97, Examaker for Windows, FastTEST, Microtest Pro, Pedagogue, Question Mark, and Test Construction Set. Issues for using test development software are covered including security, pedagogical uses, and test design and administration. Nurse educators are encouraged to consider the unique needs of each setting when selecting a software package to support test development and administration.