Observed differences in nutrition management at two time points spanning a decade in critically ill trauma patients with and without head injury

BACKGROUND

Nutritional needs of trauma patients admitted to the intensive care unit may differ from general critically ill patients, but most current evidence is based on large clinical trials recruiting mixed populations.

OBJECTIVE

The aim of the study was to investigate nutrition practices at two time points that span a decade in trauma patients with and without head injury.

METHODS

This observational study recruited adult trauma patients receiving mechanical ventilation and artificial nutrition from a single-centre intensive care unit between February 2005 to December 2006 (cohort 1), and December 2018 to September 2020 (cohort 2). Patients were categorised into head injury and non-head injury subgroups. Data regarding energy and protein prescription and delivery were collected. Data are presented as median [interquartile range]. Wilcoxon rank-sum test assessed the differences between cohorts and subgroups, with a P value ≤ 0.05. The protocol was registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001816246).

RESULTS

Cohort 1 included 109 patients, and 112 patients were included in cohort 2 (age: 46 ± 19 vs 50 ± 19 y; 80 vs 79% M). Overall, nutrition practice did not differ between head-injured and non-head-injured subgroups (all P > 0.05). Energy prescription and delivery decreased from time point one to time point two, regardless of subgroup (Prescription: 9824 [8820-10 581] vs 8318 [7694-9071] kJ; Delivery: 6138 [5130-7188] vs 4715 [3059-5996] kJ; all P < 0.05). Protein prescription did not change from time point one to time point two. Although protein delivery remained constant from time point one to time point two in the head injury group, protein delivery reduced in the non-head injury subgroup (70 [56-82] vs 45 [26-64] g/d, P < 0.05).

CONCLUSION

In this single-centre study, energy prescription and delivery in critically ill trauma patients reduced from time point one to time point two. Protein prescription did not change, but protein delivery reduced from time point one to time point two in non-head injury patients. Reasons for these differing trajectories require exploration.

STUDY REGISTRATION

Trial registered at www.anzctr.org.au.

TRIAL ID

ACTRN12618001816246.

Drivers of avian habitat use and detection of backyard birds in the Pacific Northwest during COVID-19 pandemic lockdowns

Birds living in developed areas contend with numerous stressors, including human disturbance and light, noise, and air pollution. COVID-19 pandemic lockdowns presented a unique opportunity to disentangle these effects during a period of reduced human activity. We launched a community science project in spring 2020 to explore drivers of site use by and detection of common birds in cities under lockdown in the U.S. Pacific Northwest. Our goals were twofold: (1) consider how intensity of urbanization, canopy cover, and availability of bird feeders and bird baths influenced avian habitat use; and (2) quantify how daily changes in weather, air pollution, and human mobility influenced detection of birds. We analyzed 6,640 surveys from 367 volunteers at 429 monitoring sites using occupancy models for 46 study species. Neither land cover nor canopy cover influenced site use by 50% of study species, suggesting that backyard birds may have used a wider range of habitats during lockdowns. Human mobility affected detection of 76% of study species, suggesting that birds exhibited species-specific behavioral responses to day-to-day changes in human activity beginning shortly after initial lockdown restrictions were implemented. Our study also showcases how existing community science platforms can be leveraged to support local monitoring efforts.

Evaluation of camera trap-based abundance estimators for unmarked populations

Estimates of species abundance are critical to understand population processes and to assess and select management actions. However, capturing and marking individuals for abundance estimation, while providing robust information, can be economically and logistically prohibitive, particularly for species with cryptic behavior. Camera traps can be used to collect data at temporal and spatial scales necessary for estimating abundance, but the use of camera traps comes with limitations when target species are not uniquely identifiable (i.e., "unmarked"). Abundance estimation is particularly useful in the management of invasive species, with herpetofauna being recognized as some of the most pervasive and detrimental invasive vertebrate species. However, the use of camera traps for these taxa presents additional challenges with relevancy across multiple taxa. It is often necessary to use lures to attract animals in order to obtain sufficient observations, yet lure attraction can influence species' landscape use and potentially induce bias in abundance estimators. We investigated these challenges and assessed the feasibility of obtaining reliable abundance estimates using camera-trapping data on a population of invasive brown treesnakes (Boiga irregularis) in Guam. Data were collected using camera traps in an enclosed area where snakes were subject to high-intensity capture-recapture effort, resulting in presumed abundance of 116 snakes (density = 23/ha). We then applied spatial count, random encounter and staying time, space to event, and instantaneous sampling estimators to photo-capture data to estimate abundance and compared estimates to our presumed abundance. We found that all estimators for unmarked populations performed poorly, with inaccurate or imprecise abundance estimates that limit their usefulness for management in this system. We further investigated the sensitivity of these estimators to the use of lures (i.e., violating the assumption that animal behavior is unchanged by sampling) and camera density in a simulation study. Increasing the effective distances of a lure (i.e., lure attraction) and camera density both resulted in biased abundance estimates. Each estimator rarely recovered truth or suffered from convergence issues. Our results indicate that, when limited to unmarked estimators and the use of lures, camera traps alone are unlikely to produce abundance estimates with utility for brown treesnake management.

Behavioral Intervention Components Associated With Cost-effectiveness: A Comparison of Six Domains

Background

To help implement behavior change interventions (BCIs) it is important to be able to characterize their key components and determine their effectiveness.

Purpose

This study assessed and compared the components of BCIs in terms of intervention functions identified using the Behaviour Change Wheel Framework (BCW) and in terms of their specific behavior change techniques (BCTs) identified using the BCT TaxonomyV1, across six behavioral domains and the association of these with cost-effectiveness.

Methods

BCIs in 251 studies targeting smoking, diet, exercise, sexual health, alcohol and multiple health behaviors, were specified in terms of their intervention functions and their BCTs, grouped into 16 categories. Associations with cost-effectiveness measured in terms of incremental cost-effectiveness ratio (ICER) upper and lower estimates were determined using regression analysis.

Results

The most prevalent functions were increasing knowledge through education (72.1%) and imparting skills through training (74.9%). The most prevalent BCT groupings were shaping knowledge (86.5%), changing behavioral antecedents (53.0%), supporting self-regulation (47.7%), and providing social support (44.6%). Intervention functions associated with better cost-effectiveness were those based on training (β_low = −15044.3; p = .002), persuasion (β_low = −19384.9; p = .001; β_upp = −25947.6; p < .001) and restriction (β_upp = −32286.1; p = .019), and with lower cost-effectiveness were those based on environmental restructuring (β = 15023.9_low; p = .033). BCT groupings associated with better cost-effectiveness were goals and planning (β_low = −8537.3; p = .019 and β_upp = −12416.9; p = .037) and comparison of behavior (β_low = −13561.9, p = .047 and β_upp = −30650.2; p = .006). Those associated with lower cost-effectiveness were natural consequences (β_low = 7729.4; p = .033) and reward and threat (β_low = 20106.7; p = .004).

Conclusions

BCIs that focused on training, persuasion and restriction may be more cost-effective, as may those that encourage goal setting and comparison of behaviors with others.

How do office workers respond to media coverage of sitting?

BACKGROUND

Sitting time is associated with adverse physical and mental health outcomes, and premature mortality. Office workers sit for prolonged periods, so are at particular risk. Scientific advances in public health threats are predominantly communicated to the public through media reports.

AIMS

This study aimed to examine office workers' impromptu responses to media coverage of scientific evidence related to the health risks of sedentary behaviour.

METHODS

Semi-structured interviews were run with 26 office workers (mean age 35 years), recruited from four organizations in southern England. Within the interview, each participant provided a 'think-aloud' narrative as they read three real-world news reports relating to sedentary behaviour. Thematic analysis was conducted on verbatim transcripts.

RESULTS

Three themes were extracted from the data: gauging the personal relevance of the news reports; questioning their trustworthiness and challenging the feasibility of proposed sitting-reduction strategies. Participants voiced scepticism about the applicability of the reports to their personal circumstances, and the validity of the reports and the scientific evidence underpinning them.

CONCLUSIONS

Researchers, press officers and journalists should emphasise the ways in which participants in research studies represent the broader population of office workers, and offer greater transparency in reporting study methods, when reporting scientific advances in sedentary behaviour.

Childhood correlates of adult TV viewing time: a 32-year follow-up of the 1970 British Cohort Study

Background

To identify, using a longitudinal data set, parental and childhood correlates of adult television (TV) viewing time at 32-year follow-up.

Method

Data were derived from the 1970 British Cohort Study, a longitudinal observational study of 17 248 British people born in a single week of 1970. The present analyses incorporated data from the age 10 and 42-year surveys. When participants were aged 10 years, their mothers provided information on how often participants watched TV and played sports (never/sometimes/often), and parents’ own occupation, as well as height and weight. A health visitor objectively assessed participants’ height and weight at age 10. Thirty-two years later, when participants were aged 42 years, they reported their daily TV viewing hours (none/0≤1/1<3/3<5/≥5), physical activity and health status. Associations between putative childhood and parental correlates and adult TV viewing time were investigated using logistic regression.

Results

Valid data at both time points were available for 6188 participants. Logistic regression models showed that those who reported ‘often’ watching TV at baseline were significantly more likely to watch >3 h/days of TV at follow-up (OR 1.42, 95% CI 1.21 to 1.65), as were those whose father was from a lower socio-occupational class (intermediate, routine/manual) compared with managerial (OR 1.55, 95% CI 1.14 to 2.11; OR 2.05, 95% CI 1.47 to 2.87). Body mass index (BMI) at age 10 was inversely associated with high TV in adulthood (per unit increase; OR 0.93, 95% CI 0.90 to 0.96) although fathers BMI when the child was aged 10 was positively associated with high TV in adulthood (per unit increase; OR 1.04, 95% CI 1.02 to 1.06).

Conclusions

Findings suggest that childhood TV viewing time tracks into adulthood. Parents’ health behaviours and social position appear to be associated with their children's viewing habits, which may have important implications for the direction of future policy and practice. Specifically, findings support the case for early life interventions, particularly on socioeconomic inequalities, as a way of preventing sedentary behaviour in later life.

Changing diet and physical activity to reduce gestational weight gain: a meta-analysis

Excessive pregnancy weight gain is associated with adverse maternal and child health outcomes. Intervention developers have assumed that adopting a healthier diet and increasing physical activity in pregnancy can limit weight gain, but evaluations of such interventions have yielded mixed results. Recent reviews of this literature have not identified defining characteristics of effective interventions. We systematically reviewed 10 published controlled trials of interventions that aimed to reduce gestational weight gain through changes in diet or physical activity. Characteristics of the sample, intervention content and delivery, and methodology were categorized. Meta-analysis showed that, overall, diet and physical activity change was effective in reducing gestational weight gain, but there was considerable heterogeneity in outcomes. Our analysis points to sample characteristics and aspects of intervention design, content, delivery and evaluation which differ between studies and may explain variation in effectiveness. Failure to evaluate changes in behaviour or its psychological determinants, and under-reporting of intervention content, may obscure identification of the processes by which weight change is effected. This limits our ability to discern active intervention ingredients. We suggest that behaviour-based gestational weight gain reduction interventions be more systematically designed, evaluated and reported to build on insights from behavioural science.

Assessing agreement of self-reported and observed physical exposures of the upper extremity

Assessment of workplace physical exposures by self-reported questionnaires has logistical advantages in population studies, but is subject to exposure misclassification. This study measured agreement between eight self-reported and observer-rated physical exposures to the hands and wrists, and evaluated predictors of intermethod agreement. Workers (n = 341) from three occupational categories (clerical/technical, construction, and service) completed self-administered questionnaires and worksite assessments. Analyses compared self-reported and observed ratings using a weighted kappa coefficient. Personal and psychosocial factors, presence of upper extremity symptoms, andjob type were evaluated as predictors of agreement. Weighted kappa values were substantial for lifting (0.67) and holding vibrating tools (0.61), moderate for forceful grip (0.58), and fair to poor for all other exposures. Upper extremity symptoms did not predict greater disagreement between self-reported and observed exposures. Occupational category was the only significant predictor of inter-method agreement. Self-reported exposures may provide a useful estimate of some work exposures for population studies.

Ability of unstimulated and phorbol-ester-stimulated human blood-monocyte-derived macrophages to metabolize drugs and its implications

Solutions containing 5,5-diphenyl[4-14C]hydantoin (15 micrograms/ml) or pheno[2-14C]barbital (20 micrograms/ml) were incubated for 0.5-6 h with monolayers of unstimulated and phorbol-ester-stimulated human blood-monocyte-derived macrophages and suspensions of K562 cells. The incubated solutions were centrifuged and the cell-free supernatants subjected to chromatography on Q-Sepharose Fast Flow anion exchange resin. The interaction with unstimulated macrophages but not with K562 cells resulted in a time-dependent conversion of the original radioactive drug molecules to molecules with a larger negative charge in the case of diphenylhydantoin and a smaller negative charge in the case of phenobarbital. These conversions were prevented by 20 mM tetrahydrofurane and partially inhibited by 300 U/ml superoxide dismutase (SOD) and, therefore, appeared to depend on cytochrome-P-450-mediated reactions and to some extent also on superoxide anion radicals. Macrophages which were stimulated by 20 nM phorbol myristate acetate metabolized both drugs at much faster rates than unstimulated macrophages. Since this increased metabolism was abolished in the presence of SOD, it appeared to be entirely dependent on superoxide anion radicals. These data provide biochemical evidence that unstimulated human monocyte-derived macrophages have a substantial capacity to metabolize certain xenobiotics and that stimulated macrophages have an even greater capacity to do so. This property of macrophages may have considerable biological significance and be important in the pathogenesis both of drug-induced tissue damage and of malignant disease.

Beyond Animal Husbandry

Concerns about the welfare of agricultural animals in corporate or “factory farming” systems are growing. Increasingly, it is suggested that modem farm animal production practices are morally objectionable, causing physical and mental suffering to animals. Such criticisms are premised on beliefs about the mental capacities of farm animals that are not wholly supported by scientific evidence, for little is known about farm animal cognition. Some animal scientists, realizing that concerns about the treatment of agricultural animals cannot be addressed in absence of knowledge about farm animal mentality, have begun cognitive studies of farm animals. Subsequently, several ethical problems have emerged. In this paper it is argued that while farm animal cognition studies are needed, scientists must consider the moral problems and implications of the research, and must devise empirically testable hypotheses about those aspects of cognitive behavior that are relevant to discussions about moral treatment of farm animals.

Mobility of the spine after spinal surgery in acute spinal cord injury

STUDY DESIGN

Retrospective study of mobility of the spine.

OBJECTIVES

To study the relation between mobility of the spine, operation and length of surgical stabilisation.

SETTING

The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK.

METHOD

Questionnaires were sent to 99 consecutive acute traumatic spinal cord-injured patients (UK residents) admitted in 1990-1994. All had acute spinal surgery. A total of 68 responded. Their replies, medical records and radiographs were reviewed.

RESULTS

(1) In all, 63 patients had surgery in the cervical, thoracolumbar or lumbar spine; 11 of them had more than two functional spinal units (FSUs) stabilised, 10 of these 11 (91%) had less than satisfactory results in terms of metal failure, improper placement of the implant or functional restriction of spinal mobility (FROSM). A total of 35 had 1-2 FSUs stabilised. None of them had metal failure or improper placement of implant, but 14 (40%) had less than satisfactory result due to FROSM; 17 had laminectomy alone, four of these had FROSM. (2) Five patients had surgery in the thoracic spine. Three of these who had 5-7 FSUs stabilised had no FROSM. Two had laminectomy alone, one of whom had FROSM.

CONCLUSION

(1) Long surgical stabilisation in the cervical, thoracolumbar and lumbar spines was likely to result in either metal failure or FROSM. (2) Long surgical stabilisation of the thoracic spine was not associated with either metal failure or FROSM. (3) A small proportion of patients had laminectomy alone. One of them who had multiple injuries had FROSM.

Is the nasal cycle ablated in patients with high spinal cord trauma?

We have observed at our centre that patients with high spinal cord injury frequently complain of nasal obstruction requiring decongestants. This may be due to damage to the cervical sympathetic nerves supplying the nasal mucosa, which ablates the nasal cycle. In this study we assessed the nasal cycle in 10 patients with high spinal cord trauma (above T1 segment) using acoustic rhinometry. We found that all patients assessed within 1 year of injury had nasal obstruction and no nasal cycle. Patients with injuries between 1 and 4 years who complained of a nasal obstruction showed an irregular cycle. Patients with injuries older than 4 years showed a normal alternating reciprocal nasal cycle and an improvement of nasal symptoms. The exact reason for this recovery is presently not clear from this pilot study. Further research will be undertaken to assess reasons for the recovery and possible treatment regimens for this distressing condition.

Identification of factors contributing to increased length of stay in two diagnosis related groups

This paper discusses a study conducted to identify factors that contributed to increased length of stay for two diagnosis related groups (DRGs) and their consequential impact on nursing salaries. The study shows that three separate clusters of cost drivers (DRG-related, nurse-related, and patient-related) contributed to increased length of stay for DRG 177 (chronic obstructive airways disease) and DRG 367 (cholecystectomy without exploration of the common bile duct). It was not possible to establish a link between length of stay and nursing salaries due to lack of relevant data. The results of the study can be used to raise professional awareness to the difficulties encountered by nurse managers in controlling length of stay when there are substantial numbers of different DRGs in acute care wards. The results can also be used as a basis for conducting larger studies into DRGs with higher than expected lengths of stay.

Children in crashes: mechanisms of injury and restraint systems

OBJECTIVES

To explore the levels of protection offered to children involved in motor vehicle collisions.

DESIGN

A joint study by the Children's Hospital of Eastern Ontario (CHEO) and Transport Canada, Ottawa, conducted in 2 phases: retrospective from 1990 to 1997 and prospective from 1998 to 2000.

SETTING

CHEO, a university affiliated tertiary care centre.

PATIENTS

Children admitted to CHEO between 1990 and 2000 with spinal trauma due to motor vehical crashes (MVCs). Phase I of the study involved analysis, in a series of 45 children after MVAs, by location of spinal injury versus belt type. Phase 2 was a prospective study of 22 children injured in 15 MVAs.

INTERVENTIONS

A biomechanical assessment of the vehicle and its influence on the injuries sustained.

MAIN OUTCOME MEASURES

The nature and extent of the injuries sustained, and the vehicle dynamics and associated occupant kinematics.

RESULTS

The odds ratio of sustaining a spinal injury while wearing a 2-point belt versus a 3-point belt was 24 (95% confidence interval 2.0-2.45, p < 0.1), indicating a much higher incidence with a lap belt than a shoulder strap.

CONCLUSIONS

Proper seat-belt restraint reduces the morbidity in children involved in MVCs. Children under the age of 12 years should not be front-seat passengers until the sensitivity of air bags has been improved. Three-point pediatric seat belts should be available for family automobiles to reduce childhood trauma in MVCs.

First episode of psychosis - an audit of service engagement and management at 1-2 year follow-up

BACKGROUND

The study aimed to develop and implement local audit standards for management and service engagement in the follow-up of patients suffering from a 'first episode of psychosis'.

MATERIAL AND METHODS

Audit standards, developed following a literature review and consultation with colleagues, were incorporated into a questionnaire for distribution to the community keyworkers of a 'first episode of psychosis' cohort at 1-2 years of follow-up.

RESULTS

Most satisfied standards for engagement (91%) and maintenance medication (91%). Forty-two to sixty-three per cent had received psychological, family and educational interventions but these often lacked theoretical basis and detailed content. Admission, deliberate self-harm and forensic contacts were infrequent. Less than half had any structured daytime activity. Priorities identified for improving services for this group include adequate staff training in psychosocial interventions and more active planning and resourcing of day care and other constructive daytime activities.

CONCLUSIONS

Simple locally-developed audit standards such as those described for a 'first episode of psychosis' population can offer a useful way of assessing service delivery and highlighting areas for development.

The role of phosphorylation/dephosphorylation in agonist-induced desensitization of D1 dopamine receptor function: evidence for a novel pathway for receptor dephosphorylation

Exposure of D1 dopamine receptors to agonists results in rapid desensitization of the receptor-stimulated accumulation of cAMP. It is believed that agonist-induced phosphorylation of the receptor plays a critical role in the processes that underlie this phenomenon. To investigate the role of agonist-induced receptor phosphorylation, a FLAG epitope was added to the amino terminus of the rat D1 dopamine receptor and this construct was stably expressed in C6 glioma cells. It was found that the D1 receptor was stoichiometrically phosphorylated under basal conditions and that its phosphorylation state was increased by 2- to 3-fold upon exposure of the cells to dopamine for 10 min. The dopamine-induced receptor phosphorylation could be blocked by D1-selective antagonists but was unaffected by inhibitors of either protein kinase A or protein kinase C. The incorporation of phosphate into the receptor was rapid but transient, despite the continued presence of dopamine. A comparison of the rates of receptor phosphorylation approximately ion (t(1/2) < 1 min) and dopamine-induced desensitization (t(1/2) approximately 7 min) revealed that receptor phosphorylation was not the rate limiting step for receptor desensitization. Upon removal of dopamine, the receptor was rapidly dephosphorylated (t(1/2) approximately 10 min) and this was not blocked by agents (i.e., concanavalin A or hypertonic sucrose) that inhibit D1 receptor internalization. Using specific inhibitors, the phosphatase involved in D1 receptor dephosphorylation was shown not to correlate with the recently identified "G protein-coupled receptor phosphatase" (Proc Natl Acad Sci USA 92:8343-8347, 1995). These results suggest that the phosphorylated D(1) receptor is processed through a novel recovery pathway and that internalization is not required for receptor dephosphorylation.

Interior near-field acoustical holography in flight

In this paper boundary element methods (BEM) are mated with near-field acoustical holography (NAH) in order to determine the normal velocity over a large area of a fuselage of a turboprop airplane from a measurement of the pressure (hologram) on a concentric surface in the interior of the aircraft. This work represents the first time NAH has been applied in situ, in-flight. The normal fuselage velocity was successfully reconstructed at the blade passage frequency (BPF) of the propeller and its first two harmonics. This reconstructed velocity reveals structure-borne and airborne sound-transmission paths from the engine to the interior space.

Delta-9-tetrahydrocannabinol inhibits antitumor immunity by a CB2 receptor-mediated, cytokine-dependent pathway

In this study, we show that Delta-9-tetrahydrocannabinol (THC), the major psychoactive component of marijuana, suppresses host immune reactivity against lung cancer. In two different weakly immunogenic murine lung cancer models, intermittent administration of THC (5 mg/kg, four times/wk i.p. for 4 wk) led to accelerated growth of tumor implants compared with treatment with diluent alone. In contrast to our findings in immunocompetent mice, THC did not affect tumor growth in tumor-bearing SCID mice. The immune inhibitory cytokines, IL-10 and TGF-beta, were augmented, while IFN-gamma was down-regulated at both the tumor site and in the spleens of THC-treated mice. Administration of either anti-IL-10- or anti-TGF-beta-neutralizing Abs prevented the THC-induced enhancement in tumor growth. Both APC and T cells from THC-treated mice showed limited capacities to generate alloreactivity. Furthermore, lymphocytes from THC-treated mice transferred the effect to normal mice, resulting in accelerated tumor growth similar to that seen in the THC-treated mice. THC decreased tumor immunogenicity, as indicated by the limited capacity for tumor-immunized, THC-treated mice to withstand tumor rechallenge. In vivo administration of a specific antagonist of the CB2 cannabinoid receptor also blocked the effects of THC. Our findings suggest the THC promotes tumor growth by inhibiting antitumor immunity by a CB2 receptor-mediated, cytokine-dependent pathway.

Drug action team strategies in Scotland

OBJECTIVE

To compare the Strategic Plans of Scottish Drug Action Teams (DATs) to the recommendations of the Scottish Office Ministerial Task Force Report.

DESIGN

Extraction of information from the strategic plans of DATs.

SETTING

All 15 Scottish DATs 1995-96.

RESULTS

Five DATs did not include a membership list in their Strategy, and two stated the organisations represented, but not the identity of individual members. Where individuals were identified, Health Boards, Social Work departments, Education and Police were always members. The median number of members was 12 (range 4-16). Most areas had plans to improve information on drug misuse. Every plan mentioned preventive work with young people. In Criminal Justice settings, use of Children's Hearings (20% of plans), substitute prescribing linked to probation (13%) and prison aftercare schemes (33%) were mentioned less commonly. Substitute prescribing (87% of DATs), the role of General Practitioners (100%) and monitoring mechanisms (87%) were the service issues mentioned most often. Of other service issues in the Ministerial Report, those mentioned least by DATs were childcare linked to services (20%); services for people from ethnic minorities (33%); education on dangers of injecting to existing drug users (33%); women--only residential services (33%); services for women (46%) and role of pharmacists (53%).

CONCLUSION

Membership was from a core of statutory agencies. Young people were the priority of most DATs. Criminal Justice arrangements and services for special groups of people were not well developed in many plans. DATs should review their focus on these groups.

Specific inhibition of cyclooxygenase 2 restores antitumor reactivity by altering the balance of IL-10 and IL-12 synthesis

Cyclooxygenase-2 (COX-2), the enzyme at the rate-limiting step of prostanoid production, has been found to be overexpressed in human lung cancer. To evaluate lung tumor COX-2 modulation of antitumor immunity, we studied the antitumor effect of specific genetic or pharmacological inhibition of COX-2 in a murine Lewis lung carcinoma (3LL) model. Inhibition of COX-2 led to marked lymphocytic infiltration of the tumor and reduced tumor growth. Treatment of mice with anti-PGE2 mAb replicated the growth reduction seen in tumor-bearing mice treated with COX-2 inhibitors. COX-2 inhibition was accompanied by a significant decrement in IL-10 and a concomitant restoration of IL-12 production by APCs. Because the COX-2 metabolite PGE2 is a potent inducer of IL-10, it was hypothesized that COX-2 inhibition led to antitumor responses by down-regulating production of this potent immunosuppressive cytokine. In support of this concept, transfer of IL-10 transgenic T lymphocytes that overexpress IL-10 under control of the IL-2 promoter reversed the COX-2 inhibitor-induced antitumor response. We conclude that abrogation of COX-2 expression promotes antitumor reactivity by restoring the balance of IL-10 and IL-12 in vivo.

Can interpectoral nodes be sentinel nodes?

BACKGROUND

This study was designed to determine if interpectoral nodes could be sentinel nodes for some breast cancers.

METHODS

Thirty-five consecutive breast cancer patients undergoing axillary node dissection had a dissection of the interpectoral nodes. These were sent to pathology as a separate specimen.

RESULTS

Three patients were identified with isolated interpectoral nodal metastasis.

CONCLUSION

In upper quadrants or deep breast cancers the interpectoral nodes may be the earliest site of nodal metastasis. This may lead to false negative results in some sentinel node biopsies.

T cell-derived IL-10 promotes lung cancer growth by suppressing both T cell and APC function

We have found previously that human lung cancers potently induce T lymphocyte IL-10 production in vitro. To assess the impact of enhanced T cell-derived IL-10 on antitumor immunity in vivo, we utilized transgenic mice expressing IL-10 under the control of the IL-2 promoter. We have shown previously that Lewis lung carcinoma cells (3LL) have more aggressive growth potential in IL-10 transgenic mice compared with control littermates. In this study, we show that transfer of T cells from IL-10 transgenic mice to control littermates transferred the IL-10 immunosuppressive effect and led to enhanced 3LL tumor growth. In addition to changes in T cell-mediated immunity, professional APC from IL-10 transgenic mice were found to have significantly suppressed capacity to induce MHC alloreactivity, CTL responses, and IL-12 production. Tumor Ag-pulsed dendritic cells from IL-10 transgenic mice also failed to generate antitumor reactivity. These results suggest that increased levels of T cell-derived IL-10 severely impair antitumor immunity in vivo, due to defects in both T cell and APC function.

Agonist action at D2(long) dopamine receptors: ligand binding and functional assays

1. The activities of a range of agonists at D2(long) dopamine receptors expressed in CHO cells have been determined in ligand binding and in a functional assay, the stimulation of [35S]-GTPgammaS binding. 2. For several agonists (apomorphine, dopamine, pergolide, quinpirole, NPA, ropinirole, talipexole) binding in the absence of added guanine nucleotides was best described in terms of interaction at higher and lower affinity states, whereas for other agonists (bromocriptine, DHEC, lisuride, 3-PPP) a one binding site model was a good description of the data. In the presence of GTP (100 microM) all agonist binding data were best described by a one site model. 3. All of the agonists tested increased [35S]-GTPgammaS binding above the basal level and the maximal effects and potencies of the agonists in this test were different. There was no clear relation between the ability of an agonist to stabilize the formation of the ternary complex of agonist/receptor/G-protein and the maximal activity of the agonist or the amplification factor (ratio of dissociation constant for binding to receptor to EC50 in functional assay). 4. A comparison was made between the profiles of the D2(short) and D2(long) receptor isoforms in these assays.

Cervical and breast cancer screening in wheelchair dependent females

The aim of this study was to compare the attendance rates for cervical and breast cancer screening in wheelchair dependent spinal cord injured (SCI) women with those in the general female population in England. The study was conducted as a postal questionnaire survey with an effective response rate of 79%. The attendance rates of the eligible SCI groups were 84% for cervical screening and 72% for mammography, both figures being well within the national average attendance rates in the general female population. Difficulties with cervical screening were reported in 58% and with mammography in 43% of the cases, including restricted access to clinics, examining rooms and examining couches and positioning during the procedure. These were also the main reasons given for non attendance. The article points out ways to enable even more wheelchair dependent women to benefit from the preventative screening programmes.

Evaluation of common breast problems: guidance for primary care providers

The evaluation of common breast problems requires an assessment of the patient's risks and symptoms and a thorough physical examination. When indicated, appropriate imaging studies should be done, the patient should be referred to a surgeon or a breast specialist, and operative interventions should be used.

Factors associated with acute and chronic pain following traumatic spinal cord injuries

Previous studies have estimated that between 25% and 45% of people with spinal cord injury report severe levels of chronic pain. Few studies have examined this longitudinally. This study examines the primary pain sites, intensity and variability of perceived pain in 76 patients, 6 weeks post injury and 45 patients from the same cohort, 8 year post discharge. Demographic information reveals a close similarity with the database (40,000) from Stover and Fine's cohort (1986). Data was assessed using visual analogue scales, measures were also taken of functional independence (FIM), emotional status and coping. At 6 weeks post injury, most pain is sited in the thoracic spine area, and in the upper and lower limbs. At 1 year post discharge, most pain is reported to be in the thoracic spine area, the lumbar region and the chest. Twenty-three per cent of the 6 week group reported that the intensity of their pain was severe, whilst at 1 year, 41% of the sample complained of severe pain. Factors associated with the pain at both time points were explored using correlational analyses. The emotional, functional and psychological factors that predict pain severity were explored using multiple regression analysis. Twenty-four per cent of those reporting moderate to severe pain at 6 weeks post injury were still reporting pain at 1 year post discharge. This study examines the relative contribution of psychological factors in reported pain.

Surveillance in the management of the cancer patient with special reference to breast and colon cancer

Senior surgeons of the Society of Surgical Oncology were surveyed concerning their followup practices for patients with colon and breast cancer and compared them with the recommendations in the current literature. Intensive followup is not indicated for patients with breast cancer patients and all surgeons agree by using physical examination and mammograms predominantly. Colon cancer followup was variable and the literature indicates a small survival advantage for intensive followup.

Pharmacological analysis of dopamine stimulation of [35S]-GTP gamma S binding via human D2short and D2long dopamine receptors expressed in recombinant cells

1. The activation of G-proteins by agonist-occupied D2 or D3 dopamine receptors in membranes from recombinant cells expressing the cloned receptors has been analysed by a [35S]-guanosine 5'-[gamma-thio] triphosphate ([35S]-GTP gamma S) binding assay. 2. The rate of [35S]-GTP gamma S binding was increased by dopamine in a dose-dependent manner in membranes from CHO cells stably expressing either the D2short or D2long dopamine receptor. 3. The dopamine-induced stimulation of [35S]-GTP gamma S binding could be inhibited by a range of antagonists. Affinities for antagonists derived from the inhibition of the dopamine stimulation of [35S]-GTP gamma S binding correlated very well with affinities derived from radioligand binding studies. 4. When the maximum [35S]-GTP gamma S binding responses stimulated by dopamine acting at different receptor subtypes were compared, there was a tendency for the stimulation via the D2short receptor to be greater than via the D2long receptor and for the stimulation via the D3 dopamine receptor to be less than for either D2 receptor. These differences in maximal response were also seen when the inhibitory effects of dopamine on adenylyl cyclase via the three receptor subtypes were compared. 5. The stimulation of [35S]-GTP gamma S binding by dopamine in membranes from recombinant cells therefore provides an excellent system for studying the molecular nature of agonism and the receptor/G-protein interactions for these receptors.