Behavioural determinants of COVID-19 vaccination acceptance among healthcare workers: a rapid review

OBJECTIVES

Vaccinating healthcare workers (HCWs) against COVID-19 has been a public health priority since rollout began in late 2020. Promoting COVID-19 vaccination among HCWs would benefit from identifying modifiable behavioural determinants. We sought to identify and categorize studies looking at COVID-19 vaccination acceptance to identify modifiable factors to increase uptake in HCWs.

STUDY DESIGN

Rapid evidence review.

METHODS

We searched MEDLINE and Cochrane databases until May 2021 and conducted a grey literature search to identify cross-sectional, cohort, and qualitative studies. Key barriers to, and enablers of, vaccine acceptance were categorized using the Theoretical Domains Framework (TDF), a comprehensive theoretical framework comprising 14 behavioural domains.

RESULTS

From 19,591 records, 74 studies were included. Almost two-thirds of responding HCWs were willing to accept a COVID-19 vaccine (median = 64%, interquartile range = 50-78%). Twenty key barriers and enablers were identified and categorized into eight TDF domains. The most frequently identified barriers to COVID-19 vaccination were as follows: concerns about vaccine safety, efficacy, and speed of development (TDF domain: Beliefs about consequences); individuals in certain HCW roles (Social/professional role and identity); and mistrust in state/public health response to COVID-19 (Social influences). Routinely being vaccinated for seasonal influenza (Reinforcement), concerns about contracting COVID-19 (Beliefs about consequences) and working directly with COVID-19 patients (Social/professional role and identity) were key enablers of COVID-19 vaccination among HCWs.

DISCUSSION

Our review identified eight (of a possible 14) behavioural determinants of COVID-19 vaccine acceptance among HCWs that, if targeted, could help design tailored vaccination messaging, policy, campaigns, and programs to support HCWs vaccination uptake.

Integrating Cultural Relevance into a Behavioral mHealth Intervention for Native American Youth

Native American communities are disproportionately affected by a number of behavioral health disparities, including higher rates of depression, substance abuse, and suicide. As mobile health (mHealth) interventions gain traction as methods for addressing these disparities, they continue to lack relevance to Native American youth. In an effort to explore the design of relevant behavioral mHealth intervention for Native American communities, we have developed ARORA (Amplifying Resilience Over Restricted Internet Access), a prototype behavioral mHealth intervention that has been co-designed with Native American youth, a community advisory board, and a clinical psychologist. In this paper, we qualitatively analyze our co-design and focus group sessions using a grounded theory approach and identify the key themes that Native American community members have identified as being critical components of relevant mHealth designs. Notably, we find that the Native American youth who participated in our focus groups desired a greater level of didactic interaction with cultural and behavioral health elements. We conclude with a discussion of the significant challenges we faced in our efforts to co-design software with Native American stakeholders and provide recommendations that might guide other HCI researchers and designers through challenges that arise during the process of cross-cultural design.

Irradiation dose does not affect male reproductive organ size, sperm storage, and female remating propensity in Ceratitis capitata

The Mediterranean fruit fly Ceratitis capitata is a globally invasive pest, often controlled with the sterile insect technique (SIT). For the SIT, mass-rearing of the target insect followed by irradiation are imperatives. Sterile males are often less able to inhibit female remating and transfer less number of sperm, and even irradiation could affect male reproductive organs, with consequences for their ability to inhibit female remating. On the other hand, male age could affect their ability to modulate female response after mating. Here, we evaluated the quality of the genetic sexing strain Vienna-8-tsl mass-reared in Bioplanta San Juan, Argentina, under laboratory conditions, with regard to: (i) the ability of sterile males irradiated at 100 or 140 Gy to inhibit female remating, in the same day and at 24 h of first copulation; (ii) the ability of 3, 4 or 5 day-old sterile males to inhibit female remating at 24 h of first copulation, and (iii) the effect of a reduction in irradiation doses on the number of sperm stored by females and reproductive organ size in virgin males. Sterile males were better able than wild males to inhibit female remating in the same day of first copulation and as able as wild males 1 day after first copulation. Male age did not affect their ability to inhibit female receptivity. Number of sperm stored by females, testes size and ectodermal accessory glands size were not affected by male identity, while sterile 100 Gy males had larger mesodermal accessory glands than control lab males. A reduction in irradiation dose does not impact any variable measured, except for percentage of sperm-depleted females: females mated with sterile 100 Gy males had lower probabilities to store sperm. The results showed here are very encouraging for tsl Vienna 8 strain reared in Argentina and are discussed in comparison with previous studies in C. capitata female remating with dissimilar results.

Designing a Mobile Game That Develops Emotional Resiliency in Indian Country

Communities in Indian Country experience severe behavioral health inequities [11, 12]. Based on recent research investigating scalable behavioral health interventions and therapeutic best practices for Native American (NA) communities, we propose ARORA, a social and emotional learning intervention delivered over a networked mobile game that uses geosocial gaming mechanisms enhanced with augmented reality technology. Focusing on the Navajo community, we take a community-based participatory research approach to include NA psychologists, community health workers, and educators as co-designers of the intervention activities and gaming mechanisms. Critical questions involve operation of the application across low-infrastructure landscapes as well scalability of design practices to be inclusive of the many diverse NA cultural communities in Indian Country.

Phototoxic reaction to a combined oral contraceptive (levonorgestrel/ethinylestradiol)

We present the case of a phototoxic skin reaction due to the regular intake of a combined oral contraceptive (levonorgestrel/ethinylestradiol). Upon spectrophotometer testing, we demonstrated high absorption in the UV-B region of the solar spectrum of the combined product (Ovoplex®), especially for the estrogen compound (ethinylestradiol).

[The neural networks of facial expression]

INTRODUCTION

Face perception involves a broad network of connections between cortical and subcortical regions for the exchange and synchronization of information using white matter fibers. This precise communication system can be affected by the structures and the pathways that connect them.

AIMS

To establish the neural substrate underlying the perception of facial expression and to analyze the different factors involved in modulating the integrity of this neural network, with the aim being to introduce improvements into rehabilitation programs.

DEVELOPMENT

When the complex neural network involved in the perception of facial expression is altered by trauma, neurodegenerative disorders, developmental disorders, social isolation or negative contexts, the adaptive capacity to interact with the environment also deteriorates.

CONCLUSIONS

Maintaining the neural network integrity responsible for processing facial expression requires considering different variables. To a greater or lesser extent, these variables modify the structure or function of neural networks, such as aerobic training, transcranial magnetic stimulation, transcranial electrical stimulation, and learning. These variables are affected by age, and the type and course of the condition or generator context, and raise the need for rehabilitation protocols that are adapted and designed to delimit the deficient neuronal substrate.

Dietary levels of protein and free amino acids affect pancreatic proteases activities, amino acids transporters expression and serum amino acid concentrations in starter pigs

The dietary contents of crude protein and free amino acids (AA) may affect the protein digestion and AA absorption in pigs. Trypsin and chymotrypsin activities, AA serum concentrations and expression of AA transporters in the small intestine of pigs fed a low protein, AA-supplemented (19.2%, LPAA) or a high protein (28.1%, HP), wheat-soybean meal diet were measured in two 14-d trials. The LPAA diet contained free L-Lys, L-Thr, DL-Met, L-Leu, L-Ile, L-Val, L-His, L-Trp and L-Phe. All pigs were fed the same amount of feed (890 and 800 g/d for trial 1 and 2 respectively). In trial 1, samples of mucosa (duodenum, jejunum and ileum) and digesta (duodenum and jejunum) were collected from 14 pigs (17.2 ± 0.4 kg); in trial 2, blood samples were collected from 12 pigs (12.7 ± 0.3 kg). The trypsin and chymotrypsin activities in both intestinal segments were higher in pigs fed the HP diet (p < 0.01). Trypsin activity was higher in jejunum than in duodenum regardless the dietary treatment (p < 0.05). Pigs fed the LPAA diet expressed more b^0,+ AT in duodenum, B⁰ AT1 in ileum (p < 0.05), and tended to express more y⁺ LAT1 in duodenum (p = 0.10). In pigs fed the LPAA diet, the expression of b^0,+ AT was higher in duodenum than in jejunum and ileum (p < 0.01), but no difference was observed in pigs fed the HP diet. Ileum had the lowest b^0,+ AT expression regardless the diet. The serum concentrations of Lys, Thr and Met were higher in LPAA pigs while serum Arg was higher in HP pigs (p < 0.05). Serum concentrations of AA appear to reflect the AA absorption. In conclusion, these data indicate that the dietary protein contents affect the extent of protein digestion and that supplemental free AA may influence the intestinal site of AA release and absorption, which may impact their availability for growth of young pigs.

Low-protein amino acid-supplemented diets for growing pigs: effect on expression of amino acid transporters, serum concentration, performance, and carcass composition

Pigs fed protein-bound AA appear to have a higher abundance of AA transporters for their absorption in the jejunum compared with the duodenum. However, there is limited data about the effect of dietary free AA, readily available in the duodenum, on the duodenal abundance of AA transporters and its impact on pig performance. Forty-eight pigs (24.3 kg initial BW) distributed in 4 treatments were used to evaluate the effect of the CP level and form (free vs. protein bound) in which AA are added to diets on the expression of AA transporters in the 3 small intestine segments, serum concentration of AA, and performance. Dietary treatments based on wheat and soybean meal (SBM) were 1) low-CP (14%) diet supplemented with L-Lys, L-Thr, DL-Met, L-Leu, L-Ile, L-Val, L-His, L-Trp, and L-Phe (LPAA); 2) as in the LPAA but with added L-Gly as a N source (LPAA+N); 3) intermediate CP content (16%) supplemented with L-Lys HCl, L-Thr, and DL-Met (MPAA); and 4) high-CP (22%) diet (HP) without free AA. At the end of the experiment, 8 pigs from LPAA and HP were sacrificed to collect intestinal mucosa and blood samples and to dissect the carcasses. There were no differences in ADG, ADFI, G:F, and weights of carcass components and some visceral organs between treatments. Weights of the large intestine and kidney were higher in HP pigs (P < 0.01). Expression of b(0,+) in the duodenum was higher in pigs fed the LPAA compared with the HP diet (P= 0.036) but there was no difference in the jejunum and ileum. In the ileum, y+ L expression tended to be higher in pigs fed the LPAA diet (P = 0.098). Expression of b(0,+) in LPAA pigs did not differ between the duodenum and the jejunum, but in HP pigs, the expression of all AA transporters was higher in the jejunum than in the duodenum or ileum (P < 0.05). The serum concentration of Arg, His, Ile, Leu, Phe, and Val was higher but serum Lys and Met were lower in pigs fed the HP diet (P < 0.05). These results indicate that LPAA can substitute up to 8 percentage units of protein in HP wheat-SBM diets without affecting pig performance; nonessential N does not seem to be limiting in very low-protein wheat-SBM diets for growing pigs. Also, the inclusion of free AA in the diet appears to affect their serum concentration and the expression of the AA transporter b0,+ in the duodenum of pigs.

Ontogeny influences sensitivity to climate change stressors in an endangered fish

Coastal ecosystems are among the most human-impacted habitats globally, and their management is often critically linked to recovery of declining native species. In the San Francisco Estuary, the Delta Smelt (Hypomesus transpacificus) is an endemic, endangered fish strongly tied to Californian conservation planning. The complex life history of Delta Smelt combined with dynamic seasonal and spatial abiotic conditions result in dissimilar environments experienced among ontogenetic stages, which may yield stage-specific susceptibility to abiotic stressors. Climate change is forecasted to increase San Francisco Estuary water temperature and salinity; therefore, understanding the influences of ontogeny and phenotypic plasticity on tolerance to these critical environmental parameters is particularly important for Delta Smelt and other San Francisco Estuary fishes. We assessed thermal and salinity limits in several ontogenetic stages and acclimation states of Delta Smelt, and paired these data with environmental data to evaluate sensitivity to climate-change stressors. Thermal tolerance decreased among successive stages, with larval fish exhibiting the highest tolerance and post-spawning adults having the lowest. Delta Smelt had limited capacity to increase tolerance through thermal acclimation, and comparisons with field temperature data revealed that juvenile tolerance limits are the closest to current environmental conditions, which may make this stage especially susceptible to future climate warming. Maximal water temperatures observed in situ exceeded tolerance limits of juveniles and adults. Although these temperature events are currently rare, if they increase in frequency as predicted, it could result in habitat loss at these locations despite other favourable conditions for Delta Smelt. In contrast, Delta Smelt tolerated salinities spanning the range of expected environmental conditions for each ontogenetic stage, but salinity did impact survival in juvenile and adult stages in exposures over acute time scales. Our results underscore the importance of considering ontogeny and phenotypic plasticity in assessing the impacts of climate change, particularly for species adapted to spatially and temporally heterogeneous environments.

Electrochemical aptasensor of cellular prion protein based on modified polypyrrole with redox dendrimers

This work consists of the development of an electrochemical aptasensor based on polyprrole modified with redox dendrimers, able to detect human cellular prions PrP(C) with high sensitivity. The gold surface was modified by conductive polypyrrole film coupled to polyamidoamine dendrimers of fourth generation (PAMAM G4) and ferrocenyl group as redox marker. The aptamers were immobilized on the surface via biotin/streptavidin chemistry. Electrochemical signal was detected by ferrocenyl group incorporated between dendrimers and aptamers layers. We demonstrated that the interaction between aptamer and prion protein led to variation in electrochemical signal of the ferrocenyl group. The kinetics parameters (diffusion coefficient D and heterogeneous constant transfer ket) calculated from electrochemical signals demonstrate that the variation in redox signal results from the lower diffusion process of ions during redox reaction after prion interaction due to bulk effect of larger protein. The association of redox dendrimers with conducting polypyrrole leads to high sensitivity of PrP(C) determination with detection limit of 0.8 pM, which is three orders of magnitude lower, compared to flat ferrocene-functionalized polypyrrole. Detection of PrP(C) in spiked blood plasma has been achieved and demonstrated a recovery up to 90%.

β-Cyclodextrin and permeability to water in the bladder of Bufo arenarum

We measured the effect of β-cyclodextrin (BCD, a cholesterol scavenger) on water flow across the isolated toad bladder exposed to an osmotic gradient (Jw) by a gravimetric technique. BCD, when present in the solution bathing the apical side of the bladder, inhibited the increase in Jw caused by nystatin, a polyene antibiotic that acts by directly binding apical membrane cholesterol. When present in the basolateral bath, BCD inhibited the increase in Jw caused by basolateral exposure to oxytocin (which binds membrane receptors and stimulates the synthesis of cAMP), but did not alter the response to theophylline (which inhibits hydrolysis of cAMP by cyclic nucleotide phosphodiesterase). The present data are consistent with the notion that agents that increase Jw by interacting with membrane receptors, which appear to be clustered in cholesterol-rich domains of the basolateral membrane, are altered by cholesterol depletion, whereas agents that do not interact with receptors or other basolateral membrane components are not affected by this treatment. In either case, cholesterol depletion of the apical membrane does not affect the increase in Jw brought about by an increase in intracellular cAMP concentration.

Intratumoral blood flow in cervical cancer as assessed by transvaginal color doppler ultrasonography: Correlation with tumor characteristics

The objective of this study was to evaluate whether intratumoral blood flow as assessed by transvaginal color Doppler ultrasonography (TVCD) correlates with some tumor features in cervical cancer. Clinical, sonographic, and histologic data on 49 women (mean age: 50.3 years, range: 25-85 years) diagnosed as having a carcinoma from the uterine cervix were reviewed. Intratumoral blood flow was assessed by TVCD in all cases. Subjective impression of the amount of flow (scanty, moderate, or abundant) as well as the lowest resistance index (RI) and highest peak systolic velocity (PSV, cm/s) were used for analysis. These data were correlated with some tumoral features such as histologic type, histologic grade, tumor volume, and tumor stage. Intratumoral blood flow was found in all cases. Abundant blood flow was found more frequently in squamous carcinoma, moderately or poorly differentiated tumors, tumors with larger volume, and advanced stage tumors (P < 0.0001). Significantly lower RI was found in moderately or poorly differentiated tumors and advanced stage tumors (P < 0.01) and significantly higher PSV was found in moderately or poorly differentiated tumors, tumors with larger volume, and advanced stage tumors (P < 0.01). No correlation was found between RI and PSV and histologic type. Our data indicate that intratumoral blood flow as assessed by TVCD correlates well with some tumor features in cervical cancer.

Intratumoral blood flow in cervical cancer as assessed by transvaginal color doppler ultrasonography: Correlation with tumor characteristics

The objective of this study was to evaluate whether intratumoral blood flow as assessed by transvaginal color Doppler ultrasonography (TVCD) correlates with some tumor features in cervical cancer. Clinical, sonographic, and histologic data on 49 women (mean age: 50.3 years, range: 25–85 years) diagnosed as having a carcinoma from the uterine cervix were reviewed. Intratumoral blood flow was assessed by TVCD in all cases. Subjective impression of the amount of flow (scanty, moderate, or abundant) as well as the lowest resistance index (RI) and highest peak systolic velocity (PSV, cm/s) were used for analysis. These data were correlated with some tumoral features such as histologic type, histologic grade, tumor volume, and tumor stage. Intratumoral blood flow was found in all cases. Abundant blood flow was found more frequently in squamous carcinoma, moderately or poorly differentiated tumors, tumors with larger volume, and advanced stage tumors (P < 0.0001). Significantly lower RI was found in moderately or poorly differentiated tumors and advanced stage tumors (P < 0.01) and significantly higher PSV was found in moderately or poorly differentiated tumors, tumors with larger volume, and advanced stage tumors (P < 0.01). No correlation was found between RI and PSV and histologic type. Our data indicate that intratumoral blood flow as assessed by TVCD correlates well with some tumor features in cervical cancer.

Endometrial blood flow mapping using transvaginal power Doppler sonography in women with postmenopausal bleeding and thickened endometrium

OBJECTIVE

To evaluate the role of transvaginal power Doppler sonography to discriminate between benign and malignant endometrial conditions in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography.

METHODS

Ninety-one postmenopausal women (median age, 58 years; range, 47-83 years) presenting with uterine bleeding and a thickened endometrium (> or = 5-mm double-layer endometrial thickness) on transvaginal sonography were included in this prospective study. Endometrial blood flow distribution was assessed in all patients by power Doppler immediately after B-mode transvaginal sonography. Three different vascular patterns were defined: Pattern A: multiple-vessel pattern, Pattern B: single-vessel pattern and Pattern C: scattered-vessel pattern. Histological diagnoses were obtained in all cases. No patient taking tamoxifen citrate or receiving hormone replacement therapy was included.

RESULTS

Histological diagnoses were as follows: endometrial cancer: 33 (36%), endometrial polyp: 37 (41%), endometrial hyperplasia: 14 (15%), endometrial cystic atrophy: 7 (8%). Blood flow was found in 97%, 92%, 79% and 85% of cases of carcinoma, polyp, hyperplasia and endometrial cystic atrophy, respectively. A total of 81.3% of vascularized endometrial cancers showed Pattern A, 97.1% of vascularized polyps exhibited Pattern B and 72.7% of vascularized hyperplasias showed Pattern C. Sensitivity and specificity for endometrial cancer were 78.8% and 100%. For endometrial polyp these respective values were 89.2% and 87% and for hyperplasia they were 57.1% and 88.3%.

CONCLUSIONS

Transvaginal power Doppler blood flow mapping is useful to differentiate benign from malignant endometrial pathology in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography.

Operational factors and nutrient effects on activated sludge treatment of Pinus radiata kraft mill wastewater

The biodegradability of Pinus radiata bleached kraft mill wastewater by an activated sludge treatment during a period of 280 days was evaluated. The effect of varying hydraulic retention time (HRT) in the range of 48 to 4.5 h and nitrogen (N) and phosphorus (P) addition on removal of biological oxygen demand (BOD5), chemical oxygen demand (COD), suspended solids (TSS and VSS), total phenolic compounds, tannin and lignin and reduction of toxicity was investigated. Removal of BOD5 was higher than 90% when HRT varied from 16 to 6 h, but decreased when HRT was less than 6 h. Similar performance was observed for COD removal, which was about 60% when HRT was varied from 16 to 6 h. Removal of total phenolic compounds and tannin and lignin was seriously affected by HRT. N and P addition to maintaining a ratio of 100:5:0.3 provided optimal BOD5, COD and suspended solids removal when HRT varied from 16 to 7 h, and no toxicity (using Daphnia) was detected in the treated effluent. When HRT was less than 6 h, the system showed destabilisation and pH, COD, BOD5 and suspended solids removal decreased.

Influence of hydrolysis, purification, and calibration method on furosine determination using Ion-pair reversed-phase high-performance liquid chromatography

The influence of HCI concentration (6M, 8M, and 10M) and the ratio of sample protein to acid (1 or 5 mg of protein per mL of acid) on furosine formation during sample hydrolysis is studied. The conditions that maximize furosine formation are 10M HCI in the ratio of 1 mg of protein to 1 mL of acid. Purification of the hydrolysate by solid-phase extraction is also considered by examining the effect of hydrolysate volume and volume of 3M HCI used to elute the furosine. Furosine quantitation is carried out using the standard additions and external standard methods. The results indicate that there is no interference by the sample matrix and that external calibration is adequate.

Overview of results from the WaterTox intercalibration and environmental testing phase II program: part 2, ecotoxicological evaluation of drinking water supplies

Because of rapid population growth, industrial development, and intensified agricultural production increasing amounts of chemicals are being released into the environment, polluting receiving water bodies around the world. Given the potential health risk associated with the presence of toxicants in water sources used for drinking yet the scarcity of available data, there is a need to evaluate these waters and develop strategies to reduce and prevent their contamination. The present study examined the applicability of a battery of simple, inexpensive bioassays in environmental management and the relevance of the test results in establishing the toxicological quality of water sources and drinking water within the framework of the eight-country WaterTox Network, sponsored by the International Development Research Centre, Ottawa, Canada. Seventy-six samples were collected from surface and groundwater sources and seven samples from drinking water treatment plants. Each sample was tested with a core battery of bioassays (Daphnia magna, Hydra attenuata, and Lactuca sativa root inhibition tests) and a limited set of physical and chemical parameters. In addition, three labs included the Selenastrum capricornutum test. When no toxic effects were found with the battery, samples were concentrated 10x using a solid-phase extraction (SPE) procedure. Nonconcentrated natural water samples produced a toxic response in 24% of cases with all three core bioassays. When all bioassays are considered, the percentage of raw samples showing toxicity with at least one bioassay increased to 60%. Of seven treated drinkingwater samples, four showed toxicity with at least one bioassay, raising the possibility that treatment processes in these instances were unable to remove toxic contaminants. The Daphnia magna and Hydra attenuata tests indicated a high level of sensitivity overall. Although only three of the eight countries used S. capricornutum, it proved to be an efficient and reliable bioassay for toxicity assessment.

Overview of results from the WaterTox intercalibration and environmental testing phase II program: Part 1, statistical analysis of blind sample testing

There is an urgent need to evaluate the presence of toxicants in waters used for human consumption and to develop strategies to reduce and prevent their contamination. The International Development Research Centre undertook an intercalibration project to develop and validate a battery of bioassays for toxicity testing of water samples. The project was carried out in two phases by research institutions from eight countries that formed the WaterTox network. Results for the first phase were reported in the special September 2000 issue of Environmental Toxicology. Phase II involved toxicity screening tests of environmental and blind samples (chemical solutions of unknown composition to participating laboratories) using the following battery: Daphnia magna, Hydra attenuata, seed root inhibition with Lactuca sativa, and Selenastrum capricornutum. This battery was also used to assess potential toxicity in concentrated (10x) water samples. Results are presented for a set of six blind samples sent to the participating laboratories over a 1-year period. Analyses were performed for each bioassay to evaluate variations among laboratories of responses to negative controls, violations of test quality control criteria, false positive responses induced by sample concentration, and variability within and between labs of responses to toxic samples. Analyses of the data from all bioassays and labs provided comparisons of false positive rates (based on blind negative samples), test sensitivities to a metal or organic toxicant, and interlaboratory test variability. Results indicate that the battery was reliable in detecting toxicity when present. However, some false positives were identified with a concentrated soft-water sample and with the Lactuca and Hydra (sublethal end-point) tests. Probabilities of detecting false positives for individual and combined toxic responses of the four bioassays are presented. Overall, interlaboratory comparisons indicate a good reliability of the battery.

Thrombocytopenia in HIV-infected drug users in the HAART era

The present case-control study compared 26 HIV+ drug users having persistent thrombocytopenia (TCP<150 000/mm(3)) with 54 available age, gender and HIV CDC classification matched controls with normal platelet counts. Participants were followed longitudinally over a 2-year period (1998-2000), and hematological alterations evaluated in relationship to antiretroviral treatment, drug use and nutritional (selenium) status. Demographic information and medical history, including antiretroviral treatment were obtained. Blood was drawn for complete cell blood count, T lymphocytes and viral load. Sixty-nine percent of the individuals with persistent TCP and 49% of the controls were receiving antiretrovirals. At baseline, no significant differences in CD4 existed between the two groups. Over time, CD4 cell count declined in the cases (P = 0.05) and a significantly higher proportion of the cases (38%) developed AIDS (CD4<200 cell/mm(3)), as compared to the controls (18%, P = 0.004). A high risk for development of thrombocytopenia was observed with specific drug use (heroin 2.96 times, P = 0.0007), selenium levels below 145 microg/l (6 times, P = 0.008), and abnormal liver enzyme (SGOT) levels (2 times, P = 0.002). Together, these results indicate a number of factors that may be sensitive predictors of thrombocytopenia, which, despite antiretroviral treatment, appears to be related to more rapid disease progression in drug users.

Laparoscopic cholecystectomy: fundus-down approach

BACKGROUND AND PURPOSE

Laparoscopic cholecystectomy (LC) is the primary treatment of gallstone disease. Although refinements have made it safer, bile duct injury remains more common than with the open approach. The major difference in these techniques is that open cholecystectomy approaches the gallbladder from the fundus downward, whereas conventional laparoscopic cholecystectomy proceeds in the reverse direction. A handful of fundus-down techniques appear in the literature. The use of special instruments or port sites is common. We present a technique that is safe and utilizes instruments familiar to the surgeon performing conventional LC.

PATIENTS AND METHODS

Fifty consecutive LCs were included in the study. The variables monitored were age, comorbidities, postoperative diagnosis, pathologic diagnosis, length of operation, hospital length of stay, and complications.

RESULTS

The average operating time for chronic cholecystitis was 1 hour, and the average time for acute cholecystitis was less than 2 hours. Except for one early case of bleeding, in which the procedure was completed using the familiar conventional method, no complications and no unusual technical difficulties were encountered. There were no differences between conventional and fundus-down LC with regard to time and complications.

CONCLUSIONS

This technique is safe and has several benefits: (1) standard trocar sites that offer the surgeon flexibility in the approach; (2) the ability to resect as much cystic duct as desired; and (3) utilization of standard instruments familiar to the surgeon, thus avoiding costly special instruments. The approach may offer the benefit of reducing the rate of common bile duct injury to that of open cholecystectomy.

Liquid chromatographic determination of the total available free and intrachain lysine in various foods

A method for the quantitative determination of the total available lysine in various foods is developed. The method is based on the reaction of the amino groups on the lysine molecule with fluorodinitrobenzene and is capable of furnishing simultaneous determination of the available intrachain lysine (known as N-epsilon-[2,4-dinitrophenyl]-L-lysine) or the available free and/or N-terminal lysine (known as N,N'-di-[2,4-dinitrophenyl]-L-lysine). Optimum conditions for separation and quantitation are studied. The results show the proposed method to be both accurate and precise and suitable for food samples containing hydrolyzed proteins.

Water quality improvement of treated wastewater by intermittent soil percolation

Our research aimed to evaluate intermittent soil infiltration of treated sewage for reuse in the north of Chile. Aerated lagoon effluent was infiltrated in columns packed with native soils (sandy-lime, lime-gravel and limey-sand). Columns were operated for more than a year under different cycles of filling and drying, depths and load pressures depending on soil characteristics. The efficiency of the system was determined through influent-effluent microbiological indicators level (faecal coliforms, E. coli, Salmonella spp, MS2 phage, and protozoan cysts), physicochemical characterisation (TOC, COD, BOD, nitrogen), and hydraulic flow measurement. Results showed: (a) high reduction of enteric bacteria (5-7 log10), some inactivation of phage (2-4 log10) and complete removal of intestinal cyst; (b) stable removal of organic matter (80-90% reduction of TOC, COD, BOD); and (c) partial ammonia reduction through adsorption and nitrification with denitrification mainly occurring in sandy soil. Preliminary data from pilot plant working in the field showed better results that those obtained in the laboratory especially removal of microbiological indicators. Microbiological quality of effluent met Class A regulations for agricultural reuse (WHO, 1989) and the system looks like an attractive alternative to cope with water shortage in the region.

Development and evaluation of C-telopeptide enzyme-linked immunoassay for measurement of bone resorption in mouse serum

The mouse is increasingly being used as an animal model for the study of skeletal phenotypes in humans, mainly because of the ease of genetic manipulation. Biochemical markers of bone metabolism provide a valuable parameter for the assessment of skeletal metabolism. In the mouse model, assays for bone formation have been available for a long time; however, little is known about bone resorption markers. The present study describes the development of a serum C-telopeptide enzyme-linked immunoassay (ELISA), which measures degradation products of type I collagen that are generated by osteoclastic bone resorption. The C-telopeptide ELISA uses affinity-purified antibodies generated against human sequence DFSFLPQPPQEKAHDGGR. The epitope involves an amino acid sequence, which is identical in the mouse and human C-terminal peptide of type I collagen (alpha1 chain). Sensitivity of the ELISA used was <0.1 ng/mL. The average intra- (n = 10) and interassay (n = 8) coefficient of variation for two controls was <12%. The average dilution and spike recovery rates were 98% and 97%, respectively. Application of the ELISA to measure C-telopeptide in 3-4-week postovariectomized (ovx) C57BL/6J (B6) mice (n = 9 or 10) showed a 45% higher C-telopeptide concentration than the sham-operated mice. Treatment of ovx mice with estradiol (400 microg/kg body weight) or alendronate (1.0 mg/kg body weight) resulted in a 20%-50% decrease in C-telopeptide levels compared to the vehicle-treated ovx group. In addition, B6 mice fed a calcium-deficient diet (0.01% calcium) showed a 50% higher C-telopeptide concentration compared to the B6 mice receiving a normal diet (0.6% calcium). In conclusion, the C-telopeptide ELISA exhibited acceptable analytical performance and sufficient discriminatory power to show expected directional changes in the rate of bone resorption following ovariectomy, ovx plus estradiol or alendronate treatment, and administration of a calcium-deficient diet. Therefore, the ELISA developed in this study could be used for measuring bone resorption in the mouse model.

Development and application of a synthetic peptide-based osteocalcin assay for the measurement of bone formation in mouse serum

The mouse is frequently used as an animal model to study skeletal mechanisms relevant to humans. Biochemical markers of bone formation and resorption provide one of the key parameters for assessing skeletal metabolism. One biochemical marker that has proven to be useful in the studies of mouse skeletal metabolism is osteocalcin. Assay for osteocalcin is available in the mouse. The present study describes development of an osteocalcin radioimmunoassay (RIA) using a synthetic peptide. Intact osteocalcin purified from mouse bone extracts shows parallel displacement with synthetic peptide. Sensitivity of the RIA was 19 ng/ml. The average (n = 9) intra- and interassay coefficient of variation for two controls was less than 10%; the averaged recoveries were 106%. The osteocalcin concentration measured by peptide RIA shows a high correlation (r = 0.88, n = 117, P < 0.0001) with an intact osteocalcin assay. In addition, when the intact assay and peptide assays were applied to evaluate skeletal perturbation, similar results were obtained. Accordingly, osteocalcin levels measured by both intact and peptide-based RIA in 8-week C57BL/6J (n = 8) mice treated with PTH 1-34 were twofold higher compared with the vehicle-treated control group. Further studies of the application of the peptide-based RIA for osteocalcin revealed that osteocalcin levels in 4-week postovariectomized (OVX) C57BL/6N mice (n = 10) were 80% higher than the sham-operated (n = 10) mice receiving vehicle. OVX mice receiving weekly injections of estradiol (400 microg/kg body weight) were 38% lower compared with the OVX group treated with vehicle. In conclusion, the peptide-based RIA has analytical and a discriminative power similar to that of the intact osteocalcin assay but has the advantage that the resources for this assay are much easier to accrue.

[Environmental contamination with Toxocara sp. eggs in public squares and parks from Santiago, Chile, 1999]

Most of cases of visceral larva migrans syndrome are caused by Toxocara canis larvae. Man acquires the infection by accidental ingestion of ripe eggs of the helminth. In order to find out the frequency of the presence of Toxocara sp. eggs in dog fecal specimens from public places of Santiago city in 1999 july-september a study was carried out in 84 squares and 12 parks from 32 counties. Three fecal samples were collected in each of these places, making a total of 288. Each sample was processed according to a modified Telemann method and three smears of each were microscopically examined. Toxocara sp. eggs were found in 39 (13.5%) fecal specimens. In 28/84 (33.3%) squares and in 8/12 (66.7%) parks these eggs were detected. These results make necessary the control of dogs and cats populations with the aim of reduce the presence of animals without responsible owners. It should be advisable to prevent dogs and cats defecation in public areas grounds, trying to exclude these animals from recreation areas.

Development and application of a serum C-telopeptide and osteocalcin assay to measure bone turnover in an ovariectomized rat model

Biochemical markers applicable to the ovariectomized rat model can provide important tools for studying the bone remodeling process in this animal model of postmenopausal osteoporosis. We describe the development and application of two biochemical markers, a C-telopeptide (of type-I collagen) enzyme-linked immunosorbent assay (ELISA) for measuring bone resorption and an osteocalcin radioimmunoassay (RIA) for measuring bone formation in rat serum. The C-telopeptide ELISA is based on an affinity purified polyclonal antibody generated against human sequence DFSFLPQPPQEKAHDGGR. The antibody epitope involves amino acid sequence, which is similar in rat and human carboxyl terminal peptide of type-I (alpha 1) collagen. Sensitivity of the ELISA was 0.3 ng/ml. The averaged intra- and interassay variation was CV <7%. Averaged dilution and spiked recoveries were 91% and 105%, respectively. The second marker developed is a synthetic peptide-based osteocalcin RIA, which does not require isolation and purification of intact osteocalcin from rat bone. Osteocalcin antiserum used in the RIA was generated in rabbits against a synthetic peptide comprising amino acids 33-49 of the rat osteocalcin sequence. The sensitivity of the RIA was 0.15 ng/ml of peptide. The averaged intra (n = 10) and interassay variations for two controls were CV <9% and 12%, respectively. The averaged dilution and spiked recoveries were 99.6%. In vivo validation of the C-telopeptide ELISA and osteocalcin RIA was performed in an ovariectomized (OVX) rat model. In 12-week-old OVX Sprague Dawley rats, the C-telopeptide and osteocalcin concentrations were approximately 65% and 40%, respectively, higher than the sham group. Estradiol repletion significantly lowered the C-telopeptide and osteocalcin concentration to the levels of the sham group. In addition, changes in serum C-telopeptide concentration correlated negatively with trabecular BMD measured by pQCT (r = -0.51, P < 0.001). In conclusion, the C-telopeptide ELISA and osteocalcin RIA exhibited required sensitivity, accuracy, and adequate discriminatory power to be used for measuring bone resorption and bone formation in the ovariectomized rat model.

An adipogenic cofactor bound by the differentiation domain of PPARgamma

Ligand activation of the nuclear receptor PPARgamma induces adipogenesis and increases insulin sensitivity, while activation of other PPAR isoforms (-alpha and -delta) induces little or no fat cell differentiation. Expression and activation of chimeras formed between PPARgamma and PPARdelta in fibroblasts has allowed us to localize a major domain of PPARgamma responsible for adipogenesis to the N-terminal 138 amino acids, a region with AF-1 transcriptional activity. Using this region of PPARgamma as bait, we have used a yeast two-hybrid screen to clone a novel protein, termed PGC-2, containing a partial SCAN domain. PGC-2 binds to and increases the transcriptional activity of PPARgamma but does not interact with other PPARs or most other nuclear receptors. Ectopic expression of PGC-2 in preadipocytes containing endogenous PPARgamma causes a dramatic increase in fat cell differentiation at both the morphological and molecular levels. These results suggest that interactions between PGC-2, a receptor isoform-selective cofactor and PPARgamma contribute to the adipogenic action of this receptor.

Overexpression, purification and characterization of Mycobacterium bovis BCG alcohol dehydrogenase

A previous study of the effect of zinc deprivation on Mycobacterium bovis BCG pointed out the potential importance of an alcohol dehydrogenase for maintaining the hydrophobic character of the cell envelope. In this report, the effect of the overexpression of the M. bovis BCG alcohol dehydrogenase (ADH) in Mycobacterium smegmatis and M. bovis BCG is described. The purification of the enzyme was performed to apparent homogeneity from overexpressing M. bovis BCG cells and its kinetic parameters were determined. The enzyme showed a strong preference for both aromatic and aliphatic aldehydes while the corresponding alcohols were processed 100-1000-fold less efficiently. The best kcat/Km values were found with benzaldehyde > 3-methoxybenzaldehyde > octanal > coniferaldehyde. A phylogenetic analysis clearly revealed that the M. bovis BCG ADH together with the ADHs from Bacillus subtilis and Helicobacter pylori formed a sister group of the class C medium-chain alcohol dehydrogenases, the plant cinnamyl alcohol dehydrogenases (CADs). Comparison of the kinetic properties of our ADH with some related class C enzymes indicated that the mycobacterial enzyme substrate profile resembled that of the CADs involved in plant defence rather than those implicated in lignification. A possible role for the M. bovis BCG ADH in the biosynthesis of the lipids composing the mycobacterial cell envelope is proposed.

Madangolide and laingolide A, two novel macrolides from lyngbya bouillonii (Cyanobacteria)

Two new macrolide derivatives, madangolide (2) and laingolide A (3), have been isolated from the cyanobacterium Lyngbya bouillonii, collected in Papua New Guinea. Their structures (without stereochemistry) have been established by detailed high-field 1D and 2D NMR studies and, in the case of 3, by comparison with the spectroscopic data of laingolide (1), previously isolated from the same organism.

Transient transcriptional activation of the Vibrio cholerae El Tor virulence regulator toxT in response to culture conditions

Vibrio cholerae El Tor require special in vitro culture conditions, consisting of an initial static growth period followed by shift to shaking (AKI conditions), for expression of cholera toxin (CT) and toxin coregulated pili (TCP). ToxT, a regulator whose initial transcription depends on the ToxR regulator, positively modulates expression of CT and TCP. To help understand control of CT and TCP in El Tor vibrios, we monitored ctxAB and ToxR-dependent toxT transcription by time course primer extension assays. AKI conditions stimulated CT synthesis with an absence of ctxAB transcription during static growth followed by induction upon shaking. ToxR-dependent toxT transcription was induced at the end of the static growth period but was transient, stopping shortly after shaking was initiated but, interestingly, also if the static phase was prolonged. Immunoblot assays showed that ToxR protein levels were not coincidentally transient, implying a protein on/off switch mechanism for ToxR. Despite the transient activation by ToxR, transcription of ctxAB was maintained during shaking. This finding suggested continued toxT expression, possibly through relay transcription from another promoter. The 12.6-kb distant upstream tcpA promoter responsible for expression of the TCP operon has been proposed to provide an alternate toxT message by readthrough transcription. Activation of the tcpA promoter is supported by increased expression of TcpA protein during the shaking phase of the culture. Readthrough transcription of toxT from tcpA would be compatible with reverse transcription-PCR evidence for a toxT mRNA at times when ToxR-dependent transcription was no longer detectable by primer extension.

Resistance to antibiotic and heavy metals of motile aeromonads from Chilean freshwater

In this work the resistance of 172 motile Aeromonas isolates recovered from raw drinking water supplies (56), irrigation waters (60) and runoff waters receiving sewage (56), to some antibiotics and heavy metals was investigated by agar diffusion and agar dilution methods. A high proportion of isolates from all water sources showed resistance to carbenicillin, erythromycin, streptomycin, cephradine and cadmium, and susceptibility to chloramphenicol, kanamycin, gentamicin, tetracycline, nalidixic acid, trimethoprim-sulphametoxazole and chromium. No amikacin-resistant Aeromonas were recovered. No relationship was found between antimicrobial resistance and Aeromonas species, with the exception of cephradine, that exhibited a significantly higher activity against the A. sobria isolates than the other Aeromonas species (P < 0.05). Moderately polluted waters showed lower antibiotic multiresistance and metal susceptibility than unpolluted and highly polluted ones. Although significant differences (P < 0.05), between resistance frequencies to erythromycin, carbenicillin, streptomycin and cephradine were found among isolates from different sources, the antimicrobial resistance patterns of aeromonads could not be related to the level of faecal pollution. These results indicate that aeromonads resistant to antibiotics and heavy metals are easily recovered from water sources in Chile, posing a potential public health risk.

Cognitive brain activity in Alzheimer's disease: electrophysiological response during picture semantic categorization

Semantic memory deterioration is a major component of the cognitive decline seen in patients with dementia of the Alzheimer's type (DAT); however, the exact nature of this deficit remains unclear. Some research data support a procedural deficit where there is an inability to access or retrieve the contents of semantic memory, while other data point to a degraded semantic store where the actual content of semantic memory is degraded. Additional information about semantic processing in DAT can be obtained through the use of an event-related potential (ERP) component known as N400. In the present study, ERPs were recorded from 10 young control participants, 10 elderly control participants, and 10 DAT patients in a picture-semantic matching task. Stimuli were presented sequentially as prime-target pairs, with one-half of the targets matching the primes via semantic relationships (e.g., piano-violin) and the other half mismatching the prime (e.g., helmet-violin). The task was to discriminate between semantically related and unrelated pairs of pictures. In the young and elderly control groups, ERPs generated a larger N400 for unrelated than related target pictures, with a maximum amplitude around 380 ms in the young group and around 480 ms in the elderly group. The amplitude of the N400 was significantly reduced in the DAT patients. However, a separate analysis of congruent and incongruent ERPs trials revealed significant differences only with the incongruent trials. The amplitude of incongruent recordings was larger for the elderly control group than for the DAT patients, while the amplitude for congruent recordings was similar in both groups. These findings are consistent with the neuropathological evidence that Alzheimer's disease is a neocortical disconnection syndrome in which there is a loss of structural and functional integrity of long corticocortical tracts. The semantic activation created by the context is not used efficiently in processing stimuli, which affects access to specific concepts and gradually leads to a breakdown in the structure and organization of semantic memory.

Down-regulation of the mdr gene by thyroid hormone during Xenopus laevis development

The developmental regulation of mdr in Xenopus laevis has been investigated. Xe-mdr expression was first detected in the early tadpole stage just prior to the onset of feeding and increased during intestinal development, with a sharp decline at metamorphosis. Xe-mdr expression was found to be localized specifically to the epithelial cells lining the intestinal tract. When premetamorphic tadpoles were treated with 5 nM triiodothyronine to induce metamorphosis, a significant decrease in mdr message and protein was observed after 3 days, a time at which the primary epithelium remained intact. Furthermore, in thyroid-hormone treated primary cultures of brush border epithelial cells, a reduction in mdr message also was observed. These results demonstrate that the Xe-mdr gene is developmentally regulated and suggest a role for thyroid hormone in this process. This is the first report of a naturally occurring substance that can down-regulate mdr gene expression in vivo.

Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis

The World Health Organization (WHO) has indicated that opioid analgesics are insufficiently available, particularly in developing countries, due to a variety of reasons, including legislative, educational, and policy issues. In its effort to promote the rational use of medical opioids and the adequate treatment of patients with cancer, WHO has sponsored a meeting of Latin American representatives every 2 years, which includes health professionals and government regulators. During March 24-27, 1996, a group of 86 representatives of cancer pain relief and palliative care programs from nine Latin American countries met in Santo Domingo under the auspices of the WHO Palliative Care Program for Latin America. For the first time since the First Latin American Meeting, government regulators were present to help address the issue of opioid availability from their perspective. During the meeting, issues pertaining to cancer pain, opioid availability, and palliative care were discussed. This report summarizes some of the events and presents a summary of the conclusions of an earlier meeting in 1994, as described in the Declaration of Florianopolis, and presents its follow-up, The Santo Domingo Report, generated following the 1996 meeting.