Inequality in access to hearing care for older adults in residential homes

BACKGROUND

The population of older people in residential homes is projected to rise. There are unrecognized hearing difficulties among residents and prevalence of hearing loss in this population is underreported. This can result in an overestimation of levels of cognitive impairment. Untreated hearing loss is associated with social isolation, depression, disruptive behaviour and cognitive decline. This study aimed to explore the provision of hearing care (hearing assessment, rehabilitation and staff training) in Scottish care homes for older people.

METHODS

A survey comprising 18 questions was distributed to the managers (or designated staff members) of 659 care homes across Scotland.

RESULTS

Responses were obtained from 154 care homes. The results support existing evidence that hearing is not assessed in the majority of homes, resulting in under detection of hearing loss. Staff lack training in supporting residents' hearing needs. Access to hearing care in residential homes differs across health board areas.

CONCLUSIONS

There is an urgent requirement for hearing assessment of older adults on admission to residential care. Care providers require this information to construct effective care plans and mitigate the effects of hearing loss. Those responsible for providing hearing rehabilitation services require information about service users to address any unmet need.

Role of incubation environment in determining thermal tolerance of sea turtle hatchlings

Warming global temperatures are predicted to reduce population viability in many oviparous ectothermic taxa, with increased embryonic mortality likely to be a main cause. While research on embryonic upper thermal limits is extensive, sea turtle hatchling thermal tolerance has received less attention and our understanding of how incubation conditions influence hatchling thermal tolerance is limited. Here, we report green turtle Chelonia mydas hatchling hydration and thermal tolerance following incubation in dry and wet conditions. We used packed cell volume and total protein as indicators of hydration and measured the critical thermal maximum (CTmax) of hatchlings in air. Neither hydration nor thermal tolerance was directly influenced by moisture treatment. However, hatchlings from moister nests had longer incubation durations (wet: 60.11 d vs. dry: 54.86 d), and, using incubation duration as a proxy for incubation temperature, hatchlings from cooler nests had significantly lower CTmax (wet: 39.84°C vs. dry: 40.51°C). Thus, despite not directly influencing thermal tolerance, moisture treatment influenced nest temperature indirectly; hatchlings that experienced warmer conditions in dry nests had a higher thermal tolerance than hatchlings from cooler and wetter nests. Ectothermic neonates may have greater plasticity in their thermal tolerance than previously thought, but their ability to adapt to increasing temperature is likely limited. Additionally, common management techniques to reduce nest temperatures, such as watering and shading nests, may only reduce embryonic mortality at the cost of decreased hatchling thermal tolerance and increased hatchling mortality during emergence. Nesting-site management interventions designed to reduce embryonic mortality will need to consider mitigation of the possible effects of those interventions on hatchling mortality.

Management of complex ventral hernias: results of an international survey

Background

The surgical treatment of patients with complex ventral hernias is challenging. The aim of this study was to present an international overview of expert opinions on current practice.

Methods

A survey questionnaire was designed to investigate preoperative risk management, surgical approach and mesh choice in patients undergoing complex hernias repair, and treatment strategies for infected meshes. Geographical location of practice, experience and annual volumes of the surgeons were compared.

Results

Of 408 surgeons, 234 (57.4 per cent) were practising in the USA, 116 (28.4 per cent) in Europe, and 58 (14.2 per cent) in other countries. Some 412 of 418 surgeons (98.6 per cent) performed open repair and 322 of 416 (77.4 per cent) performed laparoscopic repair. Most recommended preoperative work-up/lifestyle changes such as smoking cessation (319 of 398, 80.2 per cent) and weight loss (254 of 399, 63.7 per cent), but the consequences of these strategies varied. American surgeons and less experienced surgeons were stricter. Antibiotics were given at least 1 h before surgery by 295 of 414 respondents (71.3 per cent). Synthetic and biological meshes were used equally in contaminated primary hernia repair, whereas for recurrent hernia repair synthetic mesh was used in a clean environment and biological or no mesh in a contaminated environment. American surgeons and surgeons with less experience preferred biological mesh in contaminated environments significantly more often. Percutaneous drainage and antibiotics were the first steps recommended in treating mesh infection. In the presence of sepsis, most surgeons favoured synthetic mesh explantation and further repair with biological mesh.

Conclusion

There remains a paucity of good-quality evidence in dealing with these hernias, leading to variations in management. Patient optimization and issues related to mesh choice and infections require well designed prospective studies.

Bioactive compounds sourced from Terminalia spp. in bacterial malodour prevention: an effective alternative to chemical additives

OBJECTIVE

Recently, our group reported that extracts prepared from the Australian native plant Terminalia ferdinandiana Exell. are potent inhibitors of the growth malodorous bacteria with similar efficacy to triclosan and through these results, we highlighted a potential biological alternative to the current chemical additives. Other members of the genus Terminalia are also well documented for their antibacterial potential and tannin contents and thus were investigated as potential deodorant additives.

METHODS

Solvent extractions prepared from of selected Indian, Australian and South African Terminalia spp. were screened by disc diffusion and liquid dilution assays against C. jeikeium, S. epidermidis, P. acnes and B. linens. The antibacterial activity was quantified by liquid dilution MIC assays. The extracts were screened for toxicity using Atremia franciscana nauplii and HDF cell viability bioassays. High-resolution time-of-flight (TOF) LC-MS and GC-MS headspace fingerprint analysis was used to detect tannin, flavonoid and terpenoid components in the extracts.

RESULTS

Bacterial growth inhibition was observed in all Terminalia extracts with the methanolic T. chebula, T. carpenteriae and T. sericea extracts the most promising bacterial growth inhibitors, yielding MIC values as low as 200 µg mL^-1 . Toxicity analyses of the extracts were favourable, and we determined that the methanolic T. chebula, T. carpenteriae and T. sericea extracts were all non-toxic. Using previously detected T. ferdinandiana antimicrobials as benchmarks, LC-MS and GC-MS fingerprint analyses revealed similar compounds in the methanolic T. chebula, T. carpenteriae and T. sericea extracts.

CONCLUSION

Through these results, we propose that Terminalia spp. extracts may be useful deodorant additives to inhibit the growth of axillary and plantar malodorous bacteria, offering a biological alternative to their chemically synthesized counterparts.

Investigation of ticks and red blood cell parasites of a population of reintroduced mainland tammar wallabies (Notamacropus eugenii eugenii)

Ticks and blood smears were collected from a reintroduced population of threatened tammar wallabies (Notamacropus eugenii eugenii). Ixodes hirsti was common during autumn/winter, and Amblyomma spp. in spring/summer, reflecting the seasonal density of questing A. triguttatum triguttatum. Red blood cell parasites were not detected in the 90 smears analysed.

Terminalia ferdinandiana Exell. Extracts inhibit the growth of body odour-forming bacteria

OBJECTIVE

Terminalia ferdinandiana extracts are potent growth inhibitors of many bacterial pathogens. They may also inhibit the growth of malodour-producing bacteria and thus be useful deodorant components, although this is yet to be tested.

METHODS

Terminalia ferdinandiana fruit and leaf solvent extracts were investigated by disc diffusion and liquid dilution MIC assays against the most significant bacterial contributors to axillary and plantar malodour formation. Toxicity was determined using the Artemia franciscana nauplii bioassay. Non-targeted HPLC separation of the methanolic leaf extract coupled to high-resolution time-of-flight (TOF) mass spectroscopy was used for the identification and characterization of individual components in the extract.

RESULTS

The T. ferdinandiana leaf extracts were the most potent bacterial growth inhibitors. The leaf methanolic extract was particularly potent, with low MIC values against C. jeikeium (233 μg mL^-1 ), S. epidermidis (220 μg mL^-1 ), P. acnes (625 μg mL^-1 ) and B. linens (523 μg mL^-1 ). The aqueous and ethyl acetate leaf extracts were also potent growth inhibitors of C. jeikeium and S. epidermidis (MICs < 1000 μg mL^-1 ). In comparison, the fruit extracts were substantially less potent antibacterial agents, although still with MIC values indicative of moderate growth inhibitory activity. All T. ferdinandiana leaf extracts were non-toxic in the Artemia franciscana bioassay. Non-biased phytochemical analysis of the methanolic leaf extract revealed the presence of high levels of and high diversity of tannins and high levels of the flavone luteolin.

CONCLUSION

The low toxicity of the T. ferdinandiana leaf extracts and their potent growth inhibition of axillary and plantar malodour-producing bacteria indicate their potential as deodorant components.

Incidence, care quality and outcomes of patients with acute kidney injury in admitted hospital care

BACKGROUND/INTRODUCTION

Acute kidney injury (AKI) is common in acute hospital admission and associated with worse patient outcomes.

AIM

To measure incidence, care quality and outcome of AKI in admitted hospital care.

DESIGN

Forty-six of 168 acute NHS healthcare trusts in UK caring for 2 million acute hospital admissions per annum collected information on adults identified with AKI stage 3 (3-fold rise in serum creatinine or creatinine >354 µmol/l) through routine biochemical testing over a 5-month period in 2012.

METHODS

Information was collected on patient and care characteristics. Primary outcomes were survival and recovery of kidney function at 1 month.

RESULTS

A total of 15 647 patients were identified with biochemical AKI stage 3. Case note reviews were available for 7726 patients. In 80%, biochemical AKI stage 3 was confirmed clinically. Among this group, median age was 75 years, median length of stay was 12 days and the overall mortality within 1 month was 38%. Significant factors in a multivariable model predicting survival included age and some causes of AKI. Dipstick urinalysis, medication review, discussion with a nephrologist and acceptance for transfer to a renal unit were also associated with higher survival, but not early review by a senior doctor, acceptance for transfer to critical care or requirement for renal replacement therapy. Eighteen percent of people did not have their kidney function checked 1 month after the episode had resolved.

DISCUSSION/CONCLUSIONS

This large study of in-hospital AKI supports the efficacy of biochemical detection of AKI in common usage. AKI mortality remains substantial, length of stay comparable with single-centre studies, and much of the variation is poorly explained (model Cox and Snell R²=0.131) from current predictors.

The potential of selected Australian medicinal plants with anti-Proteus activity for the treatment and prevention of rheumatoid arthritis

Background:

A wide variety of herbal medicines are used in indigenous Australian traditional medicinal systems to treat rheumatoid arthritis (RA) and inflammation. The current study was undertaken to test the ability of a panel of Australian plants with a history of the ethnobotanical usage in the treatment of inflammation for the ability to block the microbial trigger of RA.

Materials and Methods:

One hundred and six extracts from 40 plant species were investigated for the ability to inhibit the growth of the bacterial trigger of RA (Proteusmirabilis). The extracts were tested for toxicity in the Artemia nauplii bioassay. The most potent inhibitor of P.mirabilis growth was further analyzed by reversed-phase high performance liquid chromatography (RP-HPLC) coupled to high accuracy time-of-flight (TOF) mass spectroscopy.

Results:

Sixty-five of the 106 extracts tested (61.3%) inhibited the growth of P. The Aleurites moluccanus, Datura leichardtii, Eucalyptus major, Leptospermum bracteata, L. juniperium, Macadamia integriflora nut, Melaleuca alternifolia, Melaleuca quinquenervia, Petalostigma pubescens, P. triloculorae, P. augustifolium, Scaevola spinescens, Syzygiumaustrale, and Tasmannia lanceolata extracts were determined to be the most effective inhibitors of P. mirabilis growth, with minimum inhibitory concentration (MIC) values generally significantly below 1000 μg/ml. T. lanceolata fruit extracts were the most effective P. mirabilis growth inhibitors, with a MIC values of 11 and 126 μg/ml for the methanolic and aqueous extracts, respectively. Subsequent analysis of the T. lanceolata fruit extracts by RP-HPLC coupled to high-resolution TOF mass spectroscopy failed to detect resveratrol in either T. lanceolata fruit extract. However, the resveratrol glycoside piceid and 2 combretastatin stilbenes (A-1 and A-4) were detected in both T. lanceolata fruit extracts. With the exception of the Eucalyptus and Syzygium extracts, all extracts exhibiting Proteus inhibitory activity were also shown to be nontoxic, or of low toxicity in the Artemia nauplii bioassay.

Conclusions:

The low toxicity of these extracts and their inhibitory bioactivity against Proteus spp. indicate their potential in blocking the onset of rheumatoid arthritis.

Terminalia ferdinandiana extracts as inhibitors of Giardia duodenalis proliferation: a new treatment for giardiasis

Giardisis is a debilitating disease caused by gastrointestinal parasites of the genus Giardia. High-antioxidant T. ferdinandiana fruit extracts were investigated for the ability to block Giardia duodenalis growth. Methanolic and aqueous extracts had the most potent growth inhibitory activity (IC50 values of approximately 700 and 140 μg/ml, respectively). Ethyl acetate and chloroform extracts also inhibited G. duodenalis growth, albeit with lower potency. The hexane extract was completely devoid of G. duodenalis growth inhibitory activity. All extracts were nontoxic in the Artemia fransiscana bioassay. Nontargeted HPLC-quadrupole time-of-flight (QTOF) mass spectroscopy (with screening against three compound databases) putatively identified 17 compounds in all of the inhibitory extracts but not in the inactive hexane extract. The low toxicity of the Terminalia ferdinandiana fruit extracts and their potent G. duodenalis growth inhibitory bioactivity indicate their potential as medicinal agents in the treatment and prevention of this disease.

Chronic kidney disease and diabetes in the national health service: a cross-sectional survey of the U.K. national diabetes audit

AIMS

We investigated the prevalence of chronic kidney disease and attainment of therapeutic targets for HbA1c and blood pressure in a large U.K.-based diabetes population.

METHODS

The U.K. National Diabetes Audit provided data from 1 January 2007 to 31 March 2008. Inclusion criteria were a documented urinary albumin:creatinine ratio and serum creatinine. Patients were stratified according to chronic kidney disease stage and albuminuria status. Chronic kidney disease was defined as an estimated glomerular filtration rate < 60 ml min(-1) 1.73 m(-2) , albuminuria or both. The proportions of patients achieving nationally defined glycaemic and systolic blood pressure targets were determined.

RESULTS

The cohort comprised 1,423,669 patients, of whom 868,616 (61%) met inclusion criteria. Of the patients analysed, 92.2% had Type 2 diabetes. A higher proportion of people with Type 2 diabetes (42.3%) had renal dysfunction compared with those with Type 1 diabetes (32.4%). Achievement of systolic blood pressure and HbA1c targets was poor. Among people with Type 1 diabetes, 67.8% failed to achieve an HbA1c < 58 mmol/mol (7.5%). Of all people with diabetes, 37.8% failed to achieve a systolic blood pressure < 140 mmHg. Blood pressure control was poor in advanced chronic kidney disease. For example, mean (standard deviation) systolic blood pressure rose from 128.6 (15.4) mmHg among people with Type 1 diabetes and normal renal function to 141.0 (23.6) mmHg in those with chronic kidney disease stage 5 and macroalbuminuria.

CONCLUSIONS

The high prevalence of chronic kidney disease and poor attainment of treatment targets highlights a large subset of the diabetes population at increased risk of cardiovascular mortality or progressive kidney disease.

Obesity and kidney disease in type 1 and 2 diabetes: an analysis of the National Diabetes Audit

BACKGROUND

Obesity is increasingly prevalent in many countries. Obesity is a major risk factor for the development of type 2 diabetes but its relationship with diabetic kidney disease (DKD) remains unclear. Some studies have suggested that the metabolic syndrome (including obesity) may be associated with DKD in type 1 diabetes.

AIM

To investigate the association between obesity and DKD.

DESIGN

Retrospective cross-sectional study.

METHODS

National Diabetes Audit data were available for the 2007-08 cycle. Type 1 and 2 diabetes patients with both a valid serum creatinine and urinary albumin:creatinine ratio were included. DKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2), albuminuria or both. Logistic regression was used to analyse associations of obesity (body mass index ≥30 kg/m(2)) and other variables including year of birth, year of diagnosis, ethnicity and stage of kidney disease.

RESULTS

A total of 58 791 type 1 and 733 769 type 2 diabetes patients were included in the analysis. After adjustment, when compared with type 1 diabetes patients with normal renal function those with DKD were up to twice as likely to be obese. Type 2 DKD patients were also more likely to be obese. For example, type 2 diabetes patients with an eGFR <15 ml/min/1.73 m(2) and normoalbuminuria, microalbuminuria or macroalbuminuria were all more likely to be obese; odds ratios (95% CI) 1.65 (1.3-2.1), 1.56 (1.28-1.92) and 1.27 (1.05-1.54), respectively.

CONCLUSION

This study has highlighted a strong association between obesity and kidney disease in type 1 diabetes and confirmed their association in type 2 diabetes.

Microarray analysis of gene expression in soybean roots susceptible to the soybean cyst nematode two days post invasion

Soybean root cells undergo dramatic morphological and biochemical changes during the establishment of a feeding site in a compatible interaction with the soybean cyst nematode (SCN). We constructed a cDNA microarray with approximately 1,300 cDNA inserts targeted to identify differentially expressed genes during the compatible interaction of SCN with soybean roots 2 days after infection. Three independent biological replicates were grown and inoculated with SCN, and 2 days later RNA was extracted for hybridization to microarrays and compared to noninoculated controls. Statistical analysis indicated that approximately 8% of the genes monitored were induced and more than 50% of these were genes of unknown function. Notable genes that were more highly expressed 2 days after inoculation with SCN as compared to noninoculated roots included the repetitive proline-rich glycoprotein, the stress-induced gene SAM22, ss-1,3-endoglucanase, peroxidase, and those involved in carbohydrate metabolism, plant defense, and signaling.

The use of the replica technique to record fluid emerging from exposed dentine

The effect of pulpal cavity pressure on structures present on etched and unetched dentine was determined in 24 human premolars in vitro. The dentine was exposed in vivo. After extraction, the pulp was removed and the crown stored in 2.5 N sodium hydroxide for 3 days to remove the odontoblasts. The pulp cavity was filled with Ringer's solution at atmospheric pressure, +30 or -5 mmHg. After 30s-5 min a silicone-rubber impression was taken of the cavity floor and a resin cast prepared and examined in a SEM. The replicas reproduced the dentine surface accurately when there was no outward flow through dentine. With a pressure of + 30 mmHg in the pulp cavity, but not at the lower pressures, droplets were present on unetched dentine after 30s. Droplets accumulated less rapidly on etched dentine, indicating that it may act as a sponge.

Evaluations of unformulated and formulated dendrimer-based microbicide candidates in mouse and guinea pig models of genital herpes

Prevention of sexually transmitted infections is a priority in developed and developing countries. One approach to prevention is the use of topical microbicides, and one promising approach is the use of dendrimers, highly branched macromolecules synthesized from a polyfunctional core. Three new dendrimer products developed to provide stable and cost-efficient microbicides were initially evaluated in vitro for anti-herpes simplex virus activity and then in vivo by using a mouse model of genital herpes. From these experiments one product, SPL7013, was chosen for further evaluation to define the dose and duration of protection. Unformulated SPL7013 provided significant protection from genital herpes disease and infection at concentrations as low as 1 mg/ml and for at least 1 h following topical (intravaginal) administration of 10 mg/ml. This compound was then formulated into three vehicles and further evaluated in mouse and guinea pig models of genital herpes infection. In the murine evaluations each of the formulations provided significant protection at concentrations of 10 and 50 mg/ml. Formulated compounds provided protection for at least 1 h at a concentration of 10 mg/ml. From these experiments formulation 2V was chosen for dose ranging experiments using the guinea pig model of genital herpes. The guinea pig evaluations suggested that doses of 30 to 50 mg/ml were required for optimal protection. From these studies a lead compound and formulation (2V of SPL7013) was chosen for ongoing evaluations in primate models of simian immunodeficiency virus and Chlamydia trachomatis infection.

The sources of laser Doppler blood-flow signals recorded from human teeth

Records of pulpal blood flow obtained from human teeth with a laser Doppler flowmeter include a very large component derived from periodontal and other tissues outside the pulp, but this contamination can be reduced by covering the surrounding tissues with opaque rubber dam. The present experiments were carried out to determine what proportion of the signal obtained with this dam in place is derived from non-pulpal tissues. Recordings were made from 22 healthy, intact upper incisors in 14 individuals (aged 22-40 years) with and without dam under the following conditions: from the intact teeth, after local anaesthesia (LA) and the preparation of a deep cavity in the incisal third of the labial surface of the tooth, and after removal of the pulp and arrest of bleeding. In some cases, a reading was also made after replacing the pulp in the pulp cavity. The rubber dam reduced significantly (P<0.05) the mean blood flow reading from the intact teeth by 73%, from 6.98 arbitrary perfusion units (PU) (+/-1.30 S.D., n=22) to 1.92+/-1.50 PU. After LA and cavity preparation, the mean signal with dam was 1.45+/-0.61 PU (n=16). This fell significantly by 76% to 0.35+/-0.19 PU (n=16) when the pulp was removed but not replaced, and by 43% to 0.98+/-0.36 PU (n=14) when the pulp was removed and replaced in the pulp cavity. The latter condition is thought to reproduce most closely the scattering of light in an intact tooth. The results confirm previous findings that up to 80% of the laser Doppler blood-flow signal recorded from an intact human tooth without rubber dam is of non-pulpal origin. They also show that only approximately 43% of the signal recorded with an opaque rubber dam is from pulp.

Properties of single nerve fibres that evoke blood flow changes in cat dental pulp

Single nerve fibres innervating tooth pulp were isolated from filaments dissected from the inferior alveolar nerve in 17 anaesthetized cats. The fibres were studied to determine whether electrical stimulation of single units produced detectable changes in pulpal blood flow. Single pulpal nerve fibres were electrically stimulated at just above their thresholds and blood flow was recorded with a laser-Doppler flow meter from the pulp of the ipsilateral canine. The thresholds of single fibres in dissected filaments were determined either by recording antidromic action potentials from the tooth or by using a novel technique based on collision. Units that produced blood flow changes were further characterized by recording their response to hot, cold, osmotic and hydrostatic pressure, and mechanical stimulation of exposed dentine and to drying the dentine. Of 93 units isolated, 14 produced changes in pulpal blood flow when stimulated electrically at 1 or 10 Hz. All had conduction velocities (0.8-2.0 m s(-1)) in the C-fibre range. Ten produced vasodilatation and the remaining four, vasoconstriction. Five of the fibres that produced vasodilatation also responded to the hot stimulus, suggesting that they may form part of an axon reflex or similar mechanism. The four vasoconstrictor units did not respond to any form of stimulus other than electrical and were presumed to be sympathetic post-ganglionic fibres.

Quantitative ultrasound assessment of acute bone loss following spinal cord injury: a longitudinal pilot study

Spinal cord injury (SCI) results in substantial and rapid osteoporosis. Given its rapid onset, assessment of bone changes in the early stages (first 6 months) following SCI is important. This is particularly pertinent if intervention is to be implemented. Quantitative ultrasound (QUS) represents a potential assessment tool for the evaluation of skeletal changes in the early stages following SCI. This longitudinal pilot study assessed changes in QUS measures of calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS) in 15 male subjects (age 23.9+/-7.3 years) over a 6-week period. Their mean time since SCI was 110.3+/-34.5 days. Also assessed were bone mineral density of the calcaneus (BMDc) and proximal tibia (BMDt) using dual-energy X-ray absorptiometry (DXA). Confirming the rapid onset of bone loss following SCI, BMDc and BMDt decreased by 7.5+/-3.0% ( p<0.001) and 5.3+/-4.2% ( p<0.001), respectively. QUS was sensitive to these changes. BUA decreased by 8.5+/-6.9% ( p<0.001), whilst SOS decreased by 1.5+/- 1.3% ( p<0.001). Suggesting an influence of the material properties of bone on BUA, BUA was correlated with BMDc at both the initial ( r = 0.68, p<0.01) and final ( r = 0.62, p<0.01) assessments. There were no significant correlations in the magnitude of change over the 6-week assessment period between any of the skeletal measures (all p>0.05). This suggests that skeletal qualities other than material properties also influence QUS measures. Overall, this study confirmed the rapid onset of bone loss following SCI and showed QUS to be a useful portable measure of acute bone changes. This may allow assessment of bone loss and the efficacy of intervention on this loss in the early stages following injury, a period where traditional axial DXA assessment is limited by practical constraints.

A physical map of a gene-dense region in soybean linkage group A2 near the black seed coat and Rhg (4) loci

Soybean ( Glycine max L. Merrill) linkage group A2 contains a major resistance gene to the soybean cyst nematode ( Heterodera glycines Ichinohe) at the Rhg (4) locus near a gene encoding aspartokinase homoserine dehydrogenase (AK-HSDH) and also near the I locus affecting seed coat color. To identify clones related to this region of the genome, we used a PCR assay using primers designed from a gene encoding AK-HSDH to screen approximately 40,000 clones from a bacterial artificial chromosome (BAC) library constructed from genomic DNA of the susceptible cv. Williams 82. The identified BACs were screened with a second PCR assay using primers designed from DNA sequence associated with the I locus to confirm the location of the BACs. Only BAC Gm_ISb001_056_G02 (56G2) was positive for both assays. BAC 56G2 contains several genes previously associated with stress or defense response including genes with high sequence similarity to those encoding chalcone synthase, glucosyl-transferase, a heat-shock transcription factor, a membrane-associated salt-inducible protein, adenosyl homocysteinase, a protein kinase, and a G10-like protein. The map contributes to our understanding of the organization of the soybean genome and to the completion of a physical map of the soybean genome. In addition, the genes identified provide landmarks to identify BAC clones near the Rhg (4) locus in resistant soybean genomic libraries and provide a foundation for comparison of soybean cyst nematode resistant and -susceptible DNA sequences in this region.

Efficacy of low-intensity pulsed ultrasound in the prevention of osteoporosis following spinal cord injury

Ultrasound (US), a high-frequency acoustic energy traveling in the form of a mechanical wave, represents a potential site-specific intervention for osteoporosis. Bone is a dynamic tissue that remodels in response to applied mechanical stimuli. As a form of mechanical stimulation, US is anticipated to produce a similar remodeling response. This theory is supported by growing in vitro and in vivo evidence demonstrating an osteogenic effect of pulsed-wave US at low spatial-averaged temporal-averaged intensities. The aim of this study was to investigate whether low-intensity pulsed US could prevent calcaneal osteoporosis in individuals following spinal cord injury (SCI). Fifteen patients with a 1-6 month history of SCI were recruited. Active US was introduced to one heel for 20 min/day, 5 days/week, over 6 weeks. The contralateral heel was simultaneously treated with inactive US. Patients were blind to which heel was being actively treated. Active US pulsed with a 10 microsec burst of 1.0 MHz sine waves repeating at 3.3 kHz. The spatial-averaged temporal-averaged intensity was set at 30 mW/cm(2). Bone status was assessed at baseline and following the intervention period by dual-energy X-ray absorptiometry and quantitative US. SCI resulted in significant bone loss. Bone mineral content decreased by 7.5 +/- 3.0% in inactive US-treated calcanei (p < 0.001). Broadband US attenuation and speed of sound decreased by 8.5 +/- 6.9% (p < 0.001) and 1.5 +/- 1.3% (p < 0.001), respectively. There were no differences between active and inactive US-treated calcanei for any skeletal measure (p > 0.05). These findings confirm the negative skeletal impact of SCI, and demonstrate that US at the dose and mode administered was not a beneficial intervention for SCI-induced osteoporosis. This latter finding may primarily relate to the inability of US to effectively penetrate the outer cortex of bone due to its acoustic properties.

Quality of life--ageing and Down syndrome

This article, based on pilot qualitative research, examines the quality of life of people with Down syndrome who are in the upper age bracket (45-70 years). Through use of a questionnaire, the current life experience and interests of a small group of individuals are noted, along with some of their perceptions concerning their past and present, including their views on the ageing process. Recommendations are made particularly in relation to the need to recognise the principles of variability, perception and choice, while providing support to encourage dignified and active lifestyles.

Investigation of healthcare providers' patterns of referring breast cancer patients to Reach to Recovery

Providers who referred patients to Reach to Recovery (Reach), an American Cancer Society breast cancer support group, were compared with those who did not to evaluate whether providers who identified problems with the program were less likely to make referrals. Also considered were contact with a Reach volunteer, having a Reach program in the area, years since residency or medical training, perceived value of the Reach program, belief that one's peers refer patients to Reach, urban or rural location of practice, and size of practice. When other variables were considered, physicians who identified problems with Reach were no less likely to refer patients to the program than those who did not. The factors most associated with referral (P < .001) were "having a Reach program in the area" and "having had contact with a Reach volunteer." Implications of these findings and the experience of conducting the evaluation through the Collaborative Evaluations Fellows Project are discussed.