Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making

Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence in 269 healthy, initially sedentary adults ages 50-65 years. Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year. Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later. Predictors of short-term (1-year) adherence were generally similar to predictors of 2-year adherence. Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention.

Know how--i.v. insertion sites

Patients receiving intravenous therapy are at risk of developing an infection at the insertion site. Careful monitoring of the length of time a catheter is in situ, and ensuring that only sterile dressings are used and that they do not allow accumulation of moisture at the insertion site, will reduce the rate of complications.

Can we identify who will adhere to long-term physical activity? Signal detection methodology as a potential aid to clinical decision making

Signal detection methodology was used to identify the best combination of predictors of long-term exercise adherence in 269 healthy, initially sedentary adults ages 50-65 years. Less educated individuals who were assigned to supervised home-based exercise of either higher or lower intensity and who were less stressed and less fit at baseline than other individuals had the greatest probability of successful adherence by the 2nd year. Overweight individuals assigned to a group-based exercise program were the least likely to be successful 2 years later. Predictors of short-term (1-year) adherence were generally similar to predictors of 2-year adherence. Signal detection analysis may be useful for identifying subgroups of people at risk for underadherence who subsequently might be targeted for intervention.

Pressure sores: adopting the principles of risk management

This article examines the continuing problem of pressure sores in the NHS from a purchasing and a providing manager's perspective. Risk management and the need for clinical effectiveness in treatment and prevention strategies are discussed. Reporting systems are advocated as a means to estimate risk and to form a store of information that will enable a response to made when problem areas are identified. Nursing advice and input into the contracting process is vital. The need for purchasers and NHS managers to work together to ensure that effective interventions are implemented to reduce both the financial burden on the NHS and the physiological insult offered to patients is stressed.

Reproducibility of a heteronymous monosynaptic reflex in biceps brachii

The present study provides normal data for a new technique to assess conduction across the C5/C6 segments by recording a heteronymous monosynaptic reflex response from the contracting biceps brachii in response to stimulation of the median nerve in the cubital fossa. The reflex responses were reproducible and symmetrical, with a mean latency of 14.8 msec (S.D. 1.4 msec) and an absolute side-to-side differences of 0.5 msec (S.D. 0.29 msec). Latency was significantly correlated with both age and height, and multiple regression analysis provided the following equation: latency (msec) = 0.091 x height (in cm) + 0.036 x age (years) - 1.988. Amplitudes had wide scatter (22-365 microV on the right side) and positive skew. An amplitude less than 40% of that for the other side would be outside the 90th percentile. Five cases are described to illustrate the potential clinical utility of this test. However, whether this reflex is of diagnostic value can be answered only by a prospective study comparing it with other routine investigations.

Common problems with wound care: infection with HIV

The issue of the care required by wounded patients infected with human immunodeficiency virus should be addressed by all nursing personnel. The virus can be transmitted through blood, blood products or wound exudate. Promotion of universal precautions should greatly minimise the risk. The patient's infection status is not always known and the problem may not be a major wound but an associated condition.

Intact splenic function in cystic fibrosis

Patients with cystic fibrosis (CF) suffer from severe chronic pulmonary infections but rarely develop bacteremia/septicemia suggestive of an intact splenic mononuclear phagocyte function. The splenic function of 25 patients diagnosed with CF, aged 2 to 37 years, was evaluated using erythrocyte pit count by direct interference contrast microscopy. Results were compared with patients with sickle cell disease and normal individuals. All CF patients displayed normal splenic function by pit count. The mean percentage of pitted erythrocytes was 0.20 +/- 0.28 (range: 0.0% to 1.0%) versus 0.19 +/- 0.33 (range: 0.0% to 1.4%) in normal eusplenic controls. There were no episodes of bacteremia or septicemia despite recurrent acute exacerbations of chronic bacterial bronchitis and the use of central lines. We conclude that splenic function in CF is unabridged and may account for the rarity of bacteremia/septicemia in patients with CF despite the high prevalence of chronic bronchial infection in this population.

Decreased fat content and increased lean in pigs treated with antibodies to adipocyte plasma membranes

Antibodies were prepared in sheep against purified plasma membranes from pig adipocytes. Western (immuno) blotting revealed reactions of the antisera with a large number of proteins in adipocyte plasma membranes but remarkably few in plasma membranes from muscle, kidney, liver, lung, brain, spleen, and erythrocytes. This illustrated the high degree of specificity the serum had for adipose tissue. When injected into localized subcutaneous sites such antisera were able to cause considerable adipocyte destruction, which resulted in complete loss of adipose tissue from the site for > or = 14 wk. This cell destruction was probably mediated in part by lymphocytic infiltration. Subcutaneous injections were of limited use because of the localized nature of the effects, but, when treatment was administered intraperitoneally, systemic effects were produced that resulted in a 30% reduction in backfat thickness in the region of the last rib and a 25% reduction in fat content of fore- and hind-loin joints that resulted in a significant increase in the percentage of lean tissue. Total feed intake, live weight gain, hot carcass weights, and dressing percentage were unaffected. These results demonstrate the potential for producing long-term reductions in body fat in pigs by an immunization technique that may also provide the unexpected, potential benefit of increased lean deposition. This suggests that fat deposition per se exerts a restrictive influence on lean carcass development.

Immediate-startle stimulus presentation fails to condition freezing responses to contextual cues

Twenty-eight male Wistar rats were placed in a novel and distinctive environment. Eighteen of these received an intense startle-eliciting white noise stimulus. Animals that experienced a 60-s delay between placement and the startle stimulus demonstrated significant freezing in the context, both poststartle (Session 1) and on a later startle-free test (Session 2). Animals that received immediate startle, however, did not differ on either occasion from animals that did not experience the startle stimulus. The amplitude of the startle response was not affected by this manipulation, which indicates a dissociation between freezing and startle responses with immediate- versus delay-startle presentation. The findings are consistent with Fanselow's (1986) conditioned stimulus-based associative explanation of the immediate-shock freezing deficit.

Immediate-startle stimulus presentation fails to condition freezing responses to contextual cues

Twenty-eight male Wistar rats were placed in a novel and distinctive environment. Eighteen of these received an intense startle-eliciting white noise stimulus. Animals that experienced a 60-s delay between placement and the startle stimulus demonstrated significant freezing in the context, both poststartle (Session 1) and on a later startle-free test (Session 2). Animals that received immediate startle, however, did not differ on either occasion from animals that did not experience the startle stimulus. The amplitude of the startle response was not affected by this manipulation, which indicates a dissociation between freezing and startle responses with immediate- versus delay-startle presentation. The findings are consistent with Fanselow's (1986) conditioned stimulus-based associative explanation of the immediate-shock freezing deficit.

Relation of level of exercise, age, and weight-cycling history to weight and eating concerns in male and female runners

We examined the association between level of exercise and degree of weight preoccupation in a large sample of male and female runners, as well as risk factors posited to influence weight and eating concerns in the general population. Subjects were 2,459 males and 1,786 females who had completed a questionnaire on weight and eating concerns in a national running magazine. Eight percent of the males and 24% of the females had symptomatic scores on the Eating Attitudes Test (EAT). Exercise level, defined as weekly running mileage, was positively associated with excessive weight and eating concerns in males but not in females. Both sexes with a history of weight cycling were more likely to have symptomatic EAT scores than those with no such history. These results highlight the importance of studying these concerns in males as well as females and of examining the role of exercise level and weight-cycling history in the development of serious weight preoccupations.

Flow volume loops in patients with goiters

Plain radiology is the standard means of assessing upper airway obstruction in patients with goiters. Flow volume loop curves will provide additional information, because they allow a quantitative assessment of airflow dynamics in the respiratory cycle. Fifty-one patients had flow volume loops performed before and after thyroidectomy. There was a significant increase in the maximum inspiratory flow rate (3.9 +/- 0.2 versus 4.9 +/- 0.2 L/second, p less than 0.01) after thyroidectomy. Eight of twelve patients with normal tracheal radiology had improved airflow dynamics in the postoperative period. The flow volume loop curve is a simple noninvasive means of assessing airflow dynamics in patients with goiters and may be superior to conventional radiology.

The endocrine-paracrine cells of von Brunn's nests and glandular metaplasia in the supramontanal prostatic urethra

Endocrine-paracrine (EP) cells are normal cellular constituents of the human genitourinary tract. We examined the distribution and immunostaining profile of EP cells in von Brunn's nests and glandular metaplasia in the supramontanal (proximal) prostatic urethra of adult males and in prostatic ducts of the male fetal urethra. In 15/17 transurethral prostatic resection specimens there were argyrophilic cells and/or serotonin and neuronspecific enolase containing cells in von Brunn's nests/glandular metaplasia and in the supramontanal prostatic urethra. All seven fetal specimens examined contained EP cells and five had focal calcitonin immunoreactivity in prostatic ducts and ductal buds. One adult resection specimen had focal staining for human chorionic gonadotrophin and no case showed staining for somatostatin. These results further support the contention that von Brunn's nests and glandular metaplasia are probably normal urothelial variants in the adult supramontanal prostatic urethra.