First divertor Thomson scattering measurements on MAST-U

MAST-U is equipped with a Super-X divertor, which aims to reduce heat flux to the target and promote detachment. Measurements of plasma electron density and temperature in the Super-X chamber offer insight into the processes at work in this type of divertor. First data have been obtained from the MAST-U divertor Thomson scattering diagnostic designed to measure these quantities. Following a Raman scattering calibration in nitrogen, the diagnostic operated over a number of plasma pulses in the first physics campaign. Electron density and temperature measurements have been taken in attached and detached conditions as the strike leg moved through the field of view of the diagnostic. The system operated with a dedicated 30 Hz laser with timing synchronized to seven similar lasers installed in the core Thomson system. Electron densities in the range of 1 × 10¹⁸-5 × 10¹⁹ m^-3 have been measured by the system throughout these regimes. Although the system was specified to measure from 1 to 40 eV, electron temperatures in the Super-X divertor in the first campaign were low, and measurement down to 0.5 eV has been critical, particularly close to the detachment front. This generation of polychromator has been designed with increased stray light rejection compared to those used in the core system. This has proved successful with very low levels of stray light observed.

Sexual and Reproductive Health Needs Assessment & Interventions in a Female Psychiatric Intensive Care Unit

Introduction

This quality improvement project was a collaboration between an adult, inpatient female psychiatric intensive care unit (PICU) in South London and the Sexual and Reproductive Health Rights, Inclusion and Empowerment (SHRINE) programme. SHRINE is a London-based programme delivering SRH care to any individual with serious mental illness, substance misuse and/or learning disability.

Objectives

The primary aim of this quality improvement project was to assess patients’ sexual and reproductive (SRH) needs, and the acceptability of providing SRH assessments in a female PICU setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and SHRINE interventions in the PICU.

Methods

A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.

Results

30% of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. 42% of women were assessed, representing a 3.5-fold increase in uptake. 21% of women initiated SRH interventions of which 14% had all their SRH needs met.

Conclusions

Results identified SRH needs for PICU admissions are greater than realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient’s individual risk profile considered. Providing a nurse-led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.

Disclosure

No significant relationships.

School Discipline and Racial Disparities in Early Adulthood

Despite interest in the contributions of school discipline to the creation of racial inequality, previous research has been unable to identify how students who receive suspensions in school differ from unsuspended classmates on key young adult outcomes. We utilize novel data to document the links between high school discipline and important young adult outcomes related to criminal justice contact, social safety net program participation, post-secondary education, and the labor market. We show that the link between school discipline and young adult outcomes tends to be stronger for Black students than for White students, and that approximately 30 percent of the Black-White disparities in young adult criminal justice outcomes, SNAP receipt, and college completion can be traced back to inequalities in exposure to school discipline.

POS1373 DEFINING EAR CHONDRITIS: DATA FROM 685 PATIENTS WITH RELAPSING POLYCHONDRITIS

Background:

Ear chondritis is often considered the pathognomonic feature of relapsing polychondritis (RP). Although painful redness and swelling of the pinna and a resultant cauliflower ear are universally recognized as chondritis, the complete spectrum of symptoms associated with ear chondritis have not been well described.

Objectives:

The study objective was to seek patient input to help characterize ear chondritis An online survey was administered in English or Spanish to participants with self-reported RP.

Methods:

Participants were asked questions about their ear pain, including quality, location, duration, aggravating/alleviating factors, timing of onset and duration. Participants were included who reported age ≥ 18 years, a diagnosis of RP confirmed by a physician, and sufficient symptoms to meet McAdams or Damiani’s diagnostic criteria. Participants were categorized as having “typical ear chondritis” if they reported ear pain localized to the pinna with associated redness and swelling. Atypical presentations of ear chondritis were also considered.

Results:

A total of 685 participants from five continents completed the survey. Among them, 659 met inclusion criteria for subsequent analysis. Most participants were female (n=574; 87%), white (n=548; 83%) and from the United States (n=484;74%). The median age was 50 years (interquartile range = 41-58). In total, 593 (90%) patients reported ear pain, 227 (38%) had “typical ear chondritis”, and 98 (16%) had cauliflower ear.

Ear pain was most commonly described as burning (n=334, 56%) or throbbing (n=295, 50%). The most common location of pain was the pinna (n=373, 63%). Participants reported ear redness (n=454, 60%) and swelling (n=405, 62%). Some patients experienced only ear redness without swelling (n=286, 48%) or only ear swelling without redness (n=71, 12%). The most common aggravating factors were minor trauma (n=371, 62%) and stress (n=358, 60%). The most common alleviating factor was avoidance of touching the ear (n=374, 63%). Pain was most frequently reported during the daytime (n=355, 60%) and most likely to occur in either ear at different times (n=310, 52%). Onset could be gradual (n=198, 33%) or sudden (n=155, 26%). Pain typically lasted a few hours (n=175, 30%) or 2-3 days (n=130, 22%). The majority of patients who had pinna pain also had pain in other parts of the ear (e.g. mastoid process, inner ear, whole ear) at some point (n=394, 67%). In patients with cauliflower ear, the most common location of pain was the pinna (n=57, 58%) followed by pain inside the ear (n=53, 54%). Most participants reported at least two different types of pain (n=420, 64%).

Conclusion:

Ear chondritis in patients with RP has a wide range of clinical presentations and characteristics beyond the typical triad of redness, swelling, and pain localized to the pinna. The description of pain often significantly varies within the same patient. Knowledge of the various distinct characteristics of ear involvement in RP may help physicians recognize and monitor the disease more effectively.

Disclosure of Interests:

None declared

OP0090 CLASSIFICATION OF PATIENTS WITH RELAPSING POLYCHONDRITIS BASED ON SOMATIC MUTATIONS IN UBA1

Background:

Somatic mutations in ubiquitin activating enzyme 1 (UBA1) cause a newly defined syndrome known as VEXAS. [1] More than fifty percent of patients currently identified with VEXAS meet diagnostic criteria for relapsing polychondritis (RP).

Objectives:

To determine the prevalence VEXAS within a cohort of patients with RP, to compare their clinical, laboratory, and immunologic features and to develop a clinical algorithm to inform genetic screening for VEXAS among patients with RP.

Methods:

Exome and targeted sequencing of the UBA1 gene was performed in a prospective observational cohort of patients with RP. Clinical and immunological characteristics of patients with RP were compared based on presence or absence of UBA1 mutations. Random forest was used to derive a clinical algorithm to identify patients with UBA1 mutations. Immune populations were quantified by multipanel flow cytometry. Categorical and continuous variables were compared using the chi square or Kruskal-Wallis test. P<0.05 defined statistical significance.

Results:

Seven of 92 patients with RP (7.6%) were confirmed to have UBA1 mutations (VEXAS-RP). Six additional patients with VEXAS-RP from other cohorts were included for subsequent analyses. Patients with VEXAS-RP were all male, older at disease onset, and commonly had fever, ear chondritis, skin involvement, deep vein thrombosis, and pulmonary infiltrates. Patients with RP as compared with VEXAS-RP had a significantly higher prevalence of airway chondritis, costochondritis and tenosynovitis/arthralgias. (Table). Mortality was significantly greater in VEXAS-RP than RP (27% vs 2% p=0.01). Maximum ESR, CRP, and mean corpuscular volume (MCV) values were significantly greater in VEXAS-RP. Absolute monocyte, lymphocyte, and platelet counts were significantly lower in VEXAS-RP. A decision tree based on male sex, MCV>100 fl and Platelet count<200 K/ul classified between VEXAS-RP and RP with 100% sensitivity and 96% specificity.

Table 1.

Clinical Characteristics of patients with RP vs VEXAS-RP

All Patientsn=98RPn=85VEXAS-RPn=13p valueDemographic CharacteristicsRace, White n (%)90 (92)77 (91)13 (100)0.59Sex, Male n (%)26 (27)13 (15)13 (100)<0.0001Age, Symptom onset, years, Median (IQR)38 (30-47)37 (28-43)56 (54-64)<0.0001Clinical SymptomsFever n (%)33 (34)20 (24)13 (100)<0.0001Ear chondritis n (%)61 (62)48 (56)13 (100)0.0015Nose chondritis n (%)83 (85)71 (84)12 (92)0.68Airway chondritis n (%)37 (38)37 (44)0 (0)0.0015Tenosynovitis/arthalgias n (%)83 (85)77 (91)6 (46)0.0005Skin involvement n (%)33 (34)22 (2611 (85)<0.0001Laboratory ValuesESR, mm/hr, median (IQR)12 (6-22)11 (5-19)66.5 (42-110)<0.0001CRP, mg/L, median (IQR)2.9 (0.8-9.6)1.9 (0.6-6.3)17.7 (9.6-99.5)<0.0001Platelet count (k/uL)246(201-299)258 (227-312)145 (100-169)<0.0001MCV fL93.05 (90-98)92.2 (89-95)105 (102-115)<0.0001Absolute lymphocyte count1.6 (1.1-2.3)1.78(1.4-2.4)0.92 (0.5-1.2)<0.0001CT scan abnormalitiesPulmonary infiltrates n (%)16 (16.33)6 (7.06)10 (77)<0.0001ComplicationsDeath n (%)6 (6)3 (4)3 (23)0.029Unprovoked DVT12 (12)4 (5)8 (62)<0.0001

N number; IQR = interquartile range

Conclusion:

Mutations in UBA1 are causal for disease in a subset of patients with RP. These patients are defined by disease onset in the fifth decade of life or later, male sex, ear/nose chondritis and hematologic abnormalities. Early identification is important in VEXAS given the associated high mortality rate.

References:

[1]Beck DB, Ferrada MA, Sikora KA, Ombrello AK, Collins JC, Pei W, Balanda N, Ross DL, Ospina Cardona D, Wu Z et al: Somatic Mutations in UBA1 and Severe Adult-Onset Autoinflammatory Disease. N Engl J Med 2020, 383(27):2628-2638.

Disclosure of Interests:

None declared

Impact of the COVID-19 pandemic on maternal mental heath

Introduction

As countries adopt strict quarantines and lockdowns, increasing attention has been given to the impact on mental wellbeing. The influence of this on perinatal mental health and service provision is important to consider, as these women may be particularly vulnerable to the negative effects already seen in general and psychiatric populations.

Objectives

The impact on global mental health of Covid-19, and the isolation measures used to combat it’s spread, is increasingly acknowledged. We were interested in the effect the pandemic has had specifically on the mental health of women in the peripartum period. By reflecting on our experiences, we hope to generate ideas to improve services.

Methods

We considered the effects of the pandemic in this high-risk population during each stage of contact with services. This included pre-conception, antenatal and postnatal periods, as well as the potential longitudinal and service effects. Recent case examples were identified and described from our busy and diverse South London perinatal psychiatry service.

Results

Recent referrals to our service suggest the current crisis has been a key trigger for the deterioration of many women’s mental health. This includes women who have been impacted by various factors related to the pandemic, at all stages of the perinatal period.

Conclusions

It is vital to maintain equality of access to perinatal services and to continue to consider how to deliver best care. This will involve adapting to the new working environment, and optimising care delivery using remote technologies where appropriate, in a way that is safe, accessible and acceptable to service users.

Sexual and reproductive health (SRH) needs of women admitted to eileen skellern ward (ES1) psychiatric intensive care unit (PICU)

Introduction

PICU inpatients are likely to be at increased risk of having unmet SRH needs due to barriers to accessing services. Since May 2018, an in-reach SRH assessment has been available to all psychiatric inpatients on ES1 ward, if referred. Analysis of referrals over 15 months identified only 24 had been made during this time.

Objectives

To assess the SRH needs of women admitted to ES1 PICU, the feasibility of providing a SRH in-reach clinic, and the acceptability of delivering a nurse lead referral programme.

Methods

A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on ES1 over a seven-month period. A staff training needs assessment was performed followed by training, a protocol was developed, staff attitudes were explored, and patient engagement was sought.

Results

A total of 41% (32/77) of patients were referred, which was a 29% increase. 53.1% (17/32) of the total referrals had a true SRH need, equating to a 10% increase and 22% (17/77) of all PICU admissions. 90% of referrals were made by nursing staff. A staff focus group (n15) highlighted the acceptability and perceived importance of offering SRH care in PICU, if interventions were appropriately timed and the patient’s individual risk profile was considered.

Conclusions

Results identify that SRH needs for PICU admissions are greater than previously realised. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients. This project has resulted in service improvements including offering asymptomatic STI testing to all PICU admissions.

Disclosure

No significant relationships.

Klinik für Dermatologie, Allergologie und Venerologie der Universität zu Lübeck: Interaktion von Forschung und klinischer Versorgung

Die Ursprünge der Lübecker Universitäts-Hautklinik reichen in die 30er-Jahre des letzten Jahrhunderts zurück. Die Klinik hat in den letzten Jahrzehnten eine konsequente bauliche und inhaltliche Weiterentwicklung erfahren und verfügt heute über 85 Betten auf 2 Stationen und in einer Tagesklinik. Ein modernes Weiterbildungsprogramm, das auf einem Rotationsprinzip durch 5 verschiedene stationäre und ambulante Teams beruht, vermittelt alle wesentlichen Lerninhalte der Dermatologie. Die Erweiterung der Klinik in den letzten Jahren beruhte auf einer engen Interaktion von Grundlagenforschung und klinischer Tätigkeit, insbesondere auf dem Gebiet kutaner Autoimmunerkrankungen und entzündlicher Dermatosen. Die wissenschaftliche Entwicklung der Hautklinik profitierte seit 2007 insbesondere von der Förderung durch die Exzellenzinitiative des Bundes (Exzellenzcluster Inflammation at Interfaces). Daneben wurde durch die Deutsche Forschungsgemeinschaft (DFG) seit 2011 unter Federführung der Hautklinik ein Graduiertenkolleg Modulation of Autoimmunity gefördert, das zur Entwicklung des wissenschaftlichen Nachwuchses und zur Ausbildung zahlreicher naturwissenschaftlicher und medizinischer Doktoranden/Doktorandinnen1 beitrug. Seit 2015 besteht an der Klinik auch eine Klinische Forschungsgruppe der DFG zum Thema Pemphigoid Diseases – Molecular Pathways and their Therapeutic Potential. Im Jahr 2018 haben Mitarbeiter der Klinik wesentlich zur Einwerbung eines Clinician Scientist-Programms der DFG beigetragen, das die wissenschaftliche Ausbildung forschender Kliniker verbessern soll. In den letzten Jahren haben sich aus der Lübecker Hautklinik heraus 2 eigenständige Institute neu etabliert. Hierzu zählen das Institut für Entzündungsmedizin unter der Leitung von Prof. Diamant Thaçi, in dem klinische Studien zu entzündlichen Hauterkrankungen initiiert und koordiniert werden und die Versorgung von Patienten mit entzündlichen Dermatosen stattfindet. Daneben ist aus der Hautklinik heraus das Lübecker Institut für Experimentelle Dermatologie (LIED) entstanden, in dem derzeit 5 Professoren mit ihren jeweiligen Arbeitsgruppen zu unterschiedlichen Themen der Entzündung an der Haut forschen. Die interdisziplinären wissenschaftlichen Aktivitäten zur Entzündung an der Haut am Lübecker Campus werden seit 2015 in einem Center for Research on Inflammation of the Skin (CRIS) gebündelt. CRIS erhielt kürzlich die Zusage für ein eigenständiges Forschungsgebäude, das nach § 91 Grundgesetz durch Bund und Land finanziert wird und derzeit im Zentrum des Lübecker Campus entsteht. Der Ausbau der Forschungsstrukturen der Klinik ging mit der Einrichtung von Spezialambulanzen für verschiedene entzündliche Hauterkrankungen, aber auch für die Versorgung von Hautkrebs und chronischen Wunden einher. Die Klinik verfügt über ein zertifiziertes Hautkrebszentrum und ist Teil der Lübecker universitären Gefäß- und Krebszentren. Weitere wichtige Pfeiler der klinischen Versorgung sind zertifizierte diagnostische Einsendelabore für Dermato-Histopathologie und kutane Autoimmunerkrankungen.

Pressure dependence of the metal-insulator transition in κ-(BEDT-TTF)2Hg(SCN)2Cl: optical and transport studies

The two-dimensional organic conductor κ-(BEDT-TTF)₂-Hg(SCN)₂Cl exhibits a pronounced metal-insulator transition at [Formula: see text] K. From the splitting of the molecular vibrations, the phase transition can be unambiguously assigned to charge-ordering with [Formula: see text]. We have investigated the pressure evolution of this behavior by temperature-dependent electrical transport measurements and optical investigations applying hydrostatic pressure up to 12 kbar. The data reveal a mean-field like down-shift of [Formula: see text] with a critical pressure of [Formula: see text] kbar and a metallic state above the suppression of the charge-ordered state; no traces of superconductivity could be identified down to T  =  1.5 K. As the charge order [Formula: see text] sets in abruptly with decreasing temperature, its size remains unaffected by pressure. However, the fraction of charge imbalanced molecules decreases until it is completely absent above 1.6 kbar.

Cumulative incidence and risk factors for limber tail in the Dogslife labrador retriever cohort

Limber tail is a condition that typically affects larger working breeds causing tail limpness and pain, resolving without veterinary intervention. It is poorly understood and the disease burden has not been well characterised. Data collected from owners of the Dogslife cohort of Labrador Retrievers have been used to describe incidents and a case-control study was undertaken to elucidate risk factors with 38 cases and 86 controls. The cumulative incidence of unexplained tail limpness was 9.7 per cent. Swimming is not a necessary precursor for limber tail, but it is a risk factor (OR=4.7) and working dogs were more susceptible than non-working dogs (OR=5.1). Higher latitudes were shown to be a risk factor for developing the condition and the case dogs were more related to each other than might be expected by chance. This suggests that dogs may have an underlying genetic predisposition to developing the condition. This study is the first, large-scale investigation of limber tail and the findings reveal an unexpectedly high illness burden. Anecdotally, accepted risk factors have been confirmed and the extent of their impact has been quantified. Identifying latitude and a potential underlying genetic predisposition suggests avenues for future work on this painful and distressing condition.

Gender and motor competence affects perceived likelihood and importance of physical activity outcomes among 14 year olds

BACKGROUND

Perceptions of the effects of physical activity could facilitate or deter future participation. This study explored the differences between gender and motor competence at 14 years of age in the perceptions of likelihood and importance of physical activity outcomes.

METHOD

The sample comprised 1582 14-year-old adolescents (769 girls) from the Western Australian Pregnancy Cohort (Raine) Study. Four motor competence groups were formed from a standardized Neuromuscular Developmental Index score (McCarron 1997). Perceptions of the likelihood and the importance of 15 physical activity outcomes were measured by a questionnaire developed for the NSW Schools Fitness and Physical Activity Survey (Booth et al. 1997). Gender (two) × motor competence (four) analyses of variance and Tukey post hoc were conducted on outcome scores (P < 0.02) using SPSS version 17.

RESULTS

Gender differences were found in the perceived likelihood and importance of physical activity outcomes within competition, social friendships and injury domains. Motor competence was significant in the perceived likelihood of physical health (P < 0.001), psychosocial (P < 0.009) and competition (P < 0.002) outcomes, with lower perceptions by the least competent groups. Significantly lower importance was perceived for academic outcomes for 14 year olds categorized with low compared with high motor competence (P < 0.005). Regardless of motor competence and gender, the same health and fun outcomes were ranked the highest in likelihood and the highest in importance.

CONCLUSION

Although level of motor competence at 14 years affected the perceived likelihood of health, social and fun outcomes from future participation in physical activity, adolescents highly valued these outcomes, whereas gender affected competition and winning, outcomes that were less valued. Physical activity that promotes these key and valued outcomes may encourage young people's ongoing involvement in physical activity, especially for those at risk of low participation.

Pressure-dependent structural and electronic properties of quasi-one-dimensional (TMTTF)2PF6

We have performed detailed x-ray investigations of the quasi-one-dimensional organic conductor (TMTTF)(2)PF(6) at room temperature and hydrostatic pressures up to 27 kbar. Based on the pressure-dependent crystal structure, the electronic band structure was calculated by density functional theory (DFT). Our systematic study provides important information on the coupling among the organic molecules but also to the anions. We discuss the consequences for the electronic properties and compare them with optical investigations under pressure. The increasing plasma frequency observed perpendicular to the stacks corresponds to a widening of the bands for the b-direction. Around 20 kbar a dimensional crossover occurs from a one-dimensional Mott insulator to a two-dimensional metal.

Prevalence and correlates of recent vaginal douching among African American adolescent females

STUDY OBJECTIVE

To describe the prevalence and correlates of vaginal douching among urban African American adolescents and to examine the association between douching and sexually transmitted infection (STI) status.

DESIGN

Demographic, psychosocial, and behavioral data were collected through cross-sectional, self-administered surveys. Self-collected vaginal swabs were assayed using nucleic acid amplification tests for trichomoniasis, chlamydia, and gonorrhea.

SETTING

Sexual health clinic in a large metropolitan area of the southeastern United States.

PARTICIPANTS

African American females (N = 701), ages 14-20, participating in a human immunodeficiency virus prevention intervention.

MAIN OUTCOME MEASURE

The outcome of interest was the association between vaginal douching (lifetime, past 90 days, and past 7 days) with demographic characteristics (eg, age, education, and socioeconomic status), physical and mental health status, STI status, sexual behavior (eg, number of vaginal sexual partners, age of sex partners, consistent condom use in the past 90 days, sex while self/partner was high on drugs or alcohol), and psychosocial characteristics (eg, sexual adventurism, social support, peer norms, sexual satisfaction, self-efficacy for sex refusal, self-esteem, relationship power, risk avoidance).

RESULTS

Forty-three percent reported ever douching, and 29% reported douching in the past 90 days. In bivariate analyses, recent douching was associated with demographic, behavioral, and psychosocial variables, but not current STI status. In multivariate analyses, recent douching was associated with age (odds ratio [AOR] = 1.13, confidence interval [CI] = 1.02-1.25), lower socioeconomic status (AOR = 1.25, CI = 1.05-1.47), and having sex with much older partners (AOR = 1.87, CI = 1.22-2.86).

CONCLUSION

Increased age, lower socioeconomic status, and older partners may be salient risk factors for douching behavior among African American young women.

ADHD symptom presentation and trajectory in adults with borderline and mild intellectual disability

BACKGROUND

This study examined symptoms and lifetime course of Attention Deficit Hyperactivity Disorder (ADHD) in adults with borderline and mild Intellectual Disability (ID).

METHOD

A total of 48 adults with ID and ADHD were compared with 221 adults with ADHD without ID using the informant Barkley scale for childhood and adulthood symptoms.

RESULTS

The ADHD/ID group presented with greater severity of (adult and childhood) symptoms compared with the non-ID group. For the ADHD/non-ID group, most symptoms improved significantly from childhood to adulthood, whereas only two symptoms changed significantly for the ID group. Principal component analysis revealed scattered loading of different items into five components for the ADHD/ID group that were not consistent with the classic clusters of inattentive, hyperactive and impulsive symptoms. A negative correlation was found between severity of symptoms and IQ.

CONCLUSIONS

ADHD in adults with ID may have a more severe presentation and an uneven and less favourable pattern of improvement across the lifespan in comparison with adults without ID.

Evaluation of an HIV/STD sexual risk-reduction intervention for pregnant African American adolescents attending a prenatal clinic in an urban public hospital: preliminary evidence of efficacy

STUDY OBJECTIVE

To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents.

DESIGN

A randomized controlled trial. Participants completed baseline and follow-up assessments.

SETTING

An urban public hospital in the Southeastern U.S.

PARTICIPANTS

Pregnant African-American adolescents (N=170), 14-20 years of age, attending a prenatal clinic.

INTERVENTION

Intervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition.

MAIN OUTCOME MEASURES

Consistent condom use.

RESULTS

Intervention participants reported greater condom use at last intercourse (adjusted odds ratio=3.9, P=0.05) and consistent condom use (AOR=7.9, P=0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex.

CONCLUSIONS

Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.

Neuropsychological characteristics of adults with comorbid ADHD and borderline/mild intellectual disability

This study aimed to characterise the neuropsychological functioning of adults with comorbid attention deficit hyperactivity disorder (ADHD) and intellectual disability. Individuals with ADHD and mild-borderline range intelligence (N=59) and individuals with ADHD and normal intellectual functioning (N=95) were compared on attentional and response inhibition tasks. The comorbid group had significantly lower scores on the majority of measures in comparison with the ADHD alone group. These differences remained significant after co-varying for level of intellectual functioning for variables measuring selective attention and errors of commission during sustained attention. This suggests that individuals with comorbid ADHD and intellectual disability may be vulnerable to a 'double deficit' from both disorders in certain aspects of cognitive functioning.

[Cleidocranial dysplasia. Description and analysis of a patient cohort]

BACKGROUND

Cleidocranial dysplasia (CCD) is a rare dysplasia of bony and dental tissue. Characteristic are typical craniofacial and dental findings including morphological anomalies. CCD is possibly the only general syndrome that can be diagnosed based on the dental findings alone. CCD correlates with mutations in the RUNX2 gene.

PURPOSE

The present interdisciplinary study correlates phenotypic findings with genetic variations in the corresponding gene.

PATIENTS AND METHODS

The coding sequence of the RUNX2 gene from 31 CCD patients from 20 families was analyzed using molecular genetic methods including polymerase chain reaction and direct sequencing. The craniofacial and dental findings of each patient were evaluated according to a standardized scoring scheme and tested with homogeneity analysis for general phenotypic findings.

RESULTS

Several mutations of the RUNX2 gene were identified. Depending on the mutation type, they showed different distribution patterns within the gene coinciding with the functional domains of the gene product. With homogeneity analysis of the phenotype cardinal (especially dental findings) and minor findings (pneumatization disturbances, Wormian bones) were identified. In combination with the genetic data, the statistical analysis showed that loss-of-function mutations of the RUNX2 gene result in a milder markedness of the CCD phenotype than gain-of-function or decrease-of-function mutations.

CONCLUSIONS

We found that type and location of a specific mutation within the RUNX2 gene might have an impact on the expressivity of CCD. Due to the limited sampling size this hypothesis must be verified by investigations in larger patient groups.

Cognitive impairment and fMRI in major depression

Cognitive impairment in depression may be one of the more practically important aspects of the illness, responsible for much of its morbidity. It also is at the heart of its psychopathology, may contribute to strategies of treatment, and may give us a more easily quantifiable measure of impaired function to correlate with brain activity. Functional magnetic resonance imaging (fMRI) is ideally suited to examine brain function in depression. It has the correct time window to repeatedly sample cognitive task performance; it does not require exposure to radioactive tracers and can therefore be repeated many times; it also can be linked with high resolution structural images acquired in the same imaging session that help identify the regions of activation and support the spatial transformation necessary to compare the scans of different subjects. fMRI has already produced a series of consistent results in depression, identifying increased activity of rostral anterior cingulate and other medial prefrontal structures during effortful tasks and on occasion also increased dorsolateral prefrontal activity, suggesting increased possibly compensatory activity to maintain task performance. Investigating the interplay between limbic (orbitomedial) and 'cognitive' dorsolateral structures clearly has the potential to clarify important illness mechanisms of depressive illness.

Co-twin control designs for testing behavioral economic theories of child nutrition: methodological note

OBJECTIVE

To illustrate the use and potential efficiency of the co-twin control design for testing behavioral economic theories of child nutrition.

DESIGN

Co-twin control design, in which participating twins ate an ad libitum lunch on two laboratory visits. At visit 1, child food choices were not reinforced. On visit 2, twins were randomized to conditions such that one twin was reinforced for each fruit and vegetable serving consumed during lunch ('contingent') while his co-twin was reinforced irrespective of food intake ('non-contingent').

SUBJECTS

Six male twins, 5 years old, from three monozygotic twin pairs.

MEASUREMENTS

Ad libitum intake of total energy (kcals), fat (kcals), and fruits and vegetables (servings) from the protocol test meals on the two visits.

RESULTS

Compared to twins receiving non-contingent reinforcement, twins receiving contingent reinforcement increased fruit and vegetable intake by 2.0 servings, reduced fat intake 106.3 kcals, and reduced total energy intake by 112.7 kcals. The relative efficiency of the co-twin control design compared to a conventional between-groups design of unrelated children was most powerful for detecting 'substitution effects' (i.e., reduced total energy and fat intake) more so than for detecting increased fruit and vegetable intake.

CONCLUSION

Genetically informative studies, including the co-twin control design, can provide conceptually elegant and efficient strategies for testing environmental theories of child nutrition and obesity.

Bayesian decision threshold, detection limit and confidence limits in ionising-radiation measurement

Based on Bayesian statistics and the Bayesian theory of measurement uncertainty, characteristic limits such as the decision threshold, detection limit and limits of a confidence interval can be calculated taking into account all sources of uncertainty. This approach consists of the complete evaluation of a measurement according to the ISO Guide to the Expression of Uncertainty in Measurement (GUM) and the successive determination of the characteristic limits by using the standard uncertainty obtained from the evaluation. This procedure is elaborated here for several particular models of evaluation. It is, however, so general that it allows for a large variety of applications to similar measurements. It is proposed for the revision of those parts of DIN 25482 and ISO 11929 that are still based on conventional statistics and, therefore, do not allow to take completely into account all the components of measurement uncertainty in the calculation of the characteristic limits.

Upper airways abnormalities and tracheal problems in Morquio's disease

Morquio's disease is a metabolic disorder that can cause various respiratory abnormalities. Patients who live into adulthood are likely to develop upper airway problems and respiratory failure. With advances in home ventilation, these patients are increasingly likely to be referred to specialist respiratory units. We describe our experiences with two such patients.

[Endoscopically-assisted adjustment of an oral appliance in patients with obstructive sleep apnoea]

BACKGROUND

The treatment effect of patients suffering from obstructive sleep apnoea/hypopnea (OSAHS) with an oral appliance is considerably varied, and its clinical outcome is unpredictable. The aim of our investigation was to examine the changes in pharyngeal airway size at different degrees of mandibular protrusion in order to assess the therapeutic efficacy in relation to the amount of protrusion.

METHODS

Fifteen patients with the polysomnographic diagnosis of mild to moderate OSAHS were included in this prospective study. Nasal video endoscopy of the pharynx was done with the patients in supine position at four different degrees of mandibular protrusion do assess the changes of airway size. After 3 - 4 weeks a control polysomnography was carried out, with the mandible in optimal protrusion.

RESULTS

The pharyngeal diameter did not increase linearly to the amount of mandibular protrusion. In the polysomnographic examination the respiratory variables were significantly increased. None of the patients in this group was classified as a non-responder to the oral appliance therapy.

CONCLUSIONS

The endoscopically-assisted adjustment of the mandibular protrusion appliance is an additional tool to optimise treatment effectiveness. The increase in pharyngeal diameter is not proportional to the amount of mandibular protrusion.

[Long term compliance with an oral protrusive appliance in patients with obstructive sleep apnoea]

BACKGROUND AND OBJECTIVE

Oral protrusive devices (OPD) are increasingly used in primary snoring and mild-to-moderate obstructive sleep disordered breathing. Due to evidence of reduced compliance with the well established standard treatment of nasal positive airway pressure (CPAP) and reports of patient preference for OPD treatment, particularly in mild cases, OPD may be considered another treatment alternative.

PATIENTS AND METHODS

We contacted 192 patients suffering from obstructive sleep breathing disorder, who were treated between May 1996 and September 2001 with an OPD. The patients" use of the device was evaluated, as were any reasons for ceasing to use the device.

RESULTS

105 patients (54.4%) regularly used the appliance after a mean time of 22.7 12.3 month. 21 patients (10.9%) showed no primary compliance and stopped had using the device before the first somnographic follow-up after a mean time of 3.8 months. In this investigation 76 patients (80,2%) were classified as responders and 19 patients (20.8%) as primary non-responders. 22 responders (11.4%) demonstrated no secondary compliance after a mean of 21.9 8.8 months and the discontinued OPD treatment themselves. In 21 patients (10.9%) the nightly respiratory parameters decreased after a mean of 23.0 11.7 months; hence, those patients required CPAP. The cumulative risk using the device after four years as prescribed was 32.2%. We found a correlation between patient compliance, body-mass index and the amount of teeth in the upper and lower jaws.

CONCLUSION

OPD compliance seems to be lower than frequently expected. Regular follow-up investigations are necessary to ensure adequate treatment. Poor dental status and an excess body-mass index reduce patient compliance.

[Computer-assisted screw osteosynthesis of the posterior pelvic ring. Initial experiences with an image reconstruction based optoelectronic navigation system]

Injuries of the posterior pelvic with combined anterior and posterior instability require the stabilisation of both the anterior and posterior pelvic ring. If the injury only involves the ligamental connections, then a transileosacral osteosynthesis with screws is the minimal invasive and biomechanically suitable method of choice. The difficulty with this approach is the correct placement of the screws. Their position must be monitored intraoperatively in 3 planes (inlet, outlet and lateral viewing). This denotes that conventional methods involve high radiation dosages for the patient and the surgical staff. Having the system readily available and being able to perform updates during the operation, fluoroscopically supported navigation for the treatment of fresh injuries becomes possible. Between October 1999 and December 2000 7 patients with traumatic instability of the posterior pelvic ring were treated by computer assisted percutaneous transileosacral screw osteosynthesis. In each case the osteosynthesis of the ileosacral joint was performed with two cannulated AO 7.3 mm titanium screws. After the operation the screw position was controlled by CT scanning and compared to the data acquired intraoperatively. No patients had infection, and there were no postoperative neurological defects. The postoperative CT scans showed no intraspinal or intraforminal malplacement of the screws. In two cases a slight tangential screwthread penetration through the ventral sacrum was found. Our first experiences with this novel technology are encouraging and clearly demonstrate the advantages of fluoroscopic supported passive navigation systems for the optimal placement of ileosacral screws.

[Intraoral protrusion devices in obstructive sleep apnea. Dental findings and possible treatments]

BACKGROUND

Oral protrusive devices are regarded as an alternative treatment option for snoring and mild to moderate obstructive breathing disorders. In addition to the polysomnographic indication based on the respiratory and somnographic findings, healthy stomatognatic conditions with sufficient dental retention for the device are essential for a successful treatment.

PATIENTS AND METHODS

The sleep laboratory of the University Hospital of Freiburg i. Br. referred 112 patients with obstructive sleep apnea to the Department of Orthodontics for treatment with an oral protrusive device. All patients were examined clinically and with a panoramic radiograph with regard to continuous treatment.

RESULTS

To maximize treatment success and minimize dental side effects, close collaboration with dental colleagues is necessary in treatment with an oral protrusive device.

CONCLUSIONS

Acute periodontitis, periodontal lesions, insufficient dental anchorage, and temporomandibular symptoms can result in unwanted dental side effects and therefore limit the indication of this therapeutic approach.

Phase 1 study of polyethylene glycol formulation of interferon alpha-2B (Schering 54031) in Philadelphia chromosome-positive chronic myelogenous leukemia

Interferon alpha (IFN-alpha) therapy improves prognosis in Philadelphia chromosome (Ph)-positive chronic myelogenous leukemia (CML). Polyethylene glycol (PEG) attached to IFN-alpha prolongs its half-life and may offer better therapy. The aims of this phase 1 study were to define the maximal tolerated dose (MTD), dose-limiting toxicities (DLTs), and response with PEG IFN-alpha-2b. Twenty-seven adults with Ph(+) CML in chronic or accelerated phases, in whom IFN-alpha treatment had failed, were studied. Patients had hematologic (9 patients) or cytogenetic resistance (12 patients) or intolerance to IFN-alpha (6 patients). PEG IFN-alpha-2b was given as a weekly subcutaneous injection starting at 0.75 microg/kg weekly and escalating to 1.5, 3, 4.5, 6, 7.5, and 9.0 microg/kg. The MTD was defined at 7.5 to 9 microg/kg; DLT included severe fatigue, neurotoxicity, liver function abnormalities, and myelosuppression. Longer administration of PEG IFN-alpha-2b resulted in chronic side effects not observed earlier, which defined the MTD and DLT. The proposed phase 2 dose of PEG IFN-alpha-2b was 6 microg/kg weekly. Among 19 patients with active disease, 7 (37%) achieved complete hematologic response (CHR); 2 (11%) had a cytogenetic response (complete). Among 8 patients treated in CHR, 7 (87%) improved cytogenetic response to complete (4 patients) or partial (3 patients). All 6 patients intolerant to IFN-alpha tolerated PEG IFN-alpha-2b; 4 improved their cytogenetic response. The results show that PEG IFN-alpha-2b is easier to deliver (once weekly), better tolerated, and perhaps more effective than IFN-alpha.

Coordinate changes in drug resistance and drug-induced conformational transitions in altered-function mutants of the multidrug transporter P-glycoprotein

The MDR1 P-glycoprotein (Pgp), responsible for a clinically important form of multidrug resistance in cancer, is an ATPase efflux pump for multiple lipophilic drugs. The G185V mutation near transmembrane domain 3 of human Pgp increases its relative ability to transport several drugs, including etoposide, but decreases the transport of other substrates. MDR1 cDNA with the G185V substitution was used in a function-based selection to identify mutations that would further increase Pgp-mediated resistance to etoposide. This selection yielded the I186N substitution, adjacent to G185V. Pgps with G185V, I186N, or both mutations were compared to the wild-type Pgp for their ability to confer resistance to different drugs in NIH 3T3 cells. In contrast to the differential effects of G185V, I186N mutation increased resistance to all the tested drugs and augmented the effect of G185V on etoposide resistance. The effects of the mutations on conformational transitions of Pgp induced by different drugs were investigated using a conformation-sensitive antibody UIC2. Ligand-binding analysis of the drug-induced increase in UIC2 reactivity was used to determine the K(m) value that reflects the apparent affinity of drugs for Pgp, and the Hill number reflecting the apparent number of drug-binding sites. Both mutations altered the magnitude of drug-induced increases in UIC2 immunoreactivity, the K(m) values, and the Hill numbers for individual drugs. Mutation-induced changes in the magnitude of UIC2 reactivity shift did not correlate with the effects of the mutations on resistance to the corresponding drugs. In contrast, an increase or a decrease in drug resistance relative to that of the wild type was accompanied by a corresponding increase or decrease in the K(m) or in both the K(m) and the Hill number. These results suggest that mutations that alter the ability of Pgp to transport individual drugs change the apparent affinity and the apparent number of drug-binding sites in Pgp.

Speed of sound measurements in mandibular and phalangeal bone during growth

The micromechanical and elastic properties of bone, its structural maturity and, indirectly, mineral density are important factors for the planning and assessment of orthodontic and/or jaw orthopaedic treatment. This clinical study was undertaken to evaluate age-related changes in the anterior mandibular body. The speed of sound (SOS) has demonstrated age dependency in various peripheral bones and has been proposed as an alternative method for investigating bone parameters without the use of radiation. The ultrasound transmission velocity was measured in 184 healthy subjects (93 females, 91 males; mean age 17.6 +/- 13.7 years). According to the statistical analysis, the data did not reveal any gender-related differences, but were significantly age-dependent. Different kinetics were established between the maturity of the phalanx and the anterior mandible. Further clinical investigations of age-dependent structural changes in bone maturation parameters may provide information that should be taken into account for early functional jaw orthopaedic treatment.

Dental age in southwest Germany. A radiographic study

A cross-sectional study was undertaken in order to assess the dental age of healthy Southwest German boys and girls between the ages of 2 and 20 years by evaluating 1,003 panoramic radiographs. Dental age was assessed according to the method of Demirjian et al. All permanent teeth of the lower left jaw except the third molar were rated, the development of each tooth was divided into 8 defined stages. Statistical evaluation revealed a correlation between the parameters chronological age and score sum of r = 0.85 for girls and r = 0.89 for boys. The values of the score sum in relation to chronological age were distributed as in a logistic function. Two gender-specific equations for calculating dental age were devised and a marked sexual dimorphism was found. With the beginning of root formation, the girls showed accelerated development. The fact that dental age distribution in Southwest Germany is not significantly correlated to that of a French-Canadian collective underlines Demirjian's demand for regional standards of dental development to be calculated using his score system.

Multiple advantages of alpha-fetoprotein as a marker for in vivo gene transfer

The development of improved gene transfer vectors has been hampered by the lack of a nonimmunogenic reporter gene that can be serially quantified in the serum or from other sites. In response to the need to develop a new reporter protein, we have evaluated alpha-fetoprotein (AFP) as a potential candidate. A first-generation E1/E3-deleted adenoviral vector expressing human AFP (hAFP) was generated as a preliminary tool to evaluate AFP as a reporter. Using both mouse and baboon models, hAFP expression was evaluated in serum after intravenous delivery and in serum and bronchioalveolar lavage (BAL) fluid after delivery to the lung. In immunocompetent animals, intravenous delivery of the hAFP adenoviral vector resulted in hAFP expression in the serum early after injection, which declined rapidly over time. Disappearance of hAFP from the serum was complete by 3-4 weeks after administration and was accompanied by robust antibody responses to hAFP and loss of infected cells. After lung delivery, hAFP could be detected in both serum and BAL. This allowed the analysis of the kinetics of gene expression in the lung without sacrificing the animals. In both liver and lung, immunohistochemical analysis correlated well with hAFP levels as detected in serum or BAL, indicating that serum levels were a reliable marker of tissue expression. Preliminary results with a mouse AFP expressed in a helper-dependent adenoviral vector indicate that use of a species-specific version of AFP will eliminate the complication of antibody development. These initial evaluations suggest that AFP is useful as a reporter gene to evaluate gene expression of therapeutic cassettes in multiple tissues, and it should be considered for use in human subjects.

Using ultrasound transmission velocity to analyse the mechanical properties of teeth after in vitro, in situ, and in vivo irradiation

Ultrasound transmission velocity (UTV) in isotropic material as a measure for the modulus of elasticity was correlated to mechanical properties. Changes in micromechanical properties of radiated teeth and influence of the oral cavity were to be evaluated nondestructively. UTV was measured in extracted teeth after 36 Gy and 62 Gy of in situ (enorally, with no contact to the oral cavity) and in vitro irradiation. Relative to controls, teeth subjected to 62 Gy in vivo showed higher UTV values for dentine and enamel. Sound teeth irradiated with 60 Gy in situ also showed higher UTV values for enamel, whereas dentine values were not significantly different from those of control. The mechanical properties of teeth irradiated in vitro were affected only after high experimental doses of up to 500 Gy. The difference between in vivo and in vitro mechanical properties may be due to radioxerostomia-induced damages as well as the status of dentine vitality. This supports the concept of direct radiation-induced damage in synergy with radioxerostomia-induced caries.