Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System

There is a growing concern around concussions in rugby union, at all levels of the game. These concerns highlight the need to better manage and care for players. However, consistency around concussion-related responsibilities of stakeholders across the community rugby system remains challenging. Taking a systems thinking approach, this pragmatic, qualitative descriptive study explored key stakeholder groups within New Zealand's community rugby system's perceptions of their own and others' concussion-related responsibilities. Participants included players from schools and clubs, coaches, parents, team leads and representatives from four provincial unions. A total of 155 participants (67 females and 88 males) were included in the study. Focus groups and individual interviews were conducted. Thematic content analysis was used to analyse data. Thirty concussion-related responsibilities were identified. These responsibilities were contained within four themes: (1) policies and support (responsibilities which influence policy, infrastructure, human or financial resources); (2) rugby culture and general management (responsibilities impacting players' welfare and safety, attitudes and behaviour, including education, injury reporting and communication); (3) individual capabilities (responsibilities demonstrating knowledge and confidence managing concussion, leadership or role/task shifting) and (4) intervention following a suspected concussion (immediate responsibilities as a consequence of a suspected concussion). The need for role clarity was a prominent finding across themes. Additionally, injury management initiatives should prioritise communication between stakeholders and consider task-shifting opportunities for stakeholders with multiple responsibilities. How concussions will realistically be managed in a real-world sports setting and by whom needs to be clearly defined and accepted by each stakeholder group. A 'framework of responsibilities' may act as a starting point for discussion within different individual community rugby contexts on how these responsibilities translate to their context and how these responsibilities can be approached and assigned among available stakeholders.

The effect of trait self-control on dyspnoea and tolerance to a CO2 rebreathing challenge in healthy males and females

BACKGROUND

High trait self-control is associated with greater tolerance of unpleasant sensations including effort and pain. Dyspnoea and pain have several commonalities and this study aimed to investigate for the first time whether trait self-control influences responses to a hypercapnic rebreathing challenge designed to induce dyspnoea. As sex also influences tolerance to dyspnoea, we also sought to investigate whether this moderated the role of trait self-control.

METHODS

Participants (n = 65, 32 females) scoring high or low for trait self-control, performed a standardised rebreathing challenge, in which inspired carbon dioxide (CO₂) gradually increased over a period of 6 min or until an intolerable level of dyspnoea. Air hunger (AH) intensity - a distinctive quality of dyspnoea, was measured every 30 s. The multidimensional dyspnoea profile (MDP) was completed after the rebreathing challenge for a more complete overview of breathing discomfort.

RESULTS

Males high in trait self-control (SCHIGH) (302 ± 42 s), tolerated the rebreathing challenge for longer than males low in self-control (SCLOW) (252 ± 66 s, P = 0.021), experienced slower increases in AH intensity during the rebreathing challenge (0.03 ± 0.01 cm^.s ^- 1 vs. 0.04 ± 0.01 cm^.s ^- 1,P = 0.045) and reported lower perceived mental effort on the MDP (4.94 ± 2.46 vs. 7.06 ± 1.60, P = 0.007). There was no difference between SCHIGH and SCLOW females for challenge duration. However, SCHIGH females (9.29 ± 0.66 cm) reported greater air hunger at the end of the challenge than SCLOW females (7.75 ± 1.75 cm, P = 0.003). It is possible that SCLOW females were unwilling to tolerate the same perceptual intensity of AH as the SCHIGH females.

CONCLUSIONS

These results indicate that individuals high in trait self-control are more tolerant of dyspnoea during a CO₂ rebreathing challenge than low self-control individuals. Tolerance of the stimulus was moderated by the sex of the participant, presenting an interesting opportunity for future research.

A lateral surgical approach to the larynx may impair cervical esophageal function in dogs

OBJECTIVE

To determine whether muscle-sparing laryngoplasty results in fewer changes in swallowing function compared to standard surgical treatment for laryngeal paralysis.

ANIMALS

12 clinically normal sexually intact male Beagles.

PROCEDURES

Group A dogs (n = 4) had a standard approach to the larynx, with left arytenoid cartilage lateralization. Group B dogs (n = 4) had a muscle-sparing laryngoplasty performed with the thyropharyngeus muscle fibers bluntly separated, and the cricoarytenoideus dorsalis muscle spared. Pre- and 24-hour postoperative fluoroscopic swallowing studies were performed and graded. Larynges were harvested after humane euthanasia, and glottic area was measured. Group C dogs (n = 4) acted as controls, with surgical dissection ending lateral to the thyropharyngeus muscle, arytenoid lateralization not performed, and the dogs not euthanized. The study was performed between October 15, 2011 and May 15, 2021.

RESULTS

Changes in pharyngeal and upper esophageal sphincter function were not detected in any group. There was no difference in glottic area between treatment groups. Aspiration of liquid was not a consistent finding. Two dogs in each treatment group developed moderate to severe cervical esophageal paresis. This did not occur in control dogs.

CLINICAL RELEVANCE

We found no evidence to support our hypothesis that muscle-sparing laryngoplasty results in less severe changes in swallowing function compared to a standard technique. The cervical esophageal paresis identified in both treatment groups could increase the risk of postoperative aspiration pneumonia in dogs treated for laryngeal paralysis via a lateral approach to the larynx. Further study to determine the frequency, cause, and duration of esophageal dysfunction is warranted.

Polymer formulated self-amplifying RNA vaccine is partially protective against influenza virus infection in ferrets

COVID-19 has demonstrated the power of RNA vaccines as part of a pandemic response toolkit. Another virus with pandemic potential is influenza. Further development of RNA vaccines in advance of a future influenza pandemic will save time and lives. As RNA vaccines require formulation to enter cells and induce antigen expression, the aim of this study was to investigate the impact of a recently developed bioreducible cationic polymer, pABOL for the delivery of a self-amplifying RNA (saRNA) vaccine for seasonal influenza virus in mice and ferrets. Mice and ferrets were immunized with pABOL formulated saRNA vaccines expressing either haemagglutinin (HA) from H1N1 or H3N2 influenza virus in a prime boost regime. Antibody responses, both binding and functional were measured in serum after immunization. Animals were then challenged with a matched influenza virus either directly by intranasal inoculation or in a contact transmission model. While highly immunogenic in mice, pABOL-formulated saRNA led to variable responses in ferrets. Animals that responded to the vaccine with higher levels of influenza virus-specific neutralizing antibodies were more protected against influenza virus infection. pABOL-formulated saRNA is immunogenic in ferrets, but further optimization of RNA vaccine formulation and constructs is required to increase the quality and quantity of the antibody response to the vaccine.

Presenting features of female collegiate sports-related concussion in South Africa: a descriptive analysis

Background

Sports-related concussion (SRC) is an injury with important implications, especially in collision and contact sports, and has a high symptom burden. Student athletes face particular psychosocial challenges, especially female students with pre-existing anxiety/depression are at increased risk for SRC, and have a higher symptom burden before and after injury.

Objectives

Describing female SRC presenting features at a collegiate campus-based sports medicine service; examining the association of prior concussion history (PCONC) and pre-existing anxiety/depression (PMHDx) with SRC.

Methods

A retrospective cohort and statistical analysis (including corrected effect sizes) of Sport Concussion Assessment Tool (versions 3/5) data (Step 1: PCONC and PMHDx history; Step 2: symptom evaluation) of collegiate female athletes with SRC between 2012 and 2018.

Results

Forty females with SRC were identified (age 23 ± 3). The five most frequent symptoms were headache (n = 34; 85%), feeling slowed down (n = 33; 83%), pressure in head (n = 33; 83%), don't feel right (n = 32; 80%) and fatigue/low-energy (n = 32; 80%). These five symptoms also had the highest self-rated severity (median (IQR): headache (3 (2-4)), feeling slowed down (3 (1-4)), fatigue/low-energy (3 (1-5)), don't feel right (3 (1-4)) and pressure in head (3 (2-4)). PMHDx (n = 8; 62.9 vs 38.6; p = 0.0192; Hedges' g_s = 0.95; large ES), and not PCONC (n = 13; 51.0 vs 39.8; p = 0.2183; Hedges' g_s = 0.48; small ES) was associated with increased mean total symptom severity.

Conclusion

Headache, feeling slowed down, pressure in head, don't feel right and fatigue/low-energy had the highest symptom burden. Total symptom severity was no different in those with and without PCONC, but significantly higher in those with PMHDx.

Guiding therapeutic plasma exchange for antibody-mediated rejection treatment in lung transplant recipients - a retrospective study

Antibody-Mediated Rejection (AMR) due to donor-specific antibodies (DSA) is associated with poor outcomes after lung transplantation. Currently, there are no guidelines regarding the selection of treatment protocols. We studied how DSA characteristics including titers, C1q, and mean fluorescence intensity (MFI) values in undiluted and diluted sera may predict a response to therapeutic plasma exchange (TPE) and inform patient prognosis after treatment. Among 357 patients consecutively transplanted without detectable pre-existing DSAs between 01/01/16 and 12/31/18, 10 patients were treated with a standardized protocol of five TPE sessions with IVIG. Based on DSA characteristics after treatment, all patients were divided into three groups as responders, partial responders, and nonresponders. Kaplan-Meier Survival analyses showed a statistically significant difference in patient survival between those groups (P = 0.0104). Statistical analyses showed that MFI in pre-TPE 1:16 diluted sera was predictive of a response to standardized protocol (R²  = 0.9182) and patient survival (P = 0.0098). Patients predicted to be nonresponders who underwent treatment with a more aggressive protocol of eight TPE sessions with IVIG and bortezomib showed improvements in treatment response (P = 0.0074) and patient survival (P = 0.0253). Dilutions may guide clinicians as to which patients would be expected to respond to a standards protocol or require more aggressive treatment.

COVID-19 in lung transplant recipients

Solid organ transplant recipients are considered at high risk for COVID‐19 infection due to chronic immune suppression; little data currently exists on the manifestations and outcomes of COVID‐19 infection in lung transplant recipients. Here we report 8 cases of COVID‐19 identified in patients with a history of lung transplant. We describe the clinical course of disease as well as preexisting characteristics of these patients.

Body Size Influences Stingless Bee (Hymenoptera: Apidae) Communities Across a Range of Deforestation Levels in Rondônia, Brazil

Developments in understanding bee responses to habitat loss indicate that body size is a trait with important consequences for conservation. Stingless bees (Hymenoptera, Apidae, Meliponini) are a diverse group of eusocial bees providing pollination services in tropical landscapes, exhibiting a large range in body size across species. We tested the effects of deforestation on the body sizes of stingless bee communities by using museum specimens and revisiting a previous effort that sampled stingless bee communities across varying levels of deforestation at 183 sites in Rondônia, Brazil, in 1996-1997. Body size measurements (intertegular distance) from 72 species collected were included as dependent variables in response to forest area, forest edge, and connectivity of forest patches at several spatial scales. We find that stingless bee body size is negatively related to forest cover: mean community body size was larger in areas with greater amounts of deforestation, and smaller in areas with less deforestation. Second, stingless bee species richness was positively associated with forest edge regardless of body size. Lastly, we find that as forest patch isolation increased, the stingless bee community body size also increased. These findings support hypotheses that small stingless bee species might be more negatively affected by deforestation, adding to the growing body of evidence that stingless bees require areas of intact forest in near proximity to other forest patches to conserve these diverse pollinator communities.

Telephone-based CBT and the therapeutic relationship: The views and experiences of IAPT practitioners in a low-intensity service

WHAT IS KNOWN ON THE SUBJECT

There is a move towards the use of new ways of delivering mental health care, particularly via an increased use of telephone therapies. Although some studies have noted the advantages of telephone-delivered therapies (e.g., removing access barriers) and reported on equivalent therapeutic effects when compared to face-to-face, there are concerns about how telephone-based therapy adversely affects the therapeutic relationship.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

It contributes new knowledge regarding psychological practitioners' experience and views about using telephone-based therapies and how this affects the therapeutic relationship.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

This paper provides data about the new practitioner workforce (IAPT Psychological Wellbeing Practitioners) and adds to a growing area of research regarding their clinical role. It has relevance for mental health nursing, because health services internationally and across the professions are exploring how telehealth can improve health care. This paper suggests that mental health services need to focus on what type of therapeutic relationship their practice facilitates and on offering transparency to service users. It concludes that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to focus on what facilitates and inhibits deeper therapeutic closeness and connection.

ABSTRACT

Introduction Over-the-telephone (OTT)-delivered psychological therapies as an alternative method to face-to-face (F2F) are becoming more prevalent in mental health care. Research suggests a range of benefits of OTT use in therapy, but there are growing concerns about its consequences for the therapeutic relationship. This paper presents new knowledge regarding psychological practitioners' experience and views of OTT work and its potential effects on the therapeutic relationship in the context of the UK's Increasing Access to Psychological Therapy (IAPT) programme. Aim This paper presents IAPT practitioners' experiences and views of OTT work and its potential effects on the therapeutic relationship. Methods Completed questionnaires (exploring OTT versus F2F work) which were distributed to IAPT practitioners revealed a concern about the therapeutic relationship in OTT. To explore this further, nine in-depth semi-structured interviews with PWPs were conducted and the findings from this qualitative study are reported here. Results Practitioners noted OTT use facilitated access and flexibility for service users; however, they expressed some concern over the adverse effect of OTT on the therapeutic relationship. Discussion Although a working alliance was possible OTT, this research suggests the type of therapeutic relationship formed OTT in a "low contact-high volume" service such as IAPT needs to be better defined. By addressing this, dissonance which might arise between practitioner aims and the aims of IAPT can be reduced. This research also contributes to wider debates regarding mental health care and its provision in the UK. Implications for practice This paper concludes that mental health services need to focus on what type of therapeutic relationship their practice facilitates and to offer transparency to service users. The findings suggest that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to offer a more nuanced understanding of the concept of a therapeutic relationship and focus on what facilitates and inhibits deeper therapeutic closeness and connection.

Non-sanctioning of illegal tackles in South African youth community rugby

OBJECTIVES

The tackle event in rugby union ('rugby') contributes to the majority of players' injuries. Referees can reduce this risk by sanctioning dangerous tackles. A study in elite adult rugby suggests that referees only sanction a minority of illegal tackles. The aim of this study was to assess if this finding was similar in youth community rugby.

DESIGN

Observational study.

METHODS

Using EncodePro, 99 South African Rugby Union U18 Youth Week tournament matches were coded between 2011 and 2015. All tackles were coded by a researcher and an international referee to ensure that laws were interpreted correctly. The inter- and intra-rater reliabilities were 0.97-1.00. A regression analysis compared the non-sanctioned rates over time.

RESULTS

In total, 12 216 tackles were coded, of which less than 1% (n=113) were 'illegal'. The majority of the 113 illegal tackles were front-on (75%), high tackles (72%) and occurred in the 2nd/4th quarters (29% each). Of the illegal tackles, only 59% were sanctioned. The proportions of illegal tackles and sanctioning of these illegal tackles to all tackles improved by 0.2% per year from 2011-2015 (p<0.05).

CONCLUSIONS

In these youth community rugby players, 59% of illegal tackles were not sanctioned appropriately. This was better than a previous study in elite adult rugby, where only 7% of illegal tackles were penalised. Moreover, the rates of illegal tackles and non-sanctioned illegal tackles both improved over time. However, it is critical that referees consistently enforce all laws to enhance injury prevention efforts. Further studies should investigate the reasons for non-sanctioning.

Effects of feeding two RRR-α-tocopherol formulations on serum, cerebrospinal fluid and muscle α-tocopherol concentrations in horses with subclinical vitamin E deficiency

BACKGROUND

Alpha-tocopherol (α-TP) supplementation is recommended for the prevention of various equine neuromuscular disorders. Formulations available include RRR-α-TP acetate powder and a more expensive but rapidly water-dispersible liquid RRR-α-TP (WD RRR-α-TP). No cost-effective means of rapidly increasing serum and cerebrospinal fluid (CSF) α-TP with WD RRR-α-TP and then sustaining concentrations with RRR-α-TP acetate has yet been reported.

OBJECTIVES

To evaluate serum, CSF and muscle α-TP concentrations in an 8-week dosing regimen in which horses were transitioned from WD RRR-α-TP to RRR-α-TP acetate.

STUDY DESIGN

Non-randomised controlled trial.

METHODS

Healthy horses with serum α-TP of <2 μg/mL were divided into three groups and followed for 8 weeks. In the control group (n = 5), no α-TP was administered. In the second group (Group A; n = 7), 5000 IU/day RRR-α-TP acetate was administered. In the third group (Group WD-A; n = 7), doses of 5000 IU/day of WD RRR-α-TP were administered over 3 weeks, followed by a 4-week transition from WD RRR-α-TP to RRR-α-TP acetate, and a final 1 week of treatment with RRR-α-TP acetate. Serum samples were obtained weekly; muscle biopsies were obtained before, at 2.5 weeks and after supplementation. CSF samples were obtained before and after the 8-week period of supplementation.

RESULTS

Serum α-TP increased significantly in Group WD-A at week 1 and remained significantly higher than in Group A and the control group throughout the transition, with inter-individual variation in response. Serum α-TP increased significantly by week 7 in Group A. CSF α-TP increased significantly in Group WD-A only. Muscle α-TP concentrations did not differ significantly across groups. Serum and CSF α-TP were closely correlated (r = 0.675), whereas serum and muscle-α-TP concentrations were not correlated.

MAIN LIMITATIONS

The study duration was short and data on pre-transition CSF was lacking.

CONCLUSIONS

The administration of 5000 IU/day of water-dispersible RRR-α-TP rapidly increases serum α-TP. Serum and CSF α-TP concentrations are sustained with a gradual transition to 5000 IU/day of RRR-α-TP acetate. Periodic evaluation of serum α-TP concentrations is recommended because responses vary among individuals.

Evaluation of a web-based weight loss intervention in overweight cancer survivors aged 50 years and younger

Purpose

Half of adult cancer survivors under age 50 years are obese. Excess body weight is associated with cancer recurrence, and effective weight loss interventions for younger cancer survivors are needed. Commercially available, online weight loss programmes are readily accessible, but few have been studied in this population. This study employed a single‐arm, pre‐post intervention (baseline‐6 month/baseline‐12 month comparisons) to preliminarily explore feasibility, efficacy and safety of an online, commercially available weight loss programme in breast (n = 30) and testicular (n = 16) cancer survivors under age 50 years.

Methods

The intervention included three daily components: exercise, nutritional/behavioural modification strategies and health lessons. Intention‐to‐treat and completers analyses were conducted. Feasibility was measured by participation (number of participants enrolled/number screened), retention (number of participants attending 6/12 month study visit/number of enrolled) and self‐reported adherence rates (average of mean percent adherence to each of the three intervention components). Efficacy was assessed by changes in initial weight (percent weight loss). Safety was assessed by adverse events.

Results

The mean participation rate was 42%. The retention rate was 59% at 6 and 49% at 12 months. The adherence rate for all participants (completers/dropouts/lost‐to‐follow‐up) was 50.1% at 6 and 44% at 12 months. Completers reported adherence rates of 68% at 12 months. Study participants lost 5.3% body weight at 12 months; completers lost 9%. Only three unexpected adverse events (unrelated to the intervention) were reported.

Conclusion

Clinically significant weight loss was observed, although retention rates were low. Findings generally support preliminary feasibility, efficacy and safety of this online weight loss programme, and future randomized control trials should be explored.

Appendicular Lean Mass and Mortality among Prefrail and Frail Older Adults

OBJECTIVE

Prefrail and frail older adults are a heterogeneous population. The measurement of appendicular lean mass (ALM) may distinguish those at higher versus lower risk of poor outcomes. We examined the relationship between ALM and mortality among prefrail and frail older adults.

DESIGN

This was a population-based cohort study.

SETTING

The Third National Health and Nutrition Survey (NHANES III; 1988-1994).

PARTICIPANTS

Older adults (age ≥65 years) with pre-frailty or frailty defined using the Fried criteria.

MEASUREMENTS

ALM was quantified using bioimpedance analysis. Multivariable-adjusted Cox regression analysis examined the relationship between ALM and mortality. Logistic regression analysis was used to determine if ALM added to age and sex improved the predictive discrimination of five-year and ten-year mortality.

RESULTS

At baseline, the average age was 74.9 years, 66.7% were female, 86.3% and 13.7% were prefrail and frail, respectively. The mean ALM was 18.9 kg [standard deviation (SD): 5.5]. During a median 8.9 years of follow-up, 1,307 of 1,487 study participants died (87.9%). Higher ALM was associated with a lower risk of mortality. In a multivariable-adjusted regression model that accounted for demographic, behavioral, clinical, physical function, and frailty characteristics, each SD increase in ALM was associated with an 50% lower risk of mortality [Hazard Ratio: 0.50 (95% CI: 0.27-0.92); P=0.026]. The addition of ALM to age and sex improved the predictive discrimination of five-year (P=0.027) and ten-year (P=0.016) mortality.

CONCLUSION

ALM distinguishes the risk of mortality among prefrail and frail older adults. Additional research examining ALM as a therapeutic target is warranted.

Coach-directed education is associated with injury-prevention behaviour in players: an ecological cross-sectional study

BACKGROUND/AIM

Rugby union ('rugby') presents an above-average risk of injury to participants. BokSmart is a South African nationwide intervention that aims to reduce rugby-related injuries in players. This is achieved by educating coaches and referees to improve injury behaviour of players. Thus, the aim of this study was to assess if the receipt of injury-prevention education was associated with player behaviour.

METHODS

Junior (n=2279) and senior (n=1642) players, who attended merit-based South African Rugby tournaments (2008-2012), completed an anonymous questionnaire. Logistic regressions investigated if player injury-prevention behaviours were associated with the receipt of education on the same topic. Additionally, players' preferred sources of education were explored through frequency and χ² analyses.

RESULTS

Of the 16 injury-prevention behaviours, 12 (75%) were associated with receiving education on that topic. The four behaviours not associated with education were: warming-up (before training and matches), and avoiding heat and massage post injury. Of the seven possible sources of this education, the majority of players chose either coaches or physiotherapists as their preferred media. In comparison with junior players, more senior players chose physiotherapists instead of coaches for warming-up and cooling-down education.

CONCLUSIONS

The results of this study support, to a large degree, the strategy of BokSmart-influence of player behaviour through coach education. However, these findings also suggest that BokSmart could target team physiotherapists in addition to coaches and referees with their safety education. Also, players might have different preferences for this education depending on their age.

Video analysis of concussion injury mechanism in under-18 rugby

BACKGROUND

Understanding the mechanism of injury is necessary for the development of effective injury prevention strategies. Video analysis of injuries provides valuable information on the playing situation and athlete-movement patterns, which can be used to formulate these strategies. Therefore, we conducted a video analysis of the mechanism of concussion injury in junior-level rugby union and compared it with a representative and matched non-injury sample.

METHODS

Injury reports for 18 concussion events were collected from the 2011 to 2013 under-18 Craven Week tournaments. Also, video footage was recorded for all 3 years. On the basis of the injury events, a representative 'control' sample of matched non-injury events in the same players was identified. The video footage, which had been recorded at each tournament, was then retrospectively analysed and coded. 10 injury events (5 tackle, 4 ruck, 1 aerial collision) and 83 non-injury events were analysed.

RESULTS

All concussions were a result of contact with an opponent and 60% of players were unaware of the impending contact. For the measurement of head position on contact, 43% had a 'down' position, 29% the 'up and forward' and 29% the 'away' position (n=7). The speed of the injured tackler was observed as 'slow' in 60% of injurious tackles (n=5). In 3 of the 4 rucks in which injury occurred (75%), the concussed player was acting defensively either in the capacity of 'support' (n=2) or as the 'jackal' (n=1).

CONCLUSIONS

Training interventions aimed at improving peripheral vision, strengthening of the cervical muscles, targeted conditioning programmes to reduce the effects of fatigue, and emphasising safe and effective playing techniques have the potential to reduce the risk of sustaining a concussion injury.

Scanning technology selection impacts acceptability and usefulness of image-rich content

OBJECTIVE

Clinical and research usefulness of articles can depend on image quality. This study addressed whether scans of figures in black and white (B&W), grayscale, or color, or portable document format (PDF) to tagged image file format (TIFF) conversions as provided by interlibrary loan or document delivery were viewed as acceptable or useful by radiologists or pathologists.

METHODS

Residency coordinators selected eighteen figures from studies from radiology, clinical pathology, and anatomic pathology journals. With original PDF controls, each figure was prepared in three or four experimental conditions: PDF conversion to TIFF, and scans from print in B&W, grayscale, and color. Twelve independent observers indicated whether they could identify the features and whether the image quality was acceptable. They also ranked all the experimental conditions of each figure in terms of usefulness.

RESULTS

Of 982 assessments of 87 anatomic pathology, 83 clinical pathology, and 77 radiology images, 471 (48%) were unidentifiable. Unidentifiability of originals (4%) and conversions (10%) was low. For scans, unidentifiability ranged from 53% for color, to 74% for grayscale, to 97% for B&W. Of 987 responses about acceptability (n=405), 41% were said to be unacceptable, 97% of B&W, 66% of grayscale, 41% of color, and 1% of conversions. Hypothesized order (original, conversion, color, grayscale, B&W) matched 67% of rankings (n=215).

CONCLUSIONS

PDF to TIFF conversion provided acceptable content. Color images are rarely useful in grayscale (12%) or B&W (less than 1%). Acceptability of grayscale scans of noncolor originals was 52%. Digital originals are needed for most images. Print images in color or grayscale should be scanned using those modalities.

Weight Lifting and Physical Function among Breast Cancer Survivors: A Post Hoc Analysis of a Randomized Controlled Trial

Breast cancer survivors may experience deterioration of physical function. This is important because poor physical function may be associated with premature mortality, injurious falls, bone fracture, and disability. We conducted a post hoc analysis to explore the potential efficacy of slowly-progressive weight lifting to reduce the incidence of physical function deterioration among breast cancer survivors. Methods: Between October 2005 and August 2008, we conducted a single-blind, 12-month, randomized controlled trial of twice-weekly slowly-progressive weight lifting or standard care among 295 non-metastatic breast cancer survivors. In this post hoc analysis of data from the Physical Activity and Lymphedema Trial, we examined incident deterioration of physical function after 12-months, defined as a ≥10-point decline in the physical function subscale of the Medical Outcomes Short-Form 36-item (SF-36) questionnaire. We calculated the relative risk (RR) and 95% confidence interval (95% CI) using an unadjusted generalized linear model. Results: Study participants were 56 ± 9 years old (range 36–80). Median adherence to the weight lifting protocol was 81% over 12-months. As compared with the control group, the weight lifting group had greater improvements in upper- and lower-body strength at 12-months (both comparisons P &lt; 0.001). The proportion of participants who experienced incident physical function deterioration after 12-months was 16.3% (24/147) in the control group and 8.1% (12/148) in the weight lifting group [RR: 0.49 (95% CI, 0.25–0.96); P = 0.04]. No serious or unexpected adverse events occurred that were related to weight lifting. Conclusion: Slowly-progressive weight lifting compared to standard care reduced the incidence of physical function deterioration among breast cancer survivors. These data are hypothesis generating. Future studies should directly compare the efficacy of weight lifting to other modalities of exercise, such as brisk walking, to appropriately inform the development of a confirmatory study designed to preserve physical function among breast cancer survivors.

Histiocytic sarcoma with central nervous system involvement in dogs: 19 cases (2006-2012)

Background

Reports of histiocytic sarcoma (HS) involving the central nervous system (CNS) are sparse and consist mainly of case reports describing 1–3 animals.

Objective

The objective of this study was to report the signalments, clinical signs, clinicopathologic and diagnostic imaging findings, treatment, and outcome of a series of dogs with HS and CNS involvement.

Animals

Nineteen dogs with HS examined at veterinary referral hospitals.

Methods

Retrospective case series. Medical records were reviewed and cases with a histopathological diagnosis of CNS HS were included in the study. Diagnostic imaging studies of the CNS were evaluated and histopathologic samples were reviewed to confirm the diagnosis.

Results

Retrievers and Pembroke Welsh Corgis were overrepresented in this cohort of dogs. Tumors involved the brain in 14 dogs and the spinal cord in 5. In 4 dogs, HS was part of a disseminated, multiorgan process whereas it appeared confined to the CNS in 15 dogs. Diagnostic imaging had variable appearances although extraaxial masses predominated in the brain. There was meningeal enhancement in all dogs that was often profound and remote from the primary mass lesion. Pleocytosis was present in all dogs with CSF evaluation. Median survival was 3 days.

Conclusions and Clinical Importance

Breed predispositions appear to vary from reports of HS in other organ systems. Some unique imaging and clinicopathologic characteristics, particularly brain herniation, profound meningeal enhancement, and pleocytosis in combination with 1 or more mass lesions, might help to differentiate this neoplasm from others involving the CNS, although this requires further study.

The effectiveness of the nationwide BokSmart rugby injury prevention program on catastrophic injury rates

Rugby Union ("rugby") participants have a higher than average risk of injury compared with participants of other popular team sports. BokSmart, a nationwide injury prevention program was launched in South Africa in mid-2009, with the goal of reducing catastrophic head/neck (serious) injuries in players. The program provides injury prevention information to coaches and referees. This study investigated if BokSmart has been associated with a reduction in these injuries. The BokSmart program collected data on all South African rugby-related serious injuries since 2008. Using a Poisson regression, injury numbers were compared pre-BokSmart (2008-2009) to the years post-implementation (2010-2013). Player numbers were assumed to be constant throughout this evaluation: junior = 529,483; senior = 121,663. In junior players, the "post-BokSmart" period had 2.5 less annual serious injuries than "pre-BokSmart" (incidence rate ratio: 0.6, 95% confidence interval: 0.5-0.7, P < 0.000). In contrast, there was no significant difference in these periods in seniors. The absence of effect in seniors may be a result of fewer players or of differences in effectiveness of BokSmart in this group--future studies should investigate these questions.

Lower radiation exposure from body CT imaging for trauma at a dedicated pediatric hospital

PURPOSE

We compare radiation exposure from body CT imaging for blunt trauma performed at outside hospitals (OH) versus our children's hospital (CH).

METHODS

We performed a retrospective chart review of all children transferred to our facility for management of trauma after undergoing a body CT scan at an OH from June 2011 to August 2013. Radiation from OH images was compared to our CH by matching to age, gender, and nearest date. Radiation measures included dose length product (DLP), computed tomography dose index (CTDI), and size-specific dose estimate (SSDE).

RESULTS

Fifty-one children were transferred from 39 OH. Abdomen/pelvis and chest/abdomen/pelvis imaging was performed in 30 and 21 children, respectively. Demographics are shown in Table 1. Results are illustrated in Tables 2 and 3. Contrast was utilized in 45 (1 oral, 41 IV, 3 both) and 51 (49 IV, 2 both). CT scans were performed at OH and CH, respectively (P=0.03).

CONCLUSIONS

Children receive significantly less radiation exposure with body CT imaging for blunt trauma when performed at our dedicated CH. CT scans were significantly more likely to be ordered with appropriate contrast at our CH.

The BokSmart intervention programme is associated with improvements in injury prevention behaviours of rugby union players: an ecological cross-sectional study

BACKGROUND/AIM

Participants of rugby union ('rugby') have an above-average risk of injury compared with other popular sports. Thus, BokSmart, a nationwide injury prevention programme for rugby, was introduced in South Africa in 2009. Improvements in injury-preventing behaviour of players are critical to the success of an intervention. The aim of this study was to assess whether BokSmart has been associated with improvements in rugby player behaviour.

METHODS

An anonymous knowledge, attitude and self-reported behaviour questionnaire was completed by junior (under-18) and senior (adult) tournament players who attended merit-based tournaments (2008-2012). The questionnaire was completed by 2279 junior players (99% of total estimated population) from 111 teams and 1642 senior players (96% of population) from 81 teams. A generalised linear model assessed behavioural changes over this time period.

RESULTS

Nine (50%) of the behaviours improved significantly (p<0.005) between 2008 and 2012 and the remaining behaviours remained unchanged. Improved behaviours included the targeted, catastrophic injury-preventing behaviours of the intervention: practising of tackling (adjusted overall improvement in odds: 56%) and scrummaging, in forwards only (58%), techniques. Other behaviours that improved significantly were postinjury compression and elevation as well as alcohol avoidance, mouthguard use (training and matches) and cooling down (training and matches). Practising of safe rucking techniques; warming up before training/matches; ice use; heat, massage and alcohol avoidance postinjury; and preseason and off-season conditioning remained unchanged.

CONCLUSIONS

BokSmart is associated with improvements in targeted injury-preventing behaviours in players. Future research should ascertain whether self-reported behaviours reflect actual behaviour and whether the observed improvements translate into changes in injury rates.

Physical function as a prognostic biomarker among cancer survivors

BACKGROUND

We tested the hypothesis that objectively measured physical function predicts mortality among cancer survivors.

METHODS

We assessed objectively measured physical function including the short physical performance battery (SPPB) and fast walk speed in older adult cancer survivors.

RESULTS

Among 413 cancer survivors, 315 (76%) died during a median follow-up of 11.0 years. In multivariable-adjusted analyses, each 1-unit increase in the SPPB score and 0.1 m s(-1) increase in fast walk speed predicted a 12% reduction in mortality (hazard ratio (HR): 0.88 (95% confidence interval (CI): 0.82-0.94); P<0.001, and HR: 0.88 (95% CI: 0.82-0.96); P=0.003, respectively).

CONCLUSIONS

Objectively measured physical function may predict mortality among cancer survivors.

Tackle-related injury rates and nature of injuries in South African Youth Week tournament rugby union players (under-13 to under-18): an observational cohort study

OBJECTIVES

The tackle situation is most often associated with the high injury rates in rugby union. Tackle injury epidemiology in rugby union has previously been focused on senior cohorts but less is known about younger cohorts. The aim of this study was to report on the nature and rates of tackle-related injuries in South African youth rugby union players representing their provinces at national tournaments.

DESIGN

Observational cohort study.

SETTING

Four South African Youth Week tournaments (under-13 Craven Week, under-16 Grant Khomo Week, under-18 Academy Week, under-18 Craven Week).

PARTICIPANTS

Injury data were collected from 3652 youth rugby union players (population at risk) in 2011 and 2012.

OUTCOME MEASURES

Tackle-related injury severity ('time-loss' and 'medical attention'), type and location, injury rate per 1000 h (including 95% CIs). Injury rate ratios (IRR) were calculated and modelled using a Poisson regression. A χ(2) analysis was used to detect linear trends between injuries and increasing match quarters.

RESULTS

The 2012 under-13 Craven Week had a significantly greater 'time-loss' injury rate when compared with the 2012 under-18 Academy Week (IRR=4.43; 95% CI 2.13 to 9.21, p<0.05) and under-18 Craven Week (IRR=3.52; 95% CI 1.54 to 8.00, p<0.05). The Poisson regression also revealed a higher probability of 'overall' ('time-loss' and 'medical attention' combined) and 'time-loss' tackle-related injuries occurring at the under-13 Craven Week. The proportion of 'overall' and 'time-loss' injuries increased significantly with each quarter of the match when all four tournaments were combined (p<0.05).

CONCLUSIONS

There was a difference in the tackle-related injury rate between the under-13 tournament and the two under-18 tournaments, and the tackle-related injury rate was higher in the final quarter of matches. Ongoing injury surveillance is required to better interpret these findings. Injury prevention strategies targeting the tackle may only be effective once the rate and nature of injuries have been accurately determined.

Radiation exposure from head computed tomography scans in pediatric trauma

BACKGROUND

We have previously reported that children receive significantly less radiation exposure after abdominal and/or pelvis computed tomography (CT) scanning for acute appendicitis when performed at our children's hospital (CH) rather than at outside hospitals (OH). In this study, we compare the amount of radiation children receive from head CTs for trauma done at OH versus those at our CH.

METHODS

A retrospective chart review was performed on all children transferred to our hospital after receiving a head CT for trauma at an OH between July 2012 and December 2012. These children were then blindly case matched based on date, age, and gender to children at our CH.

RESULTS

There were 50 children who underwent head CT scans for trauma at 28 OH. There were 21 females and 29 males in each group. Average age was 7.01 ± 0.5 y at the OH and 7.14 ± 6.07 at our CH (P = 0.92). Average weight was 30.81 ± 4.69 kg at the OH and 32.69 ± 27.21 kg at our CH (P = 0.81). Radiation measures included dose length product (671.21 ± 22.6 mGycm at OH versus 786.28 ± 246.3 mGycm at CH, P = 0.11) and CT dose index (53.4 ± 2.26 mGy at OH versus 49.2 ± 12.94 mGy at CH, P = 0.56).

CONCLUSIONS

There is no significant difference between radiation exposure secondary to head CTs for traumatic injuries performed at OH and those at a dedicated CH.

Radiation exposure - how do CT scans for appendicitis compare between a free standing children's hospital and non-dedicated pediatric facilities?

BACKGROUND

We compare the amount of radiation children receive from CT scans performed at non-dedicated pediatric facilities (OH) versus those at a dedicated children's hospital (CH).

METHODS

Using a retrospective chart review, all children undergoing CT scanning for appendicitis at an OH were compared to children undergoing CT imaging for appendicitis at a CH between January 2011 and November 2012.

RESULTS

One hundred sixty-three children underwent CT scans at 42 different OH. Body mass index was similar between the two groups (21.00±6.49kg/m(2), 19.58±5.18kg/m(2), P=0.07). Dose length product (DLP) was 620±540.3 at OH and 253.78±211.08 at CH (P < 0.001). OH CT scans accurately diagnosed appendicitis in 81%, while CT scans at CH were accurate in 95% (P=0.026). CTDIvol was recorded in 65 patients with subset analysis showing CTDIvol of 16.98±15.58 and 4.89±2.64, a DLP of 586.25±521.59 and 143.54±41.19, and size-specific dose estimate (SSDE) of 26.71±23.1 and 3.81±2.02 at OH and CH, respectively (P<0.001).

CONCLUSION

Using SSDE as a marker for radiation exposure, children received 86% less radiation and had improved diagnostic accuracy when CT scans are performed at a CH.

An evidence-driven approach to scrum law modifications in amateur rugby played in South Africa

BACKGROUND

In 2012, the South African Rugby Union (SARU) approved a new set of scrum laws for amateur rugby played in the country, to be implemented at the start of the 2013 rugby season. These law changes were primarily based on the relatively high proportion of scrum-related catastrophic injury data collected as part of the BokSmart National Rugby Safety Programme (BokSmart) over the preceding 4 years (2008-2011).

AIM

To describe the scrum-related catastrophic injury data in South Africa over the past 5 years (2008-2012), and to discuss how this evidence justifies the change in the Amateur Scrum Laws to make this aspect of the game safer in South Africa.

METHODS

Catastrophic injury data were collected through BokSmart at amateur and professional levels, during training and matches over 5 years (2008-2012).

RESULTS

The scrum phase accounted for 33% (n=20 of 60) of all catastrophic injuries between 2008 and 2012. Eighteen of the 20 scrum injuries (90%) were confirmed as acute spinal cord injuries, with 13 of these being permanent injuries. For the scrum injury mechanisms that were provided (n=19), 'impact on the engagement' was the most frequently reported (n=11 of 19, 58%), followed by 'collapsed scrum' (n=7 of 19, 37%) and 'popping out' (n=1 of 19, 5%).

CONCLUSIONS

Based on these scrum-related catastrophic injury data, a change in the Amateur Scrum Laws of South African Rugby was justified. The main purpose of these scrum law changes is to reduce the number of scrum-related catastrophic injuries in the country, by minimising the opportunity for impact injury and subsequent scrum collapse in amateur rugby in South Africa, thereby making this aspect of the game of rugby safer.

Safety of contrast-enhanced ultrasonography in dogs and cats: 488 cases (2002-2011)

OBJECTIVE

To determine the incidence of adverse events within 24 hours after contrast-enhanced ultrasonography (CEUS) in dogs and cats and compare the risk of death within 24 hours after imaging for animals that underwent ultrasonography with and without injection of a contrast agent.

DESIGN

Retrospective case-control study.

ANIMALS

750 animals (411 case dogs, 238 control dogs, 77 case cats, and 24 control cats).

PROCEDURES

At 11 institutions, medical records were reviewed of dogs and cats that had CEUS performed (cases) as were medical records of dogs and cats with clinical signs similar to those of case animals that had ultrasonography performed without injection of a contrast agent (controls). Information regarding signalment; preexisting disease; type, dose, and administration route of contrast agent used; immediate (within 1 hour after CEUS) and delayed (> 1 and ≤ 24 hours after CEUS) adverse events; and occurrence and cause of death (when available) was extracted from each medical record. Risk of death within 24 hours after ultrasonography was compared between case and control animals.

RESULTS

Of the 411 case dogs, 3 had immediate adverse events (vomiting or syncope) and 1 had a delayed adverse event (vomiting). No adverse events were recorded for case cats. Twenty-three of 357 (6.4%) clinically ill case animals and 14 of 262 (5.3%) clinically ill control animals died within 24 hours after ultrasonography; risk of death did not differ between cases and controls.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that CEUS was safe in dogs and cats.

Activities of muscadine grape skin and polyphenolic constituents against Helicobacter pylori

AIMS

To identify active phenolic constituents in muscadine grape skin (MGS) extracts and determine interactions among compounds while further exploring their anti-Helicobacter pylori potential in vitro.

METHODS AND RESULTS

The inhibitory effects of quercetin and resveratrol, active polyphenols identified in MGS extracts, against H. pylori were investigated. Quercetin and resveratrol significantly (P < 0.05) reduced H. pylori counts regardless of pH with minimal bactericidal concentrations of 256 and 128 μg ml(-1), respectively. MGS extracts displayed the highest efficacy, suggesting additional unidentified compounds not determined in this study. Time-course viability experiments showed a dose-dependent anti-H. pylori response to quercetin and resveratrol. Interestingly, neither quercetin nor resveratrol affected H. pylori outer membrane (OM) integrity as determined by 1-N-phenylnaphthylamine (NPN) uptake assays. However, treatment with MGS extract did increase NPN uptake, indicating OM destabilization possibly by additional unknown components. Furthermore, quercetin was found to enter H. pylori as measured by HPLC supporting intracellular drug accumulation.

CONCLUSIONS

Quercetin and resveratrol possess strong anti-H. pylori activity in vitro and are independent of pH. Our results also suggest that these compounds do not affect H. pylori OM integrity as previously hypothesized and that the primary antimicrobial activity of quercetin may be linked to interactions with intracellular components.

SIGNIFICANCE AND IMPACT OF THE STUDY

The anti-H. pylori effects of quercetin and resveratrol suggest that these compounds may be useful in the dietary prevention and/or treatment of H. pylori infection.

Vascular dysfunction in young, mid-aged and aged mice with latent cytomegalovirus infections

Human cytomegalovirus (HCMV) is associated with vascular diseases in both immunosuppressed and immunocompetent individuals. CMV infections cycle between active and latent phases throughout life. We and others have shown vascular dysfunction during active mouse CMV (mCMV) infections. Few studies have examined changes in physiology during latent CMV infections, particularly vascular responses or whether the negative effects of aging on vascular function and fertility will be exacerbated under these conditions. We measured vascular responses in intact mesenteric and uterine arteries dissected from young, mid-aged, and aged latently mCMV-infected (mCMV genomes are present but infectious virus is undetectable) and age-matched uninfected mice using a pressure myograph. We tested responses to the α(1)-adrenergic agonist phenylephrine, the nitric oxide donor sodium nitroprusside, and the endothelium-dependent vasodilator methacholine. In young latently mCMV-infected mice, vasoconstriction was increased and vasodilation was decreased in mesenteric arteries, whereas both vasoconstriction and vasodilation were increased in uterine arteries compared with those in age-matched uninfected mice. In reproductively active mid-aged latently infected mice, mesenteric arteries showed little change, whereas uterine arteries showed greatly increased vasoconstriction. These vascular effects may have contributed to the decreased reproductive success observed in mid-aged latently mCMV-infected compared with age-matched uninfected mice (16.7 vs. 46.7%, respectively). In aged latently infected mice, vasodilation is increased in mesenteric and uterine arteries likely to compensate for increased vasoconstriction to mediators other than phenylephrine. The novel results of this study show that even when active mCMV infections become undetectable, vascular dysfunction continues and differs with age and artery origin.

Optimization of contrast-enhanced multidetector abdominal computed tomography in sedated canine patients

A major disadvantage of computed tomography for abdominal screening in dogs has been the need for general anesthesia to prevent motion artifacts. With multidetector helical CT, it is possible to decrease examination time, allowing patients to be scanned under sedation. It is also desirable to decrease tube loading to prolong x-ray tube life. To develop a protocol that will allow for examination of sedated patients with minimal image artifacts, milliamperage (mA) and helical pitch were varied, providing 16 experimental scan protocols. A standard clinical protocol was also tested, providing 17 protocols for evaluation. These protocols were tested, using a standard CT phantom, canine tissues in a water bath, and a canine cadaver. The cadaver images were scored semiquantitatively by three reviewers to determine the protocol with the best combination of speed and minimal image artifact. The optimized protocol was then applied to 27 sedated canine patients of three body weight categories. The images obtained were compared to the standard protocol by two reviewers for presence of motion, streak, and quantum mottle artifacts. There was significantly more streak artifact noted by one observer using the optimized study protocol, but no significant difference in any other category. Scanning under sedation was well tolerated in all patients, and sedated CT examination is a promising tool for screening abdominal disease in dogs.

Comparison of abdominal computed tomography and abdominal ultrasound in sedated dogs

Abdominal ultrasound (US) is used frequently as a first-line screening tool for abdominal disease. Although computed tomography (CT) is superior to US in the diagnosis of some abdominal diseases, a major impediment is the requirement of general anesthesia to prevent motion and for safe restraint. With multidetector helical CT, faster examinations allow general anesthesia to be avoided, while producing diagnostic-quality images. Abdominal US and CT were compared for lesion detection in 27 sedated dogs, divided into three even groups based on body weight. Lesions were categorized further as to subjective clinical relevance. In dogs less than 25 kg, there is no significant difference in lesion detection between CT and US. In dogs weighing greater than 25 kg, more lesions were detected with CT than with US (P = 0.0001), including clinically relevant lesions (P = 0.0277). From these results, it appears that CT has an advantage in lesion detection in dogs greater than 25 kg, making it a better screening test for abdominal disease in these patients.

Quantification of genes and gene transcripts for microbial perchlorate reduction in fixed-bed bioreactors

AIMS

Optimization of full-scale, biological perchlorate treatment processes for drinking water would benefit from knowledge of the location and quantity of perchlorate-reducing bacteria (PRB) and expression of perchlorate-related genes in bioreactors. The aim of this study was to quantify perchlorate removal and perchlorate-related genes (pcrA and cld) and their transcripts in bioreactors and to determine whether these genes or transcripts could serve as useful biomarkers for perchlorate treatment processes.

METHODS AND RESULTS

Quantitative PCR (qPCR) assays targeting pcrA and cld were applied to two pilot-scale, fixed-bed bioreactors treating perchlorate-contaminated groundwater. pcrA and cld genes per microgram of DNA were two- to threefold higher and three- to fourfold higher, respectively, in the bioreactor showing superior perchlorate-removal performance. In a laboratory-scale bioreactor, quantities of pcrA and cld genes and transcripts were compared under two distinct performance conditions (c.60 and 20% perchlorate removal) for a 5-min empty bed contact time. cld genes per microgram of DNA were approximately threefold higher and cld transcripts per microgram of RNA were approximately sixfold higher under the higher perchlorate-removal condition. No differences in pcrA genes or transcripts per microgram of DNA or RNA, respectively, were detected between the c.60 and 20% perchlorate-removal conditions, possibly because these assays did not accurately quantify pcrA genes and transcripts in the mixed culture present.

CONCLUSIONS

Quantities of cld genes and transcripts per microgram of DNA and RNA, respectively, were found to be higher when perchlorate removal was higher. However, quantities of pcrA and cld genes or transcripts were not found to directly correlate with perchlorate-removal rates.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, this study represents the first application of qPCR assays to quantify perchlorate-related genes and transcripts in continuous-flow bioreactors. The results indicate that cld gene and transcript quantities can provide insights regarding the quantity, location and gene expression of PRB in bioreactors.

A cohort study of post-weaning multisystemic wasting syndrome and PCV2 in 178 pigs from birth to 14 weeks on a single farm in England

Our hypothesis was that pigs that develop post-weaning multisystemic wasting syndrome (PMWS) are detectable from an early age with signs of weight loss and other clinical and serological abnormalities. Therefore, the objective of this study was to investigate the temporally varying and fixed events linked with the clinical incidence of PMWS by comparing affected and unaffected pigs in a cohort of 178 male piglets. Piglets were enrolled at birth and examined each week. Samples of blood were collected at regular intervals. The exposures measured were porcine circovirus type 2 (PCV2) antibody titres in all 178 and PCV2 antigen in a subset of 75 piglets. We also observed piglet health and measured their weight, and a post-mortem examination was performed by an external laboratory on all pigs between 6 and 14 weeks of age that died. From the cohort, 14 (8%) pigs died from PMWS and 4% from other causes. A further 37 pigs between 6 and 14 weeks of age died from PMWS (30) and ileitis and other causes (7). PMWS was only apparent in pigs from 1 to 2 weeks before death when they wasted rapidly. There were no other characteristic clinical signs and no obvious gross clinical lesions post-mortem. There was no strong link with PCV2 antibody throughout life but PCV2 antigen level was higher from 4 to 6 weeks of age in pigs that died from PMWS compared with pigs that died from other causes.

A Mysterious Cause of Gastrointestinal Bleeding Disguising Itself as Diverticulosis and Peptic Ulcer Disease: A Review of Diagnostic Modalities for Aortoenteric Fistula

An 81-year-old male with a history of hypertension, hyperlipidemia, smoking, and peptic ulcer disease (PUD) presented with 2 episodes of maroon stools for 3 days and was found to be orthostatic. His PUD was thought to have accounted for a previous upper gastrointestinal (GI) bleed. A colonoscopy revealed 3 polyps and a few diverticuli throughout the colon that were considered to be the source of the bleeding. Two months later, the patient had massive lower GI bleeding and developed hypovolemic shock with a positive bleeding scan in the splenic flexure; however, angiography was negative. A repeat colonoscopy revealed transverse/descending colon diverticular disease and the patient was scheduled for a left hemicolectomy for presumed diverticular bleeding. Intraoperatively, an aortoenteric (AE) fistula secondary to an aorto-bi-iliac bypass graft placed during an abdominal aortic aneurysm (AAA) repair 14 years prior was discovered and was found to be the source of the bleeding. The patient had an AE fistula repair and did well postoperatively without further bleeding. AE fistulas can present with either upper GI or lower GI bleeding, and are universally deadly if left untreated. AE fistulas often present with a herald bleed before life-threatening bleeding. A careful history should always be elicited in patients with risk factors of AAAs such as hypertension, hyperlipidemia and a history of smoking. Strong clinical suspicion in the setting of a scrupulous patient history is the most important factor that allows for the diagnosis of an AE fistula. There are numerous diagnostic modalities for AE fistula, but there is not one specific test that universally diagnoses AE fistulas. Nuclear medicine scans and angiography should not be completely relied on for the diagnosis of AE fistulas or other lower GI bleeds for that manner. Although the conventional paradigm for evaluating lower GI bleeds incorporates nuclear medicine scans and angiography, there is evidence that early endoscopy with enteroscopy may have a better role in severe lower GI bleeding.

Activities of muscadine grape skin and quercetin against Helicobacter pylori infection in mice

AIMS

To explore the preventative potential of muscadine grape skin (MGS) and the single flavonoid, quercetin, as an alternative means for ameliorating Helicobacter pylori infection and/or the H. pylori-induced inflammatory response in mice.

METHODS AND RESULTS

The antimicrobial and anti-inflammatory properties of MGS and quercetin, a major phenolic constituent, were evaluated against H. pylori in vitro and in vivo. The antimicrobial activity of quercetin was evaluated against 11 H. pylori strains in vitro with inhibition of all strains at 128-64 μg ml(-1) . In vivo studies showed a moderate reduction in H. pylori counts following treatment with 5 and 10% MGS or quercetin (25 mg kg(-1) body weight) in addition to significantly reduced inflammatory cytokines (TNF-α, IL-1β and IFN-γ) when compared with untreated mice.

CONCLUSIONS

MGS and quercetin did not significantly reduce H. pylori growth in a mouse model. However, these products were effective in regulating the inflammatory response to H. pylori infection.

SIGNIFICANCE AND IMPACT OF THE STUDY

Our results suggest that H. pylori infection may be reduced or prevented via the consumption of fruits rich in certain phenolic compounds (e.g. quercetin) such as muscadine grapes.

Spontaneous thrombosis of congenital cerebral arteriovenous malformation complicated by subdural collection: in utero detection with disappearance in infancy

We report a case of congenital left temporal lobe arteriovenous malformation (AVM) detected by cranial ultrasound in utero and confirmed immediately after birth by cranial Doppler ultrasound and cranial MRI. The AVM disappeared on follow-up cranial MRI 4 months later. A small left frontal subdural collection was present on these follow-up MR images, which subsequently resolved by the 7 month MRI study. The cause of the spontaneous thrombosis of the AVM is uncertain. The frontal subdural collection may be secondary to volume loss. This case documents the perinatal presence of AVM. The baby was neurologically intact before, during and after the thrombosis of the AVM.

Effects of a single intranasal dose of modified-live bovine respiratory syncytial virus vaccine on cytokine messenger RNA expression following viral challenge in calves

OBJECTIVE

To characterize cytokine messenger RNA (mRNA) expression in intranasally vaccinated calves after bovine respiratory syncytial virus (BRSV) challenge.

ANIMALS

Twelve 8- to 12-week-old calves.

PROCEDURES

Calves received modified-live BRSV vaccine (vaccinated) or spent tissue culture medium (mock-vaccinated) intranasally, followed by challenge 30 days later with BRSV, or mock challenge with spent tissue culture medium (mock-challenge controls). Interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) mRNA was measured in lungs, bronchoalveolar lavage (BAL) fluid cells, pharyngeal tonsils, and tracheobronchial lymph nodes, and tumor necrosis factor-alpha (TNF-alpha) mRNA was measured in lungs and BAL fluid cells by reverse transcriptase-competitive polymerase chain reaction assay.

RESULTS

Resistance to clinical signs of disease was conferred in vaccinated calves. Expression of TNF-alpha mRNA in lungs and BAL fluid cells was higher in mock-vaccinated calves than control or vaccinated calves. In the lung, IL-4 mRNA expression was higher in vaccinated calves than control or mock-vaccinated calves. In pharyngeal tonsils, expression of mRNA for IL-4 and IFN-gamma was higher in mock-vaccinated calves than control calves. In tracheobronchial lymph nodes, IFN-gamma mRNA expression was higher in mock-vaccinated calves than vaccinated calves.

CONCLUSIONS AND CLINICAL RELEVANCE

Although vaccinated calves had decreased clinical signs of disease after BRSV challenge, compared with mock-vaccinated calves, this difference was not related to a T helper type 1 bias, as determined by increased expression of interferon-gamma mRNA relative to interleukin-4 mRNA in lungs, BAL fluid cells, or tracheobronchial lymph nodes of vaccinated calves. Pulmonary inflammation was decreased in vaccinated calves as determined by decreased expression of TNF-alpha mRNA.

Effects of a single intranasal dose of modified-live bovine respiratory syncytial virus vaccine on resistance to subsequent viral challenge in calves

OBJECTIVE

To determine whether a single intranasal dose of modified-live bovine respiratory syncytial virus (BRSV) vaccine protects calves from BRSV challenge and characterize cell-mediated immune response in calves following BRSV challenge.

ANIMALS

13 conventionally reared 4- to 6-week-old Holstein calves.

PROCEDURES

Calves received intranasal vaccination with modified live BRSV vaccine (VC-group calves; n = 4) or mock vaccine (MC-group calves; 6) 1 month before BRSV challenge; unvaccinated control-group calves (n = 3) underwent mock challenge. Serum virus neutralizing (VN) antibodies were measured on days -30, -14, 0, and 7 relative to BRSV challenge nasal swab specimens were collected for virus isolation on days 0 to 7. At necropsy examination on day 7, tissue specimens were collected for measurement of BRSV-specific interferon gamma (IFN-gamma) production. Tissue distribution of CD3+ T and BLA.36+ B cells was evaluated by use of immunohistochemistry.

RESULTS

The MC-group calves had significantly higher rectal temperatures, respiratory rates, and clinical scores on days 5 to 7 after BRSV challenge than VC-group calves. No difference was seen between distributions of BRSV in lung tissue of VC- and MC-group calves. Production of BRSV-specific IFN-gamma was increased in tissue specimens from VC-group calves, compared with MC- and control-group calves. Virus-specific IFN-gamma production was highest in the mediastinal lymph node of VC-group calves. Increased numbers of T cells were found in expanded bronchial-associated lymphoid tissue and airway epithelium of VC-group calves.

CONCLUSIONS AND CLINICAL RELEVANCE

An intranasal dose of modified-live BRSV vaccine can protect calves against virulent BRSV challenge 1 month later.

Eliminating the segmental tier: evidence from speech errors

The dominant viewpoint regarding phonologically driven speech errors is that segments are the units responsible behind the errors. The goal of this paper is to illustrate the point that other potential candidates for explaining these speech errors, which have gone largely unnoticed, provide a better explanatory framework for speech errors than do segments. By looking at unambiguous cases and patterns of markedness, it can be shown that there exists good evidence for features and prosodic constituents in speech errors, but never any positive evidence for segments. All of these considerations taken into account together lend strong support to the argument that there is no need for a segmental level of analysis in phonology.

Subjective well-being and dental treatment in elderly African Americans

This preliminary study examined the effect of dental treatment on psychological well-being in a sample of elderly African Americans (64 women, 43 men) seeking routine care at an urban medical/dental clinic. Scores on two scales, the Index of Self-esteem and the Generalized Contentment Scale, self-administered at initial and final dental appointments, yielded no significant differences between times of test. Dental treatment apparently was not associated in this sample with perceived psychological well-being.