Measuring Adolescent Birth Trauma: Development, Adaptation, and Evaluation of the Psychometric Properties for the Childbirth Trauma Index

BACKGROUND AND PURPOSE

Childbirth can have negative consequences; however, measurement tools to assess this event are limited; and none consider the adolescent's birth. This study assessed the psychometric properties of the childbirth trauma index (CTI).

METHODS

Construct validity and reliability of the CTI was assessed via a field test involving 160 adolescents 3 days postpartum.

RESULTS

A modified 8-item version of the original CTI exhibited acceptable construct validity and reliability criteria. The CTI was found to link with birth appraisal, but not subjective distress measurements.

CONCLUSIONS

The CTI may be a more robust means of assessing birth appraisal than use of single-item measures. Recommendations for practice suggest use of the modified CTI to assess birth appraisal, or use in combination with single-item rating scales.

Essential oils for managing Pratylenchus penetrans on Easter lilies

Easter lily bulbs for greenhouse forcing are produced in Del Norte County, California and Curry County, Oregon, USA. Pratylenchus penetrans infestation seriously affects growth of field grown bulbs. During two consecutive years of field trials containing 22 treatments, commercially prepared formulations of essential oils (EOs) were compared to an untreated control and to a standard chemical fumigant treatment (FU) (1,3-dichloropropene and metam sodium) applied preplant followed by phorate (PH) at planting to determine their value in the management of lesion nematode, and in improving plant health. The EO products Duogard, EF400, EF300, and Cinnamite were tested as preplant dips to bulblet planting stock. The treated bulblets were tested either alone, in combination with PH at-planting, at planting following FU or in combination with PH at planting following FU. The organophosphates ethoprop and fosthiazate were also tested either alone, or at a reduced rate in combination with a reduced rate of PH. With respect to bulb circumference, ten treatments consistently outperformed the control. In consecutive years, three treatments had healthier looking roots than the control. At harvest, levels of lesion nematode within roots were consistently lower in nine treatments. EOs were beneficial in mitigating nematode damage.

Predicting posttraumatic stress and depression symptoms among adolescents in the extended postpartum period

BACKGROUND

Adolescent childbirth continues as a public health concern, and investigation of postpartum posttraumatic stress symptoms (PTSS) and depression is important to inform future research and practice. Longitudinal studies exploring PTSS alone or in combination with depression are non-existent for postpartum adolescent populations. This study aimed to identify stress/PTSS and depression symptoms at 72 hours and three, six, and nine months postpartum, and determine if symptoms at each time point predicted later symptoms.

METHODS

A convenience sample of 303 adolescents 13-19 years of age were recruited from two postpartum units of one, large, public hospital. The Impact of Event Scale and the Edinburgh Postpartum Depression Inventory provided a screen of symptoms for stress/PTSS and depression at all time points. A lagged autoregressive model was developed to assess the predictive power of symptoms at each time point to the next across the extended postpartum period.

RESULTS

About 30% of adolescents displayed early symptoms; 20% showed symptoms at the final time point. Early symptoms did not predict symptoms at 3 months; yet, symptoms at 3 months predicted symptoms at 6-9 months.

LIMITATIONS

Attrition at final time points necessitated pooled data. Adolescents were primarily older, Hispanics, and recruited from one public hospital decreasing demographic representation. Use of screening tools prevented diagnostic outcomes. Unknown stressors occurring before and after pregnancy or birth may have influenced final outcomes.

CONCLUSIONS

Early symptoms were common and 3 month symptoms predicted later symptoms. For at risk adolescents, a plan for follow-up beyond hospital discharge is recommended.

Operative and survival outcomes in a series of 100 consecutive cases of robot-assisted transhiatal esophagectomies

Robotic-assisted transhiatal esophagectomy (RATE) is a technically complex procedure with potential for improved postoperative outcomes. In this report, we describe our experience with RATE in a large case series. A retrospective review was conducted to collect clinical, outcomes, and survival data for 100 consecutive patients with esophageal cancer (n = 98) and benign (n = 2) conditions undergoing RATE between March 2007 and December 2014. Progression-free (PFS) and overall (OS) survival were estimated using the Kaplan-Meier curves with comparisons by log-rank tests. Median operative time and estimated blood loss were 264 minutes and 75 mL, respectively. Median intensive care unit stay was 1 day and median length of hospital stay was 8 days. Postoperative complications commonly observed were nonmalignant pleural effusion (38%) and recurrent laryngeal nerve injury (33%); 30 day mortality rate was 2%. Median number of lymph nodes removed during RATE was 17 and R0 resection was achieved in 97.8% patients. At the end of the median follow-up period of 27.7 months, median PFS was 41 months and median OS was 54 months. 1-year and 3-year PFS rates were 82% (95% CI, 75%-89%) and 53% (95% CI, 42%-62%), respectively, and OS rates were 95% (95% CI, 91%-99%) and 57% (95% CI, 46%-67%). In our experience, RATE is an effective and safe oncologic surgical procedure in a carefully selected group of patients with acceptable operative time, minimal blood loss, standard postoperative morbidity and adequate PFS and OS profiles.

Phosphorus Additives and Albuminuria in Early Stages of CKD: A Randomized Controlled Trial

BACKGROUND

Little is known about the effects of phosphorus additives on patients with kidney disease.

STUDY DESIGN

Randomized, double-blind, crossover trial.

SETTING & PARTICIPANTS

31 adults with early stages of presumed chronic kidney disease (estimated glomerular filtration rate ≥ 45mL/min/1.73m2; urine albumin-creatinine ratio sex-specific cutoff points: men ≥ 17mg/g, women ≥ 25mg/g).

INTERVENTION

Higher versus lower phosphorus intake for 3 weeks. Higher phosphorus intake was achieved by the addition of commercially available diet beverages and breakfast bars to diet.

OUTCOMES

Change in 24-hour urine albumin excretion and plasma fibroblast growth factor 23 level.

MEASUREMENTS

Two 24-hour urine collections and a single fasting blood draw at the end of each period.

RESULTS

Mean baseline values for phosphorus intake, 24-hour urine phosphorus excretion, and estimated glomerular filtration rate were 1,113±549 (SD) mg/d, 688±300mg/d, and 74.6±22.0mL/min/1.73m2. Median urine albumin excretion of 82.7 (IQR, 39.6-174.1) mg/d. Although phosphorus intake from study products increased by 993mg/d (P<0.001) during the higher compared to lower phosphorus additive period, background phosphorus intake decreased by 151mg/d (P=0.004). Higher phosphorus additive consumption increased 24-hour urine phosphorus excretion by 505 (95% CI, 381 to 629) mg/d (P<0.001), but did not significantly increase albuminuria (higher vs lower: 14.3%; 95% CI, -2.5% to 34.0%; P=0.1) or fibroblast growth factor 23 level (higher vs lower: 3.4%; 95% CI, -5.9% to 13.6%; P=0.4).

LIMITATIONS

Small sample size, short duration of intervention, changes in background diet during the intervention.

CONCLUSIONS

A 3-week consumption of higher phosphorus food additives did not significantly increase albuminuria. Further studies are needed to confirm these results.

Depressive Symptoms and Violence Exposure: Contributors to Repeat Pregnancies Among Adolescents

Depressive symptoms and violence exposure (VE) often cooccur and have been recognized to influence childbearing; contribution to repeat pregnancy is unclear and examined in this article. This cross-sectional, descriptive, study screened for depressive symptoms and VE among 193 adolescent mothers at a large county hospital in Southwestern United States. Repeat pregnancy and depressive symptoms characterized one-third and one-quarter of adolescents, respectively. Despite minimal disclosure of VE, repeat pregnancy was significantly influenced by child abuse and past traumatic life experiences. Assessments and interventions with adolescents should focus on frequency of repeat pregnancies and symptoms of depression and VE. Nurses and childbirth educators are poised to offer birth control information and education, support, and resources highlighting depression and VE to adolescents.

Prenatal depression: Early intervention

Frequently undiagnosed and untreated, prenatal depression affects approximately one in four childbearing women. Screening and appropriate management is essential to prevent adverse consequences to both the woman and her unborn infant. Early conversations between the woman and her nurse practitioner are essential to making medical management decisions.

Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

BACKGROUND

In general populations, healthy lifestyle is associated with fewer adverse outcomes. We estimated the degree to which adherence to a healthy lifestyle decreases the risk of renal and cardiovascular events among adults with chronic kidney disease (CKD).

STUDY DESIGN

Prospective cohort.

SETTING & PARTICIPANTS

3,006 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study.

PREDICTORS

4 lifestyle factors (regular physical activity, body mass index [BMI] of 20-<25kg/m(2), nonsmoking, and "healthy diet"), individually and in combination.

OUTCOMES

CKD progression (50% decrease in estimated glomerular filtration rate or end-stage renal disease), atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease), and all-cause mortality.

MEASUREMENTS

Multivariable-adjusted Cox proportional hazards.

RESULTS

During a median follow-up of 4 years, we observed 726 CKD progression events, 355 atherosclerotic events, and 437 deaths. BMI≥25kg/m(2) and nonsmoking were associated with reduced risk of CKD progression (HRs of 0.75 [95% CI, 0.58-0.97] and 0.61 [95% CI, 0.45-0.82] for BMIs of 25 to <30 and ≥30kg/m(2), respectively, versus 20 to <25kg/m(2); HR for nonsmoking of 0.68 [95% CI, 0.55-0.84] compared to the current smoker reference group) and reduced risk of atherosclerotic events (HRs of 0.67 [95% CI, 0.46-0.96] for BMI of 25-<30 vs 20-<25kg/m(2) and 0.55 [95% CI, 0.40-0.75] vs current smoker). Factors associated with reduced all-cause mortality were regular physical activity (HR, 0.64 [95% CI, 0.52-0.79] vs inactive), BMI≥30kg/m(2) (HR, 0.64 [95% CI, 0.43-0.96] vs 20-<25kg/m(2)), and nonsmoking (HR, 0.45 [95% CI, 0.34-0.60] vs current smoker). BMI<20kg/m(2) was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-<25kg/m(2)). Adherence to all 4 lifestyle factors was associated with a 68% lower risk of all-cause mortality compared to adherence to no lifestyle factors (HR, 0.32; 95% CI, 0.11-0.89).

LIMITATIONS

Lifestyle factors were measured only once.

CONCLUSIONS

Regular physical activity, nonsmoking, and BMI≥25kg/m(2) were associated with lower risk of adverse outcomes in this cohort of individuals with CKD.

Childbirth related fears and psychological birth trauma in younger and older age adolescents

AIM

The aim of this study is to explore childbirth fears on psychological birth trauma (PBT) by adolescent age.

BACKGROUND

Among adults parity and intrapartum fears including fear of dying, loss of control, pain, and limited support have been associated with negative birth appraisal and symptoms of traumatic stress, defined here as PBT.

METHODS

This cross-sectional study surveyed a convenience sample of 201 adolescents at a large, county hospital.

RESULTS

Over 75% of adolescents perceived fear. Younger and older adolescents, similar in fears, were distinguished only by parity. The effects of parity, overall rating of fear, and father of baby absence were found to vary by age on birth appraisal; however, only parity varied by age on IES scores.

CONCLUSIONS

All age adolescents can be fearful and will benefit with childbirth education and labor support to help reduce fears and subsequent PBT.

FGF23 modifies the relationship between vitamin D and cardiac remodeling

BACKGROUND

There is growing evidence to support an important role for vitamin D and related hormones, parathyroid hormone and fibroblast growth factor 23 (FGF23), on cardiac remodeling in chronic kidney disease. Our objective was to determine the relationships between vitamin D and cardiac remodeling in chronic kidney disease and the effects of parathyroid hormone and FGF23 on these associations.

METHODS AND RESULTS

In 1431 participants from the Chronic Renal Insufficiency Cohort study, we measured 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), FGF23, and parathyroid hormone and performed quantitative echocardiography. Using linear regression methods, we determined significant negative interactions between 25(OH)D and FGF23 on left ventricular (LV) mass (P=0.016), end-diastolic volume (P=0.029), and end-systolic volumes (P=0.021). In participants with an FGF23 level greater than the median of 123.5 RU/mL, each doubling of 25(OH)D was associated with a 2.5% (95% confidence interval, -4.8, -0.2) lower LV mass. This association was less pronounced with FGF23 levels less than the median (0.4%; 95% confidence interval, -1.9, 2.7). Conversely, in participants with deficient 25(OH)D levels <20 ng/mL, each doubling of FGF23 was associated with a 3.4% (95% confidence interval, 1.2, 5.6) greater LV mass compared with only a 1.6% (95% confidence interval, -0.2, 3.5) difference in participants with sufficient 25(OH)D. Similar findings were observed with 25(OH)D and volumes (P<0.05), and 1,25(OH)2D and LV mass and volumes (P<0.005). There was no effect modification by parathyroid hormone.

CONCLUSIONS

We identified significant interactions among 25(OH)D, 1,25(OH)2D, and FGF23 on cardiac remodeling. Increased LV mass and cavity dilatation were observed with low 25(OH)D and high FGF23. Our findings suggest that consideration of both hormones is crucial to understanding the role of either in cardiac remodeling, and may have important therapeutic implications.

A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol

Background

Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care.

Methods

Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions.

Discussion

As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have incorporated stakeholder input and tailored components of the interventions to meet the specific needs of the involved clinics and communities. Results from this study will provide knowledge about how integrated multi-level interventions can improve hypertension care and reduce disparities.

Trial Registration

ClinicalTrials.gov NCT01566864

The effects of n-3 long-chain polyunsaturated fatty acid supplementation on biomarkers of kidney injury in adults with diabetes: results of the GO-FISH trial

OBJECTIVE Long-chain n-3 polyunsaturated fatty acid (n-3 PUFA) supplements may have renoprotective effects in patients with diabetes, but previous trials have been inconsistent. We performed a randomized controlled trial of n-3 PUFA supplementation on urine albumin excretion and markers of kidney injury in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS We conducted a randomized, placebo-controlled, two-period crossover trial to test the effects of 4 g/day of n-3 PUFA supplementation on markers of glomerular filtration and kidney injury in adults with adult-onset diabetes and greater than or equal to trace amounts of proteinuria. Each period lasted 6 weeks and was separated by a 2-week washout. The main outcome was urine albumin excretion and, secondarily, markers of kidney injury (kidney injury molecule-1, N-acetyl β-d-glucosaminidase [NAG], neutrophil gelatinase-associated lipocalin [NGAL], and liver fatty acid-binding protein [LFABP]), serum markers of kidney function (cystatin C, β2-microglobulin, and creatinine), and estimated glomerular filtration rate (eGFR). RESULTS Of the 31 participants, 29 finished both periods. A total of 55% were male, and 61% were African American; mean age was 67 years. At baseline, mean BMI was 31.6 kg/m(2), median eGFR was 76.9 mL/min/1.73 m(2), and median 24-h urine albumin excretion was 161 mg/day. Compared with placebo, n-3 PUFA had nonsignificant effects on urine albumin excretion (-7.2%; 95% CI -20.6 to 8.5; P = 0.35) and significant effects on urine NGAL excretion (-16% [-29.1 to -0.5%]; P = 0.04). There was no effect on serum markers of kidney function or eGFR. In subgroup analyses, there were significant decreases in 24-h urinary excretion of albumin, NGAL, LFABP, and NAG among participants taking medications that block the renin-angiotensin-aldosterone system (RAAS). CONCLUSIONS These results suggest a potential effect of n-3 PUFA supplementation on markers of kidney injury in patients with diabetes and early evidence of kidney disease. In the context of prior studies, these results provide a strong rationale for long-term trials of n-3 PUFA on chronic kidney disease progression.

Urinary sodium is a potent correlate of proteinuria: lessons from the chronic renal insufficiency cohort study

BACKGROUND

While higher blood pressure is known to increase proteinuria, whether increased dietary sodium as estimated from 24-hour urinary excretion correlates with increased proteinuria in patients with chronic kidney disease (CKD) is not well studied.

METHODS

We measured 24-hour urinary sodium, potassium and protein excretion in 3,680 participants in the Chronic Renal Insufficiency Cohort study, to determine the relationship between urinary sodium and potassium and urinary protein excretion in patients with CKD. We stratified our data based on the presence or absence of diabetes given the absence of any data on this relationship and evidence that diabetics had greater urinary protein excretion at nearly every level of urinary sodium excretion. Multiple linear regressions were used with a stepwise inclusion of covariates such as systolic blood pressure, demographics, hemoglobin A1c and type of antihypertensive medications to evaluate the relationship between urinary electrolyte excretion and proteinuria.

RESULTS

Our data demonstrated that urinary sodium (+1 SD above the mean), as a univariate variable, explained 12% of the variation in proteinuria (β = 0.29, p < 0.0001), with rising urinary sodium excretion associated with increasing proteinuria. The significance of that relationship was only partially attenuated with adjustment for demographic and clinical factors and the addition of 24-hour urinary potassium to the model (β = 0.13, R(2) = 0.35, p < 0.0001).

CONCLUSIONS

An understanding of the relationship between these clinical factors and dietary sodium may allow a more tailored approach for dietary salt restriction in patients with CKD.

Potassium intake and risk of incident type 2 diabetes mellitus: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

AIMS/HYPOTHESIS

Serum potassium has been found to be a significant predictor of diabetes risk, but the effect of dietary potassium on diabetes risk is not clear. We sought to determine if dietary potassium is associated with risk of incident type 2 diabetes in young adults.

METHODS

We used data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Potassium intake was measured by (1) an average of three 24 h urinary potassium collections at the 5-year study visit, and (2) the CARDIA dietary assessment instrument at baseline. Incident type 2 diabetes cases were ascertained on the basis of use of diabetes medication and laboratory measurements. Analyses were adjusted for relevant confounders including intake of fruit and vegetables and other dietary factors.

RESULTS

Of 1,066 participants with urinary potassium measurements, 99 (9.3%) developed diabetes over 15 years of follow-up. In multivariate models, adults in the lowest urinary potassium quintile were more than twice as likely to develop diabetes as their counterparts in the highest quintile (HR 2.45; 95% CI 1.08, 5.59). Of 4,754 participants with dietary history measurements, 373 (7.8%) developed diabetes over 20 years of follow-up. In multivariate models, African-Americans had a significantly increased risk of diabetes with lower potassium intake, which was not found in whites.

CONCLUSIONS/INTERPRETATION

Low dietary potassium is associated with increased risk of incident diabetes in African-Americans. Randomised clinical trials are needed to determine if potassium supplementation, from either dietary or pharmacological sources, could reduce the risk of diabetes, particularly in higher-risk populations.

optiCall: a robust genotype-calling algorithm for rare, low-frequency and common variants

Motivation: Existing microarray genotype-calling algorithms adopt either SNP-by-SNP (SNP-wise) or sample-by-sample (sample-wise) approaches to calling. We have developed a novel genotype-calling algorithm for the Illumina platform, optiCall, that uses both SNP-wise and sample-wise calling to more accurately ascertain genotypes at rare, low-frequency and common variants.

Results: Using data from 4537 individuals from the 1958 British Birth Cohort genotyped on the Immunochip, we estimate the proportion of SNPs lost to downstream analysis due to false quality control failures, and rare variants misclassified as monomorphic, is only 1.38% with optiCall, in comparison to 3.87, 7.85 and 4.09% for Illuminus, GenoSNP and GenCall, respectively. We show that optiCall accurately captures rare variants and can correctly account for SNPs where probe intensity clouds are shifted from their expected positions.

Availability and implementation: optiCall is implemented in C++ for use on UNIX operating systems and is available for download at http://www.sanger.ac.uk/resources/software/opticall/.

Contact:optiCall@sanger.ac.uk

Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial

BACKGROUND

Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group.

METHODS/DESIGN

A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m2) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months.

DISCUSSION

Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness.

Sucrose and dental caries: a review of the evidence

The aim of this study was to conduct a review of the literature to assess the relationship between quantity and pattern of sucrose use and dental caries. Using hand and electronic methods (MEDLINE, EMBASE) the literature was searched for epidemiological papers concerning any relationship of sugars and dental caries published since 1856. Superficial hand searching was carried out between 1856 and 1940, detailed hand searching 1940-1966 and electronic 1966-2007. Selection criteria were set based on, but not confined to, Cochran style standards. Investigations were categorized as A, fulfilling all criteria; B1, relevant fulfilling 19 of 23 criteria; B2, relevant but fulfilling only between 12 and 18 of the selection criteria; and C, all other papers. There were 95 papers meeting most (more than 12) or all of the selected criteria. Only 1 paper was graded A; 31 as B1. There were in addition some 65 as B2 and all the rest as C, which were discarded. There were a wide variety of study designs and those graded A or B1 comprised 23 ecological cross-sectional, 7 cohort and 2 case control studies. Summary results showed that 6 papers found a positive, significant relationship of sugar quantity to dental caries, 19 of 31 studies reported a significant relationship of sugar frequency of use to dental caries. The balance of studies does not demonstrate a relationship between sugar quantity, but a moderately significant relationship of sugar frequency to dental caries.

Tumorigenicity assessments of Per.C6 cells and of an Ad5-vectored HIV-1 vaccine produced on this continuous cell line

PER.C6, a cell line derived from human embryonic retinal cells transformed with the Adenovirus Type 5 (Ad5) E1A and E1B genes, is used to produce E1-deleted Ad5 vectors such as the MRKAd5 HIV-1 gag vaccine. While whole, live PER.C6 cells are capable of growing as tumours when transplanted subcutaneously into immunodeficient nude mice at a high dosage, the process for vaccine production includes filtration steps and other methods which effectively preclude contamination by intact viable substrate cells. However, because of the neoplastic nature of this cell line, we carried out a series of investigations to assess the tumorigenic risk posed by residuals from the cell substrate in a vaccine. To address concerns about transmission of oncogenic DNA, we demonstrated that purified PER.C6 cellular DNA does not induce tumours in newborn hamsters or nude mice. To address concerns about other potential residuals, including hypothetical adventitious tumour viruses, we demonstrated that a PER.C6 cell lysate and a MRKAd5 HIV-1 gag vaccine produced on PER.C6 cells do not induce tumours in newborn hamsters or newborn rats. These results, in conjunction with the wide panel of viral safety tests performed on these cells, support the safety of the PER.C6 as a cell substrate for vaccine production.

Universal Emotional Health Screening at the Middle School Transition

This article describes the implementation of the Developmental Pathways Screening Program (DPSP) and an evaluation of program feasibility, acceptability, and yield. Using the Mood and Feelings Questionnaire (MFQ) and externalizing questions from the Youth Self Report (YSR; Achenbach, 2001), universal classroom-based emotional health screening was implemented with students as they began middle school. Of all sixth graders enrolled in four participating Seattle schools, 861 (83%) were screened. Students who screened positive for emotional distress (15% of students screened) received onsite structured clinical evaluations with children's mental health professionals. Seventy-one percent of students who were evaluated were found to be experiencing significant emotional distress, with 59% warranting referral to academic tutoring, school counselor, and/or community mental health services. Successful implementation of in-class screening was facilitated by strong collaboration between DPSP and school staff. Limitations of emotional health screening and the DPSP are discussed, and future steps are outlined.

Anal condyloma: a comparison between HIV positive and negative patients

HIV positive and negative patients with anal condylomata were compared to determine an association with squamous cell neoplasia, its disease progression, and response to treatment. From 1992 to 2003, 61 patients were diagnosed with anal condylomata by anal biopsy. Thirty-four patients were HIV+ and 27 patients were considered HIV-. Upon retrospective chart review, details on disease progression, development of malignancy, and subsequent treatment were collected. Sixty-one per cent of HIV+ patients had a neoplastic process in contrast to 25 per cent of HIV- patients (P = 0.005). Five patients demonstrated disease progression, of which four were HIV+. Three HIV+ patients were treated for invasive carcinoma with excision and standard chemoradiation therapy. Two patients with T3 lesions developed recurrence and died. Eighteen HIV+ patients had noninvasive carcinoma and were treated with local excision without recurrence at mean follow-up of 28 months. HIV+ patients were shown to have more condylomata harboring squamous cell neoplasia than HIV- patients. Noninvasive carcinoma can be treated effectively with local excision, independent of HIV status; however, long-term follow-up is needed. Chemoradiation therapy in patients who are relatively healthy and have stage I disease may be successful. The role for chemoradiation in AIDS patients with stage III disease remains unclear.

Automated distal coronary bypass with a novel magnetic coupler (MVP system)

OBJECTIVE

We sought to assess the feasibility of performing sutureless distal coronary artery bypass anastomoses with a novel magnetic coupling device.

METHODS

From May 2000 to April 2001, single-vessel side-to-side coronary artery bypass grafting on a beating heart was performed in 39 domestic white pigs (35-60 kg) without the use of mechanical stabilization, shunts, or perfusion bridges. Animals were divided into 2 groups. Seventeen pigs underwent right internal thoracic artery to right coronary artery bypass grafting through a median sternotomy (group 1) with a novel magnetic vascular positioning system (MVP system; Ventrica, Inc, Fremont, Calif). Twenty-two pigs underwent left internal thoracic artery to left anterior descending artery grafting with the MVP anastomotic device through a left anterior minithoracotomy (group 2). This system consists of 2 pairs of elliptical magnetic implants and a deployment device. One pair of magnets forms the anastomotic docking port within the graft; the other pair forms an identical anastomotic docking port within the target vessel. The anastomosis is created when the 2 docking ports magnetically couple. Anastomotic patency was evaluated by means of angiography during the first postoperative week and at 1 month. Histologic studies were performed at different time points as late as 6 months.

RESULTS

Right internal thoracic artery to right coronary artery anastomoses and left internal thoracic artery to left anterior descending artery anastomoses were successfully performed with the system in all animals. The self-adherent and self-aligning properties of the implants allowed for immediate and secure approximation of the arteries (total anastomotic time between 2-3 minutes). Anastomoses were constructed without a stabilization platform. Five nondevice-related deaths occurred postoperatively. One-week angiography, performed in 35 surviving animals, showed a patent graft and anastomosis in all cases. The patency rate at 1 month was 97% (33/34). Histologic studies as late as 6 months demonstrated neointimal coverage of the magnets without any significant luminal obstruction. Histology also confirmed the presence of viable tissue between magnets.

CONCLUSION

The MVP anastomotic system uses magnetic force to create rapid and secure distal coronary artery anastomoses, which might facilitate minimally invasive and totally endoscopic coronary artery bypass surgery.

Management Options for Pratylenchus penetrans in Easter Lily

Alternatives to reduce or modify nematicide use for minimizing groundwater contamination in Easter lily were explored in two field trials. Alternatives to standard 1,3-dichloropropene (1,3-D) plus phorate injection in the first trial were: (i) delaying applications until after winter rains, (ii) removing roots from planting stock, (iii) 1,3-D via drip irrigation, (iv) a chitin-urea soil amendment, (v) the registered insecticide disulfoton, and (vi) several nonregistered nematicides. None of the treatments equaled the standard treatment. In the second trial, potential benefits of adding a systemic nematicide, oxamyl (OX), or a fungicide, metalaxyl (MX), to the standard treatment were explored. Preplant drip irrigation applications of metam sodium (MS), sodium tetrathiocarbonate (ST), and emulsifiable 1,3-D were evaluated alone and in combination with postplant applications of OX and MX. Several drip-applied treatments performed comparably to the standard treatment with respect to the most important criteria of crop quality, bulb circumference. Metam-sodium in combination with either or both OX and MX, 1,3-D plus OX and MX, and ST plus OX and MX provided the best results.

Results of laparoscopically assisted colon resection for carcinoma

BACKGROUND

Surgical resection is the primary treatment for colorectal carcinoma. Laparoscopically assisted colon resection technically is feasible for both benign and malignant disease. However, the role of laparoscopically assisted colon resection for carcinoma is controversial.

METHODS

We prospectively studied our first 100 patients with colorectal carcinoma who successfully underwent laparoscopically assisted colon resection for the carcinoma.

RESULTS

The pathologic stages were Dukes' categories A-16, B-52, C-25, and D-7. Operative mortality and morbidity were 2% and 22%, respectively. During a mean follow-up period of 40.3 months, recurrence by stage was zero patients with stage A disease, five patients with stage B disease, nine patients with stage C disease. Thirteen of these patients died as a result of their disease. At this writing, 60 patients are alive without evidence of disease, and 23 have completed the study disease free after more than 60 months. The 5-year survival probabilities by stage were 100% for stage A, 76.8% for stage B, and 51.7% for stage C.

CONCLUSIONS

Laparoscopically assisted colectomy for cancer can be performed safely. The recurrence rate after laparoscopically assisted resection appears to be at least as good as after open resection. Results from ongoing prospective, randomized trials are needed to confirm these findings.

A response of Panc-1 cells to cis-platinum, assessed with a cDNA array

BACKGROUND

The problem posed by the lack of response of cells in most solid cancers to current chemotherapy generally remains intractable.

MATERIALS AND METHODS

The use of cDNA arrays represents one global approach to identifying reasons for this failure. A messenger RNA response of pancreatic cancer (Panc-1) cells after culture for 24 hours with 12 microM cis-platinum was analyzed with a commercial cDNA array.

RESULTS

Major drug-induced events included inhibition of messenger RNAs associated with cell proliferation and up-regulation of generally countervailing DNA repair, cellular stress, heat shock protein, glutathione stress-related and multiple drug resistance enzyme messenger RNAs, accompanied by a limited programmed cell death response.

CONCLUSION

Induction of widespread normal stress-induced countervailing mRNAs by comparatively non-selective agents such as cis-platinum strongly biases against a successful therapeutic outcome. This paradoxical result of a therapeutic intent provides a further compelling argument for the use of specifically-targeted therapy such as growth factor receptor, tyrosine kinase and other discretely focused agents, probably employed in combinations based on expression of their targets in an individual patient's cancer, as identified by cDNA or proteonomic arrays.

A dissociation between symbolic number knowledge and analogue magnitude information

Semantic understanding of numbers and related concepts can be dissociated from rote knowledge of arithmetic facts. However, distinctions among different kinds of semantic representations related to numbers have not been fully explored. Working with numbers and arithmetic requires representing semantic information that is both analogue (e.g., the approximate magnitude of a number) and symbolic (e.g., what / means). In this article, the authors describe a patient (MC) who exhibits a dissociation between tasks that require symbolic number knowledge (e.g., knowledge of arithmetic symbols including numbers, knowledge of concepts related to numbers such as rounding) and tasks that require an analogue magnitude representation (e.g., comparing size or frequency). MC is impaired on a variety of tasks that require symbolic number knowledge, but her ability to represent and process analogue magnitude information is intact. Her deficit in symbolic number knowledge extends to a variety of concepts related to numbers (e.g., decimal points, Roman numerals, what a quartet is) but not to any other semantic categories that we have tested. These findings suggest that symbolic number knowledge is a functionally independent component of the number processing system, that it is category specific, and that it is anatomically and functionally distinct from magnitude representations.

Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and prosocial behavior: a meta-analytic review of the scientific literature

Research on exposure to television and movie violence suggests that playing violent video games will increase aggressive behavior. A metaanalytic review of the video-game research literature reveals that violent video games increase aggressive behavior in children and young adults. Experimental and nonexperimental studies with males and females in laboratory and field settings support this conclusion. Analyses also reveal that exposure to violent video games increases physiological arousal and aggression-related thoughts and feelings. Playing violent video games also decreases prosocial behavior.

Media violence and the American public. Scientific facts versus media misinformation

Fifty years of news coverage on the link between media violence and aggression have left the U.S. public confused. Typical news articles pit researchers and child advocates against entertainment industry representatives, frequently giving equal weight to the arguments of both sides. A comparison of news reports and scientific knowledge about media effects reveals a disturbing discontinuity: Over the past 50 years, the average news report has changed from claims of a weak link to a moderate link and then back to a weak link between media violence and aggression. However, since 1975, the scientific confidence and statistical magnitude of this link have been clearly positive and have consistently increased over time. Reasons for this discontinuity between news reports and the actual state of scientific knowledge include the vested interests of the news, a misapplied fairness doctrine in news reporting, and the failure of the research community to effectively argue the scientific case.

Evaluation of an awareness enhancement device for the treatment of thumb sucking in children

An evaluation of the awareness enhancement device (AED) described by Rapp, Miltenberger, and Long (1998) was conducted with 2 children who engaged in thumb sucking past the age at which it was developmentally appropriate. The AED effectively suppressed thumb sucking for both children. Future research evaluating the AED is discussed.

Is it time to pull the plug on the hostile versus instrumental aggression dichotomy?

Psychologists have often categorized human aggression as hostile or instrumental. Hostile aggression is "hot," impulsive behavior that is motivated by a desire to hurt someone; instrumental aggression is "cold," premeditated behavior used as a means to some other end. This dichotomy was useful to the early development of aggression theories and continues to capture important features of nonhuman aggression, but it has outlived its usefulness as a descriptor of fundamentally different kinds of human aggression. It is confounded with the automatic-controlled information-processing dichotomy, and it fails to consider aggressive acts with multiple motives. Knowledge structure models of aggression easily handle these problems. Taking extreme measures to preserve the hostile-instrumental dichotomy will delay further advances in understanding and controlling human aggression. Therefore, this seems a proper time to "pull the plug" and allow the hostile-instrumental aggression dichotomy a dignified death.

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.

Seromuscular enteric pedicles and prosthetic aortic graft complications in a porcine abdominal trauma model. An experimental study

BACKGROUND/AIMS

Abdominal vascular trauma may require prosthetic grafting despite peritoneal contamination by concurrent visceral injury. This study tested the use of vascularized, seromuscular enteric pedicles (VSEP) against the development of vascular prosthetic complications, in a porcine abdominal trauma model.

METHODS

Eight pigs underwent aortic transection and reconstruction with a Dacron interposition graft (DIG). A standard bacterial inoculum soaked the DIG in situ. An enteric segment was isolated on its mesenteric pedicle, and the mucosa stripped. This VSEP was wrapped around the DIG and oversewn. Animals received antibiotics for 5 days. Endpoints were 2-week survival, or evidence of sepsis. The animals underwent explantation of the DIG, VSEP, and native aorta for the purposes of histological, and microbiological analyses, and scanning electron microscopy (SEM). Outcome measures were graft infection, graft thrombosis, tissue incorporation, and anastomotic integrity.

RESULTS

Two pigs were excluded for perioperative death. All study group animals (n = 6), survived 2 weeks. Infection and thrombosis were found in 0/6 (0%). Incorporation and anastomotic integrity were evident in 6/6 (100%). VSEP had intact blood supplies. SEM demonstrated viable muscle, microcirculation, and fibroplasia in VSEP.

CONCLUSION

We conclude that VSEP may help prevent prosthetic graft complications in the contaminated setting.

A genomic response of H-358 bronchiolar carcinoma cells to MK 886, an inhibitor of 5-lipoxygenase, assessed with a cDNA array

Incomplete programmed cell death is one explanation for the escape of cancer cells from therapy. Inhibitors of the enzyme 5-lipoxygenase reduce proliferation and initiate programmed cell death in many different types of malignantly transformed cells. The 5-lipoxygenase inhibitor, MK 886. induces an atypical form of programmed cell death in H-358 bronchiolar lung cancer cells. A genomic response of H-358 cells after 24 hr of culture at a 40 uM concentration that inhibited proliferation was analyzed with a Clontech human cDNA array containing 588 cDNAs corresponding to identified genes. The data grouped into 3 major categories and initial conclusions regarding countervailing, cellular stress, programmed cell death, DNA damage and repair mRNA-responses as possible reasons for escape from the antiproliferative response are discussed. The use of cDNA arrays to estimate the extent to which malignantly transformed cells respond to therapy or why they do not and so infer prognosis and identify possible therapeutic modifications is indicated.

Current strengths and limitations of doctoral education in nursing: are we prepared for the future?

The number of doctoral programs in nursing has increased significantly over the past 20 years. This growth has been driven in part by the pressing need to supply faculty to teach in undergraduate and graduate programs in nursing. Yet, enrollment in and graduation from these programs has remained fairly constant even as the number of programs has grown. During this 20-year period, there have been numerous conferences, workshops, and meetings devoted to the topic of doctoral education with a constant thread running through them calling for the need to maintain quality--quality students, quality faculty, quality research, and quality course work and requirements--in them. Faculty teaching in these programs have given considerable thought to ways of assuring quality in the program of study so as to ensure the graduate's ability to function as a teacher and researcher. Yet, despite these efforts, still less than 50 per cent of nursing faculty possess the doctorate, faculty are experiencing difficulty in fulfilling the tripartite mission of colleges and universities, and extramural funding for research is very unevenly distributed across programs and, in total, is inadequate to build the science. This article examines the strengths and weaknesses of doctoral programs in nursing at the start of the new millennium in which the challenges in higher education are forecasted to become more focused and intense, using accepted benchmarks of quality for students, faculty, and curricula.

Video games and aggressive thoughts, feelings, and behavior in the laboratory and in life

Two studies examined violent video game effects on aggression-related variables. Study 1 found that real-life violent video game play was positively related to aggressive behavior and delinquency. The relation was stronger for individuals who are characteristically aggressive and for men. Academic achievement was negatively related to overall amount of time spent playing video games. In Study 2, laboratory exposure to a graphically violent video game increased aggressive thoughts and behavior. In both studies, men had a more hostile view of the world than did women. The results from both studies are consistent with the General Affective Aggression Model, which predicts that exposure to violent video games will increase aggressive behavior in both the short term (e.g., laboratory aggression) and the long term (e.g., delinquency).

Widespread countervailing genomic responses induced by chemotherapy or radiation as a cause of therapeutic failure

If chemotherapy or ionizing radiation induce widespread genomic responses tending to circumvent or antagonize their ability to kill malignant cells, an additional cause for therapeutic failure would be suggested. There is evidence that some agents evoke extensive countervailing genomic activity, the nature and extent of which can be assessed with the use of 'gene chips'.

Video games and aggressive thoughts, feelings, and behavior in the laboratory and in life

Two studies examined violent video game effects on aggression-related variables. Study 1 found that real-life violent video game play was positively related to aggressive behavior and delinquency. The relation was stronger for individuals who are characteristically aggressive and for men. Academic achievement was negatively related to overall amount of time spent playing video games. In Study 2, laboratory exposure to a graphically violent video game increased aggressive thoughts and behavior. In both studies, men had a more hostile view of the world than did women. The results from both studies are consistent with the General Affective Aggression Model, which predicts that exposure to violent video games will increase aggressive behavior in both the short term (e.g., laboratory aggression) and the long term (e.g., delinquency).